Made available in DSpace on 2015-01-26T13:21:30Z (GMT). No. of bitstreams: 0 Previous issue date: 1995-12-15Bitstream added on 2015-01-26T13:30:18Z : No. of bitstreams: 1 000026853.pdf: 4851179 bytes, checksum: b3f9b19f68ceefd09594973ca734f3bd (MD5) / A saúde bucal da população brasileira exige uma nova reflexão e uma reorientação preventiva para que a prevalência de cárie decline para índices condizentes com os esperados pela O.M.S. Várias tentativas para solucionar esta condição premente são abordadas, rotineiramente, por todos os segmentos da sociedade brasileira, com o objetivo de repartir responsabilidades e êxitos. A cárie, no entanto, continua sua escalada implacável, embora os profissionais existentes sejam capazes, os equipamentos e os materiais utilizados sejam eficientes e adequados. Os pacientes já possuem uma relativa educação odontológica que os habilitam a ações de auto-cuidado domiciliar e, contudo, ainda sofremos as mutilações causadas por esta doença obstinada. As medidas propostas no combate às cáries, apesar das dificuldades sócio-econômicas da comunidade e das disparidades regionais, têm produzido efeitos positivos em alguns locais. São comunidades integradas, participantes e motivadas que parecem estar fazendo a diferença nesta luta. Esses núcleos assistenciais, tidos como exemplares por sua racionalidade e produtividade, foram visitados e observados neste trabalho e deles subsídios importantes para futuros empreendimentos neste setor. Embora tenha-se encontrado alguns serviços mal estruturados, com coordenação omissa e produzindo aquém doas expectativas, não se pode assinalar que houve negligência por parte de seus funcionários e indiferença expressa dos responsáveis pela idealização e planejamento dos mesmos. Contudo, fica claro que onde tem-se pessoal treinado e motivado para as tarefas indicadas, obtém-se produtos e bens de qualidade. Tais bens e serviços consumidos geram uma satisfação patente na comunidade, alterando o nível de saúde da coletividade alvo. Pela revisão bibliográfica evidenciou-se que há uma dessemelhança na qualidade dos serviços ofertados e entre as regiões deste país e uma política de... / The bucal health of the Brazilian population asks for a rethink and a preventive reorientation to cause the caries rates to decline to the ones acceptable by he World Health Organization (W.H.O.). Many attempts to work over this pressing conditon are discussed, recurrently, by all the categories of the society, with the will of sharing responsabilities and results. The caries, athough, keeps its unappeasable ascendance, as even the existing professionals are capable and the equipment and technology being used are efficient and adequate. The out patients already have a pertinent odontological education, which allows them to act in their domicile self-care andd, howver, we still suffer with mutilations caused by this obstinate disease. The action suggested for the fight against caries, in spite of the social and economic difficulties of the contrast amongst regions, have been producing positive effects in some places. These are motivated and partaking integrated community, which seen to be the highight on this strie. These assistential centres, taken as examples, for their coherence of production, have been visited and observed and, from them, important grant for future projects in this field were obtained. AI though badly-structured services have been found, with omithing coordination and producing below expectations, no neglects can be pointed out, neither caused by officals, non by the ones responsible for the acomplishment and planning of these. Never theless it is clear that where there is a motivated and trained staff for the indicated tasks, products and possessions of quality are acquired. These, when consumed, originate satisfaction which will become a pattern to the community changing the level of the target commonwealth's health. By the bibliographic analysis, it was possible to show that there is a contrast on the quality of the offered services beteen the regions of this country and...

