Effects of fluoride concentration and temperature of milk on caries lesion rehardening

Objectives The aim of the present in vitro study was to investigate the effects of fluoride concentration and temperature of milk on caries lesion rehardening under pH cycling conditions. Methods Incipient caries-like lesions were formed in human enamel specimens, characterized using Vickers surface microhardness (VHN) and assigned to seven treatment groups (n = 18 per group): fluoride was tested at five levels (0, 2.5, 5, 10, 20 mg/l, all 22 °C) and milk temperature at three levels (4, 22, 60 °C), but only for 10 mg/l F. Lesions were pH cycled for 15d (4×/daily 10 min milk treatments, 1×/daily 4 h acid challenge, remineralization in human/artificial saliva mixture). VHN of specimens were measured again and changes from lesion baseline were calculated. Subsequently, enamel fluoride uptake (EFU) was determined using the micro drill technique. Results Lesions responded to fluoride in a dose–response manner with higher fluoride concentrations resulting in more lesion rehardening (20 > 10 ≥ 5 ≥ 2.5 > 0 mg/l F). Furthermore, fluoridated milk at 60 °C was found to be more efficacious than at 4 °C (60 ≥ 22 > 4 °C). EFU results were similar (20 > 10 > 5 > 2.5 ≥ 0 mg/l F; 60 > 22 ≥ 4 °C). Conclusions Both fluoride concentration and milk temperature are likely to contribute to the anti-caries potential of fluoridated milk

Effectiveness of smart phone application use as continuing medical education method in pediatric oral health care: a randomized trial

Background Continuing education aims at assisting physicians to maintain competency and expose them to emerging issues in their field. Over the last decade, approaches to the delivery of educational content have changed dramatically as medical education at all levels is now benefitting from the use of web-based content and applications for mobile devices. The aim of the present study is to investigate through a randomized trial the effectiveness of a smart phone application to increase public health service physicians’ (PHS physicians) knowledge regarding pediatric oral health care. Method Five of all seven DHCs (District Health Center) in Tehran, which were under the supervision of Tehran University of Medical Sciences and Iran University of Medical Sciences, were selected for our study. Physicians of one DHC had participated in a pilot study. All PHS physicians in the other four centers were invited to the current study on a voluntary basis (n = 107). They completed a self-administered questionnaire regarding their knowledge, attitudes, practice in pediatric dentistry, and background. PHS physicians were assigned randomly to intervention and control groups; those in the intervention group, received a newly designed evidence-based smartphone application, and those in the control group received a booklet, a CME seminar, and a pamphlet. A post-intervention survey was administered 4 months later and t-test and repeated measures ANCOVA (Analysis of Covariance) were performed to measure the difference in the PHS physicians’ knowledge, attitude and practice. Results In both groups, the mean knowledge scores were significantly higher (p-Value < 0.001) in post-intervention data compared to those at baseline. Similar results existed in attitude and practice scores. Although the scores in knowledge in the intervention group indicating potentially greater improvement when compared to those of the control group, the differences between the two groups were not statistically significant (dif: 0.84, 95% CI − 0.35 to 2.02). Conclusion In the light of the limitations of the present study, smart phone applications could improve knowledge, attitude and practice in physicians although this method was not superior to the conventional method of CME

A comparison of simple analytical methods for determination of fluoride in microlitre-volume plasma samples

