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JAMA Cardiology Aug 2023Recurrent coronary events in patients with recent myocardial infarction remain a major clinical problem. Noninvasive measures of coronary atherosclerotic disease...
IMPORTANCE
Recurrent coronary events in patients with recent myocardial infarction remain a major clinical problem. Noninvasive measures of coronary atherosclerotic disease activity have the potential to identify individuals at greatest risk.
OBJECTIVE
To assess whether coronary atherosclerotic plaque activity as assessed by noninvasive imaging is associated with recurrent coronary events in patients with myocardial infarction.
DESIGN, SETTING, AND PARTICIPANTS
This prospective, longitudinal, international multicenter cohort study recruited participants aged 50 years or older with multivessel coronary artery disease and recent (within 21 days) myocardial infarction between September 2015 and February 2020, with a minimum 2 years' follow-up.
INTERVENTION
Coronary 18F-sodium fluoride positron emission tomography and coronary computed tomography angiography.
MAIN OUTCOMES AND MEASURES
Total coronary atherosclerotic plaque activity was assessed by 18F-sodium fluoride uptake. The primary end point was cardiac death or nonfatal myocardial infarction but was expanded during study conduct to include unscheduled coronary revascularization due to lower than anticipated primary event rates.
RESULTS
Among 2684 patients screened, 995 were eligible, 712 attended for imaging, and 704 completed an interpretable scan and comprised the study population. The mean (SD) age of participants was 63.8 (8.2) years, and most were male (601 [85%]). Total coronary atherosclerotic plaque activity was identified in 421 participants (60%). After a median follow-up of 4 years (IQR, 3-5 years), 141 participants (20%) experienced the primary end point: 9 had cardiac death, 49 had nonfatal myocardial infarction, and 83 had unscheduled coronary revascularizations. Increased coronary plaque activity was not associated with the primary end point (hazard ratio [HR], 1.25; 95% CI, 0.89-1.76; P = .20) or unscheduled revascularization (HR, 0.98; 95% CI, 0.64-1.49; P = .91) but was associated with the secondary end point of cardiac death or nonfatal myocardial infarction (47 of 421 patients with high plaque activity [11.2%] vs 19 of 283 with low plaque activity [6.7%]; HR, 1.82; 95% CI, 1.07-3.10; P = .03) and all-cause mortality (30 of 421 patients with high plaque activity [7.1%] vs 9 of 283 with low plaque activity [3.2%]; HR, 2.43; 95% CI, 1.15-5.12; P = .02). After adjustment for differences in baseline clinical characteristics, coronary angiography findings, and Global Registry of Acute Coronary Events score, high coronary plaque activity was associated with cardiac death or nonfatal myocardial infarction (HR, 1.76; 95% CI, 1.00-3.10; P = .05) but not with all-cause mortality (HR, 2.01; 95% CI, 0.90-4.49; P = .09).
CONCLUSIONS AND RELEVANCE
In this cohort study of patients with recent myocardial infarction, coronary atherosclerotic plaque activity was not associated with the primary composite end point. The findings suggest that risk of cardiovascular death or myocardial infarction in patients with elevated plaque activity warrants further research to explore its incremental prognostic implications.
Topics: Humans; Male; Female; Plaque, Atherosclerotic; Prospective Studies; Cohort Studies; Sodium Fluoride; Coronary Artery Disease; Myocardial Infarction; Death
PubMed: 37379010
DOI: 10.1001/jamacardio.2023.1729 -
International Dental Journal Apr 2024Mouthwashes, a cornerstone of oral and dental hygiene, play a pivotal role in combating the formation of dental plaque, a leading cause of periodontal disease and dental... (Review)
Review
OBJECTIVES
Mouthwashes, a cornerstone of oral and dental hygiene, play a pivotal role in combating the formation of dental plaque, a leading cause of periodontal disease and dental caries. This study aimed to review the composition of mouthwashes found on retail shelves in Turkey and evaluate their prevalence and side effects, if any.
