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ORIGINAL ARTICLE
Year : 2018  |  Volume : 36  |  Issue : 3  |  Page : 257-261
 

Effect of fluoridated varnish and silver diamine fluoride on enamel demineralization resistance in primary dentition


1 Department of Pediatric Dentistry, Oral and Dental Disease Research Center, School of Dentistry, Shiraz University of Medical Science, Shiraz, Iran
2 Oral and Dental Disease Research Center, School of Dentistry, Shiraz University of Medical Science, Shiraz, Iran

Date of Web Publication24-Sep-2018

Correspondence Address:
Dr. Najmeh Mohammadi
Ghasrodasht Street, Ghom Abad Avenue, Shiraz Dental School, Shiraz
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISPPD.JISPPD_4_18

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   Abstract 


Background: International data on caries epidemiology confirm that dental caries remains a significant disease of childhood in both developing and developed countries. Based on preventive dentistry, topical fluoride may be a useful measure to arrest caries lesions. Fluoride used in various forms have been proven to be effective in dental caries prevention. Aim: This study aims to compare the effect of fluoridated varnish and silver diamine fluoride (SDF) solution on primary teeth enamel resistance to demineralization. Methods: Forty-five caries-free deciduous canine teeth extracted due to orthodontic reasons, devoid of any defects were selected. Teeth were mounted on acrylic blocks as their buccal surface was exposed and baseline surface microhardness (SMH) determination was accomplished. Enamel samples were randomly distributed into three groups with 15 specimens each. One group was used as control (distilled and deionized water) (C); in the other groups, either a fluoridated varnish (V) or an SDF solution was applied to the enamel blocks. The blocks of each group were submitted to pH-cycling solutions and treatment regimen. After pH-cycling process, SMH determination was done again for all samples. Results: According to the present findings, the percentage of decrease in SMH of control group is numerically greater than other groups and also SDF group shows the most resistance against mineral loss. However, based on one-way ANOVA test, this difference is not statistically significant (P = 0.217). Conclusion: SDF solution and fluoride varnish display similar effectiveness in preventing the demineralization of deciduous anterior teeth, and no significant difference was observed.


Keywords: Enamel demineralization, fluoride varnish, primary teeth, silver diamine fluoride


How to cite this article:
Mohammadi N, Farahmand Far MH. Effect of fluoridated varnish and silver diamine fluoride on enamel demineralization resistance in primary dentition. J Indian Soc Pedod Prev Dent 2018;36:257-61

How to cite this URL:
Mohammadi N, Farahmand Far MH. Effect of fluoridated varnish and silver diamine fluoride on enamel demineralization resistance in primary dentition. J Indian Soc Pedod Prev Dent [serial online] 2018 [cited 2019 Nov 22];36:257-61. Available from: http://www.jisppd.com/text.asp?2018/36/3/257/241971





   Introduction Top


Dental caries is one of the most common chronic dental diseases in all countries and all populations with varying degree of severity.[1] International data on caries epidemiology confirm that dental caries remains a significant disease of childhood in both developing and developed countries.[2] Treatment of dental caries, especially in children may require advanced skills of clinicians and sometimes high cost of general anesthesia for patient management.[1]

Based on preventive dentistry, use of topical fluoride may be a useful measure to arrest caries lesions because fluoride used in various forms have been proven to be effective in dental caries prevention.[3]

Due to the characteristics of deciduous teeth enamel (half as thick as that of permanent teeth,[4] lower mineral content and higher organic content,[5] and more susceptibility to caries), use of fluoride to control the development and progression of carious lesions is so important in primary dentition.[4] Topical application of fluoride has been proven to be the most important method in combating carious lesions.[6],[7],[8],[9]

High-concentration topical fluoride agents, such as 5% sodium fluoride (NaF) varnish containing 22,600 ppm fluoride have been used to arrest caries. Although encouraging results have reported in clinical trials using topical NaF solution or NaF varnish,[10],[11],[12],[13] other newer products also have been introduced.

