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Early childhood caries (ECC) is the most prevalent oral disease of children worldwide. Epidemiological studies reported that most of the ECC are left untreated. While young children may not be co-operative enough for conventional restorative treatments, silver diamine fluoride (SDF) can be topically applied on tooth surfaces as a cariostatic agent. Previous clinical trials have confirmed that annual application of 38% SDF is effective in arresting dentin caries in preschool children. However, information about the effectiveness of SDF with different combinations of concentration and frequency is still lacking. This information is important for the optimal application of SDF in the future public health programs for caries control. This prospective randomized controlled trial aimed to investigate and compare the effectiveness of 12% and 38% SDF when applied annually or biannually in arresting dentin caries of primary teeth of preschool children for 30 months. The two null hypotheses tested were firstly, there is no difference in effectiveness when SDF is applied at 12% or 38% in arresting dentin caries of preschool children; and secondly, there is no difference in effectiveness when SDF is applied annually or biannually in arresting dentin caries of preschool children. A total of 888 healthy and cooperative K1 children aged 3-4 years with at least one dentin caries surface were recruited and randomized into four treatment groups: Group 1 received annual applications of 12% SDF, Group 2 received biannual applications of 12% SDF, Group 3 received annual applications of 38% SDF, and Group 4 received biannual applications of 38% SDF. Group 3 was assigned as the positive control group. Primary outcome was soft dentin caries surface at baseline that became arrested at the follow-up examinations. Clinical examinations were conducted at the kindergartens every 6 months by the same trained examiner. Parental questionnaires were used to collect the children’s demographic information, oral hygiene related habits, parental satisfaction with children’s dental appearance and dental health at baseline, 18- and 30-month examinations. Adverse effects after treatments including increment of non-vital teeth, complaint about tooth or gingival discomfort, gingival discoloration, and black staining over arrested surfaces were also recorded. A total of 798 children with 3,268 caries surfaces were examined at 30-month follow-up. The dropout rates of the four groups were similar. The respective proportions of arrested surfaces in Group 1 to Group 4 were 48.7%, 54.0%, 60.6%, and 66.9%, respectively (p < 0.001). The two null hypotheses were rejected. Both concentration and frequency were significantly related to treatment effectiveness, but no significant interaction between these two factors was found. The effect size of concentration was much greater than frequency. Other than a higher proportion of black staining in groups receiving 38% SDF treatments, there were no significant differences in adverse effects among the children in the four treatment groups. To conclude, SDF is more effective in arresting dentin caries in primary teeth of preschool children at 38% than 12%, and when applied biannually than annually. Clinical significant improvement in effectiveness can be achieved by increasing its concentration. / published_or_final_version / Dentistry / Doctoral / Doctor of Philosophy

No description available.

Bibliography: leaves [165]-178. / xviii, 178, [27] leaves : ill. (some col.) ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Designs and implements a field trial to test the effectiveness of a 10 ppm fluoride co-crystallized sugar in inhibiting caries as a potentially inexpensive public health preventative measure. / Thesis (Ph.D.)--University of Adelaide, Dept. of Dentistry, 1997?

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 6 uppsatser.

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

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.

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