BACKGROUND: Fluoride is the main factor in reducing the prevalence of caries worldwide. However, there is insufficient knowledge about whether people in different age groups are aware of the benefits of fluoride toothpaste, as well as about people\'s daily oral care habits and whether they use fluoride. The purpose of this research is to investigate the knowledge and performance of Iranian students regarding the use of toothpaste containing fluoride.
METHODS: This study was conducted on the first- and second-year high school students of Kerman city. Questionnaires containing personal questions, general questions, and questions related to students\' knowledge and performance regarding the use of fluoride toothpaste were provided to them and then they were asked to complete and submit it. The results obtained from the survey were analyzed by T-test, Mann-Whitney test, and Chi-Square test in SPSS Version 24. The significance level in data analysis was P < 0.05.
RESULTS: In this research, 681 forms including 252 boys and 429 girls were examined. The average age of the participants was 14.1 ± 0.4. 91.2% declared that they use toothpaste and 77.8% of them used toothpaste containing fluoride. 521 people stated that the price of toothpaste is important in using the type of toothpaste. 621 people used regular toothbrush and 609 people evaluated their oral health as good. 621 of the participants stated that toothpaste makes the mouth healthy. The average knowledge score was 16.7 ± 2.1 out of 24, which indicates the average knowledge of students in this field.
CONCLUSIONS: This study showed that students\' knowledge and performance about using fluoride-containing toothpaste is average. There was no significant relationship between performance and knowledge with age and gender. There was also a positive correlation between knowledge and performance indicating that increasing knowledge leads to an increase in behavioral changes. Also, there was a positive correlation between knowledge and performance, and a correlation coefficient of 0.731 was obtained between knowledge and performance. It shows that increasing knowledge leads to increasing behavioral changes.

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BACKGROUND: Dental caries is a dynamic process. By using therapeutic agents, early, noncavitated lesions and caries limited to the enamel can be stopped or even remineralized. For the remineralization of the initial carious lesion, many nonfluoridated remineralizing agents were investigated.
OBJECTIVE: An observational study to assess the remineralizing efficacy of tricalcium phosphate (TCP), nano-hydroxyapatite (nHAp) and ozone remineralizing agents on the artificial carious lesion.
METHODS: In this observational research, the artificial carious lesion was produced on extracted 40 premolar teeth. Later, remineralizing agents (Group A: nHAp, Group B: TCP, Group C: Ozone remineralizing agents, Group D: Control group (Deionized water) were used to remineralize demineralized teeth. Utilizing the Vickers Hardness Number, the level of demineralization and remineralization was assessed. Later these readings were statistically assessed using the Tukey\'s HSD (honestly significant difference) and ANOVA tests in SPSS version 21.0. The P value was set at 0.05 or less.
RESULTS: After demineralization, there was a decrease in enamel microhardness values, with 32% in Group A, 26% in Group B, 22% in Group C, and 21% in Group D, respectively. From the baseline to demineralization, there was a statistically significant decrease in microhardness across all groups. After remineralization, Groups A, B, and C experienced an increase in microhardness while Group D experienced no changes. This showed that Group A had the highest remineralization percentage, followed by Group B and Group C.
CONCLUSIONS: nHAp and TCP had the greater remineralizing ability, which can be used to manage initial carious lesions.

