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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 3  |  Page : 55-57

Effect of fluoride- and nonfluoride-remineralizing agents in white spot lesions in mentally retarded children: A parallel randomized clinical trial


1 Resident, Department of Public Health Dentistry, Sardar Patel PG Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
2 Professor and Head, Department of Public Health Dentistry, Sardar Patel PG Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
3 Reader, Department of Public Health Dentistry, Sardar Patel PG Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
4 Postgraduate Student, Department of Periodontology, Guru Nanak Institute of Dental Science and Research, Kolkata, West Bengal, India
5 Postgraduate Student, Department of Public Health Dentistry, Pacific Dental College and Hospital, Udaipur, Rajasthan, India

Date of Submission15-Jul-2020
Date of Acceptance17-Aug-2020
Date of Web Publication29-Sep-2020

Correspondence Address:
Dr. Mayank Das
Department of Public Health Dentistry, Sardar Patel PG Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INPC.INPC_31_20

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  Abstract 


Background: Dental caries is one of the prevalent oral diseases among mentally retarded children, and restorative, preventive treatment needs are unmet.
Materials and Methods: The study was a double-blinded, parallel, randomized clinical trial. A total of 150 participants aged 7–12 years were selected. Unpaired t-test and repeated measures analysis of variance test were used for analysis.
Results: In Group A, at 12 months, 97.2% active and 2.8% inactive lesions were reported. In Group B, at 9 and 12 months, 98.6% and 94.3% active and 1.4% and 5.7% inactive white spot lesions (WSLs) were seen.
Conclusion: Fluoride- and nonfluoride-remineralizing agents reported a slight reduction in active WSLs.

Keywords: Children, clinical trial, dental caries, fluoride, remineralization


How to cite this article:
Das M, Krishna Reddy L V, Singh S, Dubey AK, Agarwal A, Todkar M. Effect of fluoride- and nonfluoride-remineralizing agents in white spot lesions in mentally retarded children: A parallel randomized clinical trial. Int J Prev Clin Dent Res 2020;7:55-7

How to cite this URL:
Das M, Krishna Reddy L V, Singh S, Dubey AK, Agarwal A, Todkar M. Effect of fluoride- and nonfluoride-remineralizing agents in white spot lesions in mentally retarded children: A parallel randomized clinical trial. Int J Prev Clin Dent Res [serial online] 2020 [cited 2020 Oct 24];7:55-7. Available from: https://www.ijpcdr.org/text.asp?2020/7/3/55/296541




  Background Top


Tooth enamel comprises 90% substituted hydroxyapatite which is subjected to consecutive cycles of dissolution and recrystallization.[1] White spot lesions (WSLs) are the first indication that the complex dynamic physicochemical processes that maintain healthy enamel have shifted in favor of demineralization.[2] Fluoride in combination with calcium and phosphate ions creates a veneer of fluorapatite on the surface of existing enamel crystals, which acts as a replacement for minerals lost from the tooth structure.[3] The possibility of stoppage of WSLs through their inactivation after the fluoride application, thereby excluding the need for invasive restorative treatment.[4] Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) complexes bind readily to the tooth surface and the bacterial plaque around the tooth and maintain a state of supersaturation inhibiting enamel demineralization and enhancing remineralization.[5],[6],[7] Dental caries is the most prevalent disease among mentally retarded children worldwide, and dental treatment is the greatest unattended health need of these children.[8],[9] Although numerous studies have documented the oral health status of special care children, further research in this field is required.[10] Therefore, the purpose of the study was to compare the effects of fluoride- and nonfluoride-remineralizing agents on WSLs.


  Materials and Methods Top


The study was a double-blinded, parallel, randomized clinical trial with 1:1 allocation ratio for each group. It was conducted among 7–12-year-old mentally retarded children in Lucknow, Utter Pradesh, India. The duration of the study was 12 months (August 2017–August 2018). The participants included in the study were those who given the consent for the study, present on the day of examination, having intelligent quotient ranging mild-to-moderate, and having at least one active WSL on the labial surface of the permanent upper or lower anterior teeth. The excluded criteria were those who had dental caries in the form of small cavities or restorations in the teeth, any development enamel alterations or periodontal diseases, using orthodontic devices, under medical treatment or taking any kind of medicine, and any sensitivity to milk proteins. The ethical clearance was obtained from the institutional ethical committee (No. 931617/PHD/EC). A sample size of 136 was calculated using G power-version 3.1.9.2 developed by Faul et al., Germany. The groups with the interventions were Group A: fluoride varnish and Group B: GC Tooth Mousse. The measurement of the WSL dimension was done using a periodontal probe (PCP-UNC-15; Hu-Friedy Manufacturing Inc., Chicago, Illinois, USA).[11] The WSL dimension (mean) was categorized as Category I (0.1–2 mm) and Category II (2.1–4 mm). Both groups' follow-up was done at 3, 6, 9, and 12 months. Descriptive statistics, unpaired t-test, and repeated measures analysis of variance tests were used. The level of statistical significance was set at 0.05.