METHODS
The mouthwashes examined were sourced from the 5 largest chain stores in each district of Istanbul. A comprehensive list of the constituents was meticulously recorded. The research was supported by an extensive compilation of references from scholarly databases such as Google Scholar, PubMed, and ScienceDirect. Through rigorous analysis, the relative proportions of mouthwash ingredients and components were determined.
RESULTS
A total of 45 distinctive variations of mouthwashes, representing 17 prominent brands, were identified. Amongst the 116 ingredients discovered, 70 were evaluated for potential adverse effects and undesirable side effects. The aroma of the mouthwash (n = 45; 100%), as welll as their sodium fluoride (n = 28; 62.22%), sodium saccharin (n = 29; 64.44%), sorbitol (n = 21; 46.6%), and propylene glycol (n = 28; 62.22%) content were the main undesireable features.
CONCLUSIONS
The limited array of mouthwashes found on store shelves poses a concern for both oral and public health. Furthermore, the intricate composition of these products, consisting of numerous ingredients with the potential for adverse effects, warrants serious attention. Both clinicians and patients should acknowledge the importance and unwarranted side effects of the compnents of the mouthwashes.
Topics: Humans; Dental Caries; Dental Plaque; Gingivitis; Mouthwashes; Sodium Fluoride
PubMed: 37709645
DOI: 10.1016/j.identj.2023.08.004 -
BMC Oral Health Nov 2023Early childhood caries (ECC) is the most prevalent chronic health problem in young children, and it can be arrested using professionally applied fluoride such as Sodium... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Early childhood caries (ECC) is the most prevalent chronic health problem in young children, and it can be arrested using professionally applied fluoride such as Sodium fluoride (NaF) varnish and Silver Diamine Fluoride (SDF). This trial compared two interventions to arrest ECC lesions: 38% SDF combined with 5% NaF varnish versus 38% SDF and assessed whether the arrest rate was affected by baseline lesion severity measured by ICDAS.
METHODS
Children aged ≤ 4 years from 4 nurseries in a rural area in Alexandria, Egypt joined the study in March 2022. They were included if they had at least one active carious lesion with ICDAS codes ≥ 3. They were randomized to receive either 38% SDF with 5% NaF varnish or 38% SDF alone. In both groups, the agents were applied at baseline and after 6 months on the caries lesions. NaF was additionally applied on all teeth in the oral cavity, and it was also applied after three months. The primary outcome was lesion arrest status after six months. Parents' satisfaction with their children's appearance was the secondary outcome. Pearson Chi-Square test was used for bivariate comparison and multi-level multiple logistic regression was used to assess the effect of the intervention on caries arrest controlling for confounders. The interaction between the intervention and baseline lesion severity (categorized into moderate and severe lesions) was assessed and the p value was calculated.
RESULTS
The study included 1606 lesions in 220 children, median (IQR) age = 48(9) months. The percentages of arrested lesions after the application of SDF + NaF and SDF only were 77.7% and 73.2% (p = 0.035). In multivariable analysis, SDF + NaF had significantly greater caries arrest effect than SDF alone (AOR = 2.12, p = 0.03) with significant difference (p = 0.03) between moderate (AOR = 4.10, p = 0.005) and advanced (AOR = 1.92, p = 0.08) lesions. Most parents were satisfied with their children's appearance with no significant difference between groups (SDF + NaF = 84.5%, SDF = 78.18%, p = 0.23).
CONCLUSION
SDF + NaF had a higher arrest rate than SDF alone and this difference was significant in moderate but not advanced lesions. The findings have implications for the non-invasive management of ECC.
TRIAL REGISTRATION
This trial was registered in the clinicaltrials.gov registry (#NCT05642494).
