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Community interventions and strategies for caries control in Latin American and Caribbean countries.Brazilian Oral Research 2021Dental caries remains highly prevalent in Latin American and Caribbean countries (LACC). However, this disease can be controlled through interventions that implement...
Dental caries remains highly prevalent in Latin American and Caribbean countries (LACC). However, this disease can be controlled through interventions that implement evidence-based strategies in an affordable manner and that target all population groups instead of the most affluent only. Therefore, the aim of this report was to summarize the main scientifically documented community interventions and strategies based on restriction of sugars consumption, use of fluoride, and the use of occlusal sealants for caries control in LACC. A critical literature review was carried out in a systematic manner that included defined search strategies, independent review of the identified publications, and compilation of results in this report. Three systematic searches were conducted using the PubMed, LILACS, and SciELO databases to identify studies related to community interventions and strategies for caries control in LACC. Of the 37 publications identified, twenty-six focused on fluoride use, eight on occlusal sealant use, and three on the restriction of sugar consumption. Documented community interventions for sugars restriction were scarce in the region and were based on food supplementation, sugar replacement, and education. Thus, local and/or national policies should prioritize investment in upstream, coherent, and integrated population-wide policies such as taxes on sugary drinks and stronger regulation of advertising and promotion of sugary foods and drinks mainly targeting children. The main fluoride-based strategies used drinking water, refined domestic salt, cow milk, toothpaste and, to a lesser extent, mouth-rinses, acidulated phosphate fluoride (APF) gels, and varnishes to deliver fluoride to the population. Evidence of fluoride use was seen in Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, and Venezuela. Studies reporting the use of occlusal sealants were mainly located in Brazil, Chile, Colombia, Costa Rica, Peru, Mexico, and Venezuela. Community interventions restricting sugar consumption should be implemented at the individual level and through public policies. The use of fluoride must be monitored at the local, regional, and national levels so as to achieve maximum anti-caries effect while also minimizing the risk of dental fluorosis. Moreover, fluoridated water and salt programs, used as a mutually exclusive community level strategy for caries control, should expand their benefits to reach non-covered areas of the LACC while also simultaneously providing adequate surveillance of the fluoride concentration delivered to the population. Regulating the concentration of soluble fluoride (for anti-caries effect) in dentifrice formulations is also necessary in order to provide the population with an effective strategy for disease control. Targeting culturally appropriate, economically sustainable caries control interventions to rural populations and native ethnic groups such as indigenous people, quilombolas (African-origin), and riverside Amazonian people remains a crucial challenge.
Topics: Argentina; Brazil; Caribbean Region; Cariostatic Agents; Child; Chile; Colombia; Dental Caries; Dental Caries Susceptibility; Guatemala; Humans; Latin America; Mexico; Nicaragua; Panama; Peru; Uruguay
PubMed: 34076078
DOI: 10.1590/1807-3107bor-2021.vol35.0054 -
Clinical Oral Investigations Jun 2021To assess whether professional fluoride application (PFA) used in addition to regular fluoride toothpaste (RFT, ≥ 1,000 ppm) is more effective than RFT alone in children. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess whether professional fluoride application (PFA) used in addition to regular fluoride toothpaste (RFT, ≥ 1,000 ppm) is more effective than RFT alone in children.
MATERIALS AND METHODS
A systematic search was conducted using the PubMed, Embase, Google Scholar and CENTRAL databases. Randomized controlled trials (RCTs) comparing the effectiveness of RFT + PFA and RFT alone were included. Meta-analyses with random-effects models were performed. The certainty of evidence was assessed using the GRADE approach.
RESULTS
A total of 2,729 records were identified from electronic and manual searches, which were screened by two reviewers independently and in duplicate. Six RCTs (5,034 participants) were included, of which four had high risk of bias and two had unclear risk of bias. The PFA used in all these trials was fluoride varnish (FV). In meta-analyses, no significant difference was observed between participants receiving FV + RFT and RFT alone of d(m/e)fs increment (mean difference (MD) - 0.17, 95% confidence interval (CI) - 0.60 to 0.26, P = 0.43, I = 38%; 6 trials, 5,034 participants, moderate certainty evidence), incidence of caries (risk ratio (RR) 0.91, 95% CI 0.80 to 1.05, P = 0.21, I = 41%; 4 trials, 4,487 participants, moderate certainty evidence) or changes in prevalence of caries (RR 0.89, 95% CI 0.78 to 1.01, P = 0.07, I = 0%, 4 trials, 4,189 participants, low certainty evidence).
