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Objectives: To evaluate the antibacterial efficacy of two fluoride-containing (1450 ppm F) toothpastes with or without zinc-citrate (ZCT), hydroxyapatite (HAP) and potassium-citrate (KCit); to assess and compare their clinical effects in terms of tooth sensitivity, plaque accumulation and gingivitis, as well as patients' satisfaction., Materials and Methods: Healthy, adult patients were selected and randomly assigned to two groups (n = 50): Experimental: ZCT-, HAP-, KCit- and fluoride-containing toothpaste; Control: fluoride-containing toothpaste. Salivary counts of Streptococcus mutans (S. mutans), plaque and gingival index, as well as clinically diagnosed sensitivity were recorded at baseline, and after 4 weeks. A custom-made questionnaire was used to assess patients' self-reported sensitivity (baseline and after 4 weeks) and overall satisfaction with the tested toothpastes. Data were statistically analyzed (α = 0.05)., Results: After 4 weeks, a statistically significant salivary reduction of S. mutans was observed in both groups (p = 0.001). Furthermore, the percentage of S. mutans decrease was significantly higher in Experimental group (p = 0.014). There were no statistically significant differences between the groups in terms of plaque and gingival index (p > 0.05). After 4 weeks, the self-reported tooth sensitivity was lower in Experimental group (p < 0.001)., Conclusions: Both toothpastes showed good antimicrobial effect after 4 weeks; however, the toothpaste containing ZCT, HAP, KCit and fluoride was found to be more effective in reducing the salivary counts of S. mutans than the product containing fluoride alone., Clinical Relevance: Toothpaste containing ZCT, HAP, KCit and fluoride can be recommended for patients at risk for developing caries and may also be beneficial for individuals experiencing dental sensitivity., Competing Interests: Declarations. Ethical approval: The study protocol was reviewed and approved by the University of Bologna Ethics Committee (793/2022/SPER/AUSLBO). Informed consent: A written informed consent was obtained from patients before their enrollment in the study. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: The objective of this randomized controlled trial was the comparison of a stannous fluoride (SnF2) dentifrice stabilized with nitrate and phosphates (test) to a regular fluoride dentifrice (negative control) for the control of plaque and gingivitis over 6 months., Methods: A total of 80 adult participants were enrolled in this study that was conducted in Loma Linda, California. After randomization and blinding of study personnel and patients, enrolled participants were provided instructions for the use of their assigned dentifrice. At three visits (0, 3, and 6 months), various gingival and plaque indices were collected to determine the clinical efficacy of the SnF2 stabilized dentifrice. These results were compared with the results of the negative control dentifrice., Results: A total of 77 participants completed the study. The test dentifrice demonstrated statistically significant reductions versus baseline in all plaque and gingivitis indices after 3 and 6 months of product use. The negative control dentifrice demonstrated significant reductions versus baseline in all plaque indices, but not gingivitis indices, after 3 months of product use and in all plaque and gingivitis indices after 6 months of product use, with the exception of the interproximal gingivitis index, which did not reach statistical significance. The test SnF2 dentifrice showed statistically significant reductions in all plaque and gingivitis indices compared to baseline and with the negative control dentifrice (P less than .001) after 3 months and 6 months of product use., Conclusions: The results of this clinical trial showed statistically significantly improved clinical outcomes for reduction of gingival inflammation and improvement in plaque control over 6 months when using a new SnF2 dentifrice stabilized with nitrate and phosphates as compared to the results from a regular fluoride dentifrice., Practical Implications: This newly formulated SnF2 dentifrice may be of benefit to patients who need help controlling plaque biofilm and in reducing gingivitis, leading to an improvement in overall oral health.

Objectives: The objective of this clinical trial was to evaluate and compare the clinical and radiographic successes of three bioactive endodontic cements (BEC) including novel portland cement-based material releasing fluoride, resin-modified silicate glass cement, and pure tricalcium silicate-based cement-in the treatment of primary molars diagnosed with reversible pulpitis via indirect pulp capping., Methods: Eighty-six (86) participants with previously untreated first and second primary molars were included in this study. The teeth were randomly allocated into three groups: pure tricalcium silicate-based cement, resin-modified silicate glass cement, and novel portland cement-based material releasing fluoride. Cavities were capped with the assigned cement after caries excavation using standard protocols. The teeth that underwent treatment were restored using glass ionomer cement and composite resin. Clinical and radiographic evaluations were performed at 1, 6, and 12 months. The data were analyzed using Pearson chi-square, Kruskal-Wallis H and Z test (P = 0.05)., Results: The success rate was 88 % (n = 25) in the pure tricalcium silicate-based cement group, 88.5 % (n = 26) in the resin-modified silicate glass cement group, and 100 % (n = 25) in the novel portland cement-based material releasing fluoride group. The differences at the 1st, 6th, and 12th month follow-up visits were not statistically significant among the groups (P > 0.05). No difference was found between the integrity of the resin composite restorations overlying pure tricalcium silicate-based cement, resin-modified silicate glass cement, and novel portland cement-based material releasing fluoride according to the USPHS criteria., Conclusions: Novel portland cement-based material releasing fluoride can be considered an alternative for preserving the tooth, as it showed a high success rate in treating primary molars diagnosed with reversible pulpitis via indirect pulp capping., Clinical Significance: Novel Portland cement-based material releasing fluoride could be beneficial in the treatment of primary molars diagnosed with reversible pulpitis via indirect pulp capping., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Dental caries is a major public health problem in most industrialised countries, affecting 60% to 90% of school children. Community water fluoridation (CWF) is currently practised in about 25 countries; health authorities consider it to be a key strategy for preventing dental caries. CWF is of interest to health professionals, policymakers and the public. This is an update of a Cochrane review first published in 2015, focusing on contemporary evidence about the effects of CWF on dental caries., Objectives: To evaluate the effects of initiation or cessation of CWF programmes for the prevention of dental caries. To evaluate the association of water fluoridation (artificial or natural) with dental fluorosis., Search Methods: We searched CENTRAL, MEDLINE, Embase and four other databases up to 16 August 2023. We also searched two clinical trials registers and conducted backward citation searches., Selection Criteria: We included populations of all ages. For our first objective (effects of initiation or cessation of CWF programmes on dental caries), we included prospective controlled studies comparing populations receiving fluoridated water with those receiving non-fluoridated or naturally low-fluoridated water. To evaluate change in caries status, studies measured caries both within three years of a change in fluoridation status and at the end of study follow-up. For our second objective (association of water fluoridation with dental fluorosis), we included any study design, with concurrent control, comparing populations exposed to different water fluoride concentrations. In this update, we did not search for or include new evidence for this objective., Data Collection and Analysis: We used standard methodological procedures expected by Cochrane. For our first objective, we included the following outcomes as change from baseline: decayed, missing or filled teeth ('dmft' for primary and 'DMFT' for permanent teeth); decayed, missing or filled tooth surfaces ('dmfs' for primary and 'DMFS' for permanent teeth); proportion of caries-free participants for both primary and permanent dentition; adverse events. We stratified the results of the meta-analyses according to whether data were collected before or after the widespread use of fluoride toothpaste in 1975. For our second objective, we included dental fluorosis (of aesthetic concern, or any level of fluorosis), and any other adverse events reported by the included studies., Main Results: We included 157 studies. All used non-randomised designs. Given the inherent risks of bias in these designs, particularly related to management of confounding factors and blinding of outcome assessors, we downgraded the certainty of all evidence for these risks. We downgraded some evidence for imprecision, inconsistency or both. Evidence from older studies may not be applicable to contemporary societies, and we downgraded older evidence for indirectness. Water fluoridation initiation (21 studies) Based on contemporary evidence (after 1975), the initiation of CWF may lead to a slightly greater change in dmft over time (mean difference (MD) 0.24, 95% confidence interval (CI) -0.03 to 0.52; P = 0.09; 2 studies, 2908 children; low-certainty evidence). This equates to a difference in dmft of approximately one-quarter of a tooth in favour of CWF; this effect estimate includes the possibility of benefit and no benefit. Contemporary evidence (after 1975) was also available for change in DMFT (4 studies, 2856 children) and change in DMFS (1 study, 343 children); we were very uncertain of these findings. CWF may lead to a slightly greater change over time in the proportion of caries-free children with primary dentition (MD -0.04, 95% CI -0.09 to 0.01; P = 0.12; 2 studies, 2908 children), and permanent dentition (MD -0.03, 95% CI -0.07 to 0.01; P = 0.14; 2 studies, 2348 children). These low-certainty findings (a 4 percentage point difference and 3 percentage point difference for primary and permanent dentition, respectively) favoured CWF. These effect estimates include the possibility of benefit and no benefit. No contemporary data were available for adverse effects. Because of very low-certainty evidence, we were unsure of the size of effects of CWF when using older evidence (from 1975 or earlier) on all outcomes: change in dmft (5 studies, 5709 children), change in DMFT (3 studies, 5623 children), change in proportion of caries-free children with primary dentition (5 studies, 6278 children) or permanent dentition (4 studies, 6219 children), or adverse effects (2 studies, 7800 children). Only one study, conducted after 1975, reported disparities according to socioeconomic status, with no evidence that deprivation influenced the relationship between water exposure and caries status. Water fluoridation cessation (1 study) Because of very low-certainty evidence, we could not determine if the cessation of CWF affected DMFS (1 study conducted after 1975; 2994 children). Data were not available for other review outcomes for this comparison. Association of water fluoridation with dental fluorosis (135 studies) The previous version of this review found low-certainty evidence that fluoridated water may be associated with dental fluorosis. With a fluoride level of 0.7 parts per million (ppm), approximately 12% of participants had fluorosis of aesthetic concern (95% CI 8% to 17%; 40 studies, 59,630 participants), and approximately 40% had fluorosis of any level (95% CI 35% to 44%; 90 studies, 180,530 participants). Because of very low-certainty evidence, we were unsure of other adverse effects (including skeletal fluorosis, bone fractures and skeletal maturity; 5 studies, incomplete participant numbers)., Authors' Conclusions: Contemporary studies indicate that initiation of CWF may lead to a slightly greater reduction in dmft and may lead to a slightly greater increase in the proportion of caries-free children, but with smaller effect sizes than pre-1975 studies. There is insufficient evidence to determine the effect of cessation of CWF on caries and whether water fluoridation results in a change in disparities in caries according to socioeconomic status. We found no eligible studies that report caries outcomes in adults. The implementation or cessation of CWF requires careful consideration of this current evidence, in the broader context of a population's oral health, diet and consumption of tap water, movement or migration, and the availability and uptake of other caries-prevention strategies. Acceptability, cost-effectiveness and feasibility of the implementation and monitoring of a CWF programme should also be taken into account., (Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

This study evaluated the effect of solutions containing aminomethacrylate copolymer (AA) and sodium fluoride (F; 225 ppm F - ) or fluoride plus stannous chloride (FSn; 225 ppm F - , 800 ppm Sn 2+ ) against enamel and dentin erosion/abrasion. Solutions F, FSn, AA, F+AA, FSn+AA, and deionized water as negative control were tested. Bovine enamel and dentin specimens (n = 13/solution/substrate) underwent a set of erosion-abrasion cycles (0.3% citric acid [5 min, 4×/day], human saliva [1 h, 4×/day], brushing [15 s, 2×/day], and treatments [2 min, 2×/day]) for each of five days. Initial enamel erosion was evaluated using Knoop microhardness after the first and second acid challenge on day 1, and surface loss with profilometry after day 5. KOH-soluble fluoride was assessed. Data were analyzed with ANOVA/Tukey tests. The combination of fluoride and AA resulted in higher protection against enamel erosion, whereas this was not the case for the combination of AA and FSn. All treatments protected against enamel and dentin loss. The lowest surface loss values were observed with F+AA and FSn+AA. The polymer did not significantly influence the KOH-soluble fluoride formation on enamel/dentin specimens. The aminomethacrylate copolymer effectively enhanced the efficacy of sodium fluoride against initial erosion and improved the control of enamel and dentin wear of F and FSn solutions., (© 2024 Scandinavian Division of the International Association for Dental Research. Published by John Wiley & Sons Ltd.)

