RESUMO
Background: Children with special health care needs including Down Syndrome, Autism Spectrum Disorder and Down Syndrome experience difficulties in receiving dental treatment. Silver Diamine Fluoride (SDF) and Silver Fluoride (SF) are a minimally invasive treatments options to arrest dental caries without sedation; local or general anaesthesia (GA). Aim: Evaluation of Brazilian's parents' acceptance of the use of SF in CSHCN. Methods: After receiving education on SF, 100 Parents of CSHCN completed a questionnaire concerning their acceptance of SF, in different dental situation. Result: Majority of parents (74,5%) agreed to the use of SF for their children. SF was more acceptable on posterior teeth (74,5%) when compared to its use on anterior teeth (43,1%). Parents accepted to use SF in order: to reduce infection and pain (82,4%); to avoid dental injection (72,5%) and treatment under GA (84,3%). The Majority of parents accepted the properties of SF (82,4%) and Silver (80,4%). Conclusion: Silver Fluoride was accepted as a treatment option for caries, by Brazilian parents of CSHCN. SF should be considered as a treatment option for caries limited to dentine for CSHCN, taking into consideration the individual needs and opinions with regard to aesthetics and exposure to fluoride and silver.
RESUMO
Introduction: Providing conventional, restorative dental care to children with special healthcare needs (CSHCN) often requires sedation using general anesthesia. Saliva consistency, diet, and oral hygiene practice are different for CSHCN, and limited evidence is available on the efficacy of silver fluoride (SF) for the management of carious lesions for this vulnerable population. Methods: Parents of CSHCN were educated about silver fluoride as a treatment option for caries. In total, 550 carious lesions from 100 participants were identified and scored according to the Nyvad Caries criteria. A total of 100 lesions with Nyvad scores 1, 2, and 3 were treated with a single application of silver fluoride and observed postoperatively at 1, 3, and 6 weeks. Result: The results indicate statistically significant (p < 0.05) differences in lesion remineralization over the 6-week follow-up period. At the 6-week follow-up, more than 85% of all lesions were remineralized across all children, regardless of condition or original Nyvad score of 1, 2, or 3. Conclusion: A single application of silver fluoride has demonstrated effectiveness in remineralization and inactivation of carious lesions over 6 weeks among Brazilian CSHCN. Silver fluoride should be considered an option for the management of carious lesions among CSHCN. Further studies are recommended, including larger sample sizes, longer follow-up times, a second application of SF, and different special needs conditions.
RESUMO
Introducción: la caries dental es considerada un problema de salud pública, para su tratamiento se han propuesto diversos biomateriales, entre ellos el uso de la mezcla de fluoruro+nitrato de plata, llamada Fluoruro Diamino de Plata (FDP) con propiedades cariostáticas, remineralizantes y bactericidas utilizado en dientes primarios. Son pocos los estudios que valoran la respuesta del tejido dentario luego de aplicarlo, es por ello que el objetivo de este estudio fue determinar el efecto del FDP en caries inducidas en ratas Wistar. Métodos: se hizo inducción de caries dental en molares de ratas Wistar, inoculándolos con S. mutans CVCM656, manteniendo dieta rica en sacarosa durante 12 semanas. Diagnosticadas las caries y distribuidas en grupos control (C1,C2) y experimental (E1,E2), se removió dentina reblandecida de los molares y se topificaron con FDP al 3,8% solo los molares de los grupos experimentales. Finalmente se hizo valoración clínica y toma de muestra para estudio histológico a las 7 y 13 semanas posteriores al tratamiento. Resultados: los grupos control registraron aumento del número de lesiones cariosas y progresión de su severidad, mientras que los grupos experimentales no revelaron cambios en estos parámetros, mostrando superficies dentinarias duras y oscuras, el reporte histológico determinó aumento en el espesor de predentina únicamente en los molares de los grupos experimentales. Conclusiones: el protocolo de inducción de caries en ratas Wistar fue exitoso; asimismo, el tratamiento con FDP inactivó los procesos cariosos sin que progresaran en severidad ni aumentara el número de caries, siendo estos resultados extrapolables a los humanos.
Introduction: dental caries is considered a public health problem. Various biomaterials have been suggested for treating it, including fluride+silver nitrate mix, known as silver diamine fluoride (SDF) which contains cariostatic, remineralizing, and bactericide properties and is used on primary teeth. Only a few studies have assessed the response of dental tissue when this substance is applied; the objective of this study was therefore to determine the effect of SDF on caries induced in Wistar rats. Methods: dental caries was induced in Wistar rats molars by inoculating them with S. mutans CVCM656 and feeding them a sucrose-rich diet for 12 weeks. Once caries were diagnosed and sorted out into control groups (C1, C2) and experimental groups (E1, E2), softened dentine was removed from molars; only the molars from experimental groups received a topical application of 3.8% SDF. Finally, clinical assessment was performed and samples were collected for histological study 7 and 13 weeks after treatment. Results: the control groups experienced an increased number of carious lesions and progression in severity, while the same parameters in the experimental groups remained unchanged, showing hard dark dentine surfaces. The histological report showed increased predentine thickness in molars from the experimental groups only. Conclusions: the protocol of caries induction in Wistar rats was successful. Treatment with SDF deactivated the carious processes, arresting not only severity progression but also the increase in number of caries; these findings may be extrapolated to humans.