Topics: Child; Child, Preschool; Humans; Sodium Fluoride; Fluorides, Topical; Cariostatic Agents; Follow-Up Studies; Dental Caries Susceptibility; Dental Caries; Silver Compounds; Quaternary Ammonium Compounds; Sodium
PubMed: 37978488
DOI: 10.1186/s12903-023-03597-5 -
Biomimetics (Basel, Switzerland) Jul 2023As the demand for clinically effective fluoride-free oral care products for consumers increases, it is important to document which types of toothpastes have been shown... (Review)
Review
As the demand for clinically effective fluoride-free oral care products for consumers increases, it is important to document which types of toothpastes have been shown in clinical studies to be effective in improving oral health. In this review, we included different indications, i.e., caries prevention, improving periodontal health, reducing dentin hypersensitivity, protecting against dental erosion, and safely improving tooth whitening in defining what constitutes improvement in oral health. While there are several professional and consumer fluoride-containing formulations fortified with calcium-phosphate-based ingredients, this review focuses on fluoride-free toothpastes containing biomimetic calcium-phosphate-based molecules as the primary active ingredients. Several databases were searched, and only clinical trials in human subjects were included; in vitro and animal studies were excluded. There were 62 oral health clinical trials on biomimetic hydroxyapatite (HAP), 57 on casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), 26 on calcium sodium phosphosilicate (CSPS, or so called Bioglass), and 2 on β-tricalcium phosphate (β-TCP). HAP formulations were tested the most in clinical trials for benefits in preventing caries, dentin hypersensitivity, improving periodontal health, and tooth whitening. Based on the current clinical evidence to date, fluoride-free HAP toothpaste formulations are the most versatile of the calcium phosphate active ingredients in toothpastes for improving oral health.
PubMed: 37622936
DOI: 10.3390/biomimetics8040331 -
BMC Oral Health Oct 2023Silver Diamine Fluoride (SDF) has gained attention as one of the minimally invasive modalities to manage ECC although it causes black staining of treated carious... (Randomized Controlled Trial)
Randomized Controlled Trial
Effectiveness of silver diamine fluoride versus sodium fluoride varnish combined with mother's motivational interviewing for arresting early childhood caries: a randomized clinical trial.
BACKGROUND
Silver Diamine Fluoride (SDF) has gained attention as one of the minimally invasive modalities to manage ECC although it causes black staining of treated carious lesions. A possible affordable alternative may be Sodium Fluoride (NaF) varnish combined with good oral hygiene promoted by parental Motivational Interviewing (MI). The study compared the effectiveness of 38% SDF solution and 5% NaF varnish supported by parental MI in arresting ECC.
MATERIALS AND METHODS
Children aged ≤ 4 years old with at least one active carious lesion (ICDAS score ≥ 3) were randomly assigned to treatment by a single application of 38% SDF solution or a single application of 5% NaF varnish supported by two MI sessions for mothers at baseline and after three months. Chi-Squared test was used to compare groups and multilevel logistic regression analysis was used to assess the effect of the interventions on ECC arrest adjusting for confounders. The interaction between the type of intervention and baseline lesion severity, moderate (ICDAS 3/4) or advanced (ICDAS 5/6), was also assessed.
RESULTS
The study included 165 children with 949 active lesions. After 6 months, there were no significant differences between SDF and NaF/MI groups in overall caries arrest (63.7% and 58.1%, p = 0.08), and in moderate lesions (72.9% and 69.6%, p = 0.52). However, in advanced lesions, the arrest rate was significantly higher in the SDF than the NaF/ MI group (60.3% and 50.0%, P = 0.01). Multilevel multiple logistic regression showed no significant differences between the interventions (AOR = 1.56, P = 0.27) with significant interaction between the intervention and baseline lesion severity (p < 0.001). Moderate lesions treated with SDF (AOR = 3.69, P = 0.008) or NaF/MI (AOR = 3.32, P < 0.001) had significantly higher odds of arrest than advanced lesions treated with NaF/ MI with no difference between advanced lesions treated with SDF or NaF/ MI (AOR = 1.85, P = 0.155) in arrest rate.