Objectives: To evaluate the in-vitro efficacy of inhibiting enamel demineralization using arginine in combination with fluoride-containing bioactive glass (FBG)., Methods: In this study, the healthy enamel blocks were first demineralized in acetic acid for 24 h, then soaked in anti-demineralization treatment solutions containing either arginine or FBG or both for 96 h.The specimens treated in acetic acid were applied as the control group. The pH, calcium and phosphorus ion concentrations of the solutions were measured before and after treatment. Changes in enamel mineral weight, microhardness, and composition were also analyzed., Results: The present of arginine facilitated fluorine release from treatment solutions with the presence of FBG. Both arginine and FBG significantly increased the pH of treatment solutions and prevented the further mineral weight loss compared to the control group. All anti-demineralization treatment groups showed significant increases in microhardness, but there was no statistical difference among the treatment groups. The SEM analysis showed enamel restoration in the arginine and FBG groups upon treatment, while the combined groups showing a superior anti-demineralization efficacy. 19 F NMR showed the formation of fluorapatite in samples treated with solutions containing FBG., Conclusions: Both arginine and FBG could inhibit enamel demineralization to some extent, and their combination demonstrated an enhanced anti-demineralization efficacy. The low-concentration combination group exhibited anti-demineralization effects comparable to those of high-concentration ones., Clinical Significance: This study introduces a new approach for caries prevention by combining the application of arginine and FBG. The release of fluorine promoted by the presented arginine along with calcium and phosphorus ions from FBG facilitated FAP formation. Additionally, the increment of pH resulting from arginine and FBG degradation further prevents enamel demineralization., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Objectives: The present study aimed to synthesize toothpastes containing Beta- TriCalcium Phosphate (β-TCP) nanoparticles, functionalized with fluoride and tin, and test their ability to reduce erosive tooth wear (ETW)., Methods: Toothpastes were synthesized with the following active ingredients: 1100 ppm of fluoride (as sodium fluoride, F - ), 3500 ppm of tin (as stannous chloride, Sn 2+ ), and 800 ppm of β-TCP (Sizes a - 20 nm; and b - 100 nm). Enamel specimens were randomly assigned into the following groups (n = 10): 1. Commercial toothpaste; 2. Placebo; 3 F - ; 4. F - + β-TCP a ; 5. F - + β-TCP b ; 6. F - + Sn 2+ ; 7. F - + Sn 2+ + β-TCP a and 8. F - + Sn 2+ + β-TCP b . Specimens were subjected to erosion-abrasion cycling. Surface loss (in µm) was measured by optical profilometry. Toothpastes pH and available F - were also assessed., Results: Brushing with placebo toothpaste resulted in higher surface loss than brushing with F - (p = 0.005) and F - + β-TCP b (p = 0.007); however, there was no difference between F - and F - + β-TCP b (p = 1.00). Commercial toothpaste showed no difference from Placebo (p = 0.279). The groups F - , F - + β-TCP a , F - + β-TCP b , F - + Sn 2+ , F - + Sn 2+ + β-TCP a and F - + Sn 2+ + β-TCP b were not different from the commercial toothpaste (p > 0.05). Overall, the addition of β-TCP reduced the amount of available fluoride in the experimental toothpastes. The pH of toothpastes ranged from 4.97 to 6.49., Conclusions: Although toothpaste containing β-TCP nanoparticles protected enamel against dental erosion-abrasion, this effect was not superior to the standard fluoride toothpaste (commercial). In addition, the functionalization of β-TCP nanoparticles with fluoride and tin did not enhance their protective effect., Clinical Significance: Although β-TCP nanoparticles have some potential to control Erosive Tooth Wear, their incorporation into an experimental toothpaste appears to have a protective effect that is similar to a commercial fluoride toothpaste., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose: Skeletal fluorosis (SF) results from chronic exposure to fluoride (F-) causing excessive aberrantly mineralized brittle bone tissue, fractures, and exostoses. There is no established treatment other than avoiding the source of F-. Still, excess F- can persist in bone for decades after exposure ceases., Case Presentation: A 50-year-old woman presented with multiple, recurrent, low AQ2 trauma fractures yet high radiologic bone mineral density. Serum F- was elevated, and osteomalacia was documented by non-decalcified transiliac biopsy. She reported intermittently "huffing" a keyboard cleaner containing F- (difluoroethane) for years. Following cessation of her F- exposure, we evaluated the administration of the parathyroid hormone analog, abaloparatide, hoping to increase bone remodeling and diminish her skeletal F- burden., Conclusion: Due to the prolonged half-life of F- in bone, SF can cause fracturing long after F- exposure stops. Anabolic therapy approved for osteoporosis, such as abaloparatide, may induce mineralized bone turnover to replace the poorly mineralized osteomalacic bone characteristic of SF and thereby diminish fracture risk. Following abaloparatide treatment for our patient, there was a decrease in bone density as well as a reduction in F- levels., (© 2024. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)

Background: Fluoride gel treatment is not recommended for children < 6 years old due to its potential toxicity. Hence the aim of this study was to compare the effect of 1.23% acidulated-phosphate fluoride (APF) gel paint-on and the conventional tray application techniques on artificial, deciduous enamel carious lesions embedded on wearable appliances., Methods: In a randomised crossover study, the volunteer children (n = 29) wore mandibular removable appliances containing embedded tooth specimens with artificial carious lesions. The volunteers had 3 different treatment protocols: (I) 0.4 mL non-fluoride (control) gel, (II) 0.4 mL paint-on 1.23% APF gel or (III) 5 mL 1.23% APF gel, 4 minutes tray application. After 1 hour, the appliances were removed and the specimens underwent an in vitro, 14 days of pH-cycling. The mean percentage reduction in fluorescence (ΔF, %) at baseline (ΔF 0 ) and after the pH-cycling (ΔF 1 ) were determined using quantitative light-induced fluorescence-digital analysis. The mean ΔΔF (ΔF 1 -ΔF 0 ) was calculated to compare the differences between groups., Results: The mean ΔΔF of groups I to III were -1.42 ± 1.49, 1.06 ± 2.11, and 1.12 ± 3.57 and -1.25 ± 1.44, 1.13 ± 1.84 and 1.44 ± 3.62 for the smooth surface and proximal surface lesions, respectively. The mean ΔΔF in the 2 treatment groups were significantly greater compared with the control group (P < .001). There was no significant difference in ΔΔF between the APF gel tray and paint-on groups either in the smooth surfaces, or the proximal surfaces (P = .629 and P = .613, respectively)., Conclusion: Our study, for the first time, indicates that the paint-on application of APF gel or the tray application of APF had a similar enamel remineralisation effect. Clinically, this implies that, particularly in younger children, the paint-on application of fluoride is less cumbersome, and possibly more tolerable with a lesser likelihood of fluoride ingestion than the tray application technique., Trial Registration: Thai Clinical Trial Registry (https://www.thaiclinicaltrials.org/show/TCTR20190724001)., Competing Interests: Conflict of interest None disclosed., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: There are many suitable strategies for addressing caries, which is an ongoing worldwide problem. Although white spot lesions (WSLs) can be either remineralized naturally or treated with non- or micro-invasive strategies, their whitish and opaque appearance may persist. To evaluate the effects of tooth bleaching as a complement to fluoride-enhanced remineralization or resin infiltration in masking WSLs, as well as in enamel surface roughness relative to that of the adjacent enamel., Methodology: Flattened rectangular bovine enamel fragments (6×3×~2.9 mm length, width and thickness) were divided into six groups (L/N, F/N, F.BL/BL, I/N, I.BL/BL, N/N; n=15). Treatments applied to the 3×3 mm left half included: L (Lesion) - WSL simulation with 50 mM acetate buffer, 96 hours, 37ºC; F (Fluoride) - WSL treatment with 2% NaF neutral gel, 1x/week, 8 weeks; I (Infiltration) - WSL treatment with H3PO4 37%/10 s; Icon®-Dry/30 s; Icon®-Infiltrant/3 min+1 min; N (Nothing) - sound enamel/control. Treatments applied to both halves after F and I included: BL (Bleaching) - Opalescence Boost 40%, 3×/20 min each; N (Nothing) - control. The differences in color (ΔE00, ΔL, Δa, Δb) and surface roughness (ΔRa) between the left and right halves were measured. Kruskal-Wallis/post-hoc tests were applied to ΔE00, ΔL, Δa and ΔRa, and 1-way ANOVA/Tukey tests to Δb (α=0.05)., Results: The factor under study significantly influenced ΔE00 (p=0.0001), ΔL (p=0.0024), Δb (p=0.0015), and ΔRa (p<0.001), but not Δa (p=0.1592). Both fluoride-enhanced remineralization and resin infiltration were able to mask WSL, regardless of subsequent bleaching. However, when bleaching was performed, ΔE00 median values did not exceed the acceptability threshold for color difference. Only resin infiltration reduced ΔRa between WSL and the adjacent enamel., Conclusions: Both remineralization and infiltration, particularly if complemented by bleaching, fostered satisfactory esthetic results. Only infiltration without bleaching led to really good results in surface roughness.

The present cross-sectional study was conducted to evaluate various caries risk factors in children from low socio-economic groups and to assess if children with broad contacts between one or more primary molars (type I and S) should be categorized as at high caries risk. Clinical examinations were performed on 107, 3- to 10-year-old children from low socio-economic settings. Contact types along with other caries risk factors (insurance, diet, plaque, and fluoride use, and diet habits) were analyzed for effect on presence of caries lesions (prevalence) and caries experience (decayed, missing, filled teeth). 78% of the study population had dental caries lesions, with an average dmft of 5.6. Of the 277 evaluated contacts, 88% were categorized as broad contacts. Multivariate analyses failed to validate that broad contacts were a predictor of dental caries lesions. However, the analysis showed an association of insurance status, plaque index with dmft. In conclusion, the present study could not implicate broad contacts as a factor that increased caries risk in the studied population; however, it validates the importance of insurance status, plaque index, as well as diet frequency as predictors of dental caries lesions., Competing Interests: The authors declare no conflict of interest., (©2024 The Author(s). Published by MRE Press.)