CONCLUSIONS
Low to moderate certainty evidence suggests that FV does not have significant additional caries-preventive benefit for children (under 8 years old) when provided as an adjunct to daily tooth brushing with RFT (≥ 1,000 ppm). There is insufficient evidence regarding the additional benefit of other PFA interventions.
CLINICAL RELEVANCE
The decision to apply FV to children needs to be made in light of their actual usage of RFT.
TRIAL REGISTRATION
PROSPERO (CRD42020165270).
Topics: Child; Dental Caries; Fluorides; Humans; Toothpastes
PubMed: 33782769
DOI: 10.1007/s00784-021-03909-5 -
Journal of Periodontal Research Jun 2021Scaling and root planning (SRP) is the gold standard for non-surgical periodontal treatment. Green tea as a supporting alternative in non-surgical periodontal treatment... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Scaling and root planning (SRP) is the gold standard for non-surgical periodontal treatment. Green tea as a supporting alternative in non-surgical periodontal treatment has been suggested as a therapeutic option in the treatment of periodontitis.
OBJECTIVE
To analyse the comparative effectiveness of green tea (Camellia sinensis) in its different forms and applications for the treatment of periodontitis.
METHODS
We included randomized clinical trials evaluating green tea as an adjuvant therapeutic agent to scaling and root planning (SRP) in the treatment of periodontitis. For the meta-analysis, we calculated standardized mean difference (SMD) and 95%CI comparing green tea and control (only SRP). We subgrouped by types of application forms of green tea. The certainty of the evidence was assessed through GRADE.
RESULTS
Nine studies were included. The follow-up time of treatments varied from 21 days to 6 months. The subgroup meta-analysis showed that the green tea as sachet reduced probing bleeding (SMD = -0.71; 95%CI) and the gingival index (SMD = -0.78; 95%CI) compared to SRP with very low certainty of evidence. The sachet (SMD = -0.29; 95%CI) and dentifrice (SMD = -1.31; 95%CI) reduced plaque index with very low certainty compared to the control. All forms of application of green tea showed very low certainty of evidence (SMD = -0.27; 95% CI) in reducing the probing depth, as well as for the loss of clinical insertion (SMD = -0.42; 95% CI) with low certainty of evidence.
CONCLUSION
There was not a difference in the effectiveness of green tea isolated or in combination with SRP to reduce probing depth. Green tea adjunct to periodontal therapy showed very low certainty of effectiveness for the treatment of periodontal disease.
Topics: Camellia sinensis; Chronic Periodontitis; Dental Scaling; Humans; Periodontal Index; Periodontitis; Root Planing; Tea
PubMed: 33729563
DOI: 10.1111/jre.12871 -
Journal of the Indian Society of... 2020Dental caries is one of the most prevailing oral health diseases in children. Recent times have focused on herbal products, because they have minimum or no side effects... (Review)
Review
BACKGROUND
Dental caries is one of the most prevailing oral health diseases in children. Recent times have focused on herbal products, because they have minimum or no side effects and are effective in prevention. Licorice is one such product belonging to Glycyrrhiza family used in the form of dentifrice, chewing gums, lollipop, gels, etc., Literature reports about the activity of licorice root extract on the biofilm thereby reducing Streptococcus mutans (SM) count and preventing dental caries in children.
OBJECTIVES
The objective is to assess the effectiveness of licorice in reducing SM count and preventing dental caries in children.
METHODOLOGY
PubMed and Google scholar were searched with search strategies for studies reporting licorice as intervention in children among 3-15 years for preventing dental caries. Only those studies with study design of randomized controlled trials, clinical trials, and comparative studies published between January 1, 2000, and October 31, 2019 were included. Cross references and hand searching for the relevant articles were also conducted.
RESULTS
A preliminary search yielded a total of 31 studies through PubMed and Google scholar. From 31 studies, nine studies were excluded based on the screening through titles. From the remaining 22 articles, six duplicates, four without parameters, six as reviews and case reports and were excluded. Finally, six articles giving ten estimates were included for qualitative synthesis.
CONCLUSION
Licorice extracts proves to be effective as an antimicrobial agent by reducing the count of SM in children. Its action on biofilm limits the fall of pH thereby preventing acidic environment that increases the risk of dental caries. Moreover, licorice in lollipop form is well accepted by children.
