Search Results (89)

Chitosan, a hydrogel derived from chitin via deacetylation, exhibits antimicrobial, bioadhesive, and regenerative properties, making it a promising biomaterial in pediatric dentistry. Despite extensive research, a comprehensive review of its preventive, restorative, and regenerative applications in children is lacking. This review consolidates current evidence on the mechanisms, clinical uses, and future potential of chitosan-based interventions in pediatric dental care. The search identified a broad spectrum of evidence encompassing preventive, restorative, and endodontic uses of chitosan. Chitosan-based mouthwashes, varnishes, and remineralizing agents demonstrated significant reductions antimicrobial and remineralizing effects, primarily in in vitro studies and limited clinical trials. Incorporating chitosan into cements, adhesives, and resins improved fluoride release, durability, and antibacterial activity without compromising mechanical strength as demonstrated in lab-based studies. In pulp therapy, chitosan nanoparticles enhanced intracanal medicaments, supported hemostasis in pulpotomy, and promoted odontogenic differentiation in regenerative procedures. Although current in vitro and early clinical data are encouraging and present chitosan as a promising biomaterial in the field of pediatric dentistry, large, well-designed trials and standardized formulations are essential to validate long-term safety, and enable consistent integration of chitosan gel-based materials into routine pediatric dental care. Full article

Objective: To evaluate the ability of an experimental propolis/chitosan varnish to inhibit the erosive process in primary tooth enamel. Materials and Methods: Forty-two primary incisors were selected and divided into three groups (n = 14): control/no treatment, Duraphat^® varnish, and propolis/chitosan varnish. The varnishes were applied to the experimental area and left in place for 4 h. After varnish removal, the specimens were subjected to erosive challenges with Coca-Cola^®. The quantitative outcome variables were mineral loss assessed by longitudinal microhardness, surface roughness, and wear profile. The data were analyzed using ANOVA and Tukey’s test (p < 0.05). Results: Wear profile and surface roughness analyses showed no significant differences among the groups (p > 0.05). In the microhardness analysis, the control and experimental groups showed significant differences between the control and demineralized areas and between the control and experimental areas (p < 0.05). In the Duraphat group, a significant difference was observed between the control and experimental areas (p < 0.05). Conclusions: The experimental propolis/chitosan varnish was unable to prevent the progression of mineral loss in the enamel of primary teeth subjected to erosive challenge. Duraphat^® fluoride varnish was also unable to protect the enamel. Clinical relevance: Several studies have investigated the use of propolis and chitosan in dentistry, and promising results have been reported when these agents are used individually; however, the propolis/chitosan combination remains poorly explored. To the best of our knowledge, this is the first study to investigate this combination for dental erosion in primary teeth. Full article

Objectives: This study characterised the bioactive properties (i.e., ion release, pH rise, and apatite formation) of a newly developed Voco Profluorid + BioMin F varnish. Three additional varnishes were investigated for comparison: Clinpro™ White Varnish (3M™, St. Paul, MN, USA), MI Varnish (GC, Tokyo, Japan), and Profluorid varnish (VOCO GmbH, Cuxhaven, Germany). The Clinpro™ White and MI varnishes were chosen for comparison due to their similar composition of active ingredients. Profluorid served as a standard fluoride-only varnish reference. Methods: Dental varnish ingredients were characterised using ATR-FTIR, XRD, and ¹⁹F and ³¹P MAS-NMR. Coated coverslips were immersed in Tris buffer and artificial saliva (pH 4.0 and 7.0) for 2–24 h. Ion release was analysed using ICP-OES and a fluoride ion-selective electrode whilst monitoring pH changes. Post-immersion, coverslips were analysed by XRD and MAS-NMR to assess possible apatite formation. Results: XRD and ¹⁹F MAS-NMR detected NaF in all four varnishes. BioMin F varnish showed a ³¹P peak matching BioMin F glass, with an additional brushite peak, indicating partial reaction of the bioactive glass (BAG) with rosin resin water. All varnishes released fluoride and calcium, but only BioMin F and MI varnishes released phosphate, which is essential for the formation of calcium fluorapatite. Post-immersion analysis confirmed fluorapatite formation in BioMin F and, to a lesser extent, the Profluorid varnish. No apatite formation was observed in the other two varnishes. MI varnish exhibited calcium fluoride formation before and after immersion, as evidenced by XRD and ¹⁹F MAS-NMR analysis. Conclusions: The novel BioMin F varnish potentially promotes remineralisation by providing a sustained and slow release of therapeutic ions that are essential for the formation of fluorapatite. Full article