Objective: This systematic review assesses the effectiveness of nanosilver fluoride in arresting dental caries in children, with one-year follow-up., Methodology: Multiple databases were searched for RCTs (randomized controlled trials) according to specified inclusion-exclusion criteria. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) reporting guidelines were followed to conduct the systematic review. Nanosilver fluoride was compared against silver diamine fluoride varnish or topical fluoride varnish or placebo. The primary outcome was effectiveness in arresting dental caries. The Cochrane risk of bias tool was used to assess the risk of bias., Data Sources: Articles were searched in the following databases: PubMed, Ovid, Web of Science, Wiley Online, Proquest and Cinahl., Data Selection: The initial search yielded a total of 3660 hits. After deduplication, a total of 2507 articles were obtained. After screening the title and abstract, 11 studies were included. After the full-text screening, a total of three articles that fulfilled the eligibility criteria were included in the analyses., Data Extraction and Data Synthesis: All the three studies were RCTs carried out in school children, and involved application of the material in primary teeth with a follow-up of one year., Results: In two studies, nanosilver fluoride varnish group showed significantly higher arrest of dental caries compared to placebo group. In the study comparing nanosilver fluoride and silver diamine, both the groups showed arrest of dental caries and there was no significant difference between the groups. One study showed high risk of bias for allocation concealment., Conclusion: The included studies in the final review effectively demonstrated the benefit of using nanosilver fluoride in the arrest of dental caries., (© 2024. The Author(s), under exclusive licence to British Dental Association.)

Article Title and Bibliographic Information: Effectiveness of Calcium Phosphate derivative agents on the prevention and remineralization of caries among children- A systematic review & meta-analysis of randomized controlled trials. Singal K, Sharda S, Gupta A, Malik VS, Singh M, Chauhan A, Agarwal A, Pradhan P, Singh M. J Evid Based Dent Pract. 2022; 22(3):101746., Source of Funding: Indian Council of Medical Research., Type of Study/design: Systematic review with meta-analysis., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: The study objectives were to examine the physical properties and enamel remineralization potential of fluoride (F) varnishes incorporated with arginine (Arg)., Methods: Four commercial F varnishes: 1) Duraphat®; 2) Flúor Protector®, 3) Fluor Protector S®, and 4) Fluorimax™ were supplemented with 2% w/v. Arg. The control/experimental varnishes underwent rheometric analysis to assess varnish density (δ), velocity (ν), and associated viscosity, both quantitatively (ν/δ) and qualitatively based on determined mass, volume, distance flow, and time under experimentation. The varnish wet/dry weights (at 2 h) were also analysed. Further, sound enamel specimens (T0) with artificial incipient caries-like lesions (T1) were treated with control/experimental varnishes and subjected to remineralization assay with artificial saliva for 6 h. Thereafter (T2), the specimens were characterized to estimate precipitated Ca and net enamel F uptake. Additionally, mineral density (MD) was assessed using micro-CT at T0, T1, and T2 to derive mineral gain (MG) and % remineralization for the treatment groups., Results: When Arg is incorporated, the physical properties of the F-containing varnishes undergo a significant transformation, resulting in higher density, varnish weight, dry varnish weight, and viscosity compared to their respective control varnishes (p < 0.05). Incorporating Arg-in Duraphat®, Fluor Protector S®, and Fluorimax™ significantly improved both enamel Ca precipitation and F uptake compared to the respective controls (p < 0.05). Additionally, the enamel F uptake was significantly higher with all the tested varnishes when enriched with Arg (p < 0.05). The combined data for MD, MG, and % remineralization suggests that the remineralization potential of F-varnishes significantly increased when enriched with Arg (p < 0.05)., Conclusion: Incorporating Arg in inorganic F varnishes improves their physical properties and enhances the enamel remineralization potential of the varnishes., Clinical Significance: This study highlights the possibility of incorporating Arg in distinct F-source varnishes. The synergism between active components (Arg-F) aids in enhanced remineralization and superior varnish physical properties, demonstrating a promising approach for high caries-risk patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: This randomised clinical trial was designed and carried out with the aim to evaluate the capacity of fluoride-substituted hydroxyapatite (HAF) toothpaste to modulate oral microflora composition and biofilm acidogenicity in schoolchildren., Methods: In all, 610 children (4 to 5 and 6 to 7 years) were enrolled. Four toothpastes were randomly administered during 24 months: 2 contained fluoride-substituted hydroxyapatite (HAF 1000 and HAF 1450 ; 1000 and 1450 ppmF) and magnesium-, strontium-, and carbonate-substituted hydroxyapatite in a chitosan matrix, and 2 were monofluorophosphate fluoridated toothpastes (F 1000 and F 1450 ; 1000 and 1450 ppmF). Caries lesions were assessed by International Caries Detection and Assessment System scores, supragingival plaque was sampled from the approximal sites between primary molars using sterile Gracey curettes for microbiological analysis, and plaque pH curves after sucrose challenge were assessed at baseline and reevaluated after 1 year and after 2 years. The minimum and maximum pH decrease was calculated for caries-free patients and participants with a caries lesion(s) at baseline and at the end of the experimental period (24 months). Differences amongst measurements were analysed with 1-way analysis of variance., Results: During the trial, the minimum pH value increased statistically significantly in all groups; in HAF 1000 and HAF 1450 , the increase was greatest. At the end of trial, in the 2 HAF groups all primary cariogenic bacteria were statistically significantly lower with respect to F groups (P = .03 for Streptococcus mutans and sobrinus, for Lactobacillus casei, and for Lactobacillus fermentum)., Conclusions: The trial provides robust but still inconclusive evidence on the efficacy of HAF toothpastes compared to traditional fluoridated toothpastes to reduce caries risk factors and to prevent caries lesions., Competing Interests: Conflict of interest None disclosed., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: White-spot lesions are considered an initial carious stage characterized by an outer enamel layer with significantly reduced mineralization. This study was conducted to assess the combined effect of Biomin F toothpaste and Diode laser on remineralization of white spot lesions., Materials and Methods: An invitro study conducted on a total of 30 premolars divided into three groups; Group A (Biomin F Tooth paste), Group B (Biomin F with laser application for 30 sec), Group C (Negative control). The three groups were submitted to three stages; stage 1:Baseline,stage 2:After demineralization ,and stage 3:After remineralization. In each stage, elemental analysis(calcium, phosphorus, and fluoride)was measured quantitatively using Energy Dispersive X-ray (EDX) analysis and qualitatively by micrographs using scanning electron microscope. The data were tested to find significant difference between mineral changes during stages by using (ANOVA) test and Bonferroni test., Results: Calcium, phosphorus and fluoride ions decreased in all groups after demineralization. In stage 3, after application of remineralizing agents, Calcium ions increased significantly in groups A and B where p<.05. As regards to the phosphorus ions, a significant increase was observed in all groups with group A showed the highest gain as phosphorus level percentage change (%mass) was 56.52±18.02 . Fluoride ions increased significantly in groups A and B (p<0.05) but decreased significantly in group C. There was no statistical significant difference between group A and B (p ≥.05) in calcium, phosphorus, and fluoride level after remineralization., Conclusion: Within the limitation of the present study, we concluded that Biomin F toothpaste is promising in the repairing of white spot lesions on the surface of the demineralized enamel. Diode laser did not affect the remineralizing ability of Biomin F toothpaste., (© 2024. The Author(s).)

Objectives: This study pursued two main purposes. The first aim was to expound on the microscopic factors of radiation-related caries (RRC). Further, it aimed to compare the remineralization effect of different remineralizing agents on demineralized teeth after radiotherapy., Methods: The enamel and dentin samples of bovine teeth were irradiated with different doses of radiation. After analysis of scanning electron microscope (SEM), X-Ray diffraction (XRD), and energy dispersive spectrometer (EDS), the samples irradiated with 50 Gy radiation were selected and divided into the demineralization group, the double distilled water (DDW) group, the Sodium fluoride (NaF) group, the Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) group, the NaF + CPP-ACP group, and the Titanium tetrafluoride (TiF 4 ) group. After demineralization, remineralizing agents treatment, and remineralization, the samples were evaluated using SEM, atomic force microscope (AFM), EDS, and transverse microradiography (TMR)., Results: A radiation dose of 30 Gy was sufficient to cause damage to the dentinal tubules, but 70 Gy radiation had little effect on the microstructure of enamel. Additionally, the NaF + CPP-ACP group and the TiF 4 group significantly promoted deposit formation, decreased surface roughness, and reduced mineral loss and lesion depth of demineralized enamel and dentin samples after radiation., Conclusions: Radiation causes more significant damage to dentin compared to enamel. NaF + CPP-ACP and TiF 4 had a promising ability to promote remineralization of irradiated dental hard tissues., Advances in Knowledge: This in vitro study contributes to determining a safer radiation dose range for teeth and identifying the most effective remineralization approach for RRC., (© 2024. The Author(s).)

Aim: This systematic review and meta-analysis evaluated theobromine's (Theobroma cacao) potential in remineralizing white spot lesions in dental enamel. Methods: This study is reported according to the PRISMA checklist and was registered in PROSPERO (CRD42023414371). In vitro tests that evaluated the remineralizing potential of theobromine compared to fluoride ion after demineralization for the formation of white spot lesions on enamel were selected, with no limitation on the year of publication. Electronic searches were performed in PubMed/MEDLINE, Scopus, and Web of Science by two independent researchers. Thirty articles were received of which six were selected according to the inclusion criteria., Results: The selected studies evaluated the Enamel Surface Microhardness (SMH), Vickers or Knoop, before and after treatment with theobromine and fluoride solutions. For the SMH Vickers, there were no differences between groups at baseline (p=1.00; mean difference: -0.00; CI: -11.36 to 11.36) and after treatment (p=0.51; mean difference: 4.12; CI: -8.16 to 16.41). The results of SMH Knoop showed differences between groups at baseline, favoring the experimental group (p=0.002; mean difference: 9.84; CI: 3.65 to 16.02) and after treatment favoring the control group (p=0.00001; mean difference: -5.45; CI: -7.62 to -3.27)., Conclusion: The use of theobromine increases the microhardness of dental enamel subjected to a demineralization process, thus being effective in the remineralization of this tissue with success equivalent to that obtained with the use of fluoride., (©Operative Dentistry, 2024.)

