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- Enerbäck, Hanna
(författare)
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Caries Prevention in Patients Undergoing Orthodontic Treatment
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Scientifically based guidelines to predict and prevent caries during orthodontic treatment with fixed orthodontic appliances are lacking. Aim: The overall aim of this thesis was to improve caries risk assessment before orthodontic treatment, as well as to evaluate caries risk and improve caries prevention during treatment. Patients and methods: Patients (n=270) undergoing treatment with fixed appliance at the Specialist Clinic of Orthodontics in Mölndal, Sweden, were included. Studies I, III and IV were performed with an RCT design, with the subjects being randomly assigned to one of the following groups: i. Fluoride mouth rinse (FMR) group, 0.2 % sodium fluoride (NaF) mouth rinse plus 1450 ppm F toothpaste; ii. High-fluoride toothpaste (HFT) group, 5000 ppm F; and iii. Control (CTR) group, 1450 ppm F toothpaste. In study I, the effect of orthodontic treatment and the different fluoride regimens on caries risk and caries risk factors were evaluated. Study II was performed with a prospective design that evaluated the CRA programmes and the caries indices abilities to predict the outcome of caries during treatment. In studies III and IV, the impacts of the different fluoride regimens on caries incidence (through radiographs and clinical photographs) during orthodontic treatment were evaluated. Results: The FMR and HFT groups showed an unchanged caries risk during treatment, while the caries risk increased significantly in the CTR group (p<0.0001). The DiFS index demonstrated the highest accuracy in predicting initial and manifest caries during treatment with fixed appliances, as compared to the multi-factorial CRA programmes. Radiographic analyses revealed no significant difference between the fluoride groups in terms of increased caries incidence during treatment. However, the numbers of patients with an increase of one or more white spot lesions (WSL) during orthodontic treatment were significantly higher in the CTR group than in the FMR group (p=0.0097) or HFT group (p=0.018) when the data for incisors, lateral incisors and canines were included. Conclusion: The DiFS index most-accurately predicts caries during orthodontic treatment. Furthermore, a mouth rinse or high-fluoride toothpaste can be recommended during orthodontic treatment to retain low caries risk and to reduce the numbers of WSLs in the aesthetic front.
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| 2. |
- Enerbäck, Hanna, et al.
(författare)
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Effect of a mouth rinse and a high-fluoride toothpaste on caries incidence in orthodontic patients: A randomized controlled trial
- 2022
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Ingår i: American Journal of Orthodontics and Dentofacial Orthopedics. - : Elsevier BV. - 0889-5406. ; 162:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The objective was to evaluate the effect of a fluoride mouth rinse and a high-fluoride toothpaste on caries incidence in patients undergoing orthodontic treatment with fixed appliances. Methods: In this 3-armed, parallel-group, randomized controlled trial, patients referred to the Specialist Clinic of Orthodontics, Mölndal, Sweden, were randomly allocated to 1 of the 3 groups. (1) Fluoride mouth rinse (FMR) group: 0.2 % sodium fluoride (NaF) mouth rinse plus 1450 ppm fluoride (F) toothpaste; (2) High-fluoride tootpaste (HFT) group: 5000 ppm F toothpaste; and (3) Control (CTR) group: 1450 ppm F toothpaste. The generation of a randomization sequence was performed in blocks of 30. Inclusion criteria included patients scheduled for treatment with fixed appliances in the maxillary and mandibular arch aged 12-20 years. The primary outcome variable was the change in Decayed Initial Filled Surfaces (ΔDiFS) based on radiographs taken before and after the treatment. For statistical comparisons between groups, the Kruskal–Wallis test were used for continuous variables, whereas the Mann-Whitney U-test was used for pairwise group comparisons. Furthermore, the risk ratio (RR) and 95% confidence interval (CI) based on clinically relevant cutoffs (DiFS ≥2) were calculated to compare the increase of caries during orthodontic treatment between 2 groups. The Cochran-Mantel-Haenszel method was used to adjust RR for baseline values. Blinding was employed during the caries registration and the data analysis. Results: In total, 270 participants were randomized, with 15 patients dropping out, such that 255 patients were included in the statistical analyses. Recruitment was from October 2010 to December 2012. An increase in DiFS (≥1 DiFS) during treatment was observed in 48.3% of the FMR group, 42.0% of the HFT group, and 35.6% of the CTR group. There was no significant difference between the groups regarding increased DiFS (P = 0.17). The risk of increase in DiFS ≥2 during orthodontic treatment was 31.0% in the FMR group, 25.9% in the HFT group, and 18.4% in the CTR group. The RR for an increase of ≥2 DiFS during orthodontic treatment was 1.38 (95% CI, 0.81-2.34; P = 0.23) for FMR vs CTR, 1.21 (95% CI, 0.70-2.10; P = 0.51) for HFT vs CTR, and 0.93 (95% CI, 0.57-1.49; P = 0.76) for HFT vs FMR. Conclusions: In patients who demonstrate a low prevalence of caries and are undergoing orthodontic treatment, daily use of high-fluoride toothpaste or fluoride mouth rinse in combination with regular toothpaste does not appear to significantly alter the caries incidence compared with the use of regular toothpaste. Trial Registration: The trial was registered in the FoU i Sverige research database (http://www.fou.nu/is/sverige), with registration no. 236251. Protocol: The protocol was not published before trial commencement. Funding: Local Research and Development Board for Gothenburg and South Bohuslän (grant no. 768531); and The Swedish Patent Revenue Fund (grant number EKF-780/19).