Background/Objectives: Dental caries is one of the most prevalent chronic diseases in childhood, disproportionately affecting socially vulnerable populations. This scoping review aimed to analyze the clinical effects of selected minimally invasive materials and approaches, specifically mouthrinses, fluoride varnishes, silver diamine fluoride, and glass ionomer-based interventions, for the prevention and management of dental caries in pediatric patients, with emphasis on public health and community-based settings. Methods: This scoping review followed the Population, Concept, and Context (PCC) framework. Electronic searches were conducted up to 23 January 2026, using tailored strategies for mouthrinses, fluoride varnishes, silver diamine fluoride (SDF), and glass ionomer cements (GICs). Randomized clinical trials (RCTs) were included. Data extraction and qualitative synthesis focused on clinical outcomes and applicability in public health contexts. Results: Fifty-five RCTs were included. Fluoride- or chlorhexidine-based mouthrinses showed potential in controlling cariogenic biofilm, with evidence primarily based on microbiological outcomes. Fluoride varnishes were associated with enamel remineralization and control of early white spot lesions, particularly in supervised programs. SDF was reported to achieve high caries’ arrest rates in cavitated dentin lesions of primary teeth, while its preventive effect on sound surfaces appeared comparable to other fluoride-based interventions. GICs were associated with acceptable clinical performance as pit-and-fissure sealants and in atraumatic restorative treatment. Conclusions: Minimally invasive dentistry (MID) approaches show promise for the prevention and management of childhood dental caries in public health and community-based settings. However, these findings should be interpreted with caution due to the heterogeneity of interventions and outcome measures, the predominance of short-term and surrogate (microbiological) outcomes, and the absence of a formal risk-of-bias assessment. As a scoping review, the synthesis is narrative in nature, which limits the ability to draw definitive conclusions. Further studies with standardized clinical outcomes and longer follow-up are needed to strengthen the evidence. Full article

Background and Objectives: Sjögren’s syndrome (SS) causes destructive salivary gland dysfunction with substantial oral morbidity. To synthesize practical, evidence-based approaches for early recognition, initial oral management, and timely referral to dental care. Materials and Methods: Narrative review of English-language literature from the Web of Science Core Collection and PubMed, prioritizing systematic reviews, randomized trials, and consensus guidelines. Results: Early oral signs include rapid multifocal root and cervical caries, burning sensations, and rising dental treatment needs. Unstimulated whole saliva ≤ 0.1 mL/min supports significant hypofunction and complements the 2016 ACR/EULAR criteria. Preventive care should combine dietary counseling, salivary stimulation, and topical remineralization. Adjuncts include high-fluoride toothpaste, biomimetic hydroxyapatite dentifrices, and casein phosphopeptide–amorphous calcium phosphate (CPP-ACP). However, evidence for fluoride varnish in SS remains mixed. Pharmacologic sialogogues require screening for contraindications. Conclusions: Embedding oral screening, simple salivary metrics, and a structured referral pathway into rheumatology visits can reduce preventable tooth loss and improve comfort, function, and treatment adherence. Full article