The aim was to compare potential methods for fluoride analysis in microlitre-volume plasma samples containing nano-gram amounts of fluoride. Methods: A group of 4 laboratories analysed a set of standardised biological samples as well as plasma to determine fluoride concentration using 3 methods. In Phase-1, fluoride analysis was carried out using the established hexamethyldisiloxane (HMDS)-diffusion method (1 mL-aliquot/analysis) to obtain preliminary measurement of agreement between the laboratories. In Phase-2, the laboratories analysed the same samples using a micro-diffusion method and known-addition technique with 200 µL-aliquot/analysis. Coefficients of Variation (CVs) and intra-class correlation coefficients (ICCs) were estimated using analysis of variance to evaluate the amount of variation within- and between-laboratories. Based on the results of the Phase-2 analysis, 20 human plasma samples were analysed and compared using the HMDS-diffusion method and known-addition technique in Phase-3. Results: Comparison of Phase-1 results showed no statistically significant difference among the laboratories for the overall data set. The mean between- and within-laboratory CVs and ICCs were < 0.13 and ≥0.99, respectively, indicating very low variability and excellent reliability. In Phase-2, the overall results for between-laboratory variability showed a poor CV (1.16) and ICC (0.44) for the micro-diffusion method, whereas with the known-addition technique the corresponding values were 0.49 and 0.83. Phase-3 results showed no statistically significant difference in fluoride concentrations of the plasma samples measured with HMDS-diffusion method and known- addition technique, with a mean (SE) difference of 0.002 (0.003) µg/mL. In conclusion, the known-addition technique could be a suitable alternative for the measurement of fluoride in plasma with microlitre-volume samples

Redesign of an informed consent form to increase participation in a school-based dental program

Objectives The study aimed to determine if modifications to the design of a consent form and consenting process increased participation rates in the Indiana University School of Dentistry's Mobile School-Based Dental Program (Seal Indiana). Methods Kaizen methodology was followed to identify problem areas in the consenting process. Additionally, stakeholders were invited to participate in focus groups and fill out surveys to identify issues preventing participation in the Seal Indiana program (N = 48) and later to evaluate the changes made (N = 48). The redesigned form and process were then used in a pilot study at 14 sites to determine the impact that changes had on levels of participation as measured by the number of consent forms completed and returned. Results There was a statistically significant increase in the number of consent forms returned. The measured change represented a 32 percent increase in program participation (P value = 0.035). A statistically significant increase was observed in how participants viewed the attractiveness of the form and how easy it was to read and comprehend. Conclusions In order to increase consenting rates, our results indicate modifications to the consent form should be focused on the following characteristics: esthetics, ease of reading and comprehending information, and making the Health Insurance Portability and Accountability Act of 1996 (HIPPA) privacy regulations easier to read and comprehend

Acceptance of Behavior Guidance Techniques Used in Pediatric Dentistry by Parents From Diverse Backgrounds

Objective. To investigate if parental background affects acceptance of behavior guidance techniques. Background. Behavior guidance techniques are used for the safe and effective treatment of pediatric patients. Acceptance of these techniques may vary by racial and ethnic background. Methods. A total of 142 parents were recruited and asked to rate videos showing: active restraint/protective stabilization (AR), general anesthesia (GA), nitrous oxide sedation (N2O), oral premedication/sedation (OP), passive restraint/protective stabilization (PR), tell-show-do (TSD), and voice control (VC) techniques. Results. Hispanic parents rated VC most acceptable, followed by TSD, PR, and pharmacologic techniques. Black and white parents rated TSD, followed by N2O, as most acceptable, and AR and PR as least favorable. Hispanics found GA significantly less acceptable than whites or blacks. Hispanics were less accepting of AR than blacks; but more accepting of PR than whites. TSD was highly rated among all 3 cohorts. Parental background affected acceptance of the techniques in this study

