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JADA Specialty Scan - Pediatric Dentistry
Pediatric DentistryJADA Specialty Scan

Dietary fluoride of 2-year-old children

Fluoride concentrations of foods and beverages vary widely, and, if items in the 95th percentile of fluoride intake distribution are ingested, children could consume more fluoride than the recommended 0.05 mg/kg/d [milligrams per kilogram of body weight per day]. That finding is from a study published in the June 2017 issue of Journal of Community Dentistry and Oral Epidemiology.

Fluoride intake calculated in this study was higher than historically reported dietary levels, the authors said.

Researchers designed the study to measure fluoride concentrations of commonly consumed foods and beverages for 2-year-old children in the US Midwest. The researchers cross-referenced total diet study food lists from the US Food and Drug Administration with data from the National Health and Nutrition Examination Survey to choose which foods and beverages to include. They identified 117 foods and beverages and grouped them into 10 categories. They then identified 164 stores from within 15 grocery chains in Marion County, IN, and narrowed the list to 3: a discount supermarket chain, a large supermarket chain, and a regional discount variety store chain.

Researchers collected 291 samples from the 3 stores. Each item had at least 2 samples; 57 items had 3. Researchers used a modified microdiffusion technique to determine fluoride concentrations. They summarized fluoride concentrations for each food categories, and they estimated daily dietary fluoride intake using a simulation analysis.

The daily food servings for a typical diet for a healthy 2-year-old were 4 milk; 2 juice; 1 dairy (cheese, yogurt, etc.); 1 sweet treat (cookie, cake); 1 snack (popcorn, pretzels); 1 fruit, 2 vegetables; 1 pasta, rice or potato; 2 bread; 2 meat; 1 cereal or egg; and 1 condiment (butter, jelly, salsa).

The researchers found that fluoride concentrations in foods and beverages varied widely, from nondetectable for some oils and dairy products to more than 3.0 micrograms of fluoride (μgF) per gram for some processed meats, fish, and fruits. Some dairy and grain samples had concentrations higher than 2.0 μgF/g. Some low-mean fluoride items included sweets at 0.2 μF per g, vegetables at 0.34 μF/g and beverages at 0.33 μF/g. High-fluoride groups included grains at 0.73 μF/g.

A diet based on foods and beverages in the fifth percentile of fluoride intake distribution for an average child would result in 247 μgF/d or 0.020 mg/kg/d, while a diet with foods and beverages in the 95th percentile would result in a total intake of 622 μgF/d or 0.051 mg/kg/d.

Study limitations included the fact that the authors did not obtain duplicate samples for individual items within a single store. They also did not include different flavors and brands, as well as product lots. Other limitations include the lack of information about the actual brands, flavors, lots, and sizes ingested by the target population. Finally, the data do not allow for the determination of the relative contribution from foods and beverages, as water intake was not included in the researchers’ simulations, which means that comparisons to some other studies are limited.

Read the full article.


Consulting Editor: Paul S. Casamassimo, DDS, MS
Professor of Pediatric Dentistry, The Ohio State University College of Dentistry and Nationwide Children's Hospital, Columbus, OH

Consulting Editor: Arthur J. Nowak, DMD
Professor Emeritus, University of Iowa College of Dentistry
Affiliate Professor, University of Washington School of Dentistry

Restorative thresholds for carious lesions

A significant proportion of dental professionals would perform a restorative intervention for carious lesions that were confined to enamel or only minimally extended into dentin, according to a clinical review published in the May issue of Journal of Dental Research.

Researchers conducted a systematic review to determine dental professionals’ current lesion threshold for carrying our restorative interventions in adults or children (primary and permanent teeth) for proximal and occlusal carious lesions. They also wanted to know whether the thresholds differed between countries and patient groups, changed over time, or were influenced by dentist’s sex and patient’s age, socioeconomic status, caries risk, tooth, and primary or permanent dentition.

Researchers searched Embase, MEDLINE via PubMed, and Web of Science for observational studies without language, time, or quality restrictions. Screening and data extraction were independent and duplicate.