Fluoride prophylaxis is a cornerstone in preventing dental caries, a disease for which orthodontic patients are at high risk due to the reduced effectiveness of home oral hygiene and increased plaque accumulation. Recent evidence defines caries as polymicrobial, involving Streptococcus mutans, Lactobacilli, and emerging species such as Selenomonas sputigena. This prospective, randomized, controlled study evaluated professional topical fluoride in the form of gel and varnish in 68 patients aged 8–17 years wearing fixed orthodontic appliances. Participants were divided into three equal groups: two intervention groups and one control group. Clinical parameters (DMFT, salivary pH, PCR%) and microbiological analyses of plaque and saliva (oral Streptococci, S. mutans, S. sputigena, Lactobacilli, total bacterial count) were assessed at baseline (T0) and after 4 months (T1), following professional hygiene and fluoride application for the intervention groups. At T1, salivary pH increased in the gel group, and PCR% decreased significantly in all groups, with the most pronounced decrease observed in the varnish group. PCR analysis showed a higher rate of S. mutans and S. sputigena negativization in intervention groups. Culture-based analyses revealed reductions in oral Streptococci and Lactobacilli in intervention groups, while levels increased in controls. Overall, both clinical and microbiological variables indicated improvements in the fluoride-treated groups compared to controls, highlighting the efficacy of professional fluoride prophylaxis in orthodontic patients. Full article

Background/Objectives: Dental caries, one of the most common oral diseases worldwide, represents a major public health concern. Contemporary dentistry has established several non-invasive approaches and resin infiltration, as a micro-invasive path, in the treatment of white spot lesions (WSLs). This study aimed to evaluate the effect of different WSL treatments on enamel surface microhardness. Materials and Methods: Seventy-five intact human premolars extracted upon orthodontic indication and the demineralizing solution composed of acetic acid, monopotassium phosphate and calcium chloride with pH = 4.4 and exposure time 96 h were used. The samples were randomly divided into five groups (n = 15): I—intact enamel (control group); II—artificial white spot lesion; III—artificial WSL treated with fluoride varnish; IV—artificial WSL treated with casein phosphopeptide—amorphous calcium phosphate (CPP-ACP) paste; V—resin-infiltrated artificial WSL. The surface microhardness was determined using the Oliver–Pharr method and a spherical indenter (Shimadzu Indenter, Kyoto, Japan). One-way analysis of variance (ANOVA) followed by a Post Hoc test (Bonferroni) was used with a level of significance set at p < 0.05. Results: Resin-infiltrated white spot lesions showed comparable microhardness mean value as the control group: 68.23 (±21.45) and 63.57 (±18.89), respectively (p > 0.05). Also, resin infiltration increased enamel microhardness compared to WSL values, with a statistically significant difference (p < 0.05). Fluoride varnish and CPP-ACP treatment resulted in equivalent values (50.84 ± 14.35 and 50.99 ± 15.31, respectively). Conclusions: Different WSL treatments (fluoride varnish, CPP-ACP and resin infiltration) produced comparable enamel microhardness values. Among the tested agents, resin infiltration resulted in higher microhardness values, while fluoride varnish and CPP-ACP demonstrated equivalent outcomes. Full article

Introduction: Fluoride varnishes are widely used in caries prevention, but the rate and duration of fluoride ion release differ depending on material composition and environmental factors. Objectives: This systematic review synthesized evidence from in vitro studies on human teeth to identify key factors influencing fluoride release. Methods: A systematic literature search was conducted in July 2025 in PubMed, Scopus, Web of Science, Embase, and the Cochrane Library using the terms “fluoride release” AND “varnish” in titles and abstracts. Study selection followed PRISMA 2020 guidelines, predefined eligibility criteria, and was structured according to the PICO framework. Of 484 retrieved records, 15 studies met the inclusion criteria and were analyzed qualitatively. Results: The primary outcome was the magnitude and duration of fluoride release from varnishes. Most studies reported peak release within the first 24 h, followed by a marked decline, although some formulations (e.g., Clinpro XT and Duraphat) maintained more stable long-term release. Substantial methodological heterogeneity was observed across studies, including differences in sample type, storage medium, pH, temperature, and measurement protocols, which influenced fluoride release dynamics. Reported secondary outcomes included enamel remineralization, changes in surface properties, and antibacterial activity, with bioactive additives such as CPP–ACP and TCP enhancing preventive effects. Acidic conditions consistently increased fluoride release. Conclusions: The magnitude and persistence of fluoride release from varnishes depend on both intrinsic material properties and external environmental conditions. Bioactive additives may prolong fluoride availability and provide additional preventive benefits. Full article

