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• W2017888891 abstract "This paper addresses a number of areas related to how effectively science and technology have met Healthy People 2010 goals for tooth decay prevention. In every area mentioned, it appears that science and technology are falling short of these goals. Earlier assessments identified water fluoridation as one of the greatest public health accomplishments of the last century. Yet, failure to complete needed clinical and translational research has shortchanged the caries prevention agenda at a critical juncture.Science has firmly established the transmissible nature of tooth decay. However, there is evidence that tooth decay in young children is increasing, although progress has been made in other age groups. Studies of risk assessment have not been translated into improved practice. Antiseptics, chlorhexidine varnish, and polyvinylpyrrolidone iodine (PVI-I) may have value, but definitive trials are needed. Fluorides remain the most effective agents, but are not widely disseminated to the most needy. Fluoride varnish provides a relatively effective topical preventive for very young children, yet definitive trials have not been conducted. Silver diamine fluoride also has potential but requires study in the United States. Data support effectiveness and safety of xylitol, but adoption is not widespread. Dental sealants remain a mainstay of public policy, yet after decades of research, widespread use has not occurred.We conclude that research has established the public health burden of tooth decay, but insufficient research addresses the problems identified in the report Oral Health in America: A Report of the Surgeon General. Transfer of technology from studies to implementation is needed to prevent tooth decay among children. This should involve translational research and implementation of scientific and technological advances into practice. This paper addresses a number of areas related to how effectively science and technology have met Healthy People 2010 goals for tooth decay prevention. In every area mentioned, it appears that science and technology are falling short of these goals. Earlier assessments identified water fluoridation as one of the greatest public health accomplishments of the last century. Yet, failure to complete needed clinical and translational research has shortchanged the caries prevention agenda at a critical juncture. Science has firmly established the transmissible nature of tooth decay. However, there is evidence that tooth decay in young children is increasing, although progress has been made in other age groups. Studies of risk assessment have not been translated into improved practice. Antiseptics, chlorhexidine varnish, and polyvinylpyrrolidone iodine (PVI-I) may have value, but definitive trials are needed. Fluorides remain the most effective agents, but are not widely disseminated to the most needy. Fluoride varnish provides a relatively effective topical preventive for very young children, yet definitive trials have not been conducted. Silver diamine fluoride also has potential but requires study in the United States. Data support effectiveness and safety of xylitol, but adoption is not widespread. Dental sealants remain a mainstay of public policy, yet after decades of research, widespread use has not occurred. We conclude that research has established the public health burden of tooth decay, but insufficient research addresses the problems identified in the report Oral Health in America: A Report of the Surgeon General. Transfer of technology from studies to implementation is needed to prevent tooth decay among children. This should involve translational research and implementation of scientific and technological advances into practice. Ample evidence demonstrates that the country is failing to move toward meeting Healthy People 2010 goals to improve the oral health of preschoolers with respect to tooth decay,1US Department of Health and Human Services. Figure 21-1. Progress quotient chart for focus area 21: oral health. Healthy People 2010 Web site. Available at: http://www.healthypeople.gov/Data/midcourse/html/tables/pq/PQ-21.htm. Accessed September 3, 2007.Google Scholar and this