Objectives: This laboratory study assessed the performance of a novel fluoride dentifrice containing micro-fibrillated cellulose (MFC) and entrapped silica., Methods: Removal of extrinsic stains was assessed using the pellicle cleaning ratio (PCR) method, and radioactive dentin abrasivity (RDA) was measured, to calculate a cleaning efficiency index (CEI). Fluoride efficacy was evaluated using widely used remineralization and fluoride uptake methods. The test product (Protegera™) was compared to common dentifrices (Crest - Cavity Protection™ and ProHealth™, Sensodyne Pronamel™, Arm & Hammer™ Advanced Whitening, Crest ProHealth™, and Colgate Optic White™)., Results: The PCR for the MFC dentifrice (141) was comparable to three known marketed stain-removing dentifrices (Arm & Hammer™ Advanced Whitening, Crest ProHealth™, and Colgate Optic White™) but it had a significantly lower RDA (88 ± 6) than 5 other products. This gave it the highest CEI of the tested products (2.0). In a 10-day pH cycling study, the fluoride efficacy of the MFC product was comparable to Sensodyne Pronamel and Crest Cavity Protection. The MFC dentifrice was superior for promoting fluoride uptake into incipient enamel lesions compared to the USP reference dentifrice., Conclusion: The MFC dentifrice has low abrasion, but despite this, it is highly effective in removing stained pellicle. It also is an efficacious fluoride source when compared to relevant commercially available fluoride dentifrices with high dentin abrasivity., Clinical Significance: The addition of micro-fibrillated cellulose to a fluoride dentifrice gives a low abrasive product that can effectively remove external stains, and serve as an effective fluoride source. This combination of benefits seems well suited to enamel protection and caries prevention., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Mohamed E. Labib, Antonio Perazzo, James L. Manganaro and Yacoob Tabani are employees of NovaFlux, Inc. and consultants to Protegera, Inc. Carmine Durham is the CEO of Protegera, Inc. Bruce R. Schemehorn and Heath C. McClure are employees of Therametric Technologies, Inc. Laurence J Walsh is a consultant to Protegera, Inc. The authors declare no other competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Introduction: Fluoride is the main factor in reducing the prevalence of caries worldwide. However, there is insufficient knowledge about whether people in different age groups are aware of the benefits of fluoride toothpaste, as well as about people's daily oral care habits and whether they use fluoride. The purpose of this research is to investigate the knowledge and performance of Iranian students regarding the use of toothpaste containing fluoride., Method: This study was conducted on the first- and second-year high school students of Kerman city. Questionnaires containing personal questions, general questions, and questions related to students' knowledge and performance regarding the use of fluoride toothpaste were provided to them and then they were asked to complete and submit it. The results obtained from the survey were analyzed by T-test, Mann-Whitney test, and Chi-Square test in SPSS Version 24. The significance level in data analysis was P < 0.05., Results: In this research, 681 forms including 252 boys and 429 girls were examined. The average age of the participants was 14.1 ± 0.4. 91.2% declared that they use toothpaste and 77.8% of them used toothpaste containing fluoride. 521 people stated that the price of toothpaste is important in using the type of toothpaste. 621 people used regular toothbrush and 609 people evaluated their oral health as good. 621 of the participants stated that toothpaste makes the mouth healthy. The average knowledge score was 16.7 ± 2.1 out of 24, which indicates the average knowledge of students in this field., Conclusion: This study showed that students' knowledge and performance about using fluoride-containing toothpaste is average. There was no significant relationship between performance and knowledge with age and gender. There was also a positive correlation between knowledge and performance indicating that increasing knowledge leads to an increase in behavioral changes. Also, there was a positive correlation between knowledge and performance, and a correlation coefficient of 0.731 was obtained between knowledge and performance. It shows that increasing knowledge leads to increasing behavioral changes., (© 2024. The Author(s).)

Objectives: Longitudinal assessment of the role of specific proteins on radiotherapy caries (RC) onset in head and neck cancer patients(HNC) up to one-year post-IMRT using a 5000ppm fluoride paste daily., Materials and Methods: Dental status/salivary protein data were obtained from 40 HNC patients pre-IMRT, six months (T1) and 12 months (T2) post-IMRT (ethical approval/consent). DMFT/salivary parameters were quantified, including flow rate, mucin 5B/7, Immunoglobulin A (IgA), cystatin S and α-amylase., Results: 45% patients had at least one carious lesion at T2, a significant reduction in the number of remaining teeth (65% <21), salivary flow rate (< 50%) and, protein secretion (< 0.05) post-IMRT. T1 IgA concentration/secretion rate was associated with RC (p < 0.05). Finally, IgA and total protein concentration obtained at T1 could provide a predictive pattern (AUC 82.3%) for the patients more predisposed to developing RC at T2., Conclusions: This study demonstrated the significant association of RC with salivary proteins in HNC patients treated with IMRT, revealing the potential role of salivary proteins in the early diagnosis of RC., Clinical Relevance: This research contributes to revealing salivary proteins association with RC, and its role in early diagnosis. Therefore, this could be the first step towards personalized medicine approaches to improve this group quality-of-life., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: One of the most prevalent health problems affecting children worldwide is untreated caries in primary teeth. Agents to arrest caries are used to manage untreated decay in children in disadvantaged communities. Nano Silver Fluoride (NSF) overcomes the staining problems of Silver Diamine Fluoride (SDF). This study compared the clinical cariostatic effect of NSF to 38% SDF for arresting caries lesions., Methods: The study included 360 children younger than 4 years, with at least one active lesion, ICDAS score ≥ 3, recruited from nurseries in a rural area in Alexandria, Egypt, in 2022. They were randomly assigned to receive a single application of NSF at baseline, or two applications of SDF at baseline and after 6 months. The arrest of active carious lesions was assessed after 6 and 12 months using ICDAS criteria, and parents' satisfaction with child appearance was also assessed. Chi-Square test was used to compare the groups and multi-level multiple logistic regression was used to assess the effect of the intervention on caries arrest at lesion level and binary logistic regression was used to assess the effect at patient level., Results: 1853 active lesions were included in children whose mean (SD) age was 42.3 (8.2) months. The arrest rate was significantly higher in the NSF than the SDF group at lesion level (78.4% and 65.0% at 6 months and 71.3% and 56.3% at 12 months, p < 0.001). In regression analysis, NSF had significantly higher odds of caries arrest than SDF at lesion level (at 6 months, AOR = 2.57, 95% CI: 1.55, 4.26 and at 12 month, AOR = 3.27, 95% CI: 1.89, 5.67). Parents of children receiving NSF had significantly greater satisfaction with their children's dental appearance than those receiving SDF: (97.2% and 76.1%, respectively, p < 0.001)., Conclusion: NSF demonstrated greater effectiveness in arresting caries in preschool children without inducing black staining of teeth and with greater parental satisfaction than SDF. NSF can be an alternative to SDF in arresting caries especially in underprivileged communities., Trial Registration: The trial was registered in the clinicaltrials.gov registry (#NCT05255913)-16/02/2022., (© 2024. The Author(s).)

Background: Early childhood caries (ECC) remain a serious oral health problem on a global scale. Risk-based caries management (RBCM) implemented in some parts of the world has been effective in preventing ECC. However, there is a lack of prospective research on the application of RBCM among Chinese children, and little is known about its effectiveness. The purpose of this study was to evaluate the effectiveness of RBCM in preventing caries among children aged 3-5 years in Wanzhou District, Chongqing Municipality, China., Methods: Three- to five-year-old children from four kindergartens in Wanzhou were randomly selected for baseline dental examination and caries risk assessment (CRA) and randomly assigned to the experimental group (EG) or the control group (CG) according to the kindergarten. The EG received caries prevention measures of different intensities based on the child's caries risk level. The CG received full-mouth fluoride twice a year according to standard prevention, regardless of their caries risk. One year later, another dental examination and CRA were conducted, to observe changes in the decayed, missing, and filled teeth (dmft) index and caries risk, and to analyze potential factors that may affect the incidence of new caries., Results: Complete data were collected from 291 children (EG, N = 140, 84.8%; CG, N = 181, 83.4%). A total of 25.7% of the EG and 50.3% of the CG children developed new caries, with newly added dmft scores of 0.54 ± 1.12 and 1.32 ± 1.72, respectively (P < 0.05). Multivariate logistic regression indicated that children living in rural areas, assigned to the CG, and rated as high-risk at baseline were more likely to develop new caries (P < 0.05). The proportion of children with an increased caries risk in the EG was significantly lower than that in the CG (P < 0.05)., Conclusions: RBCM effectively prevented new caries in 3- to 5-year-old Wanzhou children and reduced the proportion of children at increased risk of caries. It is an effective approach for preventing ECC., Clinical Trial Registration: This trial was registered in the Chinese Clinical Trials Register. The registration number was ChiCTR230067551 (11/01/2023)., (© 2024. The Author(s).)

