Llama la atención que un tema tan relevante como la prevención -en este caso desde la óptica del Fluor- no merezca mayor investigación, la blibliografía no es muy abundante, (si la comparamos con la investigación en materiales restauradores) pero si, concluyente.
Dr. Jorge Garat.
Braz Oral Res. 2009 Jul-Sep;23(3):296-301.
In vitro evaluation of fluoride products in the development of carious lesions in deciduous teeth.
Santos Lde M, Reis JI, Medeiros MP, Ramos SM, Araújo JM.
Federal University of Alagoas, Maceió, AL, Brazil. jilreis@uol.com.br
The purpose of this study was to evaluate the effect of the application of fluoride products on the development of enamel caries in deciduous teeth. A total of 108 deciduous teeth were chosen for the study. Acid-resistant varnish was applied on the teeth, leaving only one area of 5 mm x 1 mm of dental enamel exposed. The teeth were allocated randomly to one of the following groups: 1) control – toothpaste without fluoride; 2) 1.23% fluoride gel; 3) Duraflur fluoride varnish; 4) Duraphat fluoride varnish; 5) Fluorniz fluoride varnish; 6) Fluorphat fluoride varnish; 7) varnish with Duofluorid; 
12% silver fluoride diamine (Cariestop); 9) children’s fluoride toothpaste (500 ppm). The tested products were applied on the teeth according to the manufacturer’s recommendations and the teeth were stored in a moist environment for 24 hours. Each group of teeth was then subjected to a pH cycling model for 14 days, after which the teeth were cut through the center for an analysis of the depth of the carious lesion by polarized light microscopy. Comparisons were made between the treatments and the control group. The mean lesion depth values were 318 microm +/- 39 (control), 213 microm +/- 27 (fluoride gel), 203 microm +/- 34 (Duraflur), 133 microm +/- 25 (Duraphat), 207 microm +/- 27 (Fluor-niz), 212 microm +/- 27 (Fluorphat), 210 +/- 28 (Duofluorid), 146 +/- 31 (Cariestop) and 228 +/- 24 (fluoride toothpaste). None of the products used here was able to completely prevent the formation of lesions. The highest cariostatic effect was achieved by fluoride varnish Duraphat and the lowest by the fluoride toothpaste.
J Indian Soc Pedod Prev Dent. 2007 Oct-Dec;25(4):157-63.
Effect of fluoride varnish on Streptococcus mutans counts in plaque of caries-free children using Dentocult SM strip mutans test: a randomized controlled triple blind study.
Jeevarathan J, Deepti A, Muthu MS, Rathna Prabhu V, Chamundeeswari GS.
Department of Pediatric Dentistry, Meenakshi Ammal Dental College and Hospital, Chennai, Tamilnadu, India. dr_rathan@rediffmail.com
Dental caries is one of the most prevalent infectious diseases and although of multifactorial origin, Streptococcus mutans is considered the chief pathogen in its development. Fluoride is one of the most effective agents used for the reduction of dental caries apart from oral hygiene maintenance. AIMS: The aim of this study was… to estimate the counts of Streptococcus mutans and to evaluate the effect of Fluor Protector fluoride varnish on these counts in the plaque of caries-free children using Dentocult SM Strip Mutans. MATERIALS AND METHODS: Thirty caries-free subjects were selected for the study based on the information obtained from a questionnaire and were randomly assigned to the control group consisting of ten subjects and the study group consisting of twenty subjects. Plaque samples were collected on the strips from the Dentocult SM kit and after incubation, the presence of Streptococcus mutans was evaluated using the manufacturer’s chart. The study group was subjected to a Fluor Protector fluoride varnish application following which the samples were collected again after 24 hours. RESULTS: The average Streptococcus mutans counts in the primary dentition of caries-free children before and after the application of Fluor Protector fluoride varnish were 10(4)-10(5) colony forming units (CFU)/ml and <10(4) CFU/ml respectively. CONCLUSION: The results showed that the study group had a statistically significant reduction in the plaque Streptococcus mutans counts than the control group.