Researchers also performed random-effects meta-analyses with subgroup and meta-regression analyses.

Researchers identified 30 studies with 18,135 participants that met the inclusion criteria. The studies were published from 1985 through 2016. Sixteen were published within the past 10 years, 3 were published 10 through 15 years ago, and 11 were published more than 15 years ago. The studies represented 17 countries, focusing mainly on adults and permanent teeth.

Researchers found that 21% of dental professionals in 28 studies said they would intervene when the carious lesion had not reached the enamel dentin junction (EDJ). The likelihood of a restorative intervention nearly doubled in patients at high risk of developing caries.

For proximal lesions extending up to the EDJ, 48% of dentists or dental therapists said they would perform a restorative intervention. For occlusal lesions involving dentin, 74% said they would intervene. Dentists were nearly 1.5 times more likely to intervene in high-risk groups than in low-risk groups.

For occlusal lesions with enamel discoloration and cavitation but no clinical dentin involvement, 12% of dentists and dental therapists said they would intervene. Dentists were nearly 2.5 times more likely to intervene in high-risk groups than in low-risk groups.

Researchers found variances between countries but no significant temporal trends. None of the studies investigated dentists intervening at this threshold in high– versus low–caries risk patients.

Study limitations included the fact that studies measured what dentists said they would do rather than what they actually did. Sample sizes were often small and only about one-third were at a national level. Selection and response bias were also likely to have affected the results.

“A large proportion of practitioners still use a ‘drill-and-fill’ approach for enamel lesions,” researchers noted. “Nearly half of surveyed practitioners would intervene on proximal lesions extending up to the EDJ, which is increasingly difficult to justify given that most of these lesions are not cavitated and management options like sealing or infiltrating have been shown to successfully arrest most such lesions.”

Read the original article.


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Silver diamine fluoride to treat caries in children

A 38% concentration of silver diamine fluoride (SDF) is a promising strategy for managing dental caries in young children or those with special needs, according to a systematic review published in the March issue of JDR Clinical and Translational Research. The systematic review also suggested a new protocol for reporting randomized controlled trials.

Researchers set out to investigate the clinical effectiveness of SDF in arresting dental caries in children. They conducted a systematic search of literature in 7 databases containing articles in English, Chinese, Japanese, Portuguese, and Spanish. They excluded duplicate articles, screened the titles and abstracts, and excluded irrelevant publications. They retrieved the full-text versions of the remaining articles. The last search was conducted at the end of March 2016.

Researchers reviewed 19 studies from an initial pool of 1,123. Among the 19 studies, 16 investigated the caries-arresting effect of using SDF on primary teeth, and 3 studied the same on permanent teeth. Researchers conducted meta-analyses on 8 studies that used 38% SDF as a caries-arresting agent in children.

Results showed that the caries-arresting rate of SDF treatment was 86% at 6 months, 81% at 12 months, 78% at 18 months, 65% at 24 months, and 71% at or beyond 30 months. The overall proportion of arrested dental caries after SDF treatment was 81%. The application frequency of SDF varied in different studies.

Researchers did not use absolute values, or delta changes, of the number of teeth or tooth surfaces with arrested caries for analysis because the number of teeth or tooth surfaces with active caries at baseline varied among the studies. Instead, they used the proportion of teeth or tooth surfaces with active caries that were arrested after SDF treatment.

The researchers noted that study limitations included risk of selection, detection, attrition, and reporting bias. To help fight these limitations, they used an evidence-based, minimum set of standards for reporting randomized trials. The Consolidated Standards of Reporting Trials (CONSORT) statement is designed for complete and transparent reporting and to help critical appraisal and interpretation.

The authors called CONSORT part of a broader effort to improve the reporting of different types of health research and to improve the quality of research. “It is noteworthy that the reliability of some studies included in this review was relatively low,” they concluded, “because most of the clinical studies on SDF were conducted before the CONSORT statement was developed. Hence more clinical trials following the consort statement are warranted to better investigate the caries-arresting effect of SDF solution among children.”