Introduction: The decline in dental caries has been attributed to the widespread use of fluoride (F). Two forms of presentation are fluoridated toothpaste (FT) and mouthwash (MW), widely used by the population., Materials and Methods: This study aimed to evaluate in vitro the effects of combining FT and MW, whether supplemented with sodium trimetaphosphate (TMP) or not, on dental enamel demineralization. Bovine enamel blocks (n = 60) were selected based on initial surface hardness (SHi) and divided into 5 experimental groups (n = 12 each): I) Placebo Toothpaste (without F/TMP); II) 1100 ppm F Toothpaste (FT); III) 1100F associated with a MW at 100 ppm F (FT + MW 100F); IV) 1100F associated with a MW at 225 ppm F (FT + MW 250F); and V) 1100F associated with a MW at 100 ppm F supplemented with 0.4 % TMP (FT + MW 100F-TMP). The blocks were treated twice a day, undergoing 5 pH cycles over 7 days. Thus, the percentage change in surface hardness (%SH), integrated subsurface hardness loss (ΔKHN), and the concentration of F, phosphorus (P), and calcium (Ca) in the enamel were determined. The data were submitted to ANOVA and Student-Newman-Keuls test (p < 0.001)., Results: The 1100F group was statistically inferior to the groups associated with MW for %SH, ΔKHN, and the concentration of P and Ca in the enamel (p < 0.001). Blocks treated with FT + MW 225F and FT + MW 100F-TMP showed significantly lower %SH compared to the other groups (p < 0.001). The FT + MW 100F - TMP group exhibited the lowest depth mineral loss (ΔKHN), and higher concentration de P in enamel (p < 0.001)., Conclusion: The adjunct use of MW with FT produces a greater protective effect in inhibiting enamel demineralization, and the supplementation of TMP to the MW with 100F provides a superior effect compared to MW with 225F., Clinical Significance: This combination of treatments could be regarded as one of several alternative fluoride supplements for subjects at elevated risk of caries., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: This study compared the protective effect of an experimental TiF 4 /Chitosan toothpaste with a commercial toothpaste on the prevention of erosive tooth wear (ETW) in situ., Methods: Fifteen subjects took part in this crossover and double-blind study, in which they wore a palatal appliance containing 4 bovine enamel and 4 dentin in 3 phases (5 days each). Half of the samples were subjected to erosive challenges (90 s in 0.1 % citric acid, pH 2.5, 4 times/day), and the other half to erosive plus abrasive challenges (15 s plus 45 s of contact, 2 times/day). The phases corresponded to the application of the different toothpastes: 1) TiF 4 (1400 ppm F - ) plus Chitosan, 2) Elmex®, Erosion Protection (1400 ppm F - , Chitosan), and 3) Placebo (negative control). Tooth wear was measured using contact profilometry (μm) and submitted to two-way RM ANOVA/Tukey test (p < 0.05)., Results: No significant differences were detected between the experimental and commercial toothpastes, regardless of the challenge on both tissues. Both significantly reduce ETW compared to negative control (p < 0.0006). Tooth wear was increased by brushing only on eroded enamel (p < 0.01), but not on dentin (p = 0.6085). TiF 4 /Chitosan [erosion 2.98 ± 1.12 μm vs. erosion and abrasion 3.12 ± 1.33 μm] and Elmex® toothpastes [erosion 2.35 ± 0.93 μm vs. erosion and abrasion 2.98 ± 1.0 μm] minimized the impact of brushing compared to placebo on enamel [erosion 4.62 ± 1.48 μm vs. erosion and abrasion 5.15 ± 1.50 μm]., Conclusions: TiF 4 plus chitosan toothpastes showed to be effective in minimizing the ETW as the commercial toothpaste is in situ., Clinical Relevance: The experimental toothpaste has similar effect against ETW compared to the commercial toothpaste. Considering the increased ETW prevalence worldwide, this result supports clinical trials and a possible application of this experimental anti-erosive toothpaste in the future., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: Assessed the effect of dental products containing nano-hydroxyapatite (nano-HA) + fluoride on the remineralization of white spot lesions (WSL) in vivo or in situ., Methods: Seven databases were explored using a two-pronged approach (intervention/treatment). After screening, full-text assessment, and further exclusion, the qualitative synthesis of five studies (four clinical and one in situ) was performed. Based on the Cochrane collaboration guidelines relevant data of the studies were collected and summarized. The Cochrane risk of bias tool for randomized trials (RoB 2.0) was used to appraise the studies' methodological quality and the GRADE guidelines to assess their level of evidence. The RoB 2.0 domains were rated on their risk of bias (RoB) as low, high, or with some concerns, and an adaptation of the tool was used to the in situ study., Results: The included studies assessed 151 WSL in anterior permanent teeth, on patients with varying ages. The protocol application, treatment length (7d-12 w), and control groups varied greatly between the studies making the performance of a quantitative analysis unfeasible. The general RoB of the clinical studies was classified as being of low risk (n = 2) or some concerns (n = 2). The in situ study was considered as being of low risk. The level of the evidence was moderate. Most of the studies found moderate evidence regarding the superiority of this association in clinical settings., Conclusion: Even with the nano-HA + fluoride promising results for the remineralization treatment of WSL, due to the restricted number of studies and types of products, its extended use cannot be recommended based on the current systematic review, especially when considering the moderate level of the evidence found., Clinical Significance: Due to the biocompatibility and higher surface coverage of nano-HA and the remineralization capacity of fluoride formulations, the association of these elements to remineralize WSL has been positively reported. After the collection and qualitative appraise of the data, the clinical evidence of the use of these dental products is promising but limited., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To assess the protective effect of fluoride (F) gels supplemented with micrometric or nano-sized sodium trimetaphosphate (TMPmicro and TMPnano, respectively) against enamel erosion in vitro., Methods: Bovine enamel blocks (n = 140) were selected according to their surface hardness, and randomly divided into seven groups (n = 20/group), according to the gels tested: Placebo (without F/TMP), 4,500 μg F/g (4500F), 9,000 μg F/g (9000F), 4500F plus 2.5 % TMPnano (2.5 % Nano), 4500F plus 5 % TMPnano (5 % Nano), 4500F plus 5 % TMPnano (Micro 5 %) and 12,300 μg F/g (Acid gel). Blocks were treated once during one minute with the gels, and submitted to erosive (ERO, n = 10/group) or erosive plus abrasive (ERO+ABR, n = 10/group) challenges 4 times/day, for 90 s for each challenge (under reciprocating agitation), during consecutive 5 days. Blocks were analyzed by profilometry, and by surface (SH) and cross-sectional hardness (∆KHN). Data were submitted to two-way ANOVA, and Fisher's LSD test (p < 0.05)., Results: For ERO, both TMPnano-containing gels promoted enamel wear significantly lower than Placebo and 4500F, reaching levels similar to both positive controls (9000F and acid gel); significantly lower softening was observed for enamel treated with 4500F+5 % Micro and 4500F+2.5 % Nano. Also, the lowest ∆KHN values were observed for 4500F+2.5 % TMPnano among the TMP-containing gels. For ERO+ABR, the lowest enamel wear was achieved by the use of 4500F+5 % Nano among all gels, including both positive controls; lower softening was observed for Placebo and 9000F groups., Conclusion: The addition of 5 % nano-sized TMP to a low-fluoride gel produced superior protective effects for enamel under both challenges conditions, when compared with micrometric TMP, reaching values similar to or superior than both positive controls, respectively for ERO and ERO+ABR., Clinical Significance: The supplementation of low-F gels with TMP was shown to significantly improve their effects on enamel erosive wear, and the use of nano-sized TMP further enhances this protective action., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Dentin hypersensitivity (DH) is one of the most challenging and persistent dental complaints characterized by transient, intense pain triggered by various stimuli. It affects a significant portion of the global population, predominantly those aged 20-40. This study aims to evaluate the desensitizing efficacy of seventh-generation dentin bonding agents (Single Bond Universal by 3 M ESPE and Xeno-V + by Dentsply) against a control group using Bifluorid 12 by Voco in mitigating DH within a month of the follow-up period., Methods: This was a single-center, parallel-group, double-blind, controlled randomized clinical trial conducted at Dow University of Health Sciences, Karachi, Pakistan. A total of 105 patients with DH were allocated into three groups for this study. The patients were divided into three groups (Single Bond Universal by 3 M ESPE and Xeno-V + by Dentsply) and the control group containing fluoride varnish (Bifluorid 12 by Voco). Discomfort Interval Scale scores and Schiff Cold Air Sensitivity Scale scores were recorded at baseline, immediately after the intervention, after 01 weeks, and after 01 month., Results: All the materials demonstrated a statistically significant reduction in discomfort and sensitivity (DIS scores p-value 0.01) immediately after 01 week and over a period of 01 month after treatment compared with the baseline scores before application, with no single material proving superior over the one-month observation period. The study also provided insights into dental hygiene practices, with a significant majority using a toothbrush and sensitivity patterns, with cold stimuli being the most common cause of sensitivity., Conclusion: The study demonstrates that Single Bond Universal, Xeno V+, and Bifluorid 12 are equally effective in reducing dentin hypersensitivity, with no distinct superiority observed over a one-month period. The findings highlight the potential of fluoride varnishes as a less technique-sensitive and cost-effective option for treating DH, offering valuable insights for future research and clinical practice., Trial Registration: NCT04225247 ( https://clinicaltrials.gov/study/NCT04225247 ), Date of Registration: 13/01/2020. (Retrospectively registered)., (© 2024. The Author(s).)

Objective: To assess the efficacy and safety of a toothpaste containing 7.5 % HX-BGC in combating dentinal hypersensitivity., Methods: A single-center, randomized, double-blind, three-group parallel-controlled design was employed, with Schiff Index and Yeaple Index as measurement indicators. The study evaluated the effectiveness of HX-BGC toothpaste, NovaMin toothpaste, and a negative control toothpaste without desensitizing agents. Eligible subjects underwent baseline examination after a 2-week washout period, and those meeting inclusion criteria and not meeting exclusion criteria entered the study. Participants were randomly assigned to use one of the three toothpastes. Follow-up examinations were conducted immediately after a single use and at 2, 4, and 6 weeks. Intra-group and inter-group comparisons were made for Schiff and Yeaple indices. Safety of the experimental toothpastes was assessed through participant feedbacks and oral soft tissue examinations., Results: Subjects in the three groups were balanced in terms of age and gender distribution, with no baseline differences in indicators. Immediately after a single application of toothpaste, Yeaple indices increased, and Schiff indices decreased, with no significant differences among the groups. After 2 weeks of continuous use, Yeaple indices increased in all groups, with significant differences observed between the HX-BGC group and the other two groups. Schiff indices decreased in all groups, with the NovaMin group showing significant differences compared to the negative control group. At weeks 4 and 6, both indices in the HX-BGC group and the NovaMin group were significantly better than those in the negative control group, with the HX-BGC group outperforming the NovaMin group in the Yeaple index. No serious adverse reactions related to the study products were observed or reported by any participants., Clinical Significance: This clinical trial confirmed the efficacy of HX-BGC in anti-dentinal hypersensitivity and supported the clinical application of the dentifrice containing HX-BGC., Conclusion: Compared to the negative control group, both HX-BGC and NovaMin toothpaste groups demonstrated more significant effects in combating dentinal hypersensitivity. No adverse reactions related to the experimental toothpastes were observed., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Objectives: he aim of this in vitro study was to evaluate the effects of some bottled waters on fluoride toothpaste efficacy in enhancing caries lesion remineralization., Methods: Early caries lesions were created in bovine enamel specimens and stratified into treatment groups based on Vickers surface microhardness (VHN). The present study followed a two (fluoride and fluoride-free toothpaste) by five (four bottled waters and tap water) factorial design. The treatment groups were bottled water with the following attributes: (a) 309.9 ppm Ca/1.20 ppm F; (b) 118.4 ppm Ca/0.16 ppm F; (c) 1.00 ppm Ca/1.01 ppm F; and (d) 0.1 ppm Ca/0.04 ppm F and tap water (48.7 ppm Ca/0.7 ppm F). The five water groups were paired either with 1100 ppm fluoride or fluoride-free toothpaste, yielding 10 groups. Specimens were pH-cycled for 10 days with the daily regimen comprised of twice daily toothpaste slurry, with four exposures to water in between. VHN was measured again and the difference was calculated (ΔVHN). Data were analyzed using two-way ANOVA at a 5% significance level., Results: The two-way interaction between water and toothpaste was significant (p<0.001). All groups except fluoride-free toothpaste/bottled water with 0.1 ppm Ca/0.04 ppm F (p=0.411) had significant increases in VHN after pH cycling (p≤0.023). Fluoridated toothpaste resulted in a higher rate of remineralization compared to fluoride-free toothpaste (all p<0.001). Bottled water with 1.20 ppm F/309.9 ppm Ca exhibited the greatest extent of remineralization within fluoride toothpaste groups (p<0.001) and higher remineralization than lower fluoride water in fluoride-free toothpaste groups (p≤0.006). Within the fluoridated toothpaste group, tap water exhibited significantly less remineralization than all bottled waters (all p<0.001)., Conclusion: Within the limitation of this study, bottled water with higher fluoride and calcium concentrations might improve fluoridated toothpaste efficacy by enhancing remineralization of early enamel caries-like lesions., (©Operative Dentistry, 2024.)

