[Caries prevention with pediatric fluoride toothpastes].
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Biomedical subjects
Publications and source records attributed to E Hellwig.
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The last twenty years have seen substantial advances in knowledge concerning the diagnosis as well as the long-term evolution of epilepsies in infants and children. There is, however, no general agreement among epileptologists on the framework of epileptic syndroms in infancy and childhood. The main problems are the lack of a uniform terminology and the fact that there is little unanimity concerning definitions and what may be included under individual syndromic rubrics. In consequence the nosological limits between the various syndromes described are not distinct and they very often represent a heterogenous group of disorders and not a single entity. The present paper reviews the literature recently published and discusses diagnostic difficulties and nosological problems. In addition the attempt has been made to elaborate a "multi-dimensional" classification of syndromes, based on clinical (using the terminology of the international classification) and electroencephalographic criteria, but also taking into consideration aetiological and evolution data. Results show that it was possible to differentiate within a cohort of 77 infants aged 0-24 months (suffering from various types of epileptic disorders) several distinct and homogenous nosological entities and syndromes. As it is well known today, that the type of epilepsy which occurs in a child as well as the prognosis of the disease represent a confluence of age, heredity and structural brain abnormality, it seems apparent that adequate classification systems have to take into consideration the complexity of various factors "triggering" the onset and influencing the course of the disease, even when a number of cases remains outside resp. "borderline" such a syndromic classification.
In the study in question, tests were made to determine whether a dental salt, with or without the addition of fluoride, can improve the remineralization effect of the saliva. The experiments were performed in vitro by applying a method in which the dental enamel was softened and rehardened several times within a short period. The Knoop hardness of the enamel surface was used to determine the degree of de- and remineralization. The results clearly confirm the remineralization-promoting effect of the fluoride added to the dental salt.
Cylindrical enamel blocks with initial carious lesions were treated for one hour with Duraphat or Fluor-Protector. After removal of the fluoride varnishes the enamel blocks were kept in the mouths of 3 probands for 5 days. Plaque was allowed to accumulate on half of the enamel cylinders, while the other half was kept clean. Part of the enamel cylinders were retained as fluoridated controls. Compared with Duraphat the application of Fluor-Protector resulted in a significantly higher uptake of KOH soluble and firmly bound fluoride. During the 5 days of the experiment the amount of KOH soluble fluorides decreased in both groups. In the presence of plaque the fluoride loss was higher. The amount of firmly bound fluoride increased both in the plaque covered and in the clean enamel. The durable cariostatic effect of fluoridated varnishes seems to be due to the slow dissolution of Ca F2-like precipitates on the enamel surface and the concomitant fluoride uptake in the underlying demineralized enamel.
The cleansing effect of a newly introduced toothbrush, which is characterized by a thin, permanently elastic neck for reduction of abrasion pressure and an especially flat brush head, was clinically compared with two tested toothbrushes. Under identical experimental conditions, 30 subjects tested all three toothbrushes. Plaque was determined by the plaque index for toothbrush studies. On the whole, no significant differences were demonstrable with regard to the cleansing effect among the toothbrushes. Reduction of abrasion pressure, therefore, does not have a negative effect on the cleansing effect of these toothbrushes.
A modified Intra-oral Cariogenicity Test was used to study the influence of plaque on the reaction mechanism of