Braz Oral Res. 2007 Jul-Sep;21(3):228-33.
Anticariogenic effect of fluoride-releasing elastomers in orthodontic patients.
Miura KK, Ito IY, Enoki C, Elias AM, Matsumoto MA.
School of Dentistry of Ribeirão Preto, University of São Paulo, Brazil.
This in vivo experimental study evaluated the efficacy of fluoride-releasing elastomers in the control of Streptococcus mutans levels in the oral cavity. Forty orthodontic patients were recruited and divided into two groups of 20. Fluoride-releasing elastomeric ligature ties (Fluor-I-Ties, Ortho Arch Co. Inc., USA) were used in the experimental group, and conventional elastomeric ligature ties (D. Morelli, Brazil), in the control group. Two initial samples of saliva were collected at a 14-day interval to determine the number of colony forming units (CFU) of Streptococcus mutans. Immediately after collecting the second sample, fluoride-releasing elastomeric ligature ties were placed in the patients of the experimental group, and conventional ligature ties, in the patients of the control group. Seven, 14 and 28 days after placement of the elastomeric ligature ties, saliva and plaque surrounding the orthodontic appliance were collected for microbiologic analysis. There were no significant differences in the number of Streptococcus mutans CFUs in saliva or plaque in the area surrounding the fluoride-releasing or conventional elastomeric ligature ties. Thus, fluoride-releasing elastomeric ligature ties should not be indicated to reduce the incidence of enamel decalcification in orthodontic patients. Since there was no significant reduction in S. mutans in saliva or plaque, other means of prevention against enamel decalcification should be indicated for these patients.J Contemp Dent Pract. 2007 Nov 1;8(7):1-10.
Anticaries potential of commercial dentifrices as determined by fluoridation and remineralization efficiency.
Casals E, Boukpessi T, McQueen CM, Eversole SL, Faller RV.University of Barcelona in Barcelona, Spain.
AIM: The aim of this in vitro study was to investigate fluoride uptake in human enamel after use of commercially available toothpastes containing different fluoride compounds, or combinations of fluoride actives formulated into a single product, as a means of determining the efficiency of each formula for delivering caries preventing fluoride to demineralized (caries active) enamel. METHODS AND MATERIALS: Four test dentifrices and two controls were assessed and placed in groups as follows: Group 1: Lacer (Spain); Group 2: Positive control-USP Reference Standard 1100 ppm F; Group 3: Fluocaril Bi-Fluoré 250 (France); Group 4: Colgate Fluor Active (Denmark); Group 5: Elmex (France); and Group 6: A placebo (formulated the same as the USP Reference Standard toothpaste with the exception that it contained < 1 ppm F). Cores 3 mm in diameter were removed from erupted human enamel specimens (extracted by local oral surgeons for orthodontic reasons) and stored in 1% Thymol solution prior to use. They were ground and polished to remove the natural fluoride rich enamel layer, then exposed to a demineralization solution, and assessed for surface microhardness to enable randomization for use in the study. Each group of five specimens underwent a daily pH cycling procedure that involved exposure to pooled human saliva (refreshed three times daily). The groups were then exposed to dentifrice slurries four times daily for one minute per exposure and to a demineralization solution for three hours. The cycling procedure was repeated for five days. Specimens were again analyzed for surface microhardness and fluoride uptake upon completion of five days of treatment. RESULTS: Average surface hardness: Groups 2 and 3 showed a statistically significant greater (p<0.05) change indicating greater remineralization compared to all other groups. The average change was 23.45 for Group 2 and 22.65 for Group 3. All other groups had changes ranging from 4.25-8.62. No other statistically significant differences were observed between groups. Fluoride uptake results: Groups 2 and 3 showed statistically significantly greater fluoride uptake versus all other groups (p<0.05). Groups 1 and 5 were significantly different from Group 6. No other statistically significant differences were observed for either analysis. CONCLUSIONS: Of the marketed products included in the study, the Fluocaril Bi-Fluoré 250 product formulation provided both the highest level of fluoride uptake and mineralization to the demineralized enamel. The clinical significance of these in vitro results is the confirmation Fluocaril Bi-Fluoré 250 is effective at remineralizing enamel caries lesions.