One of the newest fluoride products is silver diamine fluoride (SDF). SDF 38% solution containing 44,800 ppm fluoride have been used to arrest caries. Chu et al. in a clinical trials showed that SDF prevented and arrested coronal caries in primary teeth in preschool children[11] and in root surface of permanent teeth in adult.[14] The mechanism of action of SDF is hypothesized to be its anticariogenic properties,[15],[16] ability to increase enamel surface microhardness (SMH), and reduce enamel surface mineral loss.[17],[18] Laboratory studies have also found that SDF has an intense antibacterial effect on cariogenic biofilm and hinders caries progression.[19],[20],[21]

In dentistry, different pH-cycling models have been developed to evaluate the fluoride effect in either reducing enamel demineralization or enhancing remineralization. These approaches have been used with tremendous success in cariology.[22]

In infants, both fluoridated varnish and SDF have been indicated and used due to their easy application and safety. However, comparison between these two fluoride agents on enamel resistance to demineralization process has not been clearly established. Thus, the aim of this investigation is to study the effect of the application of a fluoridated varnish or SDF solution on enamel microhardness and resistance to demineralization in an in vitro cariogenic challenge by pH-cycling method.


   Methods Top


Experimental design

The caries-free anterior deciduous teeth, devoid of stains or any other defects visible under a stereoscopic magnifying glass were selected. The teeth were collected from patients who needed primary teeth extraction due to orthodontic reasons after informed consent. Teeth were immersed in 1% thymol and stored in a refrigerator until their use. After cutting the roots with diamond disks, teeth were mounted on acrylic blocks as their buccal surface was exposed and enamel blocks (4 mm × 4 mm) were obtained. The enamel surface was polished and then baseline SMH determination was accomplished using a Future-Tech FM-ARS microhardness tester (Future-Tech Corp., Tokyo, Japan) with a Knoop diamond under 25-g load for 5 s. Five indentations were made at the center of the enamel surface. The objectives of baseline SMH determination was to select the blocks with the same SMH range and calculate the SMH change that occurs after pH-cycling. Enamel samples were randomly distributed into three groups with 15 specimens each. One group was used as control (distilled and deionized water) (C); in the other groups, either a fluoridated varnish (V) or a SDF solution (SDF) was applied to the enamel blocks. The blocks of each group were submitted to pH-cycling solutions. After pH-cycling process, SMH determination was done again for all samples.

Treatments and pH-cycling

A thin layer of fluoridated varnish (Duraphat 2.26% F-pH 7.0, Woelm and Pharma Co., Eschwege, Germany) was applied with a brush to the enamel blocks of the “V” group. After 24 h, the varnish was removed carefully with a surgical blade. Removal was completed with cotton swabs soaked in acetone. Then, the blocks were washed with deionized water for 1 min. SDF ((38% w/v) (Saforide solution [J Morita Company, JAPAN]) was applied with a cotton swab to the enamel blocks of the SDF group for 2 min. After application, the blocks were washed with a flow of deionized water for approximately 30 s and lightly dried with absorbent paper.

The blocks from each group were submitted to a pH-cycling model simulating a high caries challenge for 7 days, basically according to Vieira et al.[22] The blocks were kept in demineralizing solution (2.0 mmol/L calcium, 2.0 mmol/L phosphate in 0.075 mol/L acetate buffer, and 0.02 μm F/mL, pH 4.7) for 3 h (35.5 mL per block), and in a remineralizing solution (1.5 mmol/L calcium, 0.9 mmol/L phosphate, 150 mmol/L KCl in 0.1 mol/L Tris buffer, and 0.03 mm F/mL, pH 7.0) for 21 h (17.75 mL per block). The de- and remineralizing solutions were changed daily to prevent depletion or saturation of the solution and accumulation of enamel dissolution products. The cycle was repeated daily for 5 days and the enamel blocks remained in the remineralizing solution for 2 days until the analysis.