CONCLUSION
NaF/ MI can be an alternative to SDF in arresting advanced and moderate ECC lesions without staining with stronger effect on moderate lesions (ICDAS 3/4).
TRIAL REGISTRATION
The trial was retrospectively registered at clinicaltrial.gov registry (#NCT05761041) on 9/3/2023.
Topics: Child; Female; Child, Preschool; Humans; Sodium Fluoride; Fluorides, Topical; Cariostatic Agents; Mothers; Dental Caries Susceptibility; Motivational Interviewing; Dental Caries; Silver Compounds; Quaternary Ammonium Compounds; Sodium
PubMed: 37789300
DOI: 10.1186/s12903-023-03456-3 -
Dental and Medical Problems 2023White spot lesions (WSLs) are one of the most common adverse effects following comprehensive fixed orthodontic treatment. The purpose of this review was to evaluate... (Review)
Review
White spot lesions (WSLs) are one of the most common adverse effects following comprehensive fixed orthodontic treatment. The purpose of this review was to evaluate recent studies addressing the prevention and treatment of these lesions. Electronic databases were searched for English-written studies published between 2015 and October 2020 involving randomized clinical trials aiming at prevention or treatment of orthodontically induced WSLs using the following keywords in their title or abstracts: randomized clinical trial OR randomized controlled trial AND white spot OR caries OR demineralization OR decalcification OR remineralization. From the 23 papers which met the inclusion criteria, 11 were on preventive methods, while 12 addressed treatment protocols. However, most of the reviewed studies had a high risk of bias. The results of this review strongly support the importance of oral hygiene observation in preventing WSLs. Sodium fluoride varnish 5% was confirmed to be effective in the treatment of these lesions, as well as in the prevention of WSLs in patients with suboptimal oral hygiene. In addition, immediate CO2 laser irradiation after bonding can effectively prohibit formation of WSLs during orthodontic treatment. The literature also illustrates a promising masking effect of resin infiltration for the treatment of WSLs. However, little scientific evidence supports the effectiveness of Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) against WSLs, although more clinical trials with long-term follow-up are needed. Oral hygiene maintenance is crucial in the prevention of WSLs, and 5% sodium fluoride varnish and CO2 laser irradiation are recommended in patients with compromised oral hygiene. In the case of WSL formation, fluoride varnish and resin infiltration are effective treatment modalities.
Topics: Humans; Cariostatic Agents; Fluorides, Topical; Tooth Remineralization; Dental Caries; Sodium; Randomized Controlled Trials as Topic
PubMed: 37815515
DOI: 10.17219/dmp/140964 -
Heart (British Cardiac Society) Oct 2023In patients with abdominal aortic aneurysms, sodium [F]fluoride positron emission tomography identifies aortic microcalcification and disease activity. Increased uptake...
OBJECTIVE
In patients with abdominal aortic aneurysms, sodium [F]fluoride positron emission tomography identifies aortic microcalcification and disease activity. Increased uptake is associated with aneurysm expansion and adverse clinical events. The effect of endovascular aneurysm repair (EVAR) on aortic disease activity and sodium [F]fluoride uptake is unknown. This study aimed to compare aortic sodium [F]fluoride uptake before and after treatment with EVAR.
METHODS
In a preliminary proof-of-concept cohort study, preoperative and post-operative sodium [F]fluoride positron emission tomography-computed tomography angiography was performed in patients with an infrarenal abdominal aortic aneurysm undergoing EVAR according to current guideline-directed size treatment thresholds. Regional aortic sodium [F]fluoride uptake was assessed using aortic microcalcification activity (AMA): a summary measure of mean aortic sodium [F]fluoride uptake.