Background: Root caries is preventable and can be arrested at any stage of disease development. The aim of this study was to investigate the potential mineral exchange and fluorapatite formation within artificial root carious lesions (ARCLs) using different toothpastes containing 5,000 ppm F, 1,450 ppm F or bioactive glass (BG) with 540 ppm F., Materials and Methods: The crowns of each extracted sound tooth were removed. The remaining roots were divided into four parts (n = 12). Each sample was randomly allocated into one of four groups: Group 1 (Deionised water); Group 2 (BG with 540 ppm F); Group 3 (1,450 ppm F) and Group 4 (5,000 ppm F). ARCLs were developed using demineralisation solution (pH 4.8). The samples were then pH-cycled in 13 days using demineralisation solution (6 h) and remineralisation solution (pH 7) (16 h). Standard tooth brushing was carried out twice a day with the assigned toothpaste. X-ray Microtomography (XMT) was performed for each sample at baseline, following ARCL formation and after 13-day pH-cycling. Scanning Electron Microscope (SEM) and 19 F Magic angle spinning nuclear magnetic resonance ( 19 F-MAS-NMR) were also performed., Results: XMT results showed that the highest mineral content increase (mean ± SD) was Group 4 (0.09 ± 0.05), whilst the mineral content decreased in Group 1 (-0.08 ± 0.06) after 13-day pH-cycling, however there was evidence of mineral loss within the subsurface for Groups 1, 3 and 4 (p < 0.05). SEM scans showed that mineral contents within the surface of dentine tubules were high in comparison to the subsurface in all toothpaste groups. There was evidence of dentine tubules being either partially or completely occluded in toothpaste groups. 19 F-MAS-NMR showed peaks between - 103 and - 104ppm corresponding to fluorapatite formation in Groups 3 and 4., Conclusion: Within the limitation of this laboratory-based study, all toothpastes were potentially effective to increase the mineral density of artificial root caries on the surface, however there was evidence of mineral loss within the subsurface for Groups 1, 3 and 4., (© 2024. Crown.)

Background: Oral care regimens can be explored to improve oral health in patients with gingivitis. This study aimed to evaluate the efficacy of a multicomponent oral care regimen with a dual zinc plus arginine (DZA) toothpaste and cetylpyridinium chloride with zinc lactate (CPC + Zn) mouthwash in reducing gingival bleeding in patients with gingivitis., Methods: This randomized clinical trial included 94 participants with gingivitis who were randomized into two groups: the DZA/CPC + Zn group, which used a 1450-ppm fluoride toothpaste containing 0.96% zinc plus 1.5% arginine and a fluoride-containing mouthwash with 0.075% CPC and 0.28% zinc lactate, and the control group, which used a 1450-ppm fluoride toothpaste and a placebo mouthwash for 6 months. All participants were examined by a blinded examiner who measured the gingival index, plaque index, and gingival severity index. Data were analyzed using paired t test, independent t test, and analysis of covariance (ANCOVA)., Results: Both groups presented statistically significant reductions in all clinical parameters compared to baseline. The DZA/CPC + Zn group exhibited significantly greater reductions in gingival index, gingival severity index, proximal gingival index, plaque index and proximal plaque index compared to the control group at 1, 3, and 6 months. Furthermore, DZA/CPC + Zn significantly decreased the percentage of patients with generalized gingivitis over a 6-month follow-up period. However, differences between the DZA/CPC + Zn and the control groups were not maintained after both groups established similar regimens with fluoride toothpaste., Conclusion: The multicomponent oral care regimen consisting of DZA toothpaste and CPC + Zn mouthwash is effective in reducing gingival inflammation and supragingival biofilm in patients with gingivitis., (© 2023 American Academy of Periodontology.)

Objectives: This in vitro study aimed to evaluate the effect of resin infiltration combined with casein phosphopeptide-amorphous calcium phosphate with fluoride (CPP-ACPF) or bioactive glass (BAG) on the stability of enamel white spot lesions (WSLs) treatment., Materials and Methods: Eighty-four enamel blocks were prepared from the buccal surfaces of sound human premolars. All enamel blocks were placed in a demineralisation solution for 3 days to establish the artificial enamel WSLs. Enamel blocks with WSLs were randomly divided into three groups (n = 28 each group): RI/B: one-off resin infiltration followed by twice daily BAG treatment; RI/C: one-off resin infiltration followed by twice daily CPP-ACPF treatment; RI: one-off resin infiltration treatment only (as control) and subjected to pH cycling for 7 days. Surface morphology, elemental analysis, crystal characteristics, surface roughness and microhardness of enamel surfaces were investigated by scanning electron microscopy and energy-dispersive spectrometry observation, X-ray diffraction (XRD), atomic force microscope and Vickers' hardness testing, respectively., Results: Mean values of the surface roughness (mean±standard deviation (nm)) were 24.52±5.07, 27.39±5.87 and 34.36±4.55 for groups RI/B, RI/C and RI respectively (p = 0.003). The calcium to phosphate ratios were 1.32±0.16, 1.22±0.26 and 0.69±0.24 for groups RI/B, RI/C and RI respectively (p < 0.001). XRD revealed apatite formation in all three groups. The mean enamel surface microhardness (kg/mm 2 ) of the groups were 353.93±28.49, 339.00±27.32 and 330.38±22.55 for groups RI/B, RI/C and RI respectively (p = 0.216)., Conclusions: Resin infiltration combined with CPP-ACPF or BAG remineralisation appears to improve the surface properties of WSLs., Clinical Significance: The combination of resin infiltration and CPP-ACPF/BAG remineralisation may be a potential treatment for the management of the WSLs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: The aim for this pilot study was to investigate the effect of a sodium fluoride varnish on step height measured by a profilometer from human enamel worn by healthy volunteers with a novel in situ/ex vivo erosion design., Method: Healthy volunteers aged 18-70 years wore a palatal splint containing 8 human enamel samples and underwent two 3-day treatment periods for 6 h a day with a varnish containing sodium fluoride at 22,600 ppm and the control with the same ingredients but without fluoride. Each splint contained 4 polished and 4 unpolished samples. The interventions were applied to the surface of the enamel samples in randomised order, removed after 6 h, then immersed ex-vivo in 1 %, pH 2.7 citric acid for 2 min, repeated 4 times a day, over 2 days. Measurements of enamel were assessed blindly by microhardness on day 2 and by non-contact laser profilometry on day 3 for the two treatments., Results: 24 volunteers, 2 males and 22 females aged 27-54 years, were screened and recruited. The delta microhardness, from polished samples removed at the end of day 2, for the control and fluoride treatment was 95.7 (22.9) kgf/mm 2 and 123.7 (28.9) kgf/mm 2 , respectively (p < .005). The mean (SD) step height for the control polished enamel surfaces was 3.67 (2.07) µm and for the fluoride varnish was 1.79 (1.01) µm (p < .0005). The control unpolished enamel surfaces had a mean 2.09 (1.53) µm and the fluoride varnish was 2.11 (1.53) µm but no statistical difference was detected., Conclusions: The results from this pilot study, utilizing an in-situ model where enamel was exposed to acid over the course of 2 days, demonstrated that a high fluoride varnish containing sodium fluoride at 22,600 ppm prevented erosive wear compared to a control on the polished enamel surfaces., Clinical Significance: Intra-oral study demonstrated that a high fluoride varnish containing sodium fluoride at 22,600 ppm reduced erosive tooth wear., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Silver metal and compounds have antibacterial properties, although their action's mechanisms are not fully understood. Scientists generally consider that silver disrupts the bacterial cell wall. It causes a structural change in the bacterial cell membrane and cytoplasm. It also stops deoxyribonucleic acid replication, resulting in inactivating enzymatic activity and cell death. The antimicrobial effect of silver-containing compounds relies on the release of bioactive silver ions. Hence, silver metal and compounds have been used in medicine to prevent infection for hundreds of years. Silver metal and compounds are also used as antibacterial agents in dentistry. Studies have shown that silver compounds are effective in the management of dental caries. Fluoride-containing silver compounds have been found in experiments to be beneficial at remineralising dental cavities. Silver diamine fluoride (SDF) can assist in preventing and arresting tooth cavities. The World Health Organization included SDF in its Model List of Essential Medicine for both adults and children in 2021. Clinicians also use SDF to manage dentine hypersensitivity as well as to inhibit growth of periodontal pathogens. However, traditional silver compounds cause tooth discolouration because of the silver-staining effect. These side effects of their applications depend on the amount applied and the frequency of application. Researchers are developing nanosilver fluoride and silver nanoparticles to overcome the staining. This review gives an overview of the antibacterial mechanism of silver compounds, namely silver nitrate, silver fluoride, SDF, silver nanoparticles, and nano silver fluoride for caries management. The outlook for the future development of silver compounds will be discussed., Competing Interests: Conflict of interest None disclosed., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: This study examined how Mexican and Central American immigrants' social support was associated with three selected dental outcomes among recent immigrants, prior to the 2020 COVID-19 pandemic., Methods: Using baseline wave data from the 2017-2022 VidaSana study about the health and social networks of Mexican and Central American immigrants living in Indiana, this study utilized logistic and ordinal logistic regression to predict lifetime fluoride use, lifetime dental restoration and flossing frequency, across levels of social support and differences between Mexican and Central American immigrants., Results: Data from 547 respondents were included in the present analysis (68% women; mean age 34.4 years [SD 11.2]; Central American 42%; Mexican 58%). Results show a high level of social support was associated with increased probability of fluoride use, dental restoration and higher flossing frequency for Mexican immigrants. However, social support for Central American immigrants was associated with a decreased likelihood of fluoride use, more infrequent flossing, and had no significant association with dental restorations experience. What would be a negative association between Central American immigrants and dental restoration was accounted for by education level and never having been to a dentist., Conclusions: While higher social support was linked to beneficial outcomes for oral health in Mexican immigrants, the opposite was found in Central Americans. These findings highlighted the complexities of social relationships among new immigrants, and potential heterogeneity within the Hispanic population, particularly regarding social and behavioural measures as they pertain to oral health. Further research is needed to identify the underlying mechanisms producing both differences in social support and oral health outcomes., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Fluoridation of public water systems is known as a safe and effective strategy for preventing dental caries based on evidence from non-randomized studies. Yet 110 million Americans do not have access to a fluoridated public water system and many others do not drink tap water. This article describes the study protocol for the first randomized controlled trial (RCT) of fluoridated water that assesses its potential dental caries preventive efficacy when delivered in bottles., Methods: waterBEST is a phase 2b proof-of-concept, randomized, quadruple-masked, placebo-controlled, parallel-group trial designed to estimate the potential efficacy of fluoridated versus non-fluoridated bottled water to prevent dental caries incidence in the first 4 years of life. Two hundred children living in eastern North Carolina, USA, and aged 2-6 months at screening are being allocated at random in a 1:1 ratio to receive fluoridated (0.7 mg/L F) or non-fluoridated bottled water sourced from two local public water systems. Throughout the 3.5-year intervention, study water is delivered monthly in 5-gallon bottles to each child's home with instructions to use it whenever the child consumes water as a beverage or in food preparation. Parents are interviewed quarterly to monitor children's water consumption and health. At annual visits, the presence of dental caries is evaluated with a dental screening examination. Clippings from fingernails and toenails are collected to quantify fluoride content as a biomarker of total fluoride intake. The primary endpoint is the number of primary tooth surfaces decayed, missing, or filled due to dental caries measured by the study dentist near the time of the child's fourth birthday. Tooth decay is assessed at the threshold of macroscopic enamel loss. For the primary aim, a least-squares, generalized linear model will estimate efficacy and its one-tailed, upper 80% confidence limit., Discussion: waterBEST is the first evaluation of a randomized intervention of fluoridated drinking water in bottles to prevent dental caries in the primary dentition. This innovative method of delivering fluoridated water has the potential to prevent early childhood caries in a large segment of the US population that currently does not benefit from fluoridated public water., Trial Registration: ClinicalTrials.gov NCT04893681. Registered on March 2022. Last update posted on 10 October 2023. https://clinicaltrials.gov/study/NCT04893681?cond=Dental%20Caries%20in%20Children&term=fluoride&locStr=North%20Carolina,%20USA&country=United%20States&state=North%20Carolina&distance=50&rank=1., (© 2024. The Author(s).)

