Aim: To report the evidence on the effect of mechanical and/or chemical plaque control in the simultaneous management of gingivitis and caries. Material and Methods: A protocol was designed to identify randomized (RCTs) and controlled (CCTs) clinical trials, cohort studies and prospective case series (PCS), with at least 6 months of follow-up, reporting on plaque, gingivitis and caries. Relevant information was extracted from full papers, including quality and risk of bias. Meta-analyses were performed whenever possible. Results: After the screening of 1,373 titles, 15 RCTs, 10 CCTs and 2 PCS were included. Low to moderate evidence support that combined professional and selfperformed mechanical plaque control significantly reduces standardized plaque index [n = 4; weighted mean difference (WMD) = 1.294; 95% CI (0.445; 2.144); p = 0.003] and gingivitis scores [n = 4; WMD = 1.728; 95% CI (0.631; 2.825); p = 0.002]. The addition of fluoride to mechanical plaque control is relevant for caries management [n = 5; WMD = 1.159; 95% CI (0.145; 2.172); p = 0.025] while chlorhexidine rinses are relevant for gingivitis. Conclusion: Mechanical plaque control procedures are effective in reducing plaque and gingivitis. The addition of fluoride to mechanical plaque control is significant for caries management. Chlorhexidine rinse has a positive effect on gingivitis and inconclusive role in caries.

The clinical relevance of the frequency of fluoride dentifrice (FD) use on enamel caries is based on evidence. However, the relative effect of FD on reduction of demineralization or enhancement of remineralization is unknown and the effect of frequency on root dentine caries has not been explored. The aim of this double-blind, crossover, in situ study, which was conducted in 4 phases of 14 days each, was to evaluate the relationship between the frequency of FD use and enamel and root dentine de- and remineralization. Eighteen volunteers wore palatal appliances containing enamel and root dentine slabs, either sound or carious. Biofilm accumulation on the slab surface was allowed, and 20% sucrose solution was dripped 3 or 8 times per day on the carious and sound slabs, respectively. Volunteers used FD (1,100 μg F/g) in the frequencies 0 (fluoride-placebo dentifrice), 1, 2 and 3 times per day. The demineralization and remineralization that occurred in sound or carious slabs was estimated by the percentage of surface hardness loss (%SHL) or recovery (%SHR). Loosely (CaF₂) and firmly (FAp) bound fluoride concentrations were also determined. The relationship between the variables was analyzed by linear regression. The %SHL, CaF₂ and FAp concentrations were a function of the frequency of FD use for enamel and dentine, but the %SHR was a function of the frequency of FD use only for enamel (p < 0.05). The results suggest that demineralization in enamel and root dentine is reduced in proportion to the frequency of FD use, but for remineralization the effect of the frequency of FD use was relevant only to enamel.

High fluoride dentifrice (FD; 5,000 ppm F) has been recommended to arrest root dentine lesions and to control enamel caries in high-risk patients. Also, standard FD (1,100 ppm F) in combination with professional fluoride application has been recommended to control dentine caries, but the effect of this combination on enamel has been considered modest. Considering the lack of evaluation comparing the use of 5,000 ppm FD (5,000-FD) versus acidulated phosphate fluoride (APF) application combined with 1,100 ppm FD (1,100-FD) on the inhibition and repair of caries lesions in both enamel and dentine, we conducted this in situ, double-blind, crossover study of 3 phases of 14 days. In each phase, 18 volunteers wore palatal appliances containing enamel and root dentine specimens, either sound or carious, to evaluate the effect of the treatments on the inhibition or repair of caries lesions, respectively. The treatments were non-FD (negative control), 5,000-FD, or 1 APF gel application on dental specimens combined with 1,100-FD used twice per day (APF + 1,100-FD). The reduction of demineralization and enhancement of remineralization were assessed by surface and cross-sectional hardness. Fluoride concentration was determined on dental specimens and on the formed biofilm. For enamel, APF + 1,100-FD and 5,000-FD did not differ regarding the inhibition of demineralization and repair of caries lesions. However, for dentine the difference between these treatments was inconclusive because while APF + 1,100-FD was more effective than 5,000-FD in caries lesion reduction and repair, 5,000-FD was more effective than APF + 1,100-FD in the reduction of surface demineralization. Therefore, the findings show that the combination of APF + 1,100-FD is as effective as 5,000-FD in enamel inhibition of demineralization and enhancement of remineralization.

Resumo Trata-se de uma revisão sistemática e metanálise para estimar e comparar as prevalências de fluorose dental em localidades brasileiras abastecidas com água tratada sem suplementação de flúor e em localidades que utilizam de água de origem subterrânea. Em dezembro de 2016 foram buscados estudos transversais em 8 bases de dados incluindo a “literatura cinzenta”. As prevalências foram estimadas utilizando modelo misto de efeitos aleatórios considerando as localidades como subgrupo. A heterogeneidade entre os estudos foi avaliada através da estatística I2 e do teste Q de Cochran. Foram encontrados 1.038 registros, dos quais apenas 18 artigos preencheram os critérios de inclusão, sendo submetidos para análise. O modelo metanalítico estimou em 8,92% (IC95%:5,41% até 14,36%) a prevalência de fluorose dental em municípios com água tratada sem suplementação de flúor e em 51,96% (IC95%: 31,03% até 72,22%) em municípios abastecidos por poços artesianos. A heterogeneidade entre os estudos foi alta, I2 = 95% (p < 0,01) no primeiro subgrupo de municípios e I2 = 98% (p < 0,01) no segundo subgrupo. A prevalência foi significativamente maior (p < 0,001) em populações expostas à água de poços artesianos, indicando que a presença de flúor natural em concentrações elevadas representa um fator de risco para a ocorrência de fluorose dental.