Search Results (71)

Background: Early childhood caries is defined as a carious disease affecting primary teeth in children under 6 years of age. It may lead to pain, infections, and difficulties with eating. Despite its burden, evidence on simple, non-invasive preventive approaches which can be implemented both in dental clinics and outreach services is fragmented. The aim of this review was to identify and map such methods for the secondary and tertiary prevention of ECC and to define priorities for future research. Material and Methods: The scoping review followed the PCC framework (Population–Concept–Context). Two databases were searched: PubMed and Scopus. A systematic search was conducted in PubMed and Scopus between 1 August and 30 September 2025. Eligible studies included children under 6 years of age with existing carious lesions, evaluated non-invasive methods for secondary and tertiary ECC prevention (such as sodium fluoride (NaF), silver diamine fluoride (SDF), nano-silver fluoride (NSF), and motivational techniques), requiring simple armamentarium, and reported data on the effectiveness in the context of ECC. Only publications from the past 5 years, available in English, and in open access, were considered. The results of the analysis were summarized narratively, outlining intervention types based on their characteristics, impact, and usage context. Results: Fifteen studies were included. Most were randomized controlled trials (eight studies), focusing primarily on silver diamine fluoride (SDF), often compared with other non-invasive methods, followed by systematic reviews (two studies), reviews (two studies), cross-sectional studies (two articles), and one qualitative study. Only one publication examined the use of motivational interviewing within the context of ECC. While the evidence on non-invasive approaches is growing, significant gaps remain. Small sample sizes, short follow-up periods, and heterogenous interventions and outcomes limit comparability. To strengthen the evidence base, future studies should recruit larger cohorts, adhere to standardized procedures, and use consistent reporting. Conclusions: The majority of studies focused on SDF, reflecting the increasing interest in its use. Research on motivational interviewing in ECC is particularly scarce. Further research under standardized conditions is needed to enable reliable comparisons across treatment protocols. Full article

Background/Objectives: Adhesion to caries-affected dentin remains challenging due to its altered structure and composition. Remineralizing agents have been proposed to strengthen this substrate and improve bonding. This study evaluated the effect of three remineralization treatments, CPP-ACP, self-assembling peptide P11-4, and silver diamine fluoride (SDF), on the microtensile bond strength (μTBS) of universal adhesive systems applied to caries-affected dentin, using both etch-and-rinse and self-etch strategies. Methods: Seventy human molars were sectioned and artificially demineralized to simulate caries-affected dentin. Samples were divided into ten groups: four untreated and six treated with CPP-ACP (MI Paste™), P11-4 (Curodont™ Protect), or SDF (Riva Star™). Universal adhesives were applied via etch-and-rinse or self-etch mode, followed by composite restoration. Microtensile bond strength was measured using a universal testing machine, and results were statistically analyzed with ANOVA and t-tests (p < 0.05). Results: Untreated caries-affected dentin showed significantly lower μTBS than sound dentin (C3: 18.3 ± 5.4 MPa vs. C1: 41.3 ± 2.7 MPa). Remineralization agents improved μTBS considerably. CPP-ACP achieved the highest recovery (S1: 31.8 ± 2.6 MPa; S2: 29.2 ± 4.6 MPa), nearing sound dentin levels. P11-4 yielded moderate gains (S3: 24.4 ± 6.5 MPa; S4: 24.1 ± 4.7 MPa), while SDF provided the lowest, yet significant, improvements (S5: 23.7 ± 7.5 MPa; S6: 21.3 ± 5.3 MPa). Etch-and-rinse generally produced higher μTBS than self-etch, but differences were not statistically significant (p > 0.05). Conclusions: Pre-treatment of caries-affected dentin with CPP-ACP, P11-4, or SDF enhances universal adhesive bond strength, with CPP-ACP showing the most pronounced effect. Remineralization protocols represent a valuable adjunct in restorative procedures involving compromised dentin. Full article