Orientador: Fábio de Angelis Porto / Resumo: A saúde bucal da população brasileira exige uma nova reflexão e uma reorientação preventiva para que a prevalência de cárie decline para índices condizentes com os esperados pela O.M.S. Várias tentativas para solucionar esta condição premente são abordadas, rotineiramente, por todos os segmentos da sociedade brasileira, com o objetivo de repartir responsabilidades e êxitos. A cárie, no entanto, continua sua escalada implacável, embora os profissionais existentes sejam capazes, os equipamentos e os materiais utilizados sejam eficientes e adequados. Os pacientes já possuem uma relativa educação odontológica que os habilitam a ações de auto-cuidado domiciliar e, contudo, ainda sofremos as mutilações causadas por esta doença obstinada. As medidas propostas no combate às cáries, apesar das dificuldades sócio-econômicas da comunidade e das disparidades regionais, têm produzido efeitos positivos em alguns locais. São comunidades integradas, participantes e motivadas que parecem estar fazendo a diferença nesta luta. Esses núcleos assistenciais, tidos como exemplares por sua racionalidade e produtividade, foram visitados e observados neste trabalho e deles subsídios importantes para futuros empreendimentos neste setor. Embora tenha-se encontrado alguns serviços mal estruturados, com coordenação omissa e produzindo aquém doas expectativas, não se pode assinalar que houve negligência por parte de seus funcionários e indiferença expressa dos responsáveis pela idealização e planejamento dos mesmos. Contudo, fica claro que onde tem-se pessoal treinado e motivado para as tarefas indicadas, obtém-se produtos e bens de qualidade. Tais bens e serviços consumidos geram uma satisfação patente na comunidade, alterando o nível de saúde da coletividade alvo. Pela revisão bibliográfica evidenciou-se que há uma dessemelhança na qualidade dos serviços ofertados e entre as regiões deste país e uma política de... / Abstract: The bucal health of the Brazilian population asks for a rethink and a preventive reorientation to cause the caries rates to decline to the ones acceptable by he World Health Organization (W.H.O.). Many attempts to work over this pressing conditon are discussed, recurrently, by all the categories of the society, with the will of sharing responsabilities and results. The caries, athough, keeps its unappeasable ascendance, as even the existing professionals are capable and the equipment and technology being used are efficient and adequate. The out patients already have a pertinent odontological education, which allows them to act in their domicile self-care andd, howver, we still suffer with mutilations caused by this obstinate disease. The action suggested for the fight against caries, in spite of the social and economic difficulties of the contrast amongst regions, have been producing positive effects in some places. These are motivated and partaking integrated community, which seen to be the highight on this strie. These assistential centres, taken as examples, for their coherence of production, have been visited and observed and, from them, important grant for future projects in this field were obtained. AI though badly-structured services have been found, with omithing coordination and producing below expectations, no neglects can be pointed out, neither caused by officals, non by the ones responsible for the acomplishment and planning of these. Never theless it is clear that where there is a motivated and trained staff for the indicated tasks, products and possessions of quality are acquired. These, when consumed, originate satisfaction which will become a pattern to the community changing the level of the target commonwealth's health. By the bibliographic analysis, it was possible to show that there is a contrast on the quality of the offered services beteen the regions of this country and... / Doutor

Este estudo objetivou estabelecer condições de irradiação com o laser de Er,Cr:YSGG (de comprimento de onda de 2.79 µm) que propiciassem modificações no esmalte dental e aumentassem sua resistência à desmineralização, associadas ou não à aplicação tópica de flúor fosfato acidulado (FFA). Fluências laser de 2,8 J/cm², 5,6 J/cm² e 8,5 J/cm² foram selecionadas, as quais foram associadas com a aplicação prévia de substância fotoabsorvedora (pasta de pó de carvão) e então com aplicação de FFA posteriormente às irradiações. Inicialmente, foram avaliadas as alterações morfológicas, as modificações na temperatura superficial e os aumentos na temperatura intrapulpar decorrentes das irradiações. Posteriormente, as amostras tratadas foram submetidas a uma ciclagem de pH com duração de 10 dias. Após a produção das lesões de mancha-branca, foi avaliada a perda mineral e as quantidades de flúor