OBJECTIVE: To evaluate the protective effect of an experimental solution containing TiF4/NaF on the development of radiation-induced dentin caries lesions.
METHODS: bovine root samples were irradiated (70Gy) and distributed as following (n=12/group): Commercial Saliva (BioXtra), NaF (500 ppm F-), TiF4 (500 ppm F), TiF4/NaF (TiF4: 300 ppm F-, NaF: 190 ppm F-), and Phosphate buffer solution (PBS, negative control). Biofilm was produced using biofilm from irradiated patients and McBain saliva (0.2% of sucrose, at 37oC and 5% CO2) for five days. The treatments were applied 1x/day. Colony-forming units (CFU) were counted and demineralization was quantified by transversal microradiography. The ANOVA/Tukey test was applied for all parameters.
RESULTS: All treatments reduced CFU for total microorganisms. TiF4 reduced Lactobacillus sp. (7.04±0.26 log10 CFU/mL) and mutans streptococci (7.18±0.28) CFU the most, when compared to PBS (7.58±0.21 and 7.75±0.17) and followed by NaF (7.12±0.31 and 7.34±0.22) and TiF4/NaF (7.16±0.35 and 7.29± 0.29). TiF4 and Commercial saliva showed the lowest integrated mineral loss (ΔZ-vol%.mm) (1977±150 and 2062±243, respectively) when compared to PBS (4540±335), followed by NaF (2403±235) and TiF4/NaF (2340±200). Commercial saliva was the only to significantly reduce mineral loss (LD-µm) (111±25) compared to PBS (153±24).Mean mineral loss (R-vol%) decreased by 35.2% for TiF4 (18.2±3.3) when compared to PBS (28.1±2.9) Conclusion: TiF4/NaF has a comparable anti-cariogenic effect to TiF4 and Commercial saliva under the model in this study.

This study aimed to evaluate the influence of the Er,Cr:YSGG irradiation and 980-nm diode lasers on the surface roughness (SR) and volume loss (VL) of dentin subjected to cariogenic challenge. Subsequently, 130 specimens of bovine dentin were divided into the following 13 groups: NT: no treatment; FG: fluoride gel; FV: fluoride varnish; Di: 980-nm diode; Di + FG; Di + FV; FG + D; FV + Di; Er: Er,Cr:YSGG; Er + FG; Er + FV; FG + Er and FV + Er. Er,Cr:YSGG laser parameters were as follows: 0.25 W; 5.0 Hz; 4.46 J/cm2 without water and 55% air. Furthermore, the 980-nm diode laser parameters were 2.0 W; 2.0 Hz; 21.41 J/cm2. The samples from each group were subjected to pH cycling. A confocal laser scanning microscope was used to evaluate SR and VL. Difference between the volume of the reference and treated areas + DES/RE was used to determine SR and VL. The mean values of the different groups were subjected to analysis of variance and Tukey\'s post-hoc test. The VL values were analyzed using the Kruskal-Wallis and Dunn post-hoc test (p < 0.05). The SR of the reference area did not show a statistically significant 1807-3107-bor-38-e025treatment and cariogenic challenge (p > 0.05). Moreover, VL in the FV + Di and FV + Er groups showed a statistically significant difference compared with areas submitted to different types of treatment and cariogenic challenge (p > 0.05). Er,Cr:YSGG and 980-nm diode lasers associated with fluoride varnishes decreased dentin VL in bovine teeth submitted to cariogenic challenge.