Objective: To investigate the influence of chitosan-based nano-silver fluoride (CNSF) treatment of tooth tissues on shear bond strength (SBS) of resin composite (RC) and resin-modified glass ionomer (RMGI) restorations. Methods: 90 extracted human molars were collected. Specimens were randomly assigned to three groups (n = 30): non-pretreated (NPT) pretreated with either CNSF or silver diamine fluoride (SDF). Each group was subdivided into two restorative subgroups (n = 15): RC and RMGI. Specimens in CNSF and SDF groups were pretreated with CNSF or SDF per their manufacturer’s instructions. Then specimens in RC subgroups were etched, treated with chlorhexidine cleanser, followed by adhesive application. Specimens in RMGI subgroups were treated with cavity conditioner only. A cylindrical restoration (2.38 mm θ × 2 mm height) of RC or RMGI restoration was fabricated with a standardized mold and light-cured on all specimens. After 5000 times of thermocycling between 5 °C and 55 °C with dwell times of 30 s intervals, SBS was measured using the Ultradent UltraTester. Data was analyzed statistically (α = 0.05) using ANOVA/Tukey’s comparisons. Results: No statistically significant difference in SBS among RC restorations in the three treatment groups: NPT (17.48 ± 3.96), CNSF (18.38 ± 5.59), and SDF (14.03 ± 6.56). For RMGI restorations, SBS was significantly (p < 0.05) higher in NPT (15.99 ± 3.59) compared to CNSF-treated (11.45 ± 5.48), but there was no significant difference between NPT and SDF-treated (14.27 ± 2.17) or between SDF- and CNSF-treated groups. Conclusions: No difference in SBS of resin composite restorations when the dentin tissue is pretreated with either chitosan-based nano-silver fluoride or silver diamine fluoride. However, SBS of RMGI was lowered when the dentin tissue was pretreated with CNSF. Full article

BioFlx crowns represent an innovative hybrid resin polymer-based alternative for pediatric full-coverage restorations, addressing the clinical dilemma between durable-but-unaesthetic stainless steel crowns (SSCs) and technique-sensitive zirconia crowns. This narrative review synthesizes current evidence of BioFlx crowns’ mechanical properties, clinical performance, and material characteristics through a comprehensive literature search across PubMed, Scopus, and Web of Science from August through September 2025. The search identified 18 studies comprising four randomized controlled trials, two case reports/series, and twelve in vitro studies. In vitro analyses demonstrated favorable stress distribution under physiological loads (≤311 N) with notable brand-dependent performance variations. NuSmile BioFlx exhibited greater wear than zirconia, but superior wear resistance compared to SSCs, while Kids-e-Dental BioFlx crowns demonstrated less crown wear relative to zirconia, with both brands causing less antagonist wear than zirconia. BioFlx showed intermediate fracture resistance, comparable surface roughness to SSCs but higher than zirconia, and intermediate marginal gaps. Resin cements demonstrated superior retention compared to manufacturer-recommended glass ionomer and resin-modified glass ionomer cements. Clinical studies with a 12 month follow-up demonstrated 92–98% retention rates compared to 100% for SSCs, with significantly higher patient satisfaction and reduced plaque accumulation versus SSCs. However, a failure rate of 6.7% was observed. Color change values were lower than those of zirconia crowns; however, they remained clinically unacceptable (ΔE > 3.3), and stain resistance was lower than that of SSCs. Marginal integrity remained clinically acceptable, though some anatomic form deterioration occurred over time. Case reports highlighted clinical utility in nickel-allergic patients and for masking silver diamine fluoride discoloration. BioFlx crowns represent a clinically valuable esthetic alternative in pediatric dentistry, though evidence remains limited by recent market introduction, brand-specific performance variations (NuSmile vs. Kids-e-Dental), anterior tooth applicability constraints, and contraindications in bruxism and for the Hall technique. Future randomized controlled trials with ≥2 year follow-up periods are imperative to establish long-term performance. Until such evidence emerges, BioFlx crowns represent a viable clinical option for esthetically sensitive cases and nickel-allergic patients when applied with rigorous case selection. 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