fracamente ligado e fortemente ligado. Todas as soluções desmineralizantes e remineralizantes foram avaliadas com relação ao seu conteúdo de cálcio, fósforo inorgânico e flúor. Os dados foram avaliados quanto à normalidade e homogeneidade de sua distribuição para que pudesse ser escolhido o teste estatístico mais adequado, considerando o nível de significância de 5%. As fluências selecionadas promoveram superfícies ablacionadas; as fluências de 5,6 J/cm² e 8,5 J/cm² promoveram aumentos de temperatura superficial superiores a 110º C. A análise da temperatura intrapulpar revelou que as fluências escolhidas não aumentaram as temperaturas pulpares acima do limite estabelecido para pulpite. A pasta de pó de carvão não promoveu modificações morfológicas ou alterações significativas nas temperaturas pulpares; entretanto, aumentou as temperaturas superficiais durante as irradiações. Apenas a irradiação laser sob fluência de 8,5 J/cm² diminuiu significativamente a perda mineral quando comparado ao grupo sem tratamento; embora a associação da pasta de carvão + irradiação laser a 2,8 J/cm² + aplicação de FFA tenha apresentado o menor valor de perda mineral de todos os grupos de tratamento deste estudo, tal valor não diferiu estatisticamente daquele obtido quando apenas o FFA foi aplicado (grupo controle positivo). A análise de flúor fracamente ligado revelou que a irradiação laser proporcionou maior formação e retenção do fluoreto de cálcio formado após aplicação de FFA, provavelmente devido à ablação do esmalte, enquanto que a análise de flúor total mostrou não haver diferenças na quantidade de fluorapatita formada após a irradiação laser quando comparado às amostras não-irradiadas. A avaliação das soluções desmineralizantes e remineralizantes evidenciou não haver diferenças significativas nas concentrações de cálcio e fósforo inorgânico entre as amostras irradiadas ou não irradiadas; contudo, a determinação de flúor nestas soluções mostrou diferenças expressivas no conteúdo de flúor, sugerindo que a irradiação laser pode favorecer a uma maior formação de fluoreto de cálcio. De acordo com os resultados deste estudo, pode-se concluir que a irradiação laser proporciona maior retenção de fluoreto fracamente ligado formado no esmalte decorrente da aplicação tópica de flúor; entretanto, a associação dos tratamentos não proporcionou maior efeito na redução da desmineralização do esmalte do que o efeito da aplicação tópica de FFA isoladamente. / This study aimed to stablish irradiation conditions of Er,Cr:YSGG laser (wavelength of 2.79 µm) which could propitiate changes on human dental enamel and increase its resistance to demineralization, when associated or not with topical application of acidulated phosphate fluoride (APF). Fluences of 2,8 J/cm&sup2, 5,6 J/cm&sup2 e 8,5 J/cm&sup2 were selected; they were associated or not with previous application of a photoabsorber (coal paste) and then APF was applied or not after laser irradiation. In a first step, the morphological findings, the surface temperatures, and the pulpal temperatures were evaluated during laser irradiation. After that, the treated samples were submitted to a a ten-day pH-cycling model. After producing the incipient white-spots lesions, the following aspects were evaluated: the mineral loss, the loosely bound fluoride and the firmly bound fluoride. All the demineralizing and remineralizing pH-cycling solutions were evaluated with respect to their calcium (Ca), inorganic phosphorous (Pi) and fluoride (F-) concentrations. The data had their normality and homogeneity distribution statistically evaluated, and it was chosen an appropriated statistical test for each performed analysis according to the obtained results, considering 5% significant level. The fluences selected for this study created ablated surfaces; the fluences of 5.6 J/cm&sup2 and 8.5 J/cm&sup2 promoted increments in surface temperature above 110º C. The intrapulpal temperature changes revealed that laser irradiation did not increase the pulpal temperatures above the critical threshold for induction of pulpitis. The coal paste did not promote any changes on surface morphology or in the intrapulpal temperature changes; however, this paste increased the surface temperatures during laser irradiation. Only laser irradiation at 8.5 J/cm&sup2 was able to decrease the mineral loss when compared to the no-treatment group; although the association of coal paste + laser at 2.8 J/cm&sup2 + APF application presented the lesser mineral loss of all treatment groups of this study, this value was not statistically different than those revealed in the FFA group (positive control). The analysis of loosely bound fluoride revealed that laser irradiation was able to retain the calcium fluoride formed after APF application due to the ablation