problem is expanding, with higher disease rates and dental workforce shortages.2Milgrom P. Weinstein P. Huebner C. Graves J. Tut O. Empowering Head Start to improve access to good oral health for children from low income families.Matern Child Health J. 2008; (Epub February 2, 2008)PubMed Google Scholar The Midcourse Review for Healthy People 2010 suggested that tooth decay (caries) rates for children aged 2 to 5 years were increasing, primarily among the poor and minorities, and most lesions are untreated, to say nothing of prevented.1US Department of Health and Human Services. Figure 21-1. Progress quotient chart for focus area 21: oral health. Healthy People 2010 Web site. Available at: http://www.healthypeople.gov/Data/midcourse/html/tables/pq/PQ-21.htm. Accessed September 3, 2007.Google ScholarFigure 1 is excerpted from this report. The problem likely extends to older poor and minority children, as dental caries lesions are cumulative, and untreated decay of primary teeth strongly predicts the same condition of secondary (permanent) teeth.3Frenzel A. Das schicksal der sechsjahrmolaren in der schulzahnpflege.Deutsche Monatsschrift fur Zahnheilkunde. 1933; 51: 437Google Scholar, 4Birkeland J.M. Broach L. Jorkjend L. Caries experience as predictor for caries incidence.Community Dent Oral Epidemiol. 1976; 4: 66-69Crossref PubMed Scopus (46) Google Scholar, 5Bader J.D. Graves R.C. Disney J.A. et al.Identifying children who experienced high caries increments.Community Dent Oral Epidemiol. 1986; 14: 198-201Crossref PubMed Scopus (37) Google Scholar, 6van Palenstein Helderman W.H. van't Hof M.A. van Loveren C. Prognosis of caries increment with past caries experience variables.Caries Res. 2001; 35: 186-192Crossref PubMed Scopus (29) Google Scholar, 7Wang W.J. Li Y.H. Bian J.Y. An eight-year longitudinal study for caries status on primary and permanent dentitions in Beijing children.Zhonghua Kou Qikang Yi Xue Za Zhi. 2003; 38: 279-281PubMed Google Scholar, 8Motohashi M. Yamada H. Genkai F. et al.Employing dmft score as a risk predictor for caries development in the permanent teeth in Japanese primary school girls.J Oral Sci. 2006; 48: 233-237Crossref PubMed Scopus (16) Google Scholar However, older children are more likely to receive some preventive care (Figure 2, from the National Survey of Children's Health).9Centers for Disease Control. National Survey of Children's Health 2007. Available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/slaits/nsch07/1a_Survey_Instrument_English/NSCH_Questionnaire_052109.pdf. Accessed October 7, 2009.Google ScholarFigure 2The proportion of US children receiving any preventive dental care in 1999-2000. Source: National Survey of Children's Health, 2007.9Centers for Disease Control. National Survey of Children's Health 2007. Available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/slaits/nsch07/1a_Survey_Instrument_English/NSCH_Questionnaire_052109.pdf. Accessed October 7, 2009.Google ScholarView Large Image Figure ViewerDownload Hi-res image Download (PPT) Tooth decay is attributable mostly to the infectious nature of dental caries in humans.10Loesche W.J. Role of Streptococcus mutans in human dental decay.Microbiol Rev. 1986; 50: 353-380Crossref PubMed Google Scholar, 11van Houte J. Role of micro-organisms in caries etiology.J Dent Res. 1994; 73: 672-681PubMed Google Scholar, 12Tanzer J.M. Livingston J. Thompson A.M. The microbiology of primary dental caries in humans.J Dent Educ. 2001; 65: 1028-1037PubMed Google Scholar Complicating this problem are workforce shortages,13Bailit H. Beazoglou T. Demby N. et al.Dental safety net: current capacity and potential for expansion.J Am Dent Assoc. 2006; 137: 807-815PubMed Scopus (43) Google Scholar lack of access to care,1US Department of Health and Human Services. Figure 21-1. Progress quotient chart for focus area 21: oral health. Healthy People 2010 Web site. Available at: http://www.healthypeople.gov/Data/midcourse/html/tables/pq/PQ-21.htm. Accessed September 3, 2007.Google Scholar and discrimination against populations served by Medicaid.14Guendelman S. Angulo V. Wier M. Oman D. Overcoming the odds: access to care for immigrant children in working poor families in California.Matern Child Health J. 2005; 59: 351-362Crossref Scopus (48) Google Scholar, 15Lam M. Riedy C.A. Milgrom P. Improving access for Medicaid-insured children: focus on front-office personnel.J Am Dent Assoc. 