Background: Dental caries is a prevalent dental problem affecting primary and permanent teeth. Early demineralization of enamel lesions can be reversed through remineralization. Many studies have focused on caries prevention and disease progression arrest using silver diamine fluoride (SDF). No in vitro studies have compared the remineralization effects of different 38% SDF solutions on artificially demineralized enamel lesions. This study aimed to compare the remineralization potential of three commercial 38% silver diamine fluoride formulations on artificial enamel lesions in primary teeth using a pH cycling model. The hypothesis was as follows: different commercial SDF formulations would exhibit varying remineralization effects, as measured by surface microhardness, due to potential differences in their compositions. Materials and Methods: In this study, 75 primary molars were randomized into five groups (N = 15): I: baseline, II: SDF Riva Star Aqua^® 38%, III: Riva Star^® 38%, IV: SDF Advantage Arrest^® 38%, and V: control. Artificial caries were created by submerging teeth in 10 mL of demineralization solution (pH 4.5) for three days in a light-resistant container, ensuring distinct visual changes in the enamel as per the International Caries Detection and Assessment System (ICDAS level 2). After pH cycling, all samples underwent a standardized Vickers microhardness test (VMHT) with a 50 g load for 15 s. Data were analyzed using one-way ANOVA and Tukey’s post hoc test, with a significance level set at p ≤ 0.05. Results: The one-way ANOVA test indicated a significant difference in microhardness among the groups (SDF Riva Star Aqua, SDF Riva Star, and SDF Advantage Arrest), with an F-value of 167.73 and p < 0.001. The post hoc Scheffé test showed that SDF Riva Star Aqua and SDF Riva Star were not significantly different (p = 0.388). However, SDF Advantage Arrest had a significantly higher mean microhardness compared to both groups (p < 0.001). Overall, these results show that SDF Advantage Arrest leads to greater microhardness than SDF Riva Star Aqua or SDF Riva Star. Conclusions: SDF Advantage Arrest showed superior performance among the SDF-treated groups, significantly increasing microhardness compared to SDF Riva Star Aqua and SDF Riva Star. This suggests that SDF Advantage Arrest offers enhanced remineralization and structural strengthening, making it the most effective option for managing demineralized primary teeth. Future research should investigate the long-term performance and mechanisms of these treatments to optimize clinical protocols for preserving primary tooth integrity. Full article

Background: Early caries management is essential to enable reversal of white spot lesions without the further need for operative interventions, especially in primary dentition. Silver-based compounds can be quite effective in arresting caries lesions; however, a major drawback is teeth staining. This study aimed to evaluate the remineralization potential and aesthetic effects of novel, green-synthesized nano-silver fluoride (NSF) on artificial white spot lesions in primary teeth in comparison to 38% silver diamine fluoride (SDF) and silver diamine fluoride/potassium iodide (SDF/KI). Materials and Methods: NSF was synthesized using green tea extract. Sixty primary teeth specimens with artificial enamel lesions were randomly divided into five groups depending on the applied material: 38% SDF, 38% SDF/KI, single and double application of NSF, and control group. Treatments were followed by pH cycling. Surface microhardness and photographic analysis were conducted to assess remineralization and staining. Statistical analysis was conducted using non-parametric tests including Kruskal–Wallis and Mann–Whitney U tests with Bonferroni correction. Results: The greatest increase in microhardness was observed in the group receiving double NSF application. Its remineralizing potential was comparable to that of 38% SDF/KI, with no statistically significant difference (p = 1.000). Importantly, NSF-treated samples exhibited no teeth discoloration, unlike the black staining observed in SDF and SDF/KI groups. Conclusions: Green-synthesized NSF is a promising alternative to conventional SDF and SDF/KI, offering remineralization benefits without compromising aesthetics. The eco-friendly formulation and non-staining properties support its potential for clinical use in pediatric dentistry. Full article