Caries Res. 2007;41(6):455-9. Epub 2007 Sep 7.
Caries-preventive effectiveness of a fluoride varnish: a randomized controlled trial in adolescents with fixed orthodontic appliances.
Stecksén-Blicks C, Renfors G, Oscarson ND, Bergstrand F, Twetman S.
Department of Odontology, Paediatric Dentistry, Faculty of Medicine, Umeå University, Umeå, Sweden. christina.stecksen-blicks@odont.umu.se
The aim was to evaluate the efficacy of topical fluoride varnish applications on white spot lesion (WSL) formation in adolescents during treatment with fixed orthodontic appliances. The study design was a double-blinded randomized placebo-controlled trial with two parallel arms. The subjects were 273 consecutive 12- to 15-year-old children referred for maxillary treatment with fixed orthodontic appliances. The patients were randomly assigned to a test or a control group with topical applications of either a fluoride varnish (Fluor Protector) or a placebo varnish every 6th week during the treatment period. The outcome measures at debonding were incidence and progression of WSL on the upper incisors, cuspids and premolars as scored from digital photographs by 2 independent examiners. The attrition rate was 5%. The mean number of varnish applications was 10 (range 4-20) in both groups. The incidence of WSL during the treatment with fixed appliances was 7.4% in the fluoride varnish compared to 25.3% placebo group (p < 0.001). The mean progression score was significantly lower in the fluoride varnish group than in the placebo group, 0.8 +/- 2.0 vs. 2.6 +/- 2.8 (p < 0.001). The absolute risk reduction was 18% and the number needed to treat was calculated to 5.5. The results from the present study strongly suggest that regular topical fluoride varnish applications during treatment with fixed appliances may reduce the development of WSL adjacent to the bracket base. Application of fluoride varnish should be advocated as a routine measure in orthodontic practice. (c) 2007 S. Karger AG, Basel
Quintessence Int. 2005 Mar;36(3):183-9.
Use of laser fluorescence in monitoring the durability and cariostatic effects of fluoride and chlorhexidine varnishes on occlusal caries: a clinical study.
Gokalp S, Ba?eren M.
Hacettepe University, Faculty of Dentistry, Department of Conservative Dentistry, Ankara, Turkey.
OBJECTIVE: The aim of this study was to compare the effectiveness and caries-preventive effects of a fluoride varnish (Fluor Protector; 0.1% fluoride) and a chlorhexidine varnish (Cervitec; 1% chlorhexidine and 1% thymol) on initial caries of occlusal fissures and to monitor the durability of the varnishes by the use of a fluorescence system, DIAGNOdent (Dd). METHOD AND MATERIALS: Nineteen subjects underwent professional tooth cleaning at the beginning of the study. Afterward, fluorescence measurements (baseline) were obtained from 56 test sites and 28 control sites on the central fossae of molars. Each subject had Fluor Protector and Cervitec application on randomly assigned experimental teeth, and applications were followed by Dd measurements. Measurements were repeated after 1 and 6 months. RESULTS: There was an increase in fluorescence values immediately after application of varnish in the two test groups. One month after varnish application, Dd scores for group Fluor Protector were not significantly different from Dd scores obtained immediately after application (P = .108), whereas Dd scores for group Cervitec decreased significantly (P = .007). For both test groups, there was a significant decrease between the values obtained immediately after application and those acquired after 6 months. There was also a significant decrease between 1 month and 6 months for test groups and a slight but significant increase for the control group (P = .011). No significant difference was found between the Fluor Protector and Cervitec groups after 6 months. CONCLUSION: It was concluded that the Dd system may be used to monitor the existence of these two varnishes.