process, while the analysis of firmly bound fluoride showed no differences in fluorapatite quantities formed after laser irradiation when compared to the non-irradiated samples. The evaluation of demineralizing and remineralizing pH-cycling solutions evidenced no significant differences in calcium or inorganic phosphorous concentrations between lased or unlased samples; however, the fluoride determination exposed important differences on fluoride contents, which suggested that laser irradiation could induce a higher calcium fluoride formation. According to the results of this study, it was possible to conclude that the laser irradiation can propitiate, on enamel, higher loosely bound fluoride retention formed by topical application of fluoride; however, the association of treatments did not increased the effect obtained by APF application alone on enamel demineralization.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第22008号 / 社医博第94号 / 新制||社医||10(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 中山 健夫, 教授 木原 正博, 教授 別所 和久 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Indiana University-Purdue University Indianapolis (IUPUI) / Two of the three fluoride varnishes sold on the American market today are sold in 10-ml tubes of 5.0-percent NaF varnish (Duraphat and Duraflor). Pilot studies have shown that a separation of contents within these tubes exists. The purpose of the current study was four-fold: 1) to measure the fluoride concentration gradient in 10-ml tubes of fluoride varnish, based on the resting position of the tube prior to use; 2 ) to compare a varnish 's concentration gradient to its ability to inhibit caries in an artificial caries environment; 3) to compare and contrast fluoride concentration gradients of Duraphat and Duraflor; and finally, 4) to determine if Quantitative Light Fluorescence(QLF) can detect differences in lesions developed when exposed to an artificial caries environment and fluoride varnish. Human teeth specimens were subjected to a caries challenge and treated with a sample of fluoride varnish from one of five categories: Duraphat stored horizontally and vertically for one week; Duraflor stored horizontally and vertically for one week; or a CavityShield 0.4 ml unit-dose. Results show that no significant fluoride/ppm differences exist between groups (p = 0.29). It was shown that the order in which Duraflor varnish was dispensed from the tubes significantly affected the fluoride concentration (p < 0.05). The order effect was not significant for Duraphat (p = 0.99). QLF data analysis shows there is no significant difference (p > 0.05) in the amount of remineralization obtained by using any varnish stored in any position. This was confirmed using confocal microscopy. These results indicate that all three brands of fluoride varnish are able to remineralize incipient in vitro carious lesions, regardless of from which part of the 10-ml tube the varnish is taken. However, a fluoride concentration gradient exists in tubes of Duraflor. Also, QLF is able to detect denmineralized and remineralized incipient lesions.

Indiana University-Purdue University Indianapolis (IUPUI) / This study was designed to determine if additional fluoride, ingested as a sodium fluoride - vitamin supplement would provide added protection against dental caries without causing any significant fluorosis. A total of 456 children, one to 14 months of age, residing in cities having 0.6 - 0. 8 ppm F in the water supply were randomly assigned according to age, sex and community to the following groups : Group A, 0. 5 mg F to age 3 then 1. 0 mg thereafter; Group B (control), vitamins throughout the study; and Group C, 0.5 mg F throughout the study. Dental examinations were started at approximately 2 1/2 to 3 years of age and were repeated every six months. A fluorosis examination ended the study after about seven years. When compared according to length of time on product, Group A had a significant reduction in deft and defs of 42.2 and 47.1 percent at 60 months. Group C had a 32.1 and 37.4 percent reduction. When compared by age, Group A had a 37.5 and 44.8 percent reduction in deft and defs at 66 months. Group C had a 34.3 and 40.1 percent reduction for the same period. No significant reductions were observed in permanent teeth. Based on the fluorosis index (Group A - 0.250; Group B - 0.033; and Group C - 0.188) none of the groups had any unacceptable amounts of fluorosis. The results indicate that up to 1.0 mg per day of additional fluoride does not cause objectionable fluorosis and may be ingested safely by children residing in areas containing 0. 6 - 0. 8 ppm F in the water supply. A 0.5 mg F supplement was almost as effective as a 1.0 mg level in providing added protection against dental caries in primary teeth.