Relationship between enamel fluorosis severity and fluoride content

OBJECTIVES: Enamel fluorosis is a hypomineralization caused by chronic exposure to high levels of fluoride during tooth development. Previous research on the relationship between enamel fluoride content and fluorosis severity has been equivocal. The current study aimed at comparing visually and histologically assessed fluorosis severity with enamel fluoride content. METHODS: Extracted teeth (n=112) were visually examined using the Thylstrup and Fejerskov Index for fluorosis. Eruption status of each tooth was noted. Teeth were cut into 100 μm slices to assess histological changes with polarized light microscopy. Teeth were categorized as sound, mild, moderate, or severe fluorosis, visually and histologically. They were cut into squares (2 × 2 mm) for the determination of fluoride content (microbiopsy) at depths of 30, 60 and 90 μm from the external surface. RESULTS: Erupted teeth with severe fluorosis had significantly greater mean fluoride content at 30, 60 and 90 μm than sound teeth. Unerupted teeth with mild, moderate and severe fluorosis had significantly greater mean fluoride content than sound teeth at 30 μm; unerupted teeth with mild and severe fluorosis had significantly greater mean fluoride content than sound teeth at 60 μm, while only unerupted teeth severe fluorosis had significantly greater mean fluoride content than sound teeth at 90 μm. CONCLUSIONS: Both erupted and unerupted severely fluorosed teeth presented higher mean enamel fluoride content than sound teeth. CLINICAL SIGNIFICANCE: Data on fluoride content in enamel will further our understanding of its biological characteristics which play a role in the management of hard tissue diseases and conditions

An In Vitro Investigation of Anticaries Efficacy of Fluoride Varnishes

Most currently marketed fluoride varnishes (FVs) have not been evaluated for their effectiveness in preventing dental caries. The objective of this study was to investigate the anticaries efficacy, measured as fluoride release into artificial saliva (AS); change in surface microhardness of early enamel caries lesions; and enamel fluoride uptake (EFU) of 14 commercially available FVs and two control groups. Bovine enamel specimens (5×5 mm) were prepared and assigned to 18 groups (n=12). Early caries lesions were created in the specimens and characterized using Vickers microhardness (VHNlesion). FV was applied to each group of specimens. Immediately afterward, specimens were incubated in 4 mL of AS for 18 hours, which were collected and renewed every hour for the first six hours. AS samples were analyzed for fluoride using an ion-specific electrode. Specimens were then brushed for 20 seconds with toothpaste slurry and subjected to pH cycling consisting of a four-hour/day acid challenge and one-minute treatments with 1100 ppm F dentifrice for five days. Microhardness was measured following pH cycling (VHNpost). EFU was determined using microbiopsy. Acid resistance (eight-hour demin challenge) was performed after pH cycling, and microhardness was measured (VHNart) and compared with baseline values to test the FV impact after pH cycling. One-way analysis of variance was used for data analysis (α=0.05). FVs differed in their release characteristics (mean ± SD ranged from 14.97 ± 2.38 μg/mL to 0.50 ± 0.15 μg/mL), rehardening capability (mean ± SD ranged from 24.3 ± 15.1 to 11.7 ± 12.7), and ability to deliver fluoride to demineralized lesions (mean ± SD ranged from 3303 ± 789 μg/cm3 to 707 ± 238 μg/cm3). Statistically significant but weak linear associations were found between ΔVHN(post – lesion), EFU, and fluoride release (correlations 0.21-0.36). The results of this study demonstrated that differences in FV composition can affect their efficacy in in vitro conditions

Trend-analysis of dental hard-tissue conditions as function of tooth age

Objective This retrospective in-vitro study investigated tooth age effect on dental hard-tissue conditions. Methods Unidentified extracted premolars (n = 1500) were collected and their individual age was estimated (10–100 (±10) years old (yo)) using established dental forensic methods Dental caries, fluorosis and tooth wear (TW) were assessed using the International Caries Detection and Assessment System (ICDAS; 0–5 for crown and 0–2 for root), Thylstrup-Fejerskov (TFI; 0–9) and Basic Erosive Wear Examination (BEWE; 0–3) indices, respectively. Staining and color were assessed using the modified-Lobene (MLI) (0–3) and VITA shade (B1-C4) indices, respectively. Relationships between indices and age were tested using regression models. Results Starting at age ∼10yo, presence of caries increased from 35% to 90% at ∼50yo (coronal), and from 0% to 35% at ∼80yo (root). Caries severity increased from ICDAS 0.5 to 2 at ∼40yo and from ICDAS 0 to 0.5 at ∼60yo for coronal and root caries, respectively. Presence of TW increased from 25% (occlusal) and 15% (smooth-surfaces) to 100% at ∼80yo. TW severity increased from BEWE 0.5 to 2 at ∼50yo (occlusal) and ∼0.3 to 1.5 at ∼50yo (smooth-surfaces). Percentage and severity of fluorosis decreased from 70% to 10% at ∼80yo, and from TFI 1 to 0 at ∼90yo, respectively. Percentage of extrinsic staining increased from 0% to 85% at ∼80yo and its severity increased from MLI 0 to 2 at ∼70yo. Color changed from A3 to B3 at ∼50yo (crown), and from C2 to A4 at ∼85yo (root). Conclusions Aging is proportionally related to the severity of caries, TW, staining, and inversely to dental fluorosis. Teeth become darker with ag

