Metal and Metal Oxide Nanoparticles in Caries Prevention: A Review

Nanoparticles based on metal and metallic oxide have become a novel trend for dental use as they interfere with bacterial metabolism and prevent biofilm formation. Metal and metal oxide nanoparticles demonstrate significant antimicrobial activity by metal ion release, oxidative stress induction and non-oxidative mechanisms. Silver, zinc, titanium, copper, and magnesium ions have been used to develop metal and metal oxide nanoparticles. In addition, fluoride has been used to functionalise the metal and metal oxide nanoparticles. The fluoride-functionalised nanoparticles show fluoride-releasing properties that enhance apatite formation, promote remineralisation, and inhibit demineralisation of enamel and dentine. The particles’ nanoscopic size increases their surface-to-volume ratio and bioavailability. The increased surface area facilitates their mechanical bond with tooth tissue. Therefore, metal and metal oxide nanoparticles have been incorporated in dental materials to strengthen the mechanical properties of the materials and to prevent caries development. Another advantage of metal and metal oxide nanoparticles is their easily scalable production. The aim of this study is to provide an overview of the use of metal and metal oxide nanoparticles in caries prevention. The study reviews their effects on dental materials regarding antibacterial, remineralising, aesthetic, and mechanical properties.

New UK Chapter of the Alliance for a Cavity-Free Future

The Alliance for a Cavity-Free Future (ACFF), started in 2010, has been based at King's College London since 2013. It is a dental caries-focused charity promoting integrated clinical and public health action. ACFF Chapters seek to improve caries prevention and management locally, based on best global evidence. The UK Chapter has been created in response to a continuing need combined with opportunities including the implementation of the latest UK version of the Delivering better oral health guidance on prevention (version 4). The Chapter has been formed through a coordinating committee with UKwide representation combining expertise in dental caries management across the patient life course. This committee co-created the Chapter Values Statement: 'in pursuit of a cavity-free future across the UK we value: collaboration and innovation; realistic and implementable prevention-based solutions; approaches that reduce health inequalities; action across both oral and general health settings; and working comprehensively from the population through to the individual level.' The agreed Chapter focus is on advocating for the implementation of appropriate, effective, pragmatic caries prevention and care across three themes: 1) in everyday dental practice; 2) in health and social care curricula; and 3) for vulnerable people across their life course on the basis of increased caries risk/susceptibility.

Study protocol for a randomized clinical trial to evaluate the effect of the use of Xylitol gum in the prevention of caries lesions in children living in Ladakh—the Caries Prevention Xylitol in Children (CaPreXCh) trial

Background Xylitol use is reported to be able to reduce dental plaque amount and cariogenic bacteria and, as a consequence, the caries increment. Only few data on the oral health of Ladakh’s population are available. The aim of the present protocol will be to record the caries prevalence of primary and permanent molars of schoolchildren living in Ladakh and to implement a school-based Xylitol programme, named the Caries Prevention Xylitol in Children (CaPreXCh) trial, using chewing gums. Methods The protocol is designed as a triple-blind randomized, controlled, parallel-group clinical trial in children aged 5–14 years. The study should have been carried out from August 2021 to August 2024 in Zanskar Valley (Ladakh), but the COVID-19 pandemic does not allow today to make predictions on the exact start. Participants will be randomly allocated into two groups: subjects who will receive a chewing gum with Xylitol (70% w/v) as only sweetener, and those who will receive a sugared chewing gum containing Maltitol (23% w/v). The subjects will be instructed to chew a total of 6 pellets for 5 min divided into 3 intakes a day (2 in the morning, 2 after the midday meal and 2 in the afternoon) for one school year. Clinical examination will comprise an oral examination in which caries index (ICDAS scores), bleeding on probing and plaque pH evaluation after sucrose challenge will be recorded at baseline (t0); the clinical examination will be repeated after 12 months since the beginning of the chewing gum administration period (t1), after another 12-month period (t2) and finally after further 12 months (t3) (24 months from the end of the chewing gum use). The primary outcome will be the caries increment measured both at enamel and dentinal levels on primary and permanent molars. Data analysis will be conducted through Kaplan-Meyer graphs to evaluate caries increment. A comparison of the methods will be carried out with Cox regression with shared frailty. The net caries increment for initial, moderate and severe caries levels, using ICDAS (Δ-initial, Δ-moderate and Δ-severe), will be calculated. Discussion This trial will be the first trial conducted in India assessing the efficacy of a school-based caries preventive programme through the use of chewing gum containing only Xylitol as a sweetener. The findings could help strengthen the evidence for the efficacy of Xylitol use in community-based caries prevention programmes in children. Trial registration Clinical trials.govNCT04420780. Registered on June 9, 2020