Topics: Biofilms; Child; Dental Caries; Gels; Glycyrrhiza; Humans; Streptococcus mutans
PubMed: 33402612
DOI: 10.4103/JISPPD.JISPPD_100_20 -
International Journal of Paediatric... May 2021Early childhood caries (ECC) is a global problem, disproportionately affecting disadvantaged populations. The aim of this study was to evaluate systematically the... (Review)
Review
Early childhood caries (ECC) is a global problem, disproportionately affecting disadvantaged populations. The aim of this study was to evaluate systematically the available scientific evidence on the effectiveness of methods for ECC prevention. Six electronic databases were searched. Two independent reviewers selected the publications and analysed the quality of the included systematic reviews. Thirteen studies were included. Overall, eight reviews were classified with methodological quality critically low using the AMSTAR 2, whereas five reviews achieved a high risk of bias using the ROBIS tool. The methods identified that were positively related to the prevention of ECC were as follows: preventive dental programmes for pregnant women; advice on diet and feeding; prenatal oral health care; integration of maternal and children's oral health promotion into nursing practice; maternal oral health programmes undertaken by non-dental health professionals; dental health education in combination with the use of fluoride for children; early preventive dental visits; and the use of fluoride varnish and toothpastes with more than 1000 ppm of fluoride. The currently available evidence supporting the effectiveness of methods for prevention of ECC, although suggesting some methods of greater potential, is still lacking due to the methodological quality of the systematic reviews and the included primary studies.
Topics: Child; Child, Preschool; Dental Caries; Dental Caries Susceptibility; Female; Fluorides; Humans; Oral Health; Pregnancy; Toothpastes
PubMed: 33263186
DOI: 10.1111/ipd.12766 -
Archives of Oral Biology Dec 2020To evaluate the effects of different fluoride types and vehicles when compared to water or placebo, on prevention of enamel erosion and erosive tooth wear progression. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To evaluate the effects of different fluoride types and vehicles when compared to water or placebo, on prevention of enamel erosion and erosive tooth wear progression.
DESIGN
A systematic review followed by meta-analysis of randomized in situ trials was conducted. PubMeb, Scopus, Web of Science, LILACS, BBO, Scielo, EMBASE and CENTRAL electronic databases were searched. Studies with fluoride compounds (NaF, AmF, Sn, TiF) and vehicles (toothpaste, mouth rinse, gel, and varnishes) compared to control (water or placebo) for control of enamel loss progression were included. Reviewers independently screened potentially eligible articles, extracted data, and assessed risk of bias. GRADE approach was used to rate the overall certainty of evidence for toothpastes and rinses under erosive/abrasive challenges.
RESULTS
Thirty-two studies were elegible. Under erosive/abrasive challenges, enamel loss was significantly lower than control for NaF toothpastes [Mean difference(MD) -1.14; Confidence Interval(CI) -1.89 to -0.40] and Sn/associations [-6.02; -11.09 to -0.95], while no difference was found for AmF [-13.59; -39.7 to -12.52]. For mouth rinses, Sn/associations solutions were effective [-11.49; -16.62 to -6.37], but NaF showed no significant effect [-2.83; -8.04 to 2.38].
CONCLUSION
Overall, fluoride products are able to reduce enamel loss when compared to control, but results must be interpreted with caution. For toothpastes, NaF provided limited protection, with moderate evidence, while Sn/associations exhibited protective effect with low certainty of evidence. For rinses, NaF was not effective, with very low evidence, while the stannnous enriched fluorides offered higher protection regarding enamel erosion and erosive wear, with moderate certainty of evidence.
Topics: Dental Enamel; Fluorides; Humans; Mouthwashes; Randomized Controlled Trials as Topic; Sodium Fluoride; Tooth Abrasion; Tooth Erosion; Toothpastes
PubMed: 33113459
DOI: 10.1016/j.archoralbio.2020.104945 -
Clinical Oral Investigations Dec 2020To compare the effectiveness of remineralizing agents in the prevention and reversal of white spot lesions (WSLs), which occur during fixed orthodontic treatment,... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To compare the effectiveness of remineralizing agents in the prevention and reversal of white spot lesions (WSLs), which occur during fixed orthodontic treatment, through a systematic review and network meta-analysis.
MATERIALS AND METHODS
We reviewed controlled randomized clinical trial (RCT) data querying nine databases combined with a manual search (last search date: March 10, 2020). Of 2273 identified studies, 36 RCTs were finally included. After study selection and data extraction, pair-wise and network meta-analyses were performed to analyze the effectiveness of remineralizing agents in the prevention and reversal of WSLs in the short term (≤ 3 months) and long term (> 3 months). The risk of bias was assessed based on the Cochrane guidelines. Statistical heterogeneity, inconsistencies, and cumulative ranking were also evaluated.