Design: Prospective, randomized, double-blind, multicenter clinical trial., Case Selection: Participants between 12 and 25 years old, who were generally healthy, with 2 or more white spot lesions on the labial surface of anterior dentition., Data Analysis: 79 patients who developed white spot lesions (WSL) on the labial surface of anterior teeth following orthodontic treatment were randomly assigned to 4 intervention groups. Group 1 received 5% sodium fluoride varnish every 6 months, the second group received CPP-ACP every 6 months, the third group was treated with resin infiltration at the initial visit followed by placebo every 6 months, and the final group which was the control group was coated with 1400 ppm fluoride toothpaste every 6 months. All the candidates were instructed to brush twice daily using a specific toothbrush and 1400 ppm fluoride toothpaste. The study lasted for 12 months, and photographs of the teeth with WSL were taken before and after completion of the intervention. Photographs were analyzed using ImageJ software to compare the changes in the percentage of WSL area to total tooth surface area among the four study groups. The distribution differences among groups were compared using nonparametric tests and differences between baseline and 1-year follow-up parameters were analyzed using paired chi-square tests., Results: Reduction in the area of WSL were noted in all groups, with different levels of significance. The percentage reduction was 46.62% in the resin infiltration group and it was significantly higher than the remaining interventions. Fluoride varnish group had 26.57% reduction, the CPP-ACP group had 28.64% reduction and the control group had 29.75% reduction in the WSL area. Plaque index was noted to have significant correlation with the change in WSL area with higher plaque index scores demonstrating lesser reduction in WSL., Conclusions: The study found that resin infiltration significantly reduced the WSL area after 1-year follow-up. Fluoride toothpaste with or without CPP-ACP and fluoride varnish produced some therapeutic effects., (© 2024. The Author(s), under exclusive licence to British Dental Association.)

Objectives: Untreated caries in primary teeth is one of the most prevalent health problems in children worldwide. Silver diamine fluoride (SDF) non-invasively arrests caries but causes staining unlike Nano Silver Fluoride (NSF) which causes no stains. This study compared the effect of NSF and 38 % SDF on the oral health related quality of life (OHRQoL) of preschool children after 6 months., Methods: Children were included if they were younger than 4 years, with at least one active lesion, ICDAS score ≥3, attending nurseries in a rural area in Alexandria, Egypt. They were randomly assigned to receive NSF once at baseline, or SDF at baseline and after 6 months. The Arabic version of the Early Childhood Oral Health Impact Scale (A-ECOHIS) was used to assess the OHRQoL. The groups were compared using chi-square test and the effect of the intervention on OHRQoL was assessed using multiple linear regression., Results: 360 children were included, mean (SD) age = 42.3 (8.2) months. After 6 months, NSF had significantly lower A-ECOHIS scores than SDF in bivariate analysis (p< 0.05) and in regression analysis (B= -5.02, p = 0.001) after adjusting for confounders. There were significant reductions in the A-ECOHIS total and domains' scores in both study groups, except for the social interaction domain in the SDF group., Conclusion: After 6-month, both agents significantly improved children's OHRQoL although NSF had a significantly better impact on OHRQoL than SDF., Clinical Significance: Patient-reported outcomes support the inclusion of the two agents among the options for ECC management with better effect on quality of life after NSF., Trial Registration: The trial was registered in the clinicaltrials.gov registry (#NCT05255913)., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Aim: To assess the relationship between maternal anxiety and so- cioeconomic status, focusing on mothers' knowledge of fluoride and their views on fluoride-containing oral products., Methods: In a cross-sectional study design involving 224 mother- child pairs, mothers' socioeconomic status, level of knowledge on fluoride, and perspectives on fluoride toothpaste and topical fluoride gel/varnish were assessed through self-administered questionnaires. Maternal anxiety levels were measured using the Spielberg State-Trait Anxiety Inventory., Conclusion: Mothers with higher socioeconomic status had a greater level of knowledge regarding fluoride. However, higher socio- economic status was associated with having negative opinions about fluoride gel/varnish. No relationship was found between mothers' anxiety levels and their perspectives toward fluoride toothpaste and topical fluoride gel/varnish. The general public should be informed about optimum fluoride dosage, possible side effects, and caries- preventive effects. More studies are required to evaluate the causes of negative thoughts about topical fluoride oral products.

Design: An investigator and participant masked, parallel-group randomised control trial examining the tooth surfaces of 288 children aged 5-9 years (n = 141 in the intervention group, n = 147 in the control group). Children in the intervention group were provided a daily lozenge containing 2% arginine (prebiotic), Lacticaseibacillus rhamnosus and Lactobacillus paracasei subsp. paracasei (probiotics). Children in the control group were provided with a placebo lozenge. Parents of participants were also provided with 1450 ppm fluoride toothpaste and advised to brush their children's teeth twice daily. Clinical and radiographic examinations were undertaken at baseline and 10-12 months assessing caries activity, progression and regression at a tooth surface level. A modified ICDAS and radiographic scoring system were used to record presence and extent of carious lesions., Case Selection: Of 343 children who met the inclusion criteria, 21,888 tooth surfaces were examined in 288 low caries risk children aged between 5-9 years. Fifty-four participants withdrew consent (n = 31 for intervention group, n = 24 for control group) and 1 child was excluded as they were pre-cooperative for their dental examination. Participants were recruited from four municipalities in Denmark. To be eligible to participate, children had to be medically healthy, cooperative for clinical and radiographic examination, and able to ingest a daily lozenge., Data Analysis: The primary outcome for this study was relative risk reduction (RRR) of caries activity, progression and regression. Although not present in this study, the main study broadly showed equality between the two groups in terms of their social demographic, dietary, oral health-related factors. The authors used modified Poisson regression to determine any surface level differences between the intervention and placebo groups. The threshold for statistical significance was set as follows: p < 0.05 was considered statistically significant. The authors describe that a power calculation was undertaken for the main study. However, none of the outcomes in this study were powered for., Results: 19,950 tooth surfaces were included in the final analysis. There was no significant difference in change in caries activity between the two groups. There was a trend towards reduction in relative risk in the intervention group, with fewer active lesions (RRR: 15.3%; -6.0%, -32.4%), more caries regression (RRR: 0.3%; -0.4%, -1.0%) and reduced caries progression (RRR: 13.6%; -8.0%, -30.9%) observed than in the control group., Conclusions: The use of a probiotic and prebiotic daily lozenges as an adjunct to 1450 ppm fluoride toothpaste and oral hygiene instruction did not result in a significantly reduced relative risk of change in caries status compared to placebo. Further research over an increased intervention time with a higher caries risk population may identify potential advantages of adjunctive pre- and probiotics fluoride toothpaste in the prevention, arrest and regression of dental caries., (© 2024. The Author(s).)

Aims: The aim of this study was to examine the effectiveness of topical fluorides in prevention of root caries-related treatment in high caries risk Veterans., Methods: This retrospective analysis of longitudinal data examined the effectiveness of professionally applied or prescription (Rx) fluoride treatment, in VHA clinics from FY 2009-2018. Professional fluoride treatments included 5% Sodium Fluoride (NaF) varnish (22 600 ppm fluoride), 2% NaF gel/rinse (9050 ppm fluoride), and 1.23% APF gel (12 300 ppm fluoride). The Rx for daily home use was 1.1% NaF paste/gel (5000 ppm fluoride). Outcomes studied were new root caries restorations or extractions and percent of patients with treatment over 1 year. Logistic regressions were adjusted for age, gender, race, ethnicity, chronic medical or psychiatric conditions, number of medication classes, anticholinergic drugs, smoking, baseline root caries treatment, preventive care, and time between first-last restoration in the index year., Results: Root caries at baseline was associated with a high risk for new root caries. Veterans without root caries during the index year who received a fluoride gel/rinse intervention were 32-40% less likely to receive caries-related treatment for root caries during the follow-up period. Once Veterans had root caries, fluorides did not exhibit a positive effect., Conclusion: In older adults with high caries risk, early fluoride prevention is key, before root caries requires treatment., (© 2023 Special Care Dentistry Association and Wiley Periodicals LLC.)

Objectives: White spot lesions are more susceptible to staining agents due to their porous structure. This study examines the impact of white spot lesion treatments on discoloration caused by pediatric supplements., Method and Materials: Three treatments (fluoride, casein phosphopeptide-amorphous calcium phosphate [CPP-ACP], resin infiltration), a control, and their respective syrup-based subgroups (iron and black elderberry syrups) were established, each with eight teeth. Artificial white spot lesions were induced, and weekly applications of fluoride varnish, daily applications of CPP-ACP paste, or a single resin infiltration procedure were performed on the white spot lesions within the treatment groups over 4 weeks. Simultaneously, samples were exposed daily to iron or black elderberry syrups. Spectrophotometer measurements were taken at baseline, after demineralization (T0), and after 1 (T1), 2 (T2), and 4 weeks (T4). ΔE00 values were calculated. Statistical analysis was conducted using a three-way mixed-design ANOVA, with the significance level set at P = .05., Results: At T4, ΔE00 values from all groups exceeded the clinical acceptability limit of 1.8. At T2 and T4, the ΔE00 values obtained from the black elderberry syrup subgroups were significantly higher (P < .001). At T4, the highest ΔE00 values were seen in the CPP-ACP groups (P < .001). The lowest ΔE00 values at T2 and T4 were observed in the resin infiltration groups (P < .05)., Conclusions: Supplements containing ferrous sulfate and black elderberry extract caused color changes in white spot lesions that exceeded the clinical acceptability limit. Resin infiltration of white spot lesions provides advantages over remineralization treatments, particularly in minimizing discoloration induced by pediatric supplements.

Background: Gingivitis is driven by plaque accumulation and, if left untreated, can progress to irreversible periodontitis. For many, the mechanical action of toothbrushing does not achieve adequate plaque control. The aim of this study was to investigate whether twice-daily use of a toothpaste containing 0.2% high molecular weight (HMW) sodium hyaluronate with 67% sodium bicarbonate and 0.221% sodium fluoride (experimental toothpaste) could improve gingival health compared with a regular fluoride toothpaste (negative control). The study also assessed whether the experimental toothpaste could provide additive gingival health benefit over a toothpaste containing only 67% sodium bicarbonate and 0.221% sodium fluoride (positive control)., Methods: This was a single-center, examiner-blinded, randomized, clinical study in healthy adults with mild-to-moderate gingivitis. At baseline, after abstaining from toothbrushing for 12 h, prospective participants underwent oral soft tissue (OST) and oral hard tissue examination followed by assessments for gingival inflammation (Modified Gingival Index [MGI]), gingival bleeding (Bleeding Index [BI]), and supra-gingival plaque (Turesky Plaque Index [TPI]). Eligible participants were stratified by gender and baseline number of bleeding sites (low: <45; high: ≥45 bleeding sites). Following randomization, participants underwent prophylactic dental treatment. Participants received a full OST examination, MGI, BI and TPI assessments after 3 days, 1, 2 and 6 weeks of product use., Results: In total, 110 participants were screened for study entry and all were randomized to receive one of three toothpastes (experimental: sodium hyaluronate, sodium bicarbonate, sodium fluoride; positive control: sodium bicarbonate, sodium fluoride; negative control: regular fluoride toothpaste). For all measures, significant improvements were observed in participants receiving either sodium bicarbonate-containing toothpaste (experimental or positive control) compared with the regular fluoride toothpaste (negative control) at week 6. No significant difference was observed in any assessment or visit comparing the experimental toothpaste with the positive control., Conclusions: Both the experimental and the positive control toothpastes demonstrated clinically relevant improvements in gingival health compared with a regular fluoride toothpaste (negative control). However, no additional gingival health improvement was observed for the experimental toothpaste compared with the positive control, therefore, no additional gingival health benefit can be attributed to the inclusion of sodium hyaluronate in this formulation., Trial Registration: ClinicalTrials.gov Identifier: NCT04737538 (04/02/2021)., (© 2024. The Author(s).)

