Effect of high-fluoride mouth rinse and toothpaste on the development of demineralized lesions

A recent study suggested that high-fluoride mouth rinse and toothpaste are effective in preventing the development of demineralized lesions (DLs) during orthodontic treatment. This study was published in the European Journal of Orthodontics.

This three-armed, parallel-group, randomized controlled study included 248 participants. Randomization was performed in blocks of 30, dividing the participants into the fluoride mouth rinse (FMR) group, high-fluoride toothpaste (HFT) group, and the Control (CTR) group. Participants in the FMR group received 0.2% sodium fluoride (NaF) mouth rinse plus 1450 ppm fluoride (F) toothpaste, those in the HFT group received 5000 ppm F toothpaste. While the participants in the CTR group received 1450 ppm F toothpaste. The primary outcome of the study was the proportion of participants with at least one new demineralized lesion as assessed on digital photos taken before and after the treatment.

It was found that the number of patients with an increase of ≥1 in demineralized lesions (includes only central- and lateral incisors and canines) was significantly lower in the HFT group, compared to the CTR group and similarly, in the FMR group compared to the CTR group. Based on the above results, it can be concluded that high-fluoride mouth rinse and high-fluoride toothpaste may be recommended to prevent demineralized lesions in the aesthetic zone i.e., all central incisors, lateral incisors, and canines.

Sodium Fluoride varnish in combination with parental Motivational Interviewing as an alternative to Silver Diamine Fluoride

A recent study suggests that 5% Sodium Fluoride (NaF) varnish when combined with parental Motivational Interviewing (MI) can be used as an alternative to 38% Silver Diamine Fluoride (SDF) solution in managing early childhood caries (ECC). This study was published in the journal, BMC Oral Health.

This study included 165 children, aged ≤ 4 years old with 949 active lesions. They were randomly assigned to treatment by a single application of either SDF solution or a single application of NaF varnish, supported by 2 MI sessions for mothers at baseline and after 3 months. To assess the effect of the interventions on ECC arrest, multilevel logistic regression analysis was used. The interaction between baseline lesion severity, whether moderate (ICDAS 3/4) or advanced (ICDAS 5/6) and type of intervention, were also analyzed.

The results showed that after 6 months, the advanced lesions had an arrest rate that was significantly higher in the SDF than the NaF/ MI group. Even moderate lesions treated with SDF showed significantly higher odds of arrest than advanced lesions that were treated with NaF/MI.

Based on the above findings, it can be concluded that NaF/MI is superior to SDF in arresting advanced and moderate ECC lesions without staining.

Lower percentage of disease progression from generalized periodontitis stage III /grade C seen after usage of adjunctive systemic amoxicillin/metronidazole

A recent study suggests that a clinically relevant lower percentage of disease progression of periodontitis stage III/grade C was observed after administration of adjunctive systemic amoxicillin/metronidazole. This study was published in the Journal of Clinical Periodontology.

The exploratory re-analysis of the ABPARO trial was a multi-centre and placebo-controlled study that included 405 males. They were randomized to receive subgingival instrumentation (SI) three times a day of systemic amoxicillin 500 mg/metronidazole 400 mg (n=205; ANTI) for 7 days or placebo (n=200; PLAC) along with maintenance therapy every 3 months. Treatment effect included a percentage of sites/patients with new attachment loss of ≥1.3 mm (PSAL ≥ 1.3 mm) at 27.5 months after baseline/randomization.

The patients were assigned into stages as localized stage III (n=49), generalized stage III (n=206), and stage IV (n=150) while only 222 patients were assigned to grades (n = 73 B, n = 149 C). Both the treatments showed PSAL ≥ 1.3 mm in localized stage III (5.7), generalized stage III (8.0), stage IV (8.5), grade B (4.4), and grade C (9.4).

From the above results, it may be evident that generalized periodontitis stage III/grade C showed a clinically relevant lower percentage of disease progression with adjunctive systemic amoxicillin/metronidazole when compared to the placebo (ANTI:4.7 vs. PLAC: 9.7).

Use of 38% silver diamine fluoride for treating hypersensitive teeth in older adults

A recent study found that applying 38% silver diamine fluoride (SDF) solution topically on the exposed root surface of hypersensitive teeth in older adults had a desensitizing effect. This study was published in the Journal of Dentistry.

This double-blind, randomized clinical trial included 139 healthy adults with dentine hypersensitivity. They were first tested for hypersensitivity using a blast of compressed cold air using a three-in-one syringe. At baseline visit, the participants gave a sensitivity score (SS) in a visual analogue scale ranging from 0 to 10 (no pain to agonizing pain). Thereafter, they were administered 38% SDF or 5% potassium nitrate solution (control) as an intervention on the hypersensitive root surface. Post the intervention, the compressed cold air test and SS score were taken again at 4 and 8 weeks. Reduction in SS at 8-week before intervention with reference to the SS baseline, was the primary outcome.

It was evident from the results that 38% SDF solution reduced hypersensitivity on the exposed root surface of older adults. Thus, it may be more effective than 5% potassium nitrate solution and may help reduce hypersensitivity on the exposed root surface of older adults.