Remineralización dentaluna intervención dirigida a niños de alto riesgo para la prevención de la caries

Abstract

When dental plaque is not regularly removed, bacteria break down sugars in the diet forming acids as by-products. Lactic acid is the main acid involved in caries. As acids accumulate minerals are lost from the surface layer of the tooth. The imbalance in demineralization/remineralization favours the loss of calcium and phosphate from the teeth. Saliva contains the most important microelements for the remineralization and maturation of dental tissue and plays a crucial role in maintaining the oral environment. Fluoride is the agent par excellence in preventing and detaining cavities. However, remineralization may be hampered by limited levels of calcium and phosphate, and new products have been developed to ensure a constant supply. Two of the most used products are amorphous calcium phosphate stabilized with casein phosphopeptide (CPP-ACP) and tricalcium phosphate modified by fumaric acid (fTCP). Objective The aim of this study is to analyze the effects of coating with CPP-ACP (MI VarnishTM) and fTCP (Clinpro TM White Varnish), applied quarterly to children at high risk of cavities for 12 months, on saliva, caries index and plaque index. Methods We conducted a controlled, randomized clinical trial of the effect of the application of two varnishes ? MI VarnishTM (CPP-ACP with sodium fluoride 5%) and Clinpro TM White Varnish (fTCP with sodium fluoride 5%) - applied every three months in children with a high risk of caries, for 12 months. We included 58 children aged 4-12 years, assigned to control (placebo), Clinpro and MI groups. We assessed changes in pH, lactic acid concentrations, trace elements and whole bacteria load in saliva at baseline and three-monthly. Additionally, we measured caries index (DMFS/dmfs) and hygiene index by Turesky modification of the Quigley-Hein plaque index scale and the researcher's developed Plaque Maturity and Acidity Index (PMAI). Trial registration ISRCTN13681286. Results At 12 months, all groups showed a nonsignificant increase in pH levels and a reduction in dmfs/DMFS, lactic acid, or whole bacterial load. There was a significant reduction in 24Mg, 31P and 66Zn levels in the placebo group (p?0.05), but not in the other elements studied: 23Na, 27Al, 39K, 44Ca, 52Cr, 55Mn, 57Fe, 59Co, 63Cu, 75As, 111Cd, 137Ba, 208Pb and 19F. Furthermore, there were statistical differences within-group with a greater plaque reduction scores of both varnishes. The Clinpro group has shown to be associated with greater reductions in the Turesky QH PI index 2,59 times (160%) and IMAP index 1,54 times (54%) compared with the control group. Conclusions Neither dmfs/DMFS, pH, lactic acid concentrations, whole bacterial load or most salivary trace elements were useful in monitoring the effect of MI VarnishTM and Clinpro TM White Varnish after three-monthly application for 12 months. The results of this study indicate that fluoride-varnishes containing CPP-ACP or fTCP were more effective in reducing plaque levels in children at high or extreme risk of caries.