Caries is one of the most common diseases in dentistry. The key to preventing caries is the balance between demineralization and remineralization. Dental delivery methods such as toothpaste, gels, and varnishes are commonly applied as preventative methods against caries. With the advancement of nano-technology, dentistry can supplement traditional diagnostic and treatment methods with more advanced, efficient, and personalized dental care. Hydroxyapatite (HA) is a biomimetic agent that aims to remineralize and protect the enamel from erosion. It is formed by nanoparticles similar to apatite crystals of tooth enamel. Furthermore, it is one of the most biocompatible and bioactive materials. Because HA is present in our enamel, it will be proven as an effective biomimetic agent for the prevention and remineralization of caries. The Caries Management by Risk Assessment (CAMBRA) tool helps dental care professionals identify high-risk patients more susceptible to caries. With the addition of biomimetic agents such as hydroxyapatite, dentists can effectively provide treatment to detect early-stage lesions and correctly intervene with remineralization techniques in all patient types. Studies have shown that HA toothpastes have anti-bacterial properties against S. mutans caries causing bacteria, and inhibit demineralization, similar to fluoride. In orthodontic patients, no significant difference was found between fluoride and HA dentifrice on caries progression nor between HA and fluoride gel in remineralizing initial caries. Similar reports found non-inferiority of hydroxyapatite toothpaste compared to fluoride toothpaste. Fluoride's mechanism of action differs from HA in that hydroxyapatite protects enamel by creating a new layer of enamel, and fluoride hardens the existing enamel layer. A comparison of three biomimetic agents, Casein Phosphopeptides Amorphous Calcium Phosphate (CPP-ACP), Tricalcium Phosphate (TCP), and hydroxyapatite found hydroxyapatite to have the highest amount of remineralization with nHA being more effective in managing early caries and decreasing lesion depth. Hydroxyapatite toothpaste was also shown to be a favorable alternative to oxidizing bleaching agents and zinc-carbonate hydroxyapatite being more effective than a fluoride/potassium nitrate dentifrice in reducing dentin hypersensitivity. With the high consumption of acidic food and beverages, a Zinc-nHA toothpaste was to be more effective than fluoride toothpaste in remineralization and protection after the acid attack and demineralization from Coca-Cola. In conclusion, with the reported results of the studies in this paper, it is known that nano- hydroxyapatite is an effective and safe alternative to fluoride. Many studies have proven nano-hydroxyapatite effective in helping to remineralize early carious lesions. In some studies, it is just as promising as fluoride is. It is especially beneficial for high-risk patients to implement nHA into their oral care routine. Nano-hydroxyapatite (nHA) has been proven to promote remineralization, inhibit demineralization, whiten teeth, protect against dental erosion, and reduce dentin hypersensitivity.

The 2000 Surgeon General report declared dental caries (tooth decay) a "silent epidemic" [1]. Dental caries is preventable, yet it is the most common chronic disease among children and adolescents in the US [2]–[6]. US dental care systems have fallen short of preventing avoidable oral diseases and their consequences, despite enormous dental expenditures. Self-care through oral hygiene, a key health behavior for caries risk reduction, is not practiced nearly as consistently or accurately as dentists and health organizations would like [7],[8]. Evidence-based and cost-effective preventive dental treatments exist but are underutilized. Value-based care (VBC) is an effort to strengthen the quality of dental care, decrease unnecessary expenditure and increase cost-effectiveness through an emphasis on prevention. This paper has three aims. Aim #1 is to understand the current dental VBC landscape through a narrative review. It synthesizes the available literature on dental value-based models and their challenges. Aim #2 discusses the need for quality metrics to help meet VBC goals. It evaluates New York State’s (NYS) quality assurance of dental care among NYS’s Medicaid recipients 0-20 years of age through their Quality Assurance Reporting Requirement (QARR). Aim #3 proposes a revision of metrics and identifies the needed indicators for NYS’s quality assurance of preventive dental care for Medicaid recipients 0-20 years of age. Under Aim #1 Sixty-nine abstracts were reviewed. Forty-six articles met the