This is an update of a review first published in 2010. Use of topical fluoride has become more common over time. Excessive fluoride consumption from topical fluorides in young children could potentially lead to dental fluorosis in permanent teeth.
To describe the relationship between the use of topical fluorides in young children and the risk of developing dental fluorosis in permanent teeth.
We carried out electronic searches of the Cochrane Oral Health Trials Register, CENTRAL, MEDLINE, Embase, three other databases, and two trials registers. We searched the reference lists of relevant articles. The latest search date was 28 July 2022.
We included randomized controlled trials (RCTs), quasi-RCTs, cohort studies, case-control studies, and cross-sectional surveys comparing fluoride toothpaste, mouth rinses, gels, foams, paint-on solutions, and varnishes to a different fluoride therapy, placebo, or no intervention. Upon the introduction of topical fluorides, the target population was children under six years of age.
We used standard methodological procedures expected by Cochrane and used GRADE to assess the certainty of the evidence. The primary outcome measure was the percentage prevalence of fluorosis in the permanent teeth. Two authors extracted data from all included studies. In cases where both adjusted and unadjusted risk ratios or odds ratios were reported, we used the adjusted value in the meta-analysis.
We included 43 studies: three RCTs, four cohort studies, 10 case-control studies, and 26 cross-sectional surveys. We judged all three RCTs, one cohort study, one case-control study, and six cross-sectional studies to have some concerns for risk of bias. We judged all other observational studies to be at high risk of bias. We grouped the studies into five comparisons. Comparison 1. Age at which children started toothbrushing with fluoride toothpaste Two cohort studies (260 children) provided very uncertain evidence regarding the association between children starting to use fluoride toothpaste for brushing at or before 12 months versus after 12 months and the development of fluorosis (risk ratio (RR) 0.98, 95% confidence interval (CI) 0.81 to 1.18; very low-certainty evidence). Similarly, evidence from one cohort study (3939 children) and two cross-sectional studies (1484 children) provided very uncertain evidence regarding the association between children starting to use fluoride toothpaste for brushing before or after the age of 24 months (RR 0.83, 95% CI 0.61 to 1.13; very low-certainty evidence) or before or after four years (odds ratio (OR) 1.60, 95% CI 0.77 to 3.35; very low-certainty evidence), respectively. Comparison 2. Frequency of toothbrushing with fluoride toothpaste Two case-control studies (258 children) provided very uncertain evidence regarding the association between children brushing less than twice per day versus twice or more per day and the development of fluorosis (OR 1.63, 95% CI 0.81 to 3.28; very low-certainty evidence). Two cross-sectional surveys (1693 children) demonstrated that brushing less than once per day versus once or more per day may be associated with a decrease in the development of fluorosis in children (OR 0.62, 95% CI 0.53 to 0.74; low-certainty evidence). Comparison 3. Amount of fluoride toothpaste used for toothbrushing Two case-control studies (258 children) provided very uncertain evidence regarding the association between children using less than half a brush of toothpaste, versus half or more of the brush, and the development of fluorosis (OR 0.77, 95% CI 0.41 to 1.46; very low-certainty evidence). The evidence from cross-sectional surveys was also very uncertain (OR 0.92, 95% CI 0.66 to 1.28; 3 studies, 2037 children; very low-certainty evidence). Comparison 4. Fluoride concentration in toothpaste There was evidence from two RCTs (1968 children) that lower fluoride concentration in the toothpaste used by children under six years of age likely reduces the risk of developing fluorosis: 550 parts per million (ppm) fluoride versus 1000 ppm (RR 0.75, 95% CI 0.57 to 0.99; moderate-certainty evidence); 440 ppm fluoride versus 1450 ppm (RR 0.72, 95% CI 0.58 to 0.89; moderate-certainty evidence). The age at which the toothbrushing commenced was 24 months and 12 months, respectively. Two case-control studies (258 children) provided very uncertain evidence regarding the association between fluoride concentrations under 1000 ppm, versus concentrations of 1000 ppm or above, and the development of fluorosis (OR 0.89, 95% CI 0.52 to 1.52; very low-certainty evidence). Comparison 5. Age at which topical fluoride varnish was applied There was evidence from one RCT (123 children) that there may be little to no difference between a fluoride varnish application before four years, versus no application, and the development of fluorosis (RR 0.77, 95% CI 0.45 to 1.31; low-certainty evidence). There was low-certainty evidence from two cross-sectional surveys (982 children) that the application of topical fluoride varnish before four years of age may be associated with the development of fluorosis in children (OR 2.18, 95% CI 1.46 to 3.25).
Most evidence identified mild fluorosis as a potential adverse outcome of using topical fluoride at an early age. There is low- to very low-certainty and inconclusive evidence on the risk of having fluorosis in permanent teeth for: when a child starts receiving topical fluoride varnish application; toothbrushing with fluoride toothpaste; the amount of toothpaste used by the child; and the frequency of toothbrushing. Moderate-certainty evidence from RCTs showed that children who brushed with 1000 ppm or more fluoride toothpaste from one to two years of age until five to six years of age probably had an increased chance of developing dental fluorosis in permanent teeth. It is unethical to propose new RCTs to assess the development of dental fluorosis. However, future RCTs focusing on dental caries prevention could record children\'s exposure to topical fluoride sources in early life and evaluate the dental fluorosis in their permanent teeth as a long-term outcome. In the absence of these studies and methods, further research in this area will come from observational studies. Attention needs to be given to the choice of study design, bearing in mind that prospective controlled studies will be less susceptible to bias than retrospective and uncontrolled studies.

