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Sodium Fluoride With Tricalcium Phosphate
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This was a 24-month randomized controlled trial designed to compare the effectiveness of a 25% AgNO3 solution followed by a 5% NaF varnish (group A) with that of a 25% AgNO3 solution followed by a 5% NaF varnish with functionalized tricalcium phosphate (fTCP; group B) in arresting dentine caries in preschool children when applied semiannually. The mean (SD) number of arrested carious tooth surfaces per child in group A was 1.8 (2.2), whereas the number in group B was 2.6 (3.3). At the tooth surface level, the caries arrest rate was 42.1% for group A and 56.7% for group B (P < .001). Results of the hierarchical generalized linear model indicated that the protocol for group B had a higher predicted probability (PP, 0.656) in arresting dentine caries than did the protocol for group A (PP, 0.500) when the carious lesions were on buccal/lingual surfaces, on anterior teeth, had dental plaque coverage, and were in children from low-income families (P = .046).
- Conventional restorative treatment for the management of dentine caries in primary teeth is often inaccessible and unaffordable and can be fraught with behavioral challenges. Silver diamine fluoride can be used to arrest caries, but it is not available in some countries, whereas NaF with fTCP and AgNO3 are generally available. While laboratory studies have shown promising results demonstrating the caries-arresting effectiveness of NaF varnish with fTCP in complement with AgNO3 solution, the present study is the first clinical trial on NaF with fTCP, and provides scientific evidence of the potential benefit of complementing AgNO3 with the use of fTCP on caries arrest in young children. The authors conclude that topical application of 25% AgNO3 solution followed by 5% NaF varnish with fTCP is more effective in arresting dentine caries in primary teeth than application of 25% AgNO3 followed by 5% NaF varnish without fTCP and represents a medical model for caries management in young children.
abstract
This abstract is available on the publisher's site.
Access this abstract nowThis 24-mo randomized controlled trial was based on a double-blind parallel design, and it compared the effectiveness of 2 fluoride application protocols in arresting dentine caries in primary teeth. Three-year-old children with active dentine caries were recruited and randomly allocated to 2 treatment groups. Children in group A received a semiannual application of a 25% silver nitrate (AgNO3) solution followed by a commercially available varnish with 5% sodium fluoride (NaF) on the carious tooth surfaces. Children in group B received a semiannual application of a 25% AgNO3 solution followed by another commercially available varnish with 5% NaF containing functionalized tricalcium phosphate (fTCP). Carious tooth surfaces that were hard when probing were classified as arrested. Intention-to-treat analysis and a hierarchical generalized linear model were undertaken. A total of 408 children with 1,831 tooth surfaces with active dentine caries were recruited at baseline, and 356 children (87%) with 1,607 tooth surfaces (88%) were assessed after 24 mo. At the 24-mo evaluation, the mean (SD) number of arrested carious tooth surfaces per child were 1.8 (2.2) and 2.6 (3.3) for group A (without fTCP) and group B (with fTCP), respectively (P = 0.003). The arrest rates at the tooth surface level were 42% for group A and 57% for group B (P < 0.001). Results of the hierarchical generalized linear model indicated that protocol B (with fTCP) had a higher predicted probability (PP = 0.656) in arresting dentine caries than protocol A (without fTCP; PP = 0.500) when the carious lesions were on buccal/lingual surfaces, were on anterior teeth, had dental plaque coverage, and were in children from low-income families (P = 0.046). In conclusion, protocol B, which applied a 25% AgNO3 solution followed by a commercially available 5% NaF varnish with fTCP semiannually, is more effective in arresting dentine caries in primary teeth as compared with protocol A, which applied a 25% AgNO3 solution followed by another commercially available 5% NaF varnish without fTCP semiannually (ClinicalTrials.gov NCT03423797).
Additional Info
Randomized Clinical Trial on Sodium Fluoride With Tricalcium Phosphate
J. Dent. Res. 2021 Jan 01;100(1)66-73, KJ Chen, SS Gao, D Duangthip, ECM Lo, CH ChuFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Clinical Dentistry
The paradigm shift in contemporary caries management has accentuated minimally invasive techniques and preservation of existing tooth structure, with emphasis on chemical approaches to halt caries progression. Silver nitrate (AgNO3) has been used in dentistry not only for its hemostatic effect on biopsy sites but also for its antibacterial property on carious lesions. Sodium fluoride (NaF) varnish is known for its caries-inhibiting effect and is widely used for caries prevention. The application of AgNO3 and NaF varnish has shown to be effective in arresting cavitated dentine caries in vivo and in vitro. To enhance the remineralization process and fluoride-based nucleation activity, functionalized tricalcium phosphate (fTCP) has recently been incorporated into NaF varnish. This 24-month, double-blind, randomized clinical trial investigated the caries-arresting effectiveness on cavitated primary dentition, and compared two treatment modalities of 25% AgNO3 solution followed by 5% NaF varnish with and without fTCP. The study design utilized a visual–tactile assessment and had a large sample size with a high retention rate. Based on data analysis, several variables, such as absence of plaque accumulation, anterior teeth, and buccal/palatal surfaces, enhanced the caries arrest process, as compared with plaque presence, posterior teeth, and proximal/occlusal surfaces, respectively. Hence, tooth location, surface type, and plaque were risk factors and could potentially affect outcome of the intervention. Other factors that influenced the caries arrest rate were bottle-feeding practice and socioeconomic status. The addition of fTCP to 5% NaF varnish appeared to be more effective in arresting dentine caries in cavitated lesions than 5% NaF varnish without fTCP, and the differences were statistically significant. The application of 25% AgNO3 followed by 5% NaF varnish with fTCP therefore provides a minimally invasive and viable option in caries control for young children with caries, special needs patients, and children who are unable to tolerate dental procedures.