1999; 130: 365-373PubMed Google Scholar This paper examines advances in science and technology associated with prevention of tooth decay in young children since the report Oral Health in America: A Report of the Surgeon General of 2000.16US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, Md: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000.Google Scholar Strategies for dental caries prevention and management can take advantage of the infectious nature of the disease, or it can be viewed as independent of its infectious nature. The evidence of transmission, initially from mother to child, is demonstrated not only by the correlation of maternal salivary titers of mutans streptococci (MS) (a collective term used to embrace S. mutans, S. sobrinus, and other species less frequently found in humans) with the early colonization of her child and the early inception of caries lesions in the child, but also by the identity of MS colonizing mother and her child, based on bacteriocin typing, endonuclease, and ribotyping.12Tanzer J.M. Livingston J. Thompson A.M. The microbiology of primary dental caries in humans.J Dent Educ. 2001; 65: 1028-1037PubMed Google Scholar, 17Berkowitz R.J. Jordan H.V. Similarity of bacteriocins of Streptococcus mutans from mother and infant.Arch Oral Biol. 1975; 20: 725-730Abstract Full Text PDF PubMed Scopus (89) Google Scholar, 18Li Y. Caufield P.W. The fidelity of initial acquisition of mutans streptococci by infants from their mothers.J Dent Res. 1995; 74: 681-685Crossref PubMed Scopus (266) Google Scholar, 19Masuda N. Shimamoto T. Kitamura K. et al.Transmission of Streptococcus mutans in some selected families.Microbios. 1985; 44: 223-232PubMed Google Scholar, 20Kohler B. Bratthall D. Intrafamilial levels of Streptococcus mutans and some aspects of the bacterial transmission.Scand J Dent Res. 1978; 86: 35-42PubMed Google Scholar A strong scientific basis supports evaluation of the microbial status of young mothers as predictors of the colonization of their young childrens' teeth.12Tanzer J.M. Livingston J. Thompson A.M. The microbiology of primary dental caries in humans.J Dent Educ. 2001; 65: 1028-1037PubMed Google Scholar Interventions in the mother to suppress her MS prolong the time to colonization of her children and prolong the time and reduce the severity of carious lesion inception.21Kohler B. Andreen I. Influence of caries-preventive measures in mothers on cariogenic bacteria and caries experience in their children.Arch Oral Biol. 1994; 39: 907-911Abstract Full Text PDF PubMed Scopus (127) Google Scholar, 22Soderling E. Isokangas P. Pienihakkinen K. et al.Influence of maternal xylitol consumption on mother-child transmission of mutans streptococci: 6-year follow-up.Caries Res. 2001; 35: 173-177Crossref PubMed Scopus (100) Google Scholar, 23Isokangas P. Soderling E. Pienihakkinen K. Alanen P. Occurrence of dental decay in children after maternal consumption of xylitol chewing gum, a follow-up from 0 to 5 years of age.J Dent Res. 2000; 79: 1885-1889Crossref PubMed Scopus (136) Google Scholar The notion of a discrete window of infectivity until about 26 months of age, during which transmission occurs,24Caufield P.W. Cutter G.R. Dasanayake A.P. Initial acquisition of mutans streptococci by infants: evidence for a discrete window of infectivity.J Dent Res. 1993; 72: 37-45Crossref PubMed Scopus (470) Google Scholar has been expanded following studies that showed colonization at younger ages and prior to tooth eruption. It is estimated in one study that MS is harbored by at least 20% of children under 14 months of age25Mohan A. Morse D.E. O'Sullivan D.M. Tinanoff N. The relationship between bottle usage/content, age, and number of teeth with mutans streptococci colonization in 6–24-month-old children.Community Dent Oral Epidemiol. 1998; 26: 12-20Crossref PubMed Scopus (98) Google Scholar and at least 25% of predentate children in another.26Milgrom P. Riedy C.A. Weinstein P. et al.Dental caries and its relationship to bacterial infection, hypoplasia, diet, and oral hygiene in 6 to 3 6 month old children.Community Dent Oral Epidemiol. 