Purpose: To examine the relationship between remineralization of incipient root dentin lesions and the presence of polymicrobial biofilms, as well as examine changes in microbial composition., Methods: Bovine root dentin disks used as specimens for biofilm formation, were cultured using saliva from a single donor. Amsterdam Active Attachment biofilm model was used to grow biofilms. The culture medium was McBain 2005 with 0.2% sucrose and 0.4 ppm F as sodium fluoride. After cultivation for 48 hours to achieve demineralization, a control group (n=10) was obtained and the other specimens were further cultured for 336 hours in two types of remineralization culture medium, with sucrose (S+) and without sucrose (S-), through continuous anaerobic incubation (10% CO2,10% H2, 80% N2). Then half of the specimens cultured in the S- medium were transferred to the S+ medium for an additional 48 hours resulting in three experimental groups S(+) (n=10), S(-) (n=10), and S(-)de (n=10), respectively. Experiment 1: Transverse microradiography (TMR) analysis - Immediately after respective culture treatments, integrated mineral loss (IML) and lesion depth (LD) in the dentin specimens were analyzed by TMR. Experiment 2: Microbiome analysis - Sequence data of the 16S rRNA gene of each sample was obtained using MiSeq, and partial base sequences were determined. Next-generation sequencing was performed to determine the taxonomic groups of fungi present in the biofilm samples., Results: Experiment 1: In the control group, formation of dentin demineralization lesions by polymicrobial species biofilms was confirmed. The S(-) group showed significantly decreased IML and shallower LD compared to the control group. The S(-)de group showed a significant increase in IML and LD compared to the S(-) group. Experiment 2: There were statistically significant differences in microbiome between the control group and each of the three experimental groups, both at the genus and species levels. A significant difference in genus was observed between the S(-) group and the S(-)de group., Clinical Significance: The confirmation of the possibility of microbial shift occurring during the remineralization process of root caries will lead to the development of new remineralization therapies., Competing Interests: The authors declared no conflict of interest. This work was supported by MEXT/JSPS KAKENHI Grant Number 20K09965 Grant-in-Aid for Scientific Research (C), 2020-2023., (Copyright©American Journal of Dentistry.)

Purpose The purpose of this study was to determine dental hygiene students' perspectives regarding their knowledge and understanding about caries prevention strategies and their intention to use these regimens in clinical practice. Dental hygienists' knowledge and understanding of caries prevention is critical because they are the primary providers of these regimens and the relevant education. Methods This 2019 national cross-sectional online survey was designed by the University of Maryland (UMD), structured by the ADA staff for online administration, distributed and collected by the American Dental Hygienists' Association (ADHA) to 9533 email addresses, and de-identified response data were analyzed by UMD. The survey included questions on three caries preventive regimens: fluoride varnish, dental sealants, and silver diamine fluoride (SDF), and items on community water fluoridation (CWF), respondent's demographics and intent to use the regimens. Statistical analyses included descriptive statistics and analysis of variance. Significance was set at p <0.05. Results Of the 235 surveys returned (response rate 2.5%) the majority were female, White and born in the United States. Over half were in associate degree programs; nearly a third were in baccalaureate programs. Respondents reported greater knowledge/understanding and intention to use fluoride varnish and dental sealants than SDF. Less than half (44.7%) reported knowledge/understanding of SDF and only 22.6% had a high level of confidence regarding applying it. Additionally, only 31.1% indicated they were extremely likely to use SDF upon graduation. Conclusions To reduce the prevalence of caries, dental hygiene graduates must be well-versed with the latest science-based preventive procedures, including non-invasive caries prevention and control therapies. The results of this survey, albeit non representative of the general population of dental hygiene students, suggest a need for a more extensive review of the caries preventive regimen content, especially for silver diamine fluoride, of dental hygiene curricular programs., (Copyright © 2024 The American Dental Hygienists’ Association.)

Objective: This study assessed whether combining photobiomodulation therapy (PBMT) with casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) paste can effectively reduce post-home whitening tooth sensitivity (TS) without compromising shade change., Methods: Fifty participants were selected and assigned to one of four groups: (1) PLACEBO group-received a placebo paste and PBMT simulation; (2) PBMT group-received a placebo paste + PBMT; (3) CPP-ACPF group-received CPP-ACPF paste and PBMT simulation; (4) CPP-ACPF + PBMT group-received both CPP-ACPF paste and PBMT. The participants used whitening trays containing 22% carbamide peroxide for 2 h a day for 21 days. TS was measured daily using a visual analog scale, while shade change was assessed using a spectrophotometer: before bleaching treatment (T0), after the first (T1), second (T2), and third (T3) weeks of treatment, and 30 days (T4) after completing the whitening treatment., Results: Intragroup analysis revealed that the PLACEBO group had the highest increase in sensitivity during the whitening treatment. The CPP-ACPF and PBMT groups showed no significant difference tooth whitening (TW) between weeks regarding aesthetic change. The CPP-ACPF and PBMT group exhibited a significant reduction in TS between the first and third and between the second and third weeks TW, but not between the first and second. Conversely, the PLACEBO group showed a higher sensitivity than the other groups (p < .05). The CPP-ACPF and PBMT groups did not differ from each other. Furthermore, the CPP-ACPF and PBMT group showed a greater decrease in sensitivity than the PLACEBO group at T1, T2, and T3 (p < .01), and was significantly differed from CPP-ACPF and PBMT groups only at T2 and T3. All groups confirmed TW effectiveness. Student's and paired t-test did not reveal any significant difference between groups (p > .05)., Conclusion: Therefore, PBMT associated with CPP-ACPF paste can reduce TS without compromising the efficacy of TW., (© 2024 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Background: Dentin hypersensitivity is one of the most common complains faced by dental professionals, and there is still lack of consensus for the most effective treatment approaches. The aim of the present study was to evaluate the efficacy of ozone therapy combined with sodium fluoride in reducing pain associated with dental hypersensitivity, compared to a paint-on adhesive desensitizing agent., Methods: The study included 20 patients (131 teeth), selected according to specific inclusion criteria and divided into two groups according to the type of desensitizing therapy (ozone with sodium fluoride or paint-on adhesive). The efficacy of both treatments were evaluated recording pain for each treated tooth immediately after treatment, after 1 month and after 6 months using a Numeric Rating Scale (NRS). Subjective parameters were also recorded: patients were asked to report whether they experienced pain caused by air, teeth brushing, cold and hot topical stimuli (present/absent)., Results: In both groups, pain values significantly decreased over time. Six months after treatment we registered significantly lower pain values in the ozone-treated group compared with the adhesive group and the mean percentage of NRS reduction from was significantly higher in the ozone-treated group. We did not register significant differences in subjective pain-related parameters between groups., Conclusions: The results of this exploratory study were aimed at exploring the combined effect of ozone with natrium fluoride, which was before described only in vitro. With the limitation of the sample size, our results suggest that this approach provides a pain reduction that was comparable to the paint-on adhesive.

Introduction: Many pre-school children in Ireland experience dental caries in their primary dentition. The rate of dental caries varies, impacted by the levels of fluoride in the water and socio-economic status (18%-55%). This article reports on a novel initiative in which dental hygienists (DHs) supported pre-school teachers (PST) to implement a toothbrushing programme for children attending pre-schools in Ireland. It was hypothesised that such an initiative would create an environment in pre-schools that would improve the oral hygiene skills and habits of children and increase the oral health knowledge of parents and PST., Methods: A storybook (Brushing our teeth with Brush Bunny), a toothbrushing song and information leaflets were developed. DHs were provided with specific online training for the programme. The resources, including toothbrushes and toothpastes, were delivered to the pre-schools and training was provided by the DHs to the PST to prepare for and implement daily toothbrushing sessions. The standards for the toothbrushing programme followed the ChildSmile© programme. Before and after questionnaires gathered quantitative and qualitative data from the parents and PST. The toothbrushing programme was implemented by PST for 3 months., Results: Sixteen DHs and PST from 19 classes in 17 schools successfully delivered the programme to 331 children, and 227 parents completed both pre- and post-questionnaires. Poor baseline knowledge in relation to the 'spit don't rinse' message increased from 29% to 48%. However, there was no improvement in awareness of the benefits of fluoride in toothpaste. Awareness of the best brushing routines in relation to frequency and length was good at baseline and remained so after the programme. Most parents (90%) felt the programme had impacted positively on their child's toothbrushing routine., Conclusion: This experimental study suggests that the logistics of implementing a daily toothbrushing routine to improve the oral hygiene skills and habits of pre-school children are possible in Irish pre-school settings when PST are supported by DHs. Parents' oral health knowledge may be improved, and it may impact positively on the children's daily toothbrushing routine. A larger study is required to confirm these findings., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: The significance of the underlying literature in clinical guidelines can be weakened by the risk of bias, which could negatively affect the recommendations. Especially in controversial matters, such as fluoride use for caries prevention in children, biased results may be not reliable and lead to incorrect conclusions. This study was performed to detect bias in underlying literature of the German guideline for caries prevention using fluoride in children, where no consensus was reached between paediatricians and paediatric dentists., Methods: Three tools used for risk of bias assessments of different study designs were RoB 2 for RCTs, ROBINS-I for non-randomized studies, and ROBIS for systematic reviews. For each study cited in the guideline two independent risk of bias assessments were performed. Disagreements were resolved by consensus., Results: Out of 58 papers, 48.3% (n = 28) showed high risk of bias, with the majority in sections regarding fluoride tablets, fluoridated toothpaste, and paediatricians' recommendations. 9 out of 20 recommendations and statements were based on studies with high risk of bias, all of which were in these three controversial sections. 13 out of 29 RCTs showed high risk of bias (44.8%), as all 13 non-randomized trials did, while only 2 of 16 (12.5%) systematic reviews had high risk of bias., Conclusion: Considering risk of bias of cited studies in clinical guidelines may result in substantial changes in its recommendations and aid in reaching consensus. Efforts should be made to assess risk of bias of underlying literature in future clinical guidelines., (© 2023. The Author(s).)