This study aimed to determine the optimal application sequence of cold atmospheric helium plasma (CAP) with fluoride varnish to enhance enamel protection and fluoride uptake. A total of 91 bovine incisor teeth were randomly assigned into seven groups (n = 13 each): negative control (C, no treatment), comparative controls [helium gas (He, gas only)], helium plasma (P, plasma only)], positive control [fluoride varnish (V)], and three experimental groups: plasma followed by varnish (PV), varnish followed by plasma (VP), and plasma before and after varnish (PVP). Specimens were analyzed using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX), and microhardness testing at 0, 24, and 48 h post-treatment. SEM revealed that helium plasma treatment enhanced the even dispersion of fluoride and reduced imperfections on the enamel surface. EDX analysis indicated significant alterations in the elemental composition, particularly with respect to the amount of fluoride (F) and the calcium-to-phosphorus (Ca/P) ratios. In the PVP group (CAP before and after varnish), the fluoride atomic percentage increased notably from 1.21% (varnish group) to 7.31% at 48h. Concurrently, the Ca/P ratio increased from 1.95 to 2.39 corresponding with a statistically significant 24% improvement in enamel hardness (repeated-measures ANOVA with Bonferroni correction, p < 0.05). The timing of CAP application critically affects fluoride absorption and enamel hardening. This study clearly demonstrates how sequential CAP treatment maximizes fluoride effectiveness, offering a promising route for non-invasive caries prevention. Full article

Dental caries is a prevalent health condition affecting 87% of the population. The application of fluorinated varnishes to incipient lesions promotes remineralization. To evaluate the remineralizing effect of three fluorinated varnishes through chemical and physical characterization of incipient enamel lesions in vitro, a total of 150 enamel surfaces were randomly divided into five groups (n = 30): healthy enamel, initial lesion, Fluor-Protector, β-Clinpro-White-Varnish, and Duraphat. All groups, except for the healthy enamel, were immersed in a demineralizing solution (pH 4.4) for 96 h. Remineralization was assessed using a pH cycling model over 5, 10, and 15 days. Fluoride release was measured via ISE-F, and enamel was analyzed by Raman spectroscopy (PO₄³⁻), roughness, and Vickers hardness. Data were analyzed using ANOVA and a post hoc test (Tukey). Ion Selective Electron-Fluor showed a residual F concentration of 0.40 ppm for the Fluor-Protector remineralizing solution: 40.00 ppm for Clinpro-White-Varnish, and 50.0 ppm for Duraphat. Raman analysis confirmed PO₄³⁻ at 956 cm⁻¹ mainly in CDu group. Roughness decreased with varnish application: Fluor-Protector (0.36 µm), β-Clinpro-White-Varnish (0.73 µm), and Duraphat (0.65 µm). Hardness increased with Fluor-Protector. Statistically significant differences were found between FP and other types of varnish. Fluorinated varnishes enhance remineralization and reduce enamel roughness and demineralization. Fluor Protector and β-Clinpro-White-Varnish showed the most favorable results, suggesting their recommendation for high-risk pediatric patients. Full article