Microhardness determination

After pH-cycling, SMH of the blocks from the C, V, and SDF groups measured again (SMH1). Five indentations spaced 100 μm from each other in relation to the baseline were made using the microhardness tester Shimadzu HMV-2000 (Shimadzu Corporation, Kyoto, Japan). The percentage loss of SMH (%SML) calculated (%SML = [(SMH1 – SMH)/SMH] × 100). The results were analyzed with SPSS package, version 20 (SPSS Inc., Chicago, IL, USA).


   Results Top


Mean values of enamel SMH for all three groups: control (C), sodium fluoride varnish (V), and SDF before and after the pH-cycling process have been presented in [Table 1].
Table 1: Mean values of enamel surface microhardness before and after pH-cycling process

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In this study, no statistically significant difference was observed between the control, sodium fluoride varnish, and SDF groups before the pH recycling process (P = 0.217). Hence, the data were confirmed to be homogenous.

After pH-cycling process, analysis of data by Paired t-test showed that the decrease of microhardness was statistically significant in all three groups of the study (P = 0.00).

The percentage loss of SMH (%SML) calculated for all groups (%SML = [(SMH1 – SMH)/SMH] x 100) and is shown in [Table 2] and [Figure 1]. [Figure 2] shows the mean values of enamel surface microhardness before and after pH-cycling process and percentage of microhardness loss for all groups of the study.
Table 2: Percentage of microhardness decrease in three groups

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Figure 1: Percentag of microhardness loss (%SML) for all groups

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Figure 2: Mean values of enamel surface microhardness before and after pH-cycling process and percentage of microhardness loss for all groups

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According to the present findings, the percentage of decrease in SMH of control group is numerically greater than other groups and SDF group shows the most resistance against mineral loss. However, based on one-way ANOVA analysis, this difference is not statistically significant (P = 0.219).


   Discussion Top


The aim of the present study was to compare the effect of two fluoride therapy products on primary teeth enamel resistance to demineralization using pH-cycling method.

Measuring the surface characteristics of teeth by means of microhardness test is a common method for studying enamel surface changes after remineralization and demineralization cycles.

In order to rule out the initial SMH variations of enamel samples, SMH in all three groups was measured and found to have no statistically significant difference (P = 0.217). Hence, changes in microhardness values after intervention would be attributed to the fluoride therapy procedure.

The effect of fluoride ion on surface hardness of dental enamel has been investigated in numerous studies. Argenta et al. studied the effect of fluoride on the surface hardness of teeth and found that higher concentrations of fluoride ion were correlated with decrease in loss of inorganic content.[23]

Wiegand also showed that increasing fluoride concentration results in higher microhardness of enamel samples.[24]

Various forms of fluoridated products have been compared in former studies. Lee et al. in 2009 investigated the effectiveness of three local fluoride therapy agents (NaF 2% solution, APF foam, and fluoride varnish) and observed that changes in microhardness as a result of the application of these agents were not significantly different.[25]

SDF is one of the latest fluoride-containing products that its influence on arresting caries has been evaluated formerly in several clinical studies. Chu et al. examined the effect of SDF and sodium fluoride varnish on arresting carious lesions in the dentin in Chinese children. After 30 months, they found SDF to be effective in arresting caries in deciduous anterior maxillary teeth.[11] Yee et al. also found 38% silver fluoride to be effective in arresting dental caries.[26]

There are controversial results comparing SDF and fluoride varnish efficacy. In a review of the article, it was reported that SDF is more effective than sodium fluoride in preventing caries.[27] However, in contrary to these results, in a study on bovine incisors, Delbem et al. found that fluoride varnish displays a stronger effect on caries prevention.[17]

Based on the results of our study, the difference of the effect of SDF and fluoride varnish on enamel resistance to demineralization was not statistically significant. This would be because the effect of SDF is more prominent on dentinal caries. In a study by Chu et al., it was shown that SDF is more effective on dentinal carious lesions. The reason is that dentinal tissue has a higher content of protein, carbonate, and phosphate available to react with silver. In contrast, these compounds are scarce in enamel tissue.[19]

In the present study, samples treated with SDF and fluoride varnish showed higher quantitative resistance to demineralization compared to the control group. Even though this difference was not statistically significant, it can be substantial in clinical use. As we know, fluoride therapy is more effective in clinical practice if it is done repeatedly and regularly. By repeating fluoride therapy at least two times per year, the difference would be more significant clinically.