Br Dent J. 2003 Sep 27;195(6):313-7.
Prevention. Part 7: professionally applied topical fluorides for caries prevention.
Hawkins R, Locker D, Noble J, Kay EJ.
University of Toronto, Ontario, Canada. robert.haekins@utoronto.ca
This paper reviews the use of professionally applied topical fluorides (PATF) in caries prevention. PATFs are indicated for children and adults with one or more decayed smooth surfaces and/or those who are at high caries risk. Frequency of administration depends on the patient’s caries risk, and is usually every 6 months. The effectiveness of fluoride varnish and gel applications has been well established in caries prevention trials involving permanent teeth. Although both types are effective, varnish may be preferred because it is easier to apply, reduces the risk of fluoride over-ingestion, and has greater patient acceptance. Fluoride foams are similar products to gels, but have not been tested clinically. The use of in-office two-part rinses is not recommended because they have not been proven effective. A cleaning, or prophylaxis, is not necessary before the application of topical fluoride for caries prevention. In conclusion, when used appropriately, PATFs are a safe, effective means of reducing caries risk among high-risk populations.
3:45 PM-5:00 PM, Friday, March 8, 2002 San Diego Convention Center Exhibit Hall C
Streptococcus mutans in vitro Colonization of Enamel Treated with One, two and Three Applications of a 5% Sodium Fluoride Varnish
I. URZUA, G. MONCADA, V. ARANGUIZ1, P. UZEDA, and M. ULLOA.
Chile University Dental School, Chile.
Objectives: The purpose of this study was to determine the effects of the application of a 5% Sodium Fluoride varnish (Duraphat*) on the quantitative and in vitro colonization of S. Mutans on human enamel. Methods: Enamel chips from free surfaces of healthy pre molars extracted by orthodontic indication were set up into five groups. Group 1 of 12 specimens treated once with the NaF varnish; Group 2, 12 chips treated in two stages with layers of the same NaF varnish; Group 3, 2 chips treated three times with NaF; Group 4 had 4 chips treated with one layer of 10% Chlorhexidine varnish(CHX)(Chlorzoin**) as positive control and Group 5 which had 4 chips untreated as negative control. The study was conducted by immersing each specimen into serial dilutions of ATCC 35668 S. mutans (10 CFU/ml –Todd Hewitt Broth), incubated at 37° C under 3-5% CO2. Count of CFUs of S. Mutans adhered to the chips was performed 14 days later. The count was performed after scraping the surface of the chips with a minibrush which was blaced in a tube with buffer phosphated solution, then vortexed for one min. and inoculated on to agar blood plates. Results: The results for the five groups are:Median values (expressed as CFU/ml x 106, )Group 1 (1.99);Group 2 (1.50);Group 3 (1.16);Group 4( 0.60);Group 5 (8.30). Variance Group 1( 0.059);Group 2( 0.097);Group 3 (0.019);Group 4 (0.002);Group 5 (1.455) and Standard Deviation Group 1 (0.242);Group 2 (0.312);Group 3 (0.137);Group 4( 0.041);Group 5(1.206). Conclusions: Group 4, treated with 10% CHX varnish, had the highest reduction in S. mutans. Group 3 treated three times with 5% NaF varnish had a greater reduction, 71.6% (p=0.019) (SD 0.019), of S. mutans than that of Group 1. Two applications of 5%NaF reduced the S. mutans population 32.6% (p=0.097)(SD 3.12), as compared to Group 1.
J Am Dent Assoc, 131:589-596, 2000 10-16
Fluoride Varnishes: A Review of Their Clinical Use, Cariostatic Mechanism, Efficacy and Safety
Beltran-Aguilar ED, Goldstein JW, Lockwood SA
Surveillance, Investigations and Research Branch, Division of Oral Health, Centers for Disease Control and Prevention, CDC-DOH, Chamblee, Ga. 30341, USA.