Background: Dental caries remains one of the most prevalent chronic diseases worldwide. Fluoride has long been recognized as a cornerstone of caries prevention through enamel remineralization, inhibition of demineralization, and antibacterial activity. However, controversies persist regarding systemic exposure, potential health risks, and ethical debates over community water fluoridation. Previous reviews often focused on isolated interventions, whereas a critical synthesis of mechanisms, clinical efficacy, safety, and public health perspectives is still lacking. Methods: This narrative review synthesized peer-reviewed publications from 2000 to 2025 retrieved from PubMed, Scopus, Web of Science, and leading dental journals. Emphasis was placed on randomized controlled trials, systematic reviews, meta-analyses, and major policy documents. Evidence was thematically appraised across mechanisms of action, clinical applications, comparative efficacy, safety, and sociocultural considerations. Results: Fluoride consistently shows preventive and therapeutic benefits across multiple delivery forms, including toothpaste, varnishes, mouthrinses, supplements, and silver diamine fluoride, with particular advantages for high-risk groups such as children, orthodontic patients, and older adults. Nonetheless, study heterogeneity, variations in protocols, and concerns regarding fluorosis and possible neurodevelopmental effects highlight persistent uncertainties. Comparative analyses reveal trade-offs between efficacy and acceptance, for example, the high caries-arrest rate of silver diamine fluoride compared with its esthetic drawback. Emerging alternatives such as nano-hydroxyapatite, fluoride-containing bioactive glass, and probiotic-based approaches are promising but currently supported by limited clinical data. Conclusions: Fluoride remains central to caries prevention, yet its optimal use requires balancing benefits against risks, addressing cultural and socioeconomic barriers, and tailoring strategies to individual and community contexts. This narrative synthesis underscores the need for well-designed multicenter randomized controlled trials, longitudinal studies to refine safe exposure thresholds, evaluations of novel biomaterials and delivery systems, and the incorporation of patient-reported outcomes to guide future evidence-based policies and clinical practices. Full article

Tooth bleaching is a widely used esthetic treatment; however, bleaching agents can temporarily alter the surface morphology of enamel, increasing surface roughness and porosity, which may lead to increased susceptibility to discoloration. This in vitro study investigated the effectiveness of fluoride varnish in preventing immediate discoloration of bovine incisors after bleaching. Specimens were bleached with 35% hydrogen peroxide and treated with either Clinpro White Varnish (CW) or Enamelast Fluoride Varnish (EN), whereas control specimens received no treatment after bleaching. The samples were immersed in coffee for 24 h, and the color difference (ΔE₀₀) was calculated using the CIEDE2000 formula. The surface morphology of enamel was examined using SEM. The fluoride varnish groups showed significantly lower color difference values than the control group (p < 0.05), with ΔE₀₀ reduced by approximately two-thirds in both the CW and EN groups. SEM observations showed that the enamel surfaces in the varnish-treated groups exhibited reduced surface irregularities compared to the untreated group, suggesting remineralization. These results suggest that the immediate application of fluoride varnish after bleaching can effectively reduce short-term discoloration by providing physical protection and promoting remineralization. Fluoride varnish may serve as a simple and effective strategy to maintain whitening outcomes and minimize early discoloration. Full article

Objective: This study evaluated the efficacy of a novel interproximal fluoride delivery device, Cav-Aid^®, in remineralizing initial proximal caries, comparing it with conventional fluoride treatments. Methods: Initial caries lesions were produced on bovine enamel blocks by subjecting the blocks to a 3-day demineralization process by plaque growth in a mixed-species microbial caries model. After demineralization, the baseline surface microhardness (SMHb) was measured. The blocks were embedded into cavities prepared on the proximal surfaces of extracted human teeth to simulate natural interproximal contacts. The teeth were randomly assigned to six treatment groups (20/group): artificial saliva (AS), Cav-Aid^® only (CA), Cav-Aid^®/fluoride toothpaste (CA+F), fluoride varnish applied via flossing (FV-Floss), fluoride varnish applied via painting on the interdental cleavage (FV-Paint), and daily fluoride mouthrinse (F-Mouthrinse). The samples then underwent a 14-day pH cycling protocol to simulate remineralization conditions. The post-treatment SMH (SMHr) was measured. Statistical analysis comprised paired t-tests and ANOVA/Tukey’s post hoc comparisons (p < 0.05). Results: All fluoride-treated groups exhibited significant increases in SMHr compared with SMHb (p < 0.001). CA+F group showed the highest percentage remineralization (27.39%), followed by CA (22.16%), then the FV and mouthrinse groups (9.25–11.80%). The AS group exhibited the lowest remineralization (4.89%). CA+F demonstrated significantly greater remineralization than FV or mouthrinse (p < 0.05). However, there was no significant difference between CA alone and CA+F. Also, there was no significant difference between CA alone and FV-Floss or FV-Paint (p > 0.05). Conclusions: Within the limit of the present study, the Cav-Aid^® targeted fluoride delivery system demonstrated greater efficacy than FV alone in interproximal remineralization. Dual-modality fluoride treatments (CA+F) provided the greatest remineralization benefits, highlighting the importance of sustained fluoride exposure. Full article