However, other researches also in former studies reported the same results. In 2009 Lee et al. examined the effect of three fluoride containing local agents on remineralizing incipient carious lesions. They found that fluoride did not have an increasing effect on SMH compared to the control group.[25]

In dental practice, the most prominent disadvantage of silver compounds is the black discoloration, particularly on carious tissue and on occasion causes esthetic problems. Potassium iodide can be used to reduce this effect since silver iodide is white. Other studies have used other reducing agents to lower the amount of silver ions. Tannic acid has been used to facilitate the sedimentation of silver ions without interfering with anticaries effect of SDF.[26]

In overall, discoloration in deciduous teeth or teeth that can be restored in future is not a prominent concern.


   Conclusion Top


According to the present findings, SDF and fluoride varnish act similarly in preventing the demineralization of deciduous anterior teeth.

Acknowledgments

The authors would like to thank the Vice-Chancellory of Shiraz University of Medical Science for supporting this research. This manuscript is based on the thesis number: 1922 by Dr. Mohammad Hossein Farahmand Far with the advisory of Najmeh Mohammadi. The authors also thank Dr. Mehrdad Vosughi of the Center for Research Improvement of the School of Dentistry for the statistical analysis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Chu CH. Treatment of early childhood caries: A review and case report. Gen Dent 2000;48:142-8.  Back to cited text no. 1
    
2.
Chu CH, Lo EC. Promoting caries arrest in children with silver diamine fluoride: A review. Oral Health Prev Dent 2008;6:315-21.  Back to cited text no. 2
    
3.
Hiiri A, Ahovuo-Saloranta A, Nordblad A, Mäkelä M. Pit and fissure sealants versus fluoride varnishes for preventing dental decay in children and adolescents. Cochrane Database Syst Rev 2006;17:CD003067.  Back to cited text no. 3
    
4.
Mortimer KV. The relationship of deciduous enamel structure to dental disease. Caries Res 1970;4:206-23.  Back to cited text no. 4
    
5.
Brown LJ, Wall TP, Lazar V. Trends in total caries experience: Permanent and primary teeth. J Am Dent Assoc 2000;131:223-31.  Back to cited text no. 5
    
6.
Chedid S. Evaluation of the amount of fluoride dentifrice or 0.02% NaF in the development of caries in deciduous teeth: an in vitro study using pH cycling model [Doctoral Thesis]. São Paulo: Faculty of Dentistry, University of São Paulo; 1999.  Back to cited text no. 6
    
7.
Hicks J, Wild T, Flaitz CM, Seybold S. Fluoride varnishes and caries development in primary tooth enamel: An in vitro study. ASDC J Dent Child 2001;68:304-10, 300.  Back to cited text no. 7
    
8.
ten Cate JM. Current concepts on the theories of the mechanism of action of fluoride. Acta Odontol Scand 1999;57:325-9.  Back to cited text no. 8
    
9.
Rølla G, Saxegaard E. Critical evaluation of the composition and use of topical fluorides, with emphasis on the role of calcium fluoride in caries inhibition. J Dent Res 1990;69:780-5.  Back to cited text no. 9
    
10.
Llodra JC, Rodriguez A, Ferrer B, Menardia V, Ramos T, Morato M, et al. Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial. J Dent Res 2005;84:721-4.  Back to cited text no. 10
    
11.
Chu CH, Lo EC, Lin HC. Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin caries in Chinese pre-school children. J Dent Res 2002;81:767-70.  Back to cited text no. 11
    