In vitro Validation of Quantitative Light-Induced Fluorescence for the Diagnosis of Enamel Fluorosis in Permanent Teeth

This study aimed to validate quantitative light-induced fluorescence (QLF) as a diagnostic tool for mild and moderate enamel fluorosis in permanent teeth, comparing it to visual diagnosis and histological assessment completed using polarized light microscopy (PLM). The buccal surfaces of 139 teeth were visually classified using the Thylstrup and Fejerskov Index (TFI) into sound (TFI 0; n = 17), mild (TFI 1-2; n = 69), and moderate (TFI 3-4; n = 43) fluorosis. Fluorosis was then assessed with QLF (variables ΔF, A, and ΔQ at 5-, 15-, and 30-radiance thresholds) using as reference areas the entire surface and a region of interest (ROI), identified as the most representative region of a fluorosis lesion. PLM images of longitudinal thin sections including the ROI were assessed for histological changes. Correlations among TFI, PLM, and QLF were determined. A receiver-operating characteristic curve was conducted to determine QLF's diagnostic accuracy when compared to the TFI and PLM assessments. This was used to assess the probability that the images were correctly ranked according to severity as determined by PLM and TFI. A positive correlation was found between QLF and PLM, and between QLF and TFI. QLF showed the highest sensitivity and specificity for the diagnosis of mild fluorosis. There was also a strong agreement between TFI and PLM. The selection of a ROI resulted in a stronger correlation with TFI and PLM than when the entire surface was used. The study results indicate that defining an ROI for QLF assessments is a valid method for the diagnosis of mild and moderate enamel fluorosis

Fluoride in the diet of 2-years-old children

Objectives This study aimed to calculate the fluoride concentrations of commonly consumed foods and beverages for 2-years-old children utilizing market basket information for the US Midwest region. Methods Total Diet Study food lists were cross-referenced with National Health and Nutrition Examination Survey—What We Eat in America data to determine the foods and beverages to be included. Fluoride concentrations were determined using a modification of the hexamethyldisiloxane microdiffusion technique. Fluoride concentrations were summarized for each of the food categories. Daily dietary fluoride intake was estimated using a simulation analysis. Results Food and beverage fluoride concentrations varied widely, ranging from nondetectable for some oils and dairy products to more than 3.0 μgF/g food for some processed meats, fish and fruits. The estimated mean (±SD) daily dietary fluoride intake, excluding dentifrice and supplements, was 412±114 μgF/d. The estimated average ingestion for a 2-years-old weighing 12.24 kg was 0.034±0.009 mg/kg/d. A diet based on foods and beverages in the fifth percentile of fluoride intake distribution for an average child would result in 247 μgF/d or 0.020 mg/kg/d, while a diet with foods and beverages in the 95th percentile would result in a total intake of 622 μgF/d or 0.051 mg/kg/d. Conclusions The fluoride concentrations of foods and beverages vary widely, and, if items in the 95th percentile of fluoride intake distribution are ingested, children could consume more fluoride than the recommended 0.05 mg/kg/d. Fluoride intake calculated in this study was higher than historically reported dietary levels