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| 3. |
- Enerbäck, Hanna, et al.
(författare)
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Effect of high-fluoride toothpaste and mouth rinse on the prevention of demineralized lesions during orthodontic treatment: a randomized controlled trial
- 2023
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Ingår i: European Journal of Orthodontics. - : Oxford University Press. - 0141-5387 .- 1460-2210. ; 45:5, s. 477-484
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Tidskriftsartikel (refereegranskat)abstract
- Objective To evaluate the effect of high-fluoride mouth rinse and high-fluoride toothpaste on the development of demineralized lesions (DLs) during orthodontic treatment. Trial design Three-armed parallel-group randomized controlled trial. Methods The trial was performed with 270 adolescent orthodontic patients. Randomization was performed in blocks of 30, enrolling the patients into one of the following groups: the fluoride mouth rinse (FMR) group receiving 0.2% sodium fluoride (NaF) mouth rinse plus 1450 ppm fluoride (F) toothpaste; high-fluoride toothpaste (HFT) group receiving 5000 ppm F toothpaste; and the Control (CTR) group receiving 1450 ppm F toothpaste. Inclusion criteria were patients scheduled for treatment in both arches with fixed appliances and age between 12 and 20 years. The primary outcome variable was the proportion of participants with at least one new demineralized lesion as assessed on digital photos taken before and after treatment, analysed by a blinded clinician. The analysis included all teeth or teeth in the aesthetic zone, i.e. all central incisors, lateral incisors, and canines. A random sample of 30 participants was assessed to check intra- and inter-reliability. For pairwise comparison between groups, Fisher's non-parametric permutation test was used for continuous variables. Blinding was employed during the caries registration and data analysis. Recruitment October 2010 to December 2012 Results In total, 270 patients were randomized, of which 22 were excluded during treatment. Therefore, 248 participants were included in the study. The number of patients with an increase of & GE;1 DL, including only central- and lateral incisors and canines, during orthodontic treatment, was significantly lower in the HFT group, 51/85 60%, compared to the CTR group, 64/82 78%, RR 0.77 (CI 0.62; 0.95), P = .01 and in the FMR group, 47/81 58%, compared to the CTR group, RR 0.74 (CI 0.60; 0.92), P < .01. Conclusions To prevent demineralized lesions in the aesthetic zone, high-fluoride mouth rinse and high-fluoride toothpaste may be recommended. Limitations The protocol was not registered, and the present study did not use a double-blinded design.
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| 4. |
- Enerbäck, Hanna, et al.
(författare)
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Validation of caries risk assessment methods in orthodontic patients
- 2020
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Ingår i: American Journal of Orthodontics and Dentofacial Orthopedics. - : Elsevier BV. - 0889-5406. ; 158
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Dental caries is an undesirable side effect of orthodontic treatment with fixed appliances. Caries lesions can result in long-term esthetic disturbance, costly interventions, and even interrupted treatment. Therefore, it is crucial to assess accurately both a patient's caries risk before treatment and their suitability for orthodontic treatment. This study aimed to evaluate the validity of 5 caries risk assessment methods for predicting caries outcome during orthodontic treatment: Cariogram, Caries Management by Risk Assessment (CAMBRA), R2, decayed filled teeth (DFT), and decayed initial filled surfaces (DiFS). Methods: A prospective longitudinal clinical study of 270 adolescents who were referred to the Specialist Clinic for Orthodontics, Mölndal Hospital, Sweden for treatment with fixed orthodontic appliances. The following data were collected before treatment: plaque index, radiographs to determine caries prevalence (DFT, DiFS), photographs to determine white-spot lesions, saliva samples (Streptococcus mutans and Lactobacilli), and responses to a questionnaire (regarding diet and oral hygiene). The variables were compiled to assess caries risk according to Cariogram, CAMBRA, and R2. Radiographs were also taken posttreatment to assess caries incidence. The caries outcomes after treatment were analyzed and compared with the caries risk, assessed by the caries risk assessment methods at baseline. Results: DiFS proved to be the most reliable method for predicting caries during orthodontic treatment, presenting the highest area under the receiver operating characteristic curve for both manifest caries (0.77) and initial caries (0.71). Conclusions: The DiFS prevalence index was demonstrated to be useful in identifying patients who are at risk for developing manifest and initial caries during orthodontic treatment. © 2020
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