RESULTS
In terms of WSL prevention, sodium fluoride (NaF) varnish had the highest cumulative ranking for the short-term decalcification index (99.3%); acidulated phosphate fluoride (APF) foam ranked first for long-term incidence (96.9%), followed by difluorosilane (Dfs) varnish and high-concentration fluoride toothpaste (HFT) (79.4% and 77.4%, respectively). In the reversal of WSLs, no significant difference was found among different agents or their combinations for the two available outcomes (short-term integrated fluorescence loss and short-term percentage of fluorescence loss).
CONCLUSIONS
In the prevention of WSLs, APF foam showed the best remineralizing effectiveness in the long term (after debonding), followed by Dfs varnish and HFT. It is unclear whether remineralizing agents can effectively reverse WSLs based on the existing evidence.
CLINICAL RELEVANCE
APF foam may be recommended as a remineralizing agent for preventing orthodontically induced WSLs.
PROSPERO REGISTRATION NUMBER
CRD42019116852.
Topics: Cariostatic Agents; Dental Caries; Humans; Network Meta-Analysis; Tooth Remineralization; Toothpastes
PubMed: 33057826
DOI: 10.1007/s00784-020-03610-z -
The Journal of Evidence-based Dental... Sep 2020Network Meta-Analysis on the Effect of Desensitizing Toothpastes on Dentine Hypersensitivity. Hu ML, Zheng G, Lin H, Yang M, Zhang YD, Han JM. J Dent 2019;88:103170. (Meta-Analysis)
Meta-Analysis
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION
Network Meta-Analysis on the Effect of Desensitizing Toothpastes on Dentine Hypersensitivity. Hu ML, Zheng G, Lin H, Yang M, Zhang YD, Han JM. J Dent 2019;88:103170.
SOURCE OF FUNDING
National Natural Science Foundation of China (81771119).
TYPE OF STUDY/DESIGN
Systematic review with meta-analysis of data.
Topics: China; Dentin Desensitizing Agents; Dentin Sensitivity; Humans; Toothpastes
PubMed: 32921380
DOI: 10.1016/j.jebdp.2020.101460 -
Nederlands Tijdschrift Voor... 2020Activated charcoal-based whitening dentifrices claim to whiten teeth. Scientific evidence for the actual whitening effect, however, is still limited. A search in PubMed...
Activated charcoal-based whitening dentifrices claim to whiten teeth. Scientific evidence for the actual whitening effect, however, is still limited. A search in PubMed shows one randomized controlled double blinded in vitro study in which the'Black is White Curaprox® dentifrice is less effective in reducing extrinsic staining than other whitening dentifrices. One systematic literature review and one review article concluded there is insufficient scientific evidence to substantiate the cosmetic benefits of charcoal-based dentifrices.
Topics: Dentifrices; Humans; Silicon Dioxide; Sodium Fluoride; Tooth Bleaching; Tooth Discoloration
PubMed: 32840494
DOI: 10.5177/ntvt.2020.07/08.20020 -
Brazilian Dental Journal Jun 2020There is an increased accessibility of over-the-counter (OTC) whitening agents with very little data in the literature regarding their effectiveness. This review was...
There is an increased accessibility of over-the-counter (OTC) whitening agents with very little data in the literature regarding their effectiveness. This review was done to determine their effectiveness of the predominant OTC whitening agents from 2006 until 2018 where a comparison of each agent was made with a placebo, no treatment or with other OTC whitening agents. The major categories of OTC whitening agents such as dentifrices, whitening strips and paint on gels. Dentist prescribed bleaching applied at home and in-office bleaching studies and studies that demonstrated whitening products to participants were excluded. Articles were searched for in the databases of Medline (Ovid), PubMed, the Cochrane Library and Cochrane Central Register of Controlled Trials. Twenty-four articles were included in the systematic review and the quality of studies was determined by the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) ranking criteria. Compared to other OTC, strips are reported to be effective. Two studies determined whitening strips to be effective. Whitening strips have been shown to be effective when compared with placebos and other OTC whitening agents. Dentifrices are effective in changing the shade of the tooth "by removing extrinsic stains" when compared to a placebo and non-whitening dentifrices, but they are not as effective in comparison to whitening strips. There is a lack of evidence with regards to the effectiveness of paint-on gels. While there is some evidence that OTC can alter shade in the short term, there is a need for better-designed studies.
Topics: Carbamide Peroxide; Humans; Tooth Bleaching; Tooth Bleaching Agents; Tooth Discoloration; Urea
PubMed: 32667517
DOI: 10.1590/0103-6440202003227