Background/Objectives: The implementation of preventive treatments in pediatric dental care has been a priority in recent years. Understanding the factors that influence the timing and frequency of childhood preventive treatments, such as the impacts of the COVID-19 pandemic, are the focus of many health informatics researchers. Methods: A retrospective study was approved to assess changes in specific preventive treatments at a pediatric dental school clinic (sealants, fluoride varnish, and silver diamine fluoride) in the three years prior to (2017–2019) and following the COVID-19 pandemic (2020–2022). Results: A detailed analysis of these data revealed significant and unexpected shifts in these preventive services, with significant increases in dental sealants from pre- to post-pandemic (35.1%, p = 0.012), but corresponding decreases in other preventive treatments, such as the number of fluoride varnish (−37.6%, p = 0.011) and SDF treatments (−24.0%, p = 0.032), among this patient population. Conclusions: These data suggest that the selective pursuit of particular preventive dental services and treatments rather than others and understanding these shifts might help health informatics and dental public health researchers understand which factors influenced these decisions and behaviors, such as long-term durability and efficacy (sealants) or changing public perceptions of safety (fluoride and SDF). Full article

Dental caries is a prevalent global health issue characterized by the progressive demineralization of dental tissues, which occurs when the balance between demineralization and remineralization processes is disrupted at the tooth level. Silver diamine fluoride (SDF) has gained recognition for its ability to arrest caries. However, its interaction with mineralized tissues remains incompletely understood. This study aimed to investigate the chemical interactions between SDF and mineralized bioceramics, using hydroxyapatite (HA) and beta-tricalcium phosphate (β-TCP) as analogs for enamel and dentin. Fourier transform infrared spectroscopy (FTIR) and X-ray photoelectron spectroscopy (XPS) were employed to identify functional groups and quantify elemental compositions at varying depths. FTIR analysis revealed structural modifications in HA and β-TCP. XPS demonstrated high retention of fluoride, with limited penetration into deeper layers, while silver exhibited deeper penetration. These findings suggest that SDF primarily acts on superficial layers, forming calcium fluoride and silver phosphate as key reaction products. These findings highlight the potential of SDF in managing deep carious lesions by demonstrating its ability to form a protective CaF₂ layer at the surface while allowing deeper penetration of silver ions into mineralized tissues. This dual mechanism may contribute to SDF’s clinical efficacy in arresting caries and preventing further demineralization. Full article

Objectives: Dental erosion has evolved into a common condition with growing concern in the dental community. The aim of this study was to explore the protective effects of two highly fluoridated products, silver fluoride solution (silver diamine fluoride-potassium iodide solution, SDF-KI) and fluoride varnish, on dental erosion in mouse. Methods: Two groups of ten young CD-1 mouse were given a cola drink ad libitum over a 6-week period. A prophylactic treatment with a silver fluoride solution (38% SDF 48,000 ppm F with a silver concentration of 253,900 ppm) and a fluoride varnish (NaF, 22,600 ppm F) were applied on the mandibular molars, performed under sedation twice a week during the whole experiment. Furthermore, two control groups of ten mice were included, a positive (cola drink) and a negative (distilled water) control. A terminal procedure was followed by dissection of mandibular molars and analysis of them using scanning electron microscopy (SEM). The first molars were transversely ground, further analyzed by SEM, and measured for tooth height and tooth tissue loss. Results: Analyses of mandibular molars treated with a fluoride varnish indicated a 5% decreased tooth tissue loss, compared to the molars which served as a positive control. The best effect was achieved with the application of silver fluoride solution, displaying a 35% decreased tooth tissue loss compared to the positive control group. Conclusions: Preventive treatment with a solution of silver fluoride solution exhibits greater protection against dental erosion compared to a traditional fluoride varnish. This study indicates that silver fluoride solution is an effective fluoride compound and is highly beneficial in a clinical setting with the aim of preventing dental erosion. Full article