2000; 28: 295-306Crossref PubMed Scopus (185) Google Scholar The source of the MS after 5 years of age is not known but is likely to include siblings and caretakers, at least. This review focuses on the preventive strategies and technologies that address goals of Healthy People 2010 applicable to individual children, which, if applied, might mitigate the inequities identified by the Surgeon General's Report on Oral Health (SGROH).16US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, Md: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000.Google Scholar The science and technologies to be reviewed are 1) detection and risk assessment and 2) interventions to improve prevention of tooth decay. Industry has developed high-technology devices that allow detection of early signs of decay lesions. Early detection could increase opportunity to arrest and reverse tooth damage by using a “medical” approach”27Kohler B. Andreen I. Jonsson B. The earlier the colonization by mutans streptococci, the higher the caries prevalence at 4 years of age.Oral Microbiol Immunol. 1988; 3: 14-17Crossref PubMed Scopus (223) Google Scholar and prevent the need for traditional “surgical” interventions that partially remove and reconstruct (fill) the teeth, or extract them. The devices generally have high sensitivity but inadequate specificity. Their clinical application is further limited because one method cannot be used for all tooth surfaces and under all circumstances.28Zandona A.F. Zero D.T. Diagnostic tools for early caries detection.J Am Dent Assoc. 2006; 137: 1675-1684Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar Presently the devices appear to add little to competent visual/tactile examination.29Kavvadia K. Lagouvardos P. Clinical performance of a diode laser fluorescence device for detection of occlusal caries in primary teeth.Int J Paediatr Dent. 2008; 18: 197-204Crossref PubMed Scopus (23) Google Scholar, 30Kuhnisch J. Berger S. Goddon I. et al.Occlusal caries detection in permanent molars according to WHO basic methods, ICDAS II and laser fluorescence measurements.Community Dent Oral Epidemiol. 2008; 36 (Epub April 14, 2008): 475-484Crossref PubMed Scopus (88) Google Scholar Moreover, these devices may be misused to justify surgical interventions and fabrication of fillings, sometimes mislabeled “minimally invasive,” instead of intensifying efforts to arrest early lesions. Devices with the best performance are expensive and cumbersome, and their use is time consuming, with little application in typical dental practice, community practice, or community health centers. Simpler approaches, such as fiber-optic transillumination, may be more readily adopted.31Davies G.M. Worthington H.V. Clarkson J.E. et al.The use of fibre-optic transillumination in general dental practice.Br Dent J. 2001; 191: 145-147Crossref PubMed Scopus (29) Google Scholar A multinational academic group has begun testing a totally visual caries lesion assessment scheme (International Caries Detection and Assessment System) that focuses on early lesion detection before cavitation has begun.32Ekstrand K.R. Martignon S. Ricketts D.J. Qvist V. Detection and activity assessment of primary coronal caries lesions: a methodologic study.Oper Dent. 2007; 32: 225-235Crossref PubMed Scopus (203) Google Scholar, 33Ismail A.I. Sohn W. Tellez M. et al.The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries.Community Dent Oral Epidemiol. 2007; 35: 170-178Crossref PubMed Scopus (876) Google Scholar As with the technology-based systems, the rationale is that earlier detection will increase opportunity to arrest and reverse lesions and prevent need for surgical interventions. The International Caries Detection and Assessment System has acceptable reliability and validity but requires rigorous training and remains in development.34Jablonski-Momeni A. Stachniss V. Ricketts D.N. Heinzel-Gutenbrunner M. Pieper K. Reproducibility and accuracy of the ICDAS-II for detection of occlusal caries in vitro.Caries Res. 2008; 42 (Epub January 15, 2008): 79-87Crossref PubMed Scopus (195) Google Scholar To date, there has been limited impact on training of dental students or adoption by