Read the original article.


Primary tooth vital pulp therapy

The highest levels of success and evidence support indirect pulp therapy (IPT) and the pulpotomy techniques using mineral trioxide aggregate (MTA) and formocresol (FC) for treating deep caries in primary teeth after 24 months. Direct pulp therapy showed similar success rates to indirect pulp therapy and MTA or FC pulpotomy, but the quality of evidence was lower.

Those findings are part of a study published in the January/February issue of Pediatric Dentistry.

The authors conducted a systematic review and meta-analysis of vital pulp therapy (VPT) in cariously involved vital primary teeth to see whether 1 VPT was superior. They also evaluated VPT factors that could affect outcomes such as method of isolation, type of restoration, and number of appointments to treat.

Researchers searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials Ebsco, and International Clinical Trials Registry Platform databases from 1960 through September 2016. They chose dissertation abstracts and gray literature for parallel and split-mouth randomized controlled trials of at least 12 months to compare the success of IPT, direct pulp capping, and pulpotomy in children with deep caries in primary teeth.
Initial searches from all sources identified 2,204 references on pulp therapy in primary teeth, which yielded 926 nonduplicate titles. After review, 41 articles qualified for meta-analyses.

Researchers found variable success rates and levels of evidence for the treatment of deep dental caries in primary teeth. The 24-month overall success rates for IPT, DPC, and pulpotomy were 94.4 percent, 88.8 percent, and 82.6 percent, respectively. IPT, MTA pulpotomy, and FC pulpotomy had higher quality evidence at 24 months to support their use. MTA and FC 24-month success rates were the highest of all pulpotomy types in this time frame and did not differ statistically.

The study’s limitations included the limited responses received from the primary studies’ authors to clarify issues related to risk of bias or data reporting. Another limitation was that the only non–English language articles reviewed were in Spanish or Portuguese. The authors could not assess publication bias owing to the limited number of included studies per outcome. The authors had to combine trials judged as unclear risk of bias with low risk of bias in the analyses owing to the relatively small number of trials found in each comparison and the small number of low risk of bias trials.

Read the original article.

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Pedo Teeth Talk

Brought to you by the American Academy of Pediatric Dentistry, Pedo Teeth Talk is just getting started. With two episodes available already, this show is off to a fantastic start. We’ll be discussing scientific, clinical and the most up-to-date, relevant information out there for anyone and everyone in the pediatric dental community. Topics include, but are not limited to silver diamine fluoride (SDF), behavior management, practice management, trauma, and more.

“Podcasts are a quick and effortless way to stay on top of cutting edge issues in our profession,” said Dr. Joel Berg, dean, University of Washington School of Dentistry, past president of AAPD, and one of the podcast’s featured speakers. ”And they are fun … giving listeners a chance to hear the voices of experts in the field.”

Drs. Berg and Jeremy Horst tackle the popular topic of SDF in the very first episode. In episode two, Drs. Jessica Lee and Ron Hsu discuss whether it’s possible to regenerate a pulp following dental trauma.

With more episodes in the works, you’ll want to subscribe today so you don’t miss a single one.  Search “Pedo Teeth Talk” in the iTunes store, Google Play store, Stitcher, or TuneIn. Visit for more details


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JADA+ Specialty Scans and JADA+ Scans

JADA+ Specialty Scans and JADA+ Scans are quarterly newsletters updating dentists on the latest research in selected specialties and disciplines in dentistry. ADA Publishing and the consulting editors from the represented specialties and disciplines aggregate and summarize research from previously published materials, each item attributed to its publication of origin. JADA+ Scan specialties and disciplines include endodontics, oral pathology, orthodontics, pediatric dentistry, periodontics, prosthodontics, radiology, cosmetic/esthetic and osseointegration. The ADA has engaged the specialty organizations in these areas as well as its own Science Institute and Division of Legal Affairs to assist with these newsletters. View past issues here.

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