12.
Milgrom P, Rothen M, Spadafora A, Skaret E. A case report: Arresting dental caries. J Dent Hyg 2001;75:241-3.  Back to cited text no. 12
    
13.
Lo EC, Schwarz E, Wong MC. Arresting dentine caries in Chinese preschool children. Int J Paediatr Dent 1998;8:253-60.  Back to cited text no. 13
    
14.
Lo EC, Luo Y, Tan HP, Dyson JE, Corbet EF. ART and conventional root restorations in elders after 12 months. J Dent Res 2006;85:929-32.  Back to cited text no. 14
    
15.
Knight GM, McIntyre JM, Craig GG, Mulyani, Zilm PS, Gully NJ, et al. Differences between normal and demineralized dentine pretreated with silver fluoride and potassium iodide after an in vitro challenge by Streptococcus mutans. Aust Dent J 2007;52:16-21.  Back to cited text no. 15
    
16.
Knight GM, McIntyre JM, Craig GG, Mulyani, Zilm PS, Gully NJ, et al. Inability to form a biofilm of Streptococcus mutans on silver fluoride- and potassium iodide-treated demineralized dentin. Quintessence Int 2009;40:155-61.  Back to cited text no. 16
    
17.
Delbem AC, Bergamaschi M, Sassaki KT, Cunha RF. Effect of fluoridated varnish and silver diamine fluoride solution on enamel demineralization: PH-cycling study. J Appl Oral Sci 2006;14:88-92.  Back to cited text no. 17
    
18.
Chu CH, Lo EC. Microhardness of dentine in primary teeth after topical fluoride applications. J Dent 2008;36:387-91.  Back to cited text no. 18
    
19.
Chu CH, Mei L, Seneviratne CJ, Lo EC. Effects of silver diamine fluoride on dentine carious lesions induced by Streptococcus mutans and Actinomyces naeslundii biofilms. Int J Paediatr Dent 2012;22:2-10.  Back to cited text no. 19
    
20.
Mei ML, Li QL, Chu CH, Lo EC, Samaranayake LP. Antibacterial effects of silver diamine fluoride on multi-species cariogenic biofilm on caries. Ann Clin Microbiol Antimicrob 2013;12:4.  Back to cited text no. 20
    
21.
Knight GM, McIntyre JM, Craig GG, Mulyani, Zilm PS, Gully NJ, et al. An in vitro model to measure the effect of a silver fluoride and potassium iodide treatment on the permeability of demineralized dentine to Streptococcus mutans. Aust Dent J 2005;50:242-5.  Back to cited text no. 21
    
22.
Vieira AE, Delbem AC, Sassaki KT, Rodrigues E, Cury JA, Cunha RF, et al. Fluoride dose response in pH-cycling models using bovine enamel. Caries Res 2005;39:514-20.  Back to cited text no. 22
    
23.
Argenta RM, Tabchoury CP, Cury JA. A modified pH-cycling model to evaluate fluoride effect on enamel demineralization. Pesqui Odontol Bras 2003;17:241-6.  Back to cited text no. 23
    
24.
Wiegand A, Krieger C, Attin R, Hellwig E, Attin T. Fluoride uptake and resistance to further demineralisation of demineralised enamel after application of differently concentrated acidulated sodium fluoride gels. Clin Oral Investig 2005;9:52-7.  Back to cited text no. 24
    
25.
Lee YE, Baek HJ, Choi YH, Jeong SH, Park YD, Song KB, et al. Comparison of remineralization effect of three topical fluoride regimens on enamel initial carious lesions. J Dent 2010;38:166-71.  Back to cited text no. 25
    
26.
Yee R, Holmgren C, Mulder J, Lama D, Walker D, van Palenstein Helderman W, et al. Efficacy of silver diamine fluoride for arresting caries treatment. J Dent Res 2009;88:644-7.  Back to cited text no. 26
    
27.
Peng JJ, Botelho MG, Matinlinna JP. Silver compounds used in dentistry for caries management: A review. J Dent 2012;40:531-41.  Back to cited text no. 27
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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