Background/Objectives: The use of silver diamine fluoride (SDF) has increased in recent years for the management of caries lesions in children and adults. The aim of this study is to determine the level of knowledge and the attitude of Spanish dentists (GDPs) and final-year dental students (DSs) regarding the use of SDF. Methods: A cross-sectional survey (questionnaire) was carried out aimed at final-year dental students (DSs) (n = 43) and registered dentists (GDPs) (n = 1050) in the autonomous community of the region of Murcia (Spain). Results: the response rates were GDPs 7.7% (n = 81) and DSs 84.5% (n = 38). Only 20.98% of GDP respondents reported having been trained on SDF versus 100% of DSs. Significant differences were observed between the groups (p < 0.05). While 94.7% of the students were aware of the indications for the use of SDF, only 56.8% of the general dentists reported it. Similarly, for hypersensitivity treatment, 71.1% of the students were informed versus 40.7% of the general dentists, and indications for paediatric patients, 100% for the DS group and 59.3% in GDPs. In adult patients, indications vary from GDPs’ (50%) to DSs’ (25.9%) responses. About 94.7% of DSs know the advantages of use and only 50.6% of GDPs. Both groups showed reluctance to use SDF in esthetic zones, with greater acceptance in non-esthetic areas (p < 0.05). In practice, fewer GDPs (27.16%) and DSs (23.68%) had applied SDF, reflecting a gap between knowledge and implementation. Conclusions: Dental students had a significantly higher level of knowledge, a situation that evidences the high level of education and training in the curricular guides of the universities. Full article

This study investigated the effect of silver diamine fluoride (SDF) on the shear bond strength (SBS) of dual, light, and self-cured cement on enamel and dentin. Specimens were randomized into four groups (n = 32): G1, sound; G2, sound/treated with SDF; G3, demineralized; G4, demineralized/treated with SDF. Buildups were made using the following: dual-cured cement; RelyX Unicem (RXU); light-cured cement; Variolink Esthetic LC (VE); and self-cured cement Ketac Cem Maxicap (KetC). The SBS was performed, and data were analyzed using ANOVA models followed by Tukey’s test (α = 0.05). Enamel (E) had a significantly different SBS value (p < 0.001), (11.6–19.9 MPa) than dentin (D) (7.2–14.8 MPa), except for the KetC group (D: 3.1–5.1 MPa, E: 3.4–3.7 MPa), apart from G3 (E: 3.8 MPa, D: 3.1 MPa). In E/D, RXU had a more significant SBS value (p < 0.001), (11.5–19.9 MPa), followed by VE (7.2–15.4 MPa), then KetC (3.1–5.1 MPa). All groups within VE/E were more significant (p = 0.035) than G2. However, G4 in KetC/D was more significant (p < 0.001) than G1 and G2, which were more significant than G3. Enamel had a more significant SBS value than dentin in RXU and VE cements. RXU had significant strength, followed by VE, then KetC cements. SDF decreased the SBS of VE cement on sound enamel. However, it increased the SBS of demineralized dentin with KetC cement. Full article