inclusion criterion and were classified according to four prominent themes: dental metrics, interprofessional collaboration, information technology, and care/case management. Common challenges were identified in dental VBC, including but not limited to, the requirement for interdisciplinary, interoperability; too much involvement of stakeholders; variations in dental treatment modalities and coverage; and challenges in developing appropriate metrics. While initiatives in the peer-reviewed articles leveraged value metrics for the assessment of their programs, no studies among the 46 articles evaluated statewide governmental quality measures’ effectiveness for VBC. Gray literature was therefore utilized for Aim #2. The second aim discusses the need for quality metrics to help meet VBC goals and identifies tested and scalable dental metrics. Healthcare Effectiveness Data Information Set and Dental Quality Alliance were found to be the leading dental metric developers. NYS’s Quality Assurance Reporting Requirement (QARR) indicators were identified as the lead metric set used to evaluate NYS’s Medicaid Managed Care plans and Managed Care Organizations. Several limitations were identified in NYS’s QARR dental metric. It is limited to one dental indicator, it does not measure the quality of dental services and has unintended consequences. Under AIM #3, ten recommended steps are provided for the NYS Department of Health Office of Health Insurance Program (NYS DOH OHIP) to strengthen their quality assurance of preventive dental care among Medicaid recipients 0-20 years of age. The ten steps NYS DOH OHIP can take to develop a dental metric set aimed to assess and improve the utilization of preventive dental services are as follows, 1. Define value from the perspective of the patient 2. Select tested, specific, and measurable metrics 3. Metrics need to be attainable, relevant and anchored within a time frame 4. Metrics need to be appropriate proxies 5. Account for patient characteristics, when feasible 6. Strive for standardized data collection and harmonization 7. Build appropriate information technology infrastructure 8. Reimburse dental providers through alternative payment models 9. Strengthen Provider Accountability by Improving QARR’s Use of Dental Metrics 10. Amend QARR to strengthen quality assurance of preventive dental services A final set of recommendations proposes revisions to NYS’s assessment of preventive dental services through QARR. The recommendations provide technical details on the needed amendments and additions for a more robust metric set to improve NYS’s quality assurance of preventive dental care among NY’s youngest Medicaid recipients. The final set of recommendations which will make system-level changes in dental care delivery and shift NYS towards dental VBC are as follows,  Revise QARR’s oral health indicator to measure the percentage of all enrolled children under age 21 who received dental services within the reporting year  Replace QARR’s dental screening encounter code (D0190) with comprehensive (D0150) or periodic (D0120) oral examination codes  Create a metric for the application of sealants in the erupted, unrestored adult molar teeth of children.  Create a metric for the application of topical fluoride at least once every six months on all teeth of children and adolescents under the age of 21  Utilize existing tested and validated preventive dental metrics  Raise statewide QARR benchmark metrics annually to encourage higher utilization and success of services  Tie performance metrics’ achievement to reimbursement (P4P)  Evaluate implemented metrics for their effectiveness in reducing the need for restorative services to help achieve VBC goals among NYS Medicaid recipients 0-20 years of age  Release an open comment period to seek stakeholders’ perception

<p>Dental caries is a huge problem among the previously disadvantaged population. Early childhood caries is a problem with infants. This thesis contained information concerning the parents knowledge about their children's oral health and their own personal details. These children were all in the age group 2-5 years. The study findings suggest that parent and parents-to-be, need to be informed on oral health issues concerning their children. This should not solely be the task of dentists but other health care workers as well.</p>