community or health center practices, although this situation could rapidly change if research demonstrated how best to achieve this aim. These methods, whether high tech or visual, rely on detection of lesions after they have occurred. As cited above, detection of carious lesions of young children is a strong risk predictor of carious lesions of older children. Also, early carious lesions (“white spots”) are strong predictors of frank cavitation of the teeth.12Tanzer J.M. Livingston J. Thompson A.M. The microbiology of primary dental caries in humans.J Dent Educ. 2001; 65: 1028-1037PubMed Google Scholar Dietary risk factors are also important. Risk assessment tools have been promoted to guide clinicians.35Kutsch V.K. Milicich G. Domb W. et al.How to integrate CAMBRA into private practice.J Calif Dent Assoc. 2007; 35: 778-785PubMed Google Scholar, 36Caries management by risk assessment Available at.www.nnoha.org/goopages/pages_downloadgallery/download.php?filename=5519_8469001.doc&orig_name=CAMBRA%20ECC%20Risk%20Assmt%200–5%20yrs.docGoogle Scholar These strategies may be helpful to primary care providers who see infants and toddlers on a regular basis. One example is the CAMBRA Caries Risk Assessment Form for Age 0 to 5 Years.37American Academy of Pediatric Dentistry. Policy on use of a Caries-risk Assessment Tool (CAT) for infants, children, and adolescents. 2006. Available at: http://www.aapd.org/media/policies.asp. Accessed September 21, 2009.Google Scholar However, assessments of the childrens' mothers or caretakers in terms of microbiology or caries experience, or on their infection status, may be appropriate as well.20Kohler B. Bratthall D. Intrafamilial levels of Streptococcus mutans and some aspects of the bacterial transmission.Scand J Dent Res. 1978; 86: 35-42PubMed Google Scholar At the extremes, the level of colonization by MS is an indicator and a predictor of caries activity.12Tanzer J.M. Livingston J. Thompson A.M. The microbiology of primary dental caries in humans.J Dent Educ. 2001; 65: 1028-1037PubMed Google Scholar High levels are typical of children with Early Childhood Caries (ECC).26Milgrom P. Riedy C.A. Weinstein P. et al.Dental caries and its relationship to bacterial infection, hypoplasia, diet, and oral hygiene in 6 to 3 6 month old children.Community Dent Oral Epidemiol. 2000; 28: 295-306Crossref PubMed Scopus (185) Google Scholar, 38Marchant S. Brailsford S.R. Twomey A.C. et al.The predominant microflora of nursing caries lesions.Caries Res. 2001; 35: 397-406Crossref PubMed Scopus (153) Google Scholar At lower levels of colonization, the relationship is poorer, no doubt due—at least in part—to the confounding effect of fluoride exposure and the diverse testing methods used. Testing is relatively simple and cost effective if it leads to sound anticipatory guidance and prevention of disease in children. Nevertheless, bacterial testing in US dental practices does not appear widespread. Research on the adoption of these technologies in both primary medicine and dentistry practice is needed. Efforts to develop vaccines against dental caries based on both active and passive immunization continue. Secretory immune response to antigens of MS can influence caries pathogenesis.39Taubman M.A. Nash D.A. The scientific and public-health imperative for a vaccine against dental caries.Nat Rev Immunol. 2006; 6: 555-563Crossref PubMed Scopus (76) Google Scholar, 40Smith D.J. Mattos-Graner R.O. Secretory immunity following mutans streptococcal infection or immunization.Curr Top Microbiol Immunol. 2008; 319: 131-156PubMed Google Scholar, 41Xu O.A. Yu F. Fan M.W. et al.Protective efficacy of a targeted anti-caries DNA plasmid against cariogenic bacteria infections.Vaccine. 2007; 25: 1191-1195Crossref PubMed Scopus (24) Google Scholar, 42Canettieri A.C. Kretchetoff F.Y. Kogga Ito C.Y. et al.Production of monoclonal antibodies against Streptococcus mutans antigen.Braz Oral Res. 2006; 20: 297-302PubMed Google Scholar, 43Culshaw S. Larosa K. Tolani H. et al.Immunogenic and protective potential of mutans streptococcal glucosyltransferase peptide constructs selected by major histocompatibility complex Class II allele binding.Infect Immun. 