Background: The World Health Organisation (WHO) included silver diamine fluoride (SDF) in the WHO Model List of Essential Medicines for the management of early childhood caries. SDF is typically available as a 38% aqueous solution, which is watery to apply. A 38% SDF gel has recently been developed, but its caries-arrest effectiveness remains unsubstantiated. The objective of this study is to determine whether the efficacy of a 38% SDF gel is non-inferior to a 38% SDF solution in arresting early childhood caries. Methods: This is a 30-month, randomised, active-controlled, parallel-group non-inferiority pragmatic clinical trial with two arms. The hypothesis is that the 38% SDF gel is not worse than the 38% SDF solution by a non-inferiority margin of 10% caries-arrest rate when applied semi-annually to preschool children. This trial will recruit 630 3-year-old kindergarten children through block randomisation to receive either an application of SDF gel or SDF solution on cavitated carious lesions in their primary teeth every 6 months. The primary outcome is the proportion of soft (active) carious tooth surfaces that turn hard (arrested) at the 30-month follow-up. The same calibrated dentist will conduct 6-monthly dental examinations in the kindergartens to assess the status of carious lesions over 30 months. The examiner, the children, and parents will be blinded to treatments. The parents will be surveyed on their child’s oral health-related behaviours and socioeconomic background to allow adjustment for effect modification. Results: If the anticipated results are obtained, clinicians can use the 38% SDF gel as an alternative of the 38% SDF solution in arresting early childhood caries. Conclusions: As SDF gel is cost-effective, non-invasive, and non-aerosol-generating, it can be widely recommended for caries control. Trial registration: ClinicalTrials.gov NCT06241261. Registered on 7 February 2024. Full article

Background: Molar–incisor hypomineralization (MIH) is an enamel defect affecting molars and incisors, often leading to hypersensitivity, enamel breakdown, and increased caries risk. Non-invasive treatments, such as casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) and fluoride varnish, show potential in remineralizing affected enamel and reducing sensitivity, but their efficacy is still debated. This study systematically reviews and analyzes the effectiveness of CPP-ACP and other non-invasive agents in improving remineralization and reducing hypersensitivity in MIH-affected teeth. Methods: A systematic search was conducted on PubMed, Embase, and Central in July 2024, including interventional and observational studies on remineralization and hypersensitivity in pediatric MIH patients (<18 years). A total of 1566 studies were found, with 15 included in the meta-analysis. A random-effects model was applied, including subgroup analysis by lesion severity. Results: CPP-ACP showed no statistically significant advantage over fluoride in remineralization (MD −3.80, 95% CI: −8.57; 0.98), but it significantly reduced hypersensitivity compared to fluoride varnish (MD −2.36, 95% CI: −3.83; −0.89). Although this reduction in hypersensitivity may be clinically relevant, the high heterogeneity (I² = 83%) and wide confidence intervals limit the reliability of these findings. Conclusions: CPP-ACP has a moderate effect in reducing hypersensitivity but does not outperform fluoride in remineralization. Other agents, such as calcium glycerophosphate and silver diamine fluoride, showed mild benefits. The current evidence base is limited and heterogeneous, highlighting the need for high-quality, long-term studies to confirm these findings and guide MIH management. Full article

Background/Objectives: School-based caries prevention can increase access to critical dental services and reduce oral health inequities. However, little is known regarding the incidence of dental caries in children participating in school caries prevention, and caries diagnosis is often interval censored. Methods: In this paper, we used data from a longitudinal, school-based, randomized clinical trial of minimally invasive treatments for dental caries to estimate the per-visit incidence rate and compare the hazard of dental caries in children receiving either silver diamine fluoride or glass ionomer dental sealants. To account for interval censoring, we used semiparametric transformation models for univariate failure time data and imputed caries incidence using G-imputation. Results: There were 3040 children that met inclusion criteria for analysis, 1516 (49.9%) of which were randomly assigned to receive silver diamine fluoride and 1524 (50.1%) were assigned to receive glass ionomer dental sealants and atraumatic restorations. There were no differences in the hazard of caries between treatments (HR = 0.99, 95% CI = 0.72, 1.24), while children with caries at baseline had a significant increase in the hazard of new caries (HR = 2.54, 95% CI = 2.26, 2.83) compared to those that were caries free. The per-visit caries incidence ranged from 4.8 to 11.1 at the individual level and increased with each successive study observation. Conclusions: School-based caries prevention can positively affect caries incidence, and the results can be used to inform future program design and implementation. Full article