The Role of Remineralizing and Anticaries Agents in Caries Management

Background Fissure sealant (FS) and fluoride varnish (FV) have been shown to be effective in preventing dental caries when tested against a no-treatment control. However, the relative clinical effectiveness and cost-effectiveness of these interventions is unknown. Objective To compare the clinical effectiveness and cost-effectiveness of FS and FV in preventing dental caries in first permanent molars (FPMs) in 6- and 7-year-olds and to determine their acceptability. Design A randomised controlled allocation-blinded clinical trial with two parallel arms. Setting A targeted population programme using mobile dental clinics (MDCs) in schools located in areas of high social and economic deprivation in South Wales. Participants In total, 1016 children were randomised, but one parent subsequently withdrew permission and so the analysis was based on 1015 children. The randomisation of participants was stratified by school and balanced for sex and primary dentition baseline caries levels using minimisation in a 1 : 1 ratio for treatments. A random component was added to the minimisation algorithm, such that it was not completely deterministic. Of the participants, 514 were randomised to receive FS and 502 were randomised to receive FV. Interventions Resin-based FS was applied to caries-free FPMs and maintained at 6-monthly intervals. FV was applied at baseline and at 6-month intervals over the course of 3 years. Main outcome measures The proportion of children developing caries into dentine (decayed, missing, filled teeth in permanent dentition, i.e. D4–6MFT) on any one of up to four treated FPMs after 36 months. The assessors were blinded to treatment allocation; however, the presence or absence of FS at assessment would obviously indicate the probable treatment received. Economic measures established the costs and budget impact of FS and FV and the relative cost-effectiveness of these technologies. Qualitative interviews determined the acceptability of the interventions. Results At 36 months, 835 (82%) children remained in the trial: 417 in the FS arm and 418 in the FV arm. The proportion of children who developed caries into dentine on a least one FPM was lower in the FV arm (73; 17.5%) than in the FS arm (82, 19.6%) [odds ratio (OR) 0.84, 95% confidence interval (CI) 0.59 to 1.21; p = 0.35] but the difference was not statistically significant. The results were similar when the numbers of newly decayed teeth (OR 0.86, 95% CI 0.60 to 1.22) and tooth surfaces (OR 0.85, 95% CI 0.59 to 1.21) were examined. Trial fidelity was high: 95% of participants received five or six of the six scheduled treatments. Between 74% and 93% of sealants (upper and lower teeth) were intact at 36 months. The costs of the two technologies showed a small but statistically significant difference; the mean cost to the NHS (including intervention costs) per child was £500 for FS, compared with £432 for FV, a difference of £68.13 (95% CI £5.63 to £130.63; p = 0.033) in favour of FV. The budget impact analysis suggests that there is a cost saving of £68.13 (95% CI £5.63 to £130.63; p = 0.033) per child treated if using FV compared with the application of FS over this time period. An acceptability score completed by the children immediately after treatment and subsequent interviews demonstrated that both interventions were acceptable to the children. No adverse effects were reported. Limitations There are no important limitations to this study. Conclusions In a community oral health programme utilising MDCs and targeted at children with high caries risk, the twice-yearly application of FV resulted in caries prevention that is not significantly different from that obtained by applying and maintaining FSs after 36 months. FV proved less expensive. Future work The clinical effectiveness and cost-effectiveness of FS and FV following the cessation of active intervention merits investigation. Trial registration EudraCT number 2010-023476-23, Current Controlled Trials ISRCTN17029222 and UKCRN reference 9273. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 21. See the NIHR Journals Library website for further project information.