Fluoride varnishes have been widely used in European countries, where they have contributed to sharp declines in caries incidence. A growing body of scientific and clinical data support their efficacy. The current status of fluoride varnishes–including their clinical application, mechanism of cariostatic effect, safety, and toxicity–was reviewed.
Clincial Use.–Three fluoride varnishes are currently approved for use in the United States: Duraphat and Durafluor, both with 5% sodium fluoride/2.26% fluoride; and Fluor Protector, 1% difluorosilane/0.1% fluoride (Table). These products are approved as medical devices for use as cavity liners and for the treatment of tooth sensitivity. Additional review would be required to approve them as anticaries agents.
In clinical use, the teeth are simply cleaned, and 0.3 to 0.5 mL of varnish is applied directly to the teeth for 1 to 4 minutes, depending on the number of teeth treated. Patients should not eat for 2 to 4 hours after application. Annual application appears to be the most common schedule. Extensive studies from Europe and elsewhere support the efficacy of fluoride varnishes in preventing dental caries. So far, all of these studies have been conducted in children; Duraphat has been the most extensively evaluated. Several factors must be considered in interpreting these trials, but the quality of the supporting evidence is considered level I, the highest possible rating.
Mechanism and Toxicity.–Many studies have established the fact that fluoride varnishes deposit large amounts of fluoride on human enamel, with an even greater amount on demineralized enamel. Remineralization of early caries appears to be the major cariostatic effect. Some calcium fluoride may be lost to saliva, but this may serve as a reservoir of fluoride ions. Under favorable conditions, part of this calcium fluoride is redeposited as fluorapatite. Studies show that Fluor Protector produces consistently higher fluoride deposits than Duraphat, despite its lower fluoride content.
Fluroide varnishes are used in small doses and have a rapid setting time, yet there is still a risk that small children will ingest some of the product during placement. However, the rate of acute toxic reactions is minimal, lower than with acidulated phosphate fluoride gels. Because exposure is infrequent, the risk of dental fluorosis is also minimal. A temporary change in tooth color is the only disadvantage of fluoride varnishes.
Discussion.–Extensive data support the efficacy and safety of fluoride varnishes for caries prevention. These products have significant advantages over other forms of topical fluoride and can be tailored for use in high-risk children. Fluoride varnishes are not approved for caries prevention in the United States, but many dentists are using them for this purpose in off-label fashion. More research of these products is needed, including their use in high-risk preschool children, their use in preventing root caries, and their cost-effectiveness characteristics.
This review of the evidence of efficacy of fluoride varnishes concludes that they are as good as other topical fluoride products in preventing dental caries. Fluoride varnishes are easy to apply, especially for targeted tooth surfaces, and expose patients to lower amounts of fluoride than do fluoride gels.
Rev Belge Med Dent – 1998; 53(1): 269-77
Fluoride dentifrices
Declerck D
School voor Tandheelkunde, Katholieke Universiteit Leuven.
The introduction of fluoride-containing dentifrices is held responsible for the important decrease in caries prevalence that was seen in the past decades. Fluoride in toothpaste is available in different formulations and combinations. Differences exist between dentifrices regarding the concentration of fluoride in the paste. Optimal results are obtained at levels of 1000 ppm fluoride. The efficiency of low-dose products is still a matter of further investigation. More research is necessary to determine the amount of toothpaste that should be used and the optimal frequency of use.
Pediatr Dent 2000 Nov-Dec;22(6):513-6
Fluoride varnishes: should we be using them?
Vaikuntam J.
Department of Pediatric Dentistry, University of Texas Health Science Center at San Antonio, USA. Vaikuntam@uthscsa.edu
Fluoride varnishes are fast becoming the standard of care as topical fluoride treatments. Fluoride varnishes still await approval from the FDA for use as caries preventive agents. In the meantime, their use for such purposes is considered “off-label.” This article highlights the efficacy of fluoride varnishes as caries preventive agents and introduces some of the commercially available fluoride varnishes to the reader. As more clinical trials in the US unravel the efficacy of these agents, there is little doubt that fluoride varnishes will become an integral part of our preventive armamentarium in the battle against dental caries.