Objectives: This study aimed to compare in vitro the protective effect of two enamel remineralizing agents, a varnish containing β-tricalcium phosphate with sodium fluoride (β-TCP-F) and a paste containing casein phosphopeptide-amorphous calcium phosphate with sodium fluoride (CPP-ACP-F), on artificially demineralized human enamel. Methods: A total of 120 human third molar enamel specimens were randomly assigned to four groups (n = 30 each): Group I (healthy enamel, control), Group II (initially demineralized, lesioned enamel), Group III (demineralized enamel and treated with β-TCP-F), and Group IV (demineralized enamel and treated with CPP-ACP-F). Groups II–IV underwent, for 15 days, a daily pH cycling regimen consisting of 21 h of demineralization under pH 4.4, followed by 3 h of remineralization under pH 7. Groups III and IV were treated with either β-TCP-F or CPP-ACP-F, prior to each 24 h demineralization–remineralization cycle. Fluoride ion release was measured after each pH cycle. Surface hardness, roughness, wettability, and Streptococcus mutans biofilm formation were assessed on days 5, 10, and 15 after a daily pH cycle. Results: CPP-ACP-F treatment showed a larger improvement in surface hardness (515.2 ± 10.7) compared to β-TCP-F (473.6 ± 12.8). Surface roughness decreased for both treatments compared to initially lesioned enamel; however, the decrease in roughness in the β-TCP-F group only reached a value of 1.193 μm after 15 days of treatment, a significantly larger value in comparison to healthy enamel. On the other hand, the decrease in roughness in the CPP-ACP-F treatment group reached a value of 0.76 μm, similar to that of healthy enamel. Contact angle measurements indicated that wettability increased in both treatment groups (β-TCP-F: 71.01°, CPP-ACP-F: 65.24°) compared to initially lesioned samples in Group II, reaching WCA values similar to or smaller than those of healthy enamel surfaces. Conclusions: Both treatments, β-TCP-F and CPP-ACP-F, demonstrated protective effects against enamel demineralization, with CPP-ACP-F showing superior enhancement of surface hardness and smoother enamel texture under in vitro pH cycling conditions. β-TCP-F varnish and CPP-ACP-F paste treatments counteracted surface modifications produced on human healthy enamel by in vitro demineralization. Full article

White spot lesions (WSLs) are early clinical stages of enamel demineralization, often related to orthodontic treatment or poor oral hygiene. The use of gels such as fluoride for topical application inhibits demineralization and promotes remineralization of dental tissues through various mechanisms. A variety of therapeutic approaches are available; however, recent research indicates that combined treatment strategies may yield superior clinical outcomes compared to monotherapy. The aim of this study was to critically compare the efficacy of combining multiple treatment techniques for WSLs compared to using these techniques alone. A systematic search was conducted in PubMed, Scopus, and Cochrane databases according to PRISMA guidelines. The PICO strategy was used to formulate the research question: Which clinical approaches combined or isolated (C) influence the treatment and prevention effectiveness (O) of white spot lesions (I) in humans (P) in the last ten years (T)? Inclusion criteria focused on clinical studies from the last ten years evaluating the combined use of at least two treatment techniques for WSL, resulting in a total of 8 randomized controlled trials selected from an initial pool of 1185 articles. Our results suggest that combined treatment strategies, including resin infiltration with fluoride varnish and ozone therapy combined with fluoride application, demonstrated enhanced efficacy in lesion masking and remineralization compared to single-treatment approaches. CPP-ACP and hydroxyapatite-based creams improved aesthetics, particularly when used alongside fluoride varnish. Our study concluded that the combination of remineralization agents like fluoride gel, infiltrative resins, and antimicrobial treatments offers superior outcomes on white spot lesion treatment than using these techniques alone. However, long-term clinical studies are needed to standardize treatment protocols and confirm durability. Full article