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“…14 The presence of fluoride at the tooth surface prevents demineralisation of the dental enamel and encourages remineralisation.…”

Section: Fluoride Varnishmentioning

confidence: 99%

Seal or Varnish? A randomised controlled trial to determine the relative cost and effectiveness of pit and fissure sealant and fluoride varnish in preventing dental decay

Chestnutt

Hutchings

Playle

et al. 2017

Health Technol Assess

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“…2 The average depth and area of groups A and B had no statistically significant differences prior to treatment. In the demineralizing solution, the concentrations of calcium and phosphate were saturated, therefore causing less damage to the enamel surface and creating the conditions for the formation of lesions in the enamel subsurface.…”

Section: 3mentioning

confidence: 88%

“…24,No. 2,[45][46][47][48][49] authors have identified the benefits of the morphological changes of teeth in different conditions.…”

Section: Using Scanning Electron Microscopy (Sem) Manymentioning

confidence: 99%

“…3 Hence, the CPP-ACP is deposited with a high concentration of ACP near the surface of the tooth. 2,3,8 Reynolds et al 's results showed that the remineralization process involved in the diffusion of CaHPO4, neutral ion pairs of calcium, and phosphate are formed by acid and calcium ions. The phosphate is linked to the hole filled with protein and water on the surface of the tooth.…”

Section: 3mentioning

confidence: 99%

“…This compound is proven as effective agent in preventing tooth caries due to the capability of providing fluoride, calcium, and phosphate for the remineralization of enamel. 2,3 Research studies on the effectiveness of CPP-ACPF in the remineralization process of caries lesions at an early stage have been conducted in many countries both in vitro and in vivo. Therefore, the effectiveness of the use of products that contain CPP-ACPF is still unclear due to a lack of studies on its effect on remineralization.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Casein Phosphopeptide-amorphous Calcium Fluoride Phosphate on the Remineralization of Artificial Caries Lesions: An In Vitro Study

Nhu¹,

Hong²,

Le³

et al. 2017

J Dent Indones

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The studies on electron microstructure of the effect of the use of products that contain casein phosphopeptideamorphous calcium fluoride phosphate (CPP-ACPF) on enamel remineralization are still needed. It is important method to observe of the morphological changes of teeth in different conditions. Objective: To evaluate the remineralization potential of paste on enamel lesions using scanning electron microscopy (SEM). Methods: Sixty enamel specimens were prepared from extracted human premolars. The specimens were placed in a demineralizing solution for four days to produce artificial carious lesions. The specimens were then randomly assigned to two study groups: group A (control group) and group B. Group B was incubated in remineralizing paste (CPP-ACPF) for 30 minutes per day for 10 days. The control group received no intervention with remineralizing paste. All 60 specimens were stored in artificial saliva at 37 0 C. After remineralization, the samples were observed using SEM. Results: The statistical analysis showed a decrease in the lesion area between the demineralized and remineralized samples, but no significant difference was observed in the lesion depth for group B. There was a significant increase observed in both the lesion depth and lesion area for group A (p = 0.03). Conclusion: The results showed the capacity of CPP-ACPF in supplying calcium and phosphate to the enamel, decreasing the dissolution of the enamel surface and increasing the remineralization of the enamel surface.Keywords: CPP-ACPF, enamel, fluoride, remineralization, scanning electron microscopy How to cite this article: Ngoc VTN, Thuy PTH, Anh LQ, Son TM, Phuong NTT. The effect of casein phosphopeptideamorphous calcium fluoride phosphate on the remineralization of artificial caries lesions: an in vitro study. J Dent Indones. 2017;24(2): 45-49

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Caries Management by Risk Assessment vs. Traditional Preventive Strategies: Effect on Oral Health Behaviors and Caries Diagnoses: A Retrospective Case‐Control Observational Design

Kriegler

Blue

2021

Clinical Case Reports

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The Role of Remineralizing and Anticaries Agents in Caries Management

Cited by 42 publications

References 23 publications

Seal or Varnish? A randomised controlled trial to determine the relative cost and effectiveness of pit and fissure sealant and fluoride varnish in preventing dental decay

Seal or Varnish? A randomised controlled trial to determine the relative cost and effectiveness of pit and fissure sealant and fluoride varnish in preventing dental decay

The Effect of Casein Phosphopeptide-amorphous Calcium Fluoride Phosphate on the Remineralization of Artificial Caries Lesions: An In Vitro Study

Caries Management by Risk Assessment vs. Traditional Preventive Strategies: Effect on Oral Health Behaviors and Caries Diagnoses: A Retrospective Case‐Control Observational Design

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