Background
A panel of experts convened by the American Dental Association (ADA) Council on Scientific Affairs presents evidence-based clinical recommendations regarding professionally applied and prescription-strength, home-use topical fluoride agents for caries prevention. These recommendations are an update of the 2006 ADA recommendations regarding professionally applied topical fluoride and were developed by using a new process that includes conducting a systematic review of primary studies.

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Topical fluoride for caries prevention

On the basis of existing literature, efficient oral hygiene was found to have a caries preventive effect. The quality of the cleaning appears to be more important than the frequency of its performance. Professional tooth cleaning at regular intervals may inhibit caries on all tooth surfaces. The effect of self-performed oral hygiene has been demonstrated mainly on free smooth surfaces and on front teeth.

Oral hygiene and caries. A review.

Aim
To report the evidence on the effect of mechanical and/or chemical plaque control in the simultaneous management of gingivitis and caries.

Material and Methods
A protocol was designed to identify randomized (RCTs) and controlled (CCTs) clinical trials, cohort studies and prospective case series (PCS), with at least 6 months of follow-up, reporting on plaque, gingivitis and caries. Relevant information was extracted from full papers, including quality and risk of bias. Meta-analyses were performed whenever possible.

Results
After the screening of 1,373 titles, 15 RCTs, 10 CCTs and 2 PCS were included. Low to moderate evidence support that combined professional and self-performed mechanical plaque control significantly reduces standardized plaque index [n = 4; weighted mean difference (WMD) = 1.294; 95% CI (0.445; 2.144); p = 0.003] and gingivitis scores [n = 4; WMD = 1.728; 95% CI (0.631; 2.825); p = 0.002]. The addition of fluoride to mechanical plaque control is relevant for caries management [n = 5; WMD = 1.159; 95% CI (0.145; 2.172); p = 0.025] while chlorhexidine rinses are relevant for gingivitis.

Conclusion
Mechanical plaque control procedures are effective in reducing plaque and gingivitis. The addition of fluoride to mechanical plaque control is significant for caries management. Chlorhexidine rinse has a positive effect on gingivitis and inconclusive role in caries.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jcpe.12674

Mechanical and chemical plaque control in the simultaneous management of gingivitis and caries: a systematic review

The aim of the present investigation was to study any additional effects of systematic plaque control procedures on oral hygiene, caries and gingival status in school children subjected to long-term orthodontic treatment with fixed appliances. The material comprised 60 school children requiring orthodontic treatment. In all patients a standard edgewise technique was used in both arches.

The study included three consecutive periods, namely an introductory period, an active orthodontic treatment period and a retention period. During the introductory period of 1½ months each participant received oral hygiene education given directly on a verbal basis. At the beginning of active orthodontic treatment the patients were divided randomly into four groups: three test groups (A, B and C) and one control group. Each group consisted of 15 individuals. During this period of 24 ± 3.5 months the test groups each received a specific systematic plaque control programme based on mechanical and/or chemical prevention delivered every 3 weeks by a specially trained dental nurse. The children in the control group rinsed with a placebo solution only. During the retention period of a minimum of 12 months no prophylactic sessions were enforced. The final examination was performed 6 months after retention.

The results show that following an introductory period including intense dental health education a high level of oral hygiene control can be established and maintained. As a result initial caries and gingival inflammation only occur to a minor degree. Under such circumstances additional prophylactic measures did not further improve individual oral cleanliness and dental health.

Systematic plaque control in children undergoing long-term orthodontic treatment

The preset study was performed to assess the effect on caries and gingivitis of plaque control measures such as oral hygiene instruction, toothcleaning practice and professional toothcleaning. 104 children, 13-14 years old, participated in the trial. Prior to the start of the preventive treatment all children were examined regarding oral hygiene, gingivitis and caries. The caries examintion was limited to the proximal surfaces of molars and premolars. Following this baseline examination the children were randomly divided into two treatment groups A, and B. Both groups of children were recalled for professional toothcleaning once every 2 weeks during an 18-month period. In each child the professional toothcleaning was restricted to either the right or the left jaws by random selection. In addition, the children of Group A at each recall appointment received careful oral hygiene instruction and practice in proper toothcleaning methods. In conjunction with the professional toothcleaning an abrasive paste was used including fluoride. The children were re-examined 18 months after the baseline examination. The result of the present investigation demonstrated that professional toothcleaning repeated every second and week is a prophylactic measure which in children substantially improves the oral hygiene status, and effectively reduces clinical signs of gingivitis and caries. It was also observed that while oral hygiene instruction and practice in proper toothcleaning techniques reduced plaque and gingivitis, no such effect could be detected regarding the development of caries.

Effect of oral hygiene instruction and professional toothcleaning on caries and gingivitis in schoolchildren.

The effect of a field program, based on systematic plaque control, on caries and gingivitis was tested during a 3-ycar period on 1,100 schoolchildren. Once every 3rd week the children were given oral hygiene instructions, professional toothcleaning and fluorides topically delivered by specially trained dental nurses. The children of a control group of approximately the same number of pupils, participated in a preventive program consisting of mouthrinsings once every 2nd week with a 0.2% sodium fluoride solution. The children of the third and fourth grades were, at the start of the experiment, selected as reference groups and then continuously examined once every year. At the end of the trial the mean reduction of surfaces harboring plaque and units with gingival inflammation was 59% and 73%, respectively. The reduction in caries increment was 51%.

R. Karlsson

Papers

Effect of a field program based on systematic plaque control on caries and gingivitis in schoolchildren after 3 years.