RESULTS
Ten participants were recruited (76±6 years) with a mean aortic diameter of 57±2 mm at time of EVAR. Mean time from EVAR to repeat scan was 62±21 months. Prior to EVAR, there was higher abdominal aortic AMA when compared with the thoracic aorta (AMA 1.88 vs 1.2; p<0.001). Following EVAR, sodium [F]fluoride uptake was markedly reduced in the suprarenal (ΔAMA 0.62, p=0.03), neck (ΔAMA 0.72, p=0.02) and body of the aneurysm (ΔAMA 0.69, p=0.02) while it remained unchanged in the thoracic aorta (ΔAMA 0.11, p=0.41).
CONCLUSIONS
EVAR is associated with a reduction in AMA within the stented aortic segment. This suggests that EVAR can modify aortic disease activity and aortic sodium [F]fluoride uptake is a promising non-invasive surrogate measure of aneurysm disease activity.
Topics: Humans; Aortic Aneurysm, Abdominal; Fluorides; Endovascular Aneurysm Repair; Cohort Studies; Blood Vessel Prosthesis Implantation; Treatment Outcome; Endovascular Procedures; Calcinosis; Retrospective Studies; Risk Factors; Blood Vessel Prosthesis
PubMed: 37164479
DOI: 10.1136/heartjnl-2023-322514 -
BMC Oral Health Feb 2024Gingivitis is driven by plaque accumulation and, if left untreated, can progress to irreversible periodontitis. For many, the mechanical action of toothbrushing does not... (Randomized Controlled Trial)
Randomized Controlled Trial
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).
Topics: Adult; Humans; Toothpastes; Sodium Fluoride; Sodium Bicarbonate; Hyaluronic Acid; Fluorides; Prospective Studies; Gingivitis; Dental Plaque; Dental Plaque Index; Sodium; Double-Blind Method
PubMed: 38336635
DOI: 10.1186/s12903-024-03981-9 -
BMC Oral Health Aug 2023Nanoparticles and regenerative biomineralization are new caries prevention technologies. This study assessed the remineralizing effect of self-assembling peptide... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Nanoparticles and regenerative biomineralization are new caries prevention technologies. This study assessed the remineralizing effect of self-assembling peptide (P11-4), Nanosilver Fluoride (NSF) and sodium fluoride (NaF) on white spot lesions (WSLs) in permanent teeth.
METHODS
Sixty six young adults with WSLs on buccal surfaces in permanent teeth and ICDAS code 1 or 2, were randomly assigned to one of three groups; P11-4, NSF or NaF. Assessment of ICDAS scores, lesion activity (Nyvad scores) and diagnodent readings of lesions were done at baseline and after 1, 3, 6 and 12 months of agents' application. Comparisons between groups were made using chi squared test and comparison within groups were made using McNemar test. Multilevel binary logistic regression was used to assess the effect of agents on change of ICDAS scores after 3, 6 and 12 months (reduction versus no reduction).
RESULTS
There were 147 teeth in 66 patients; mean ± SD age = 13.46 ± 4.31 years. There were significant differences in the change of ICDAS scores among the three groups after 3 and 6 months (p = 0.005). The reduction in ICDAS score increased steadily in all groups across time with the greatest increase in the P11-4 group: 54.5% after 12 months. Lesion activity (Nyvad scores) showed significant differences among the three groups with the greatest percentage of inactive cases in the P11-4 group. Multilevel binary logistic regression showed non-significant reduction of ICDAS in P11-4 and NSF varnishes compared to NaF varnish (AOR = 2.56, 95% CI: 0.58, 8.77 and AOR = 2.12, 95% CI: 0.59, 7.64 respectively).
CONCLUSION
P11-4 and NSF varnish reduced the ICDAS scores, caries activity and diagnodent readings of WSLs in permanent teeth. However, the change in ICDAS scores was not significantly different from NaF.
TRIAL REGISTRATION
This trial was prospectively registered on the clinicaltrials.gov registry with ID: NCT04929509 on 18/6/2021.
Topics: Young Adult; Humans; Child; Adolescent; Fluorides; Dental Caries; Dental Enamel; Peptides
PubMed: 37598194
DOI: 10.1186/s12903-023-03269-4