2007; 75: 915-923Crossref PubMed Scopus (16) Google Scholar, 44Childers N.K. Li F. Dasanayake A.P. et al.Immune response in humans to a nasal boost with Streptococcus mutans antigens.Oral Microbiol Immunol. 2006; 21: 309-313Crossref PubMed Scopus (10) Google Scholar With some exceptions, most work has been done in animal models. Protection is attributable to salivary sIgA antibodies (active). Antibodies made in another host and delivered to humans (passive immunity) are also of interest. By selection of different antigens as the target for immunization, both active and passive strategies seek to inhibit a variety of functions critical to MS in the biofilm on teeth (dental plaque). Replacement of virulent (cariogenic) MS with nonvirulent streptococci is also being investigated in experimental animals and humans.45Hillman J.D. Mo J. McDonell E. et al.Modification of an effector strain for replacement therapy of dental caries to enable clinical safety trials.J App Microbiol. 2007; 102: 1209-1219Crossref PubMed Scopus (49) Google Scholar Early in vitro work on specifically targeted antimicrobial peptides46Eckert R. He J. Yarbrough D.K. et al.Targeted killing of Streptococcus mutans by a pheromone-guided “smart” antimicrobial peptide.Antimicrob Agents Chemother. 2006; 50: 3651-3657Crossref PubMed Scopus (180) Google Scholar continues but no in vivo validation has been reported. Approval by the US Food and Drug Administration (FDA) of specific immunization and clinical applications is still problematic because of unresolved risk-benefit questions and commercial investment required to fund extensive trials to meet regulatory requirements. There are several studies of the utility of antiseptic agents to inhibit caries in older, self-compliant individuals.21Kohler B. Andreen I. Influence of caries-preventive measures in mothers on cariogenic bacteria and caries experience in their children.Arch Oral Biol. 1994; 39: 907-911Abstract Full Text PDF PubMed Scopus (127) Google Scholar, 47Zickert I. Emilson C.G. Krasse B. Effect of caries preventive measures in children highly infected with the bacterium Streptococcus mutans.Arch Oral Biol. 1982; 27: 861-868Abstract Full Text PDF PubMed Scopus (176) Google Scholar With regard to preschoolers, some practitioners are strong advocates for combining fluorides with various antimicrobials, especially for those with disparities and whose families are mobile, because topical fluorides do not provide complete protection against tooth decay.48Featherstone J.D. Delivery challenges for fluoride, chlorhexidine and xylitol.BMC Oral Health. 2006; 15: S8Crossref Scopus (60) Google Scholar Two topical antimicrobials have been investigated to some extent: chlorhexidine digluconate (CH) and polyvinylpyrrolidone iodine (PVP-I). Chlorhexidine rinses, available in the United States, are sold by prescription but are lower in concentration (to reduce staining of teeth) than products sold in other countries. Approved by the FDA for gingivitis control, no formulation has FDA approval for caries control in children. Research, particularly in Europe and China, has examined the effectiveness of a CH varnish coating for the teeth, with mixed results. A recent systematic review of 14 publications of controlled clinical trials concluded there was a moderate caries-reducing effect when the varnish was applied every 3 to 4 months.49Zhang Q. van Palenstein Helderman W.H. van't Hof M.A. Truin G.J. Chlorhexidine varnish for preventing dental caries in children, adolescents and young adults: a systematic review.Eur J Oral Sci. 2006; 114: 449-455Crossref PubMed Scopus (53) Google Scholar The variability in CH varnish formulations may have strongly influenced bioavailability and thus effect of CH. Although CH varnish and other CH-containing vehicles may have value in caries prevention for very young children, the evidence is inconclusive; no child products are available in the United States, and none can be recommended. The in vitro and in vivo iodine antiseptic literature of 3 decades ago on dental caries was promising, but most human studies were very small.50Tanzer J.M. Slee A.M. Ka B. Scheer E.R. In vitro evaluation of three iodine-containing compounds as antiplaque agents.Antimicrob Agents Chemother. 