PECULIARITIES OF DENTAL CARIES PREVENTION IN CHILDREN WITH OLIGOPHRENIA

Nowadays dental caries and periodontal diseases are among the most pressing problems in Paediatric Dentistry. Young patients with psychoneurological disorders are a special category among children with somatic pathology. At the same time, the issue of providing dental care to such children is underrepresented. Today, traditional schemes used for the prevention and treatment of caries and periodontal disease in children with mental retardation requires further improvement taking into account the clinical status of children with particular forms of mental retardation, including oligophrenia. Thus, the aim of our study was to develop and evaluate the effectiveness of a complex of measures to prevent dental caries in children with oligophrenia. To assess the effectiveness of the elaborated preventive complex, 56 children aged 12 years with the diagnosis of oligophrenia of I degree of severity (mild mental backwardness) were under observation during 2 years; 27 children received the complex we developed. The group of comparison included 29 children; caries prevention measures for these children were based on regional protocols (hygienic education, keeping oral hygiene, use of fluoride toothpastes). The effectiveness of the developed preventive complex was evaluated 6, 12 and 24 months after the beginning of its implementation according to the following criteria: the growth of dental caries intensity; reduction in the growth of dental caries intensity; level of oral hygiene (OHI-S index); changes in the biocenosis of the oral cavity (in 1 and 6 months of the observation). The results of the examination after the 6 month observation period have shown the dental caries intensity in children of the main group is 6.65 ± 0.45 teeth that is 1.02 times lower than in the children of the comparison group (6.79 ± 0.26 teeth, p ˃0.05). Thus, the growth of dental caries intensity in the children of the main group is, on average, 0.41 ± 0.05 tooth, which is significantly lower than in children of the comparison group (0.58 ± 0.06 tooth, p <0.05 ). The reduction in the growth of caries intensity in children who received the developed preventive complex was 41.46%. Thus, during two years of the observation, the growth of caries intensity in children of the main group is 1.52 ± 0.08 tooth that is 1.74 times lower than in children of the comparison group (2.64 ± 0.9 tooth, p <0, 05). The reduction in the growth of caries intensity in children who received this preventive complex is, on average, 42.42%. The effectiveness of the proposed preventive complex for children with oligophrenia and carious lesions was also evaluated by using the hygienic Green-Vermillion index. According to the data obtained, at the period of inclusion into the study, the children in both groups demonstrated nearly the same indices of the oral hygiene. However, over the period of the study, the indices of the hygiene index between the children of the main group and the comparison group differed significantly. The application of preventive complex in children with oligophrenia resulted in better oral hygiene than in that the children of the comparison group. This can be explained by professional hygiene, quality control of toothbrushing and hygiene education of children and their parents. The effectiveness of the elaborated complex of preventive measures was also evidenced by changes in the oral biocenosis in the children of the main group in 1 and 6 months of the observation. The findings of microbiological studies showed that the microbial spectrum of the oral cavity changed toward the healthier balance in the children of the main group during the observation period: there was gradual decrease in pathogenic microflora and an increase in symbiotic microflora. Thus, the analysis of findings obtained over the two year observation period in children with oligophrenia, who received the complex of measures to prevent dental caries prevention has confirmed its effectiveness by reducing the growth of caries intensity, the reduction in the growth of caries intensity, hygiene improvement and normalization of oral microbiocenosis.

Enamel remineralisation-inducing materials for caries prevention

Background: Dental caries is a multifactorial disease indicated by the progressive demineralisation process of dental tissue. It is caused by an imbalance between the remineralisation and demineralisation processes. The focus of caries management is on prevention. Providing materials that can induce remineralisation is one management of caries prevention. Various materials have been or are being researched, such as casein phosphopeptide amorphous calcium phosphate (CPP–ACP), tricalcium phosphate (fTCP), bioactive glass (BAG), and nanotechnologies such as nano-hydroxyapatite (n-HAP) and silver nano fluorine (NSF). Purpose: This study aims to review the development of enamel remineralisation inducing materials as a newer approach in caries prevention. Review: Various ingredients have been shown to increase enamel remineralisation through different mechanisms in preventing the development of carious lesions. Conclusion: CPP–ACP, fTCP, BAG, n-HAP, and NSF can induce enamel remineralisation as caries prevention agents. n-HAP and NSF are the most effective agents to enhance enamel remineralisation to prevent caries.

Conceptualization of Bioactive Materials in Dental Caries Prevention

Clinicians always face a challenge in selecting the appropriate material for clinical use. Presently, the term bioactive is being used judiciously and unquestionably in the field of dental materials. The introduction of nanotechnology brought about a revolution in material science leading to the development of bioactive materials for caries prevention and management. This review comprehensively evaluates the use of bioactive materials for modification of the oral biome, prevention of dental caries, and the management of dental caries as restorative materials. Six online database (PubMed, Scopus, Science Direct, Embase, Web of Science, and Cochrane library) were systematically searched using broad keywords. Published articles were scrutinized, analyzed and the full-text articles were selected. Data reveals relatively limited application of tissue engineering and regeneration for enamel and dentin due to their limited ability to remodel. However, many steps are being taken in biomimetic approach for the modification of dentin. The path to overcoming any challenges will require active collaboration among clinicians, a material scientist and pulp biologist.