  Results Top


Of 150 participants, the participants' drop rate was reported at around 6%. [Table 1] depicts that among Group A, WSL dimension Category I and II, there was no significant difference found. [Table 2] depicts that among Group B, WSL dimension Category I, there was no significant difference found. [Table 3] depicts that among Group A, 97.2% active and 2.8% inactive WSLs were seen at 12 months. [Table 4] depicts that in Group B, 98.6% and 94.3% active and 1.4% and 5.7% inactive WSLs were seen at 9 and 12 months, respectively.
Table 1: Intragroup comparison of white spot lesions dimensions among Group A (n=75)

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Table 2: Intragroup comparison of white spot lesions dimensions among Group B (n=75)

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Table 3: Distribution of active and inactive white spot lesions among Group A (n=75)

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Table 4: Distribution of active and inactive white spot lesions among Group B (n=75)

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  Discussion Top


In the present study, in WSL dimension Category I of Group A, the mean scores decreased at 6, 9, and 12 months and there was no significant difference found between them. In the study done by Ferreira et al.,[1] among 7–12-year-old schoolchildren, three lesions showed no real change in the dimension measurements in millimeters. In this study, in WSL dimension Category II of Group A, there was a slight decrease in the scores at 6, 9, and 12 months reported and there was no significant difference found. In the study conducted by Memarpour et al.,[3] among 140 children aged 12–36 months with WSL in the anterior maxillary teeth, the interventions led to significant decrease in the size of the WSL. In the present study, in WSL dimension Category I of Group B, the mean score decreased after 3, 6, 9, and 12 months and there was no significant difference found. In the study conducted by Itaborahy et al.,[4] the mean WSL dimension reduction was higher in the fluoride-remineralization group, and the difference between groups was not statistically significant. In this study, in WSL dimension Category II of Group B, the mean score decreased after 3, 6, 9, and 12 months and there was no significant difference found. In the study done by Guclu et al.,[5] the majority of WSL in the control and fluoride varnish group exhibited no shift in appearance. In the present study, fluoride varnish showed a slight shift in the decrease of WSLs. The study conducted by Llena et al.[12] among 6–14-year-old schoolchildren reported that ACP-CPP is not superior to fluoride varnish by any of the measures studied. In the study done by Beerens et al.,[13] among 54 participants with multiple WSLs were followed up for 3 months and the size of the WSL area did not change significantly over time among the participants. The present study underlined the considerable need for the prevention and treatment among mentally retarded children. The limitations of the present study were small sample size, and it can be done with long duration and follow-up.


  Conclusion Top


The effect of fluoride- and nonfluoride-remineralizing agents has reported a slight reduction on WSLs among mentally retarded children.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ferreira JM, Aragão AK, Rosa AD, Sampaio FC, Menezes VA. Therapeutic effect of two fluoride varnishes on white spot lesions: A randomized clinical trial. Braz Oral Res 2009;23:446-51.  Back to cited text no. 1
    
2.
Ebrahimi M, Mehrabkhani M, Ahrari F, Parisay I, Jahantigh M. The effects of three remineralizing agents on regression of white spot lesions in children: A two-week, single-blind, randomized clinical trial. J Clin Exp Dent 2017;9:e641-8.  Back to cited text no. 2
    
3.
Memarpour M, Fakhraei E, Dadaein S, Vossoughi M. Efficacy of fluoride varnish and casein phosphopeptide-amorphous calcium phosphate for remineralization of primary teeth: A randomized clinical trial. Med Princ Pract 2015;24:231-37.  Back to cited text no. 3
    
4.
Itaborahy R, Machado F, Elias G, Ribeiro L, Ribeiro R. Clinical effectiveness of two commercial fluoride varnish formulations on the control of white spot lesion in primary teeth: A pilot study. Braz Res Ped Dent Int Clinic 2015;15:41-8.  Back to cited text no. 4
    
5.
Guclu ZA, Alacam A, Coleman NJ. A 12-week assessment of the treatment of white spot lesions with CPP-ACP paste and/or fluoride varnish. Biomed Res Int 2016;4:1-9.  Back to cited text no. 5
    
6.
Solanki J, Gupta S, Arya A. Dental caries and periodontal status of mentally handicapped institutilized children. J Clin Diagn Res 2014;8:25-7.  Back to cited text no. 6
    
7.
Pithon MM, Baião FS, Sant'Anna LI, Tanaka OM, Cople-Maia L. Effectiveness of casein phosphopeptide-amorphous calcium phosphate-containing products in the prevention and treatment of white spot lesions in orthodontic patients: A systematic review. J Investig Clin Dent 2019;10:e12391.  Back to cited text no. 7
    
8.
Bozkurt FY, Fentoglu O, Yetkin Z. The comparison of various oral hygiene strategies in neuromuscularly disabled individuals. J Contemp Dent Pract 2004;5:23-31.  Back to cited text no. 8
    
9.
Muñoz-Millán P, Zaror C, Espinoza-Espinoza G, Vergara-Gonzalez C, Muñoz S, Atala-Acevedo C, et al. Effectiveness of fluoride varnish in preventing early childhood caries in rural areas without access to fluoridated drinking water: A randomized control trial. Community Dent Oral Epidemiol 2018;46:63-9.  Back to cited text no. 9
    
10.
Kumar M, Chandu GN, Shafiulla MD. Oral health status and treatment needs in institutionalized psychiatric patients: One year descriptive cross sectional study. Indian J Dent Res 2006;17:171-7.  Back to cited text no. 10
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11.
Sethna GD, Gaikwad RP, Banodkar AB, Attar NB, Patil CL. Comparison of the reproducibility of measurements obtained by a 1st generation, 2nd generation and 3rd generation periodontal probe. Int J Adv Res 2016;4:418-26.  Back to cited text no. 11
    
12.
Llena C, Leyda AM, Forner L. CPP-ACP and CPP-ACFP versus fluoride varnish in remineralisation of early caries lesions. A prospective study. Eur J Paediatr Dent 2015;16:181-6.  Back to cited text no. 12
    
13.
Beerens MW, van der Veen MH, van Beek H, ten Cate JM. Effects of casein phosphopeptide amorphous calcium fluoride phosphate paste on white spot lesions and dental plaque after orthodontic treatment: A 3-month follow-up. Eur J Oral Sci 2010;118:610-17.  Back to cited text no. 13
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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