1977; 12: 107-113Crossref PubMed Scopus (22) Google Scholar, 51Caufield P.W. Wannemuehler Y.M. In vitro susceptibility of Streptococcus mutans 6715 to iodine and sodium fluoride, singly and in combination, at various pH values.Antimicrob Agents Chemother. 1982; 2: 115-119Crossref Scopus (11) Google Scholar Pilot and small-scale clinical studies of utility of PVP-I in young children, some with established active ECC, show strongly encouraging data.52Tinanoff N. O'Sullivan D.M. Early childhood caries: overview and recent findings.Pediatr Dent. 1997; 19: 12-16PubMed Google Scholar, 53Zahn L. Featherstone J.D.B. Gansky S.A. et al.Antibacterial treatment needed for severe early childhood caries.J Pub Health Dent. 2006; 66: 174-179Crossref PubMed Scopus (44) Google Scholar, 54Amin MS, Harrison RL, Benton TS, et al. Effect of povidone-iodine on Streptococcus mutans in children with extensive dental caries. Pediatr Dent. 26:5–10.Google Scholar, 55Lopez L. Berkowitz R.J. Spiekerman C. Weinstein P. 2002. Topical antimicrobial therapy in the prevention of early childhood caries: a follow-up report.Pediatr Dent. 2004; : 204-206Google Scholar Larger scale evaluations are warranted and timely. The benefits of fluoride delivery via professional in-office applications, and home-use mouthrinses, gels, and toothpastes, are well established. These strategies have had limited impact on populations with little access to the dentist. Community water fluoridation is highly effective but depends upon public water supplies and political approval of their fluoridation. Mouthrinses, gels, and toothpastes are individual compliance–dependent, and dependent on economic and access feasibility. In the late 1990s, manufacturers gained approval from the FDA to market topical sodium fluoride varnishes, first available in Europe in the 1960s. Although indicated formally for tooth sensitivity reduction primarily in adults, they are being used for decay prevention and arrest in children, and good data suggest that they are more effective than the older technologies.56Marinho V.C.C. Higgins J.P.T. Logan S. Sheiham A. Fluoride varnishes for preventing dental caries in children and adolescents.Cochrane Database Syst Rev. 2002; 1 (CD002279. Available at) (Accessed September 3, 2007)http://doi.wiley.com/10.1002/14651858.CD002279Google Scholar, 57National Institutes of Health (US)Diagnosis and management of dental caries throughout life.NIH Consensus Statement. 2001; 18: 1-23PubMed Google Scholar The varnishes are safe for infants and toddlers. Manufacturers have not sought, however, an indication for prevention of decay, perhaps because they see the market as small and return on investment not large. The formulation of the varnishes is largely unregulated, and manufacturers have produced various forms of varnish that alter the properties of the varnish. No data show that these competing products are equivalent. The varnishes are important because they provide an easy-to-use, safe, and cheap fluoride vehicle for preschoolers, our most vulnerable population. Although the varnishes are being adopted in public health practice, use in private dental practice lags. There has been movement for physicians and nurses to apply varnish, and in some states Medicaid reimburses these primary care practitioners, in addition to dentists and dental hygienists, for this service.58Slade G.D. Rozier R.G. Zeldin L.P. Margolis P.A. Training pediatric health care providers in prevention of dental decay: results from a randomized controlled trial.BMC Health Serv Res. 2007; 7: 176Crossref PubMed Scopus (29) Google Scholar The Preventive Services Task Force, Centers for Disease Control and Prevention, American Dental Association, and American Academy of Pediatrics have not endorsed topical fluoride treatment for primary prevention in children aged before 24 months, and American Academy of Pediatrics guidelines specifically note the lack of a definitive trial.59American Academy of Pediatr" @default.
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• W2017888891 title "An Examination of the Advances in Science and Technology of Prevention of Tooth Decay in Young Children Since the Surgeon General's Report on Oral Health" @default.
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