BACKGROUND: One of the most prevalent health problems affecting children worldwide is untreated caries in primary teeth. Agents to arrest caries are used to manage untreated decay in children in disadvantaged communities. Nano Silver Fluoride (NSF) overcomes the staining problems of Silver Diamine Fluoride (SDF). This study compared the clinical cariostatic effect of NSF to 38% SDF for arresting caries lesions.
METHODS: The study included 360 children younger than 4 years, with at least one active lesion, ICDAS score ≥ 3, recruited from nurseries in a rural area in Alexandria, Egypt, in 2022. They were randomly assigned to receive a single application of NSF at baseline, or two applications of SDF at baseline and after 6 months. The arrest of active carious lesions was assessed after 6 and 12 months using ICDAS criteria, and parents\' satisfaction with child appearance was also assessed. Chi-Square test was used to compare the groups and multi-level multiple logistic regression was used to assess the effect of the intervention on caries arrest at lesion level and binary logistic regression was used to assess the effect at patient level.
RESULTS: 1853 active lesions were included in children whose mean (SD) age was 42.3 (8.2) months. The arrest rate was significantly higher in the NSF than the SDF group at lesion level (78.4% and 65.0% at 6 months and 71.3% and 56.3% at 12 months, p < 0.001). In regression analysis, NSF had significantly higher odds of caries arrest than SDF at lesion level (at 6 months, AOR = 2.57, 95% CI: 1.55, 4.26 and at 12 month, AOR = 3.27, 95% CI: 1.89, 5.67). Parents of children receiving NSF had significantly greater satisfaction with their children\'s dental appearance than those receiving SDF: (97.2% and 76.1%, respectively, p < 0.001).
CONCLUSIONS: NSF demonstrated greater effectiveness in arresting caries in preschool children without inducing black staining of teeth and with greater parental satisfaction than SDF. NSF can be an alternative to SDF in arresting caries especially in underprivileged communities.
BACKGROUND: The trial was registered in the clinicaltrials.gov registry (#NCT05255913)-16/02/2022.

Silver diamine fluoride (SDF) and atraumatic restorative treatment (ART) are treatment modalities that are minimally invasive and used for the prevention and control of dental caries. The amalgamation of these two techniques has led to the development of silver modified atraumatic restorative treatment (SMART). In this approach the carious lesion is restored with glass-ionomer cement (GIC) after SDF application. SMART effectively arrests caries without removing additional tooth structure, making it a promising option for caries management in children who lack cooperative ability.This article reviews the literature on SMART, the evidence regarding its applications in dental practice, its advantages, drawbacks, the scope for research, and clinical use.

BACKGROUND: The black staining effect of silver-containing solutions for use to arrest caries can have a negative aesthetic impact on children and parents. This study aims to assess the staining effects of Silver Diamine Fluoride/Potassium Iodide (SDF/KI), SDF and Nanosilver Fluoride (NSF).
METHODS: Forty-four extracted carious primary molars were collected and randomly divided into four groups (n = 11). The carious tissue in all teeth was removed using a chemo-mechanical caries removal agent with an excavator. After caries removal in all groups, SDF, SDF/KI, and NSF were applied to the different groups, while no solution was applied to the control group. Subsequently, the teeth in all groups were restored with compomer. Color values L*, a* and b* were measured using a spectrophotometer at three time points: immediately after compomer restoration (T0), one week later (T1), and four week later (T2). Changes in brightness (ΔL) and color (ΔE) over time were calculated and comparisons among groups were made.
RESULTS: The SDF solution induced statistically significant black staining (p = 0.013) and a decrease in L* value (p < 0.001) on the compomer material compared to the other groups over time.
CONCLUSIONS: It was observed that SDF/KI has the potential to reduce the black staining effect of SDF, though not entirely. Novel experimental solutions like NSF may offer an alternative to counteract the staining effect of SDF.

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