A irradiação com o laser de Er,Cr:YSGG promove aumento da área de superfície do esmalte dental irradiado, o que pode resultar em uma maior retenção e um efeito prolongado do fluoreto (F-) presente em produtos fluoretados de diferentes concentrações. O produto formado na superfície de esmalte originado de uma única aplicação de flúor fosfato acidulado (FFA 12.300 &mu;g F-/g) ou da frequente aplicação tópica de dentifrício contendo 1.100 &mu;g F-/g poderia ter seu efeito cariostático prolongado, pelo aumento de sua retenção na superfície do esmalte dental irradiado. Uma vez que o esmalte dentário livre de biofilme não sofre desmineralização na cavidade bucal, sugerimos um estudo in situ onde se possa avaliar o prolongamento do efeito do destas associações, também na presença de placa. As condições de irradiação do estudo in situ, foram determinadas, in vitro, com laser Er,Cr:YSGG no esmalte de maneira isolada ou combinada com as aplicações tópicas de: 1- dentifrício de concentração 1.100 &mu;g F-/g ou 2- FFA, para posteriores análises da formação e retenção de CaF2. Foram realizadas análises morfológicas por microscopia eletrônica de varredura, determinação da concentração do flúor solúvel em álcali por meio do eletrodo íon específico e análise da microdureza em corte longitudinal. Os resultados por microscopia eletrônica de varredura verificaram qualitativamente a formação de produtos na superfície de esmalte na forma de CaF2. A análise bioquímica para determinação quantitativa do F- solúvel em álcali determinou como sendo estatisticamente diferentes (p&le;0,05) os Grupos nos quais o laser foi utilizado previamente à aplicação tópica dos dois tipos de produtos fluoretados de diferentes concentrações (dentifrício e FFA), in vitro. Em seguida, foi realizado o estudo in situ quando voluntários utilizaram dispositivos palatinos, contendo blocos de esmalte humano, previamente tratados, com o objetivo de acúmulo da placa nativa sobre os mesmos. Durante a fase in situ, os voluntários permaneceram utilizando dentifrício F- para verificação da ação do mesmo na presença de biofilme sobre os blocos irradiados. Foram correlacionados os efeitos da formação de F-, decorrentes dos tratamentos propostos, na redução da desmineralização. A análise bioquímica para quantificação do F- solúvel em álcali determinou como sendo estatisticamente diferentes (p0,05) os Grupos nos quais o laser foi utilizado após a aplicação tópica dos dois tipos de produtos fluoretados de diferentes concentrações (dentifrício e FFA), in situ, sugerindo um efeito prolongado da sinergia dos tratamentos na diminuição da desmineralização. / The effect of the Er, Cr: YSGG laser promotes increased surface enamel area, which can result in increased retention and prolonged effects of Fluoride (F-) present in products with different concentrations of fluoride. The cariostatic effect from product formed in the enamel surface originated from a single application of acidulated phosphate fluoride (APF 12 300 &mu;g F-/ g), or frequent topical application of dentifrice containing 1,100 &mu;g F-/ g, could be prolonged by increasing its retention on irradiated enamel surface. Once the biofilm-free enamel does not suffer demineralization within the oral cavity, it is proposed an in situ study where we can evaluate the prolongation of the effect of these associations, also in the presence of plaque. The irradiation conditions of the in situ study were determined in vitro with Er, Cr: YSGG laser irradiation of enamel surface either alone or combined with one of the topical applications: 1 - dentifrice F-1,100 &mu;g / g or 2 - APF For further analysis of the formation and retention of CaF2. Morphological analyzes were performed by scanning electron microscopy, determination of the concentration of alkali-soluble fluoride by specific ion electrode analysis and microhardness. The results of scanning electron microscopy verified qualitatively the formation of products in the enamel surface in the form of CaF2. Biochemical analysis for quantitative determination of F-soluble in alkali determined to be statistically different (p&le;0.05) Groups in which the laser was used prior to application of topical fluoride products of two types of different concentrations (APF and dentifrice) in vitro. Then, the study was conducted in situ when volunteers wore palatal appliances containing blocks of human enamel, pretreated aiming native plaque formation. During in situ experiment, the volunteers remained using F-dentifrice. Correlations with the effects of F-formation, resulting from treatments proposed in the reduction of demineralization were made. Biochemical analysis for quantitative determination of F- alkali soluble determined to be statistically different (p 0.05). Groups in which the laser was used after topical application of both types of different fluoride concentrations (APF and toothpaste), in situ, suggested an synergic effect, extending treatment efficiency in reducing demineralization.