Caries Res – 2000 Mar-Apr; 34(2): 140-3
Effect of quarterly treatments with a chlorhexidine and a fluoride varnish on approximal caries in caries-susceptible teenagers: a 3-year clinical study.
Petersson LG; Magnusson K; Andersson H; Almquist B; Twetman S
Department of Preventive and Paediatric Dentistry, Medical and Dental Health Centre, Lanssjukhuset, Sweden. lars.g.petersson@lthalland.se
The aim of this study was to compare the effect of two different dental varnishes on approximal caries incidence in teenagers with proven caries susceptibility during a 3-year period. Two hundred 13- to 14-year-old subjects exhibiting at least two approximal enamel caries lesions were selected to take part in the study. One hundred and eighty subjects participated after informed consent and were randomly assigned to two equally sized groups. One group was treated with a fluoride varnish (FV, Fluor Protector) containing 0.1% F every 3rd month and the participants of the other group were treated in the same mode with a chlorhexidine varnish (CV, Cervitec((R))) containing 1% chlorhexidine and 1% thymol. In total, each subject was treated 12 times during the experimental period. Approximal caries including enamel lesions (DMFS(appr)) were recorded from four bitewing radiographs exposed at the start and end of the study. The mean (+/-SD) caries prevalence at baseline was 2.2+/-3.4 in the FV group and 2.5+/-4.0 in the CV group. After 3 years, the average approximal caries incidence was 2.7+/-3.1 and 3.1+/-3.5 in the FV and CV groups, respectively. The differences at baseline and after 3 years were not statistically significant. In conclusion, treatments every 3rd month with either a fluoride- or a chlorhexidine/thymol-containing varnish showed a promising effect with low approximal caries incidence and progression in teenagers with proven caries susceptibility.
Am J Orthod Dentofacial Orthop 2001 Jul;120(1):28-35
Am J Orthod Dentofacial Orthop 2001 Sep;120(3):279
Effects of combined application of antimicrobial and fluoride varnishes in orthodontic patients.
Ogaard B, Larsson E, Henriksson T, Birkhed D, Bishara SE.
Department of Orthodontics, Faculty of Dentistry, University of Oslo, Oslo, Norway. bogaard@odont.uio.no
A randomized prospective clinical study, with 220 patients scheduled for fixed orthodontic therapy, was conducted to test the hypothesis that application of an antimicrobial varnish in combination with a fluoride varnish (group 1) is significantly more efficient in reducing white spot lesions on the labial surfaces than application of the fluoride varnish alone (group 2). The effects of the antimicrobial varnish on the occurrence of gingivitis and plaque formation were also studied. A third aim was to investigate whether white spot lesion development could be predicted early during treatment. The antimicrobial varnish significantly reduced the number of mutans streptococci in plaque during the first 48 weeks of treatment. This effect did not result in significantly less development of white spot lesions on the labial surfaces compared with the group receiving only the fluoride varnish application. There was however a clear trend that the combination of the antimicrobial and fluoride varnishes more effectively reduced the increments of new lesions on the maxillary incisors. It was speculated that this could be due partly to an inhibiting effect of the antimicrobial varnish in an area with low oral clearance (with low pH and loss of fluoride) and partly to an inhibiting effect of the varnish on mutans streptococci. No significant differences between the groups with respect to gingivitis and plaque were found. Lesion development was difficult to predict early after bonding, despite a number of caries-relevant parameters of orthodontic importance. The best predictors for white spot lesions at debonding were visible plaque and mutans streptococci (eg, the level of oral hygiene and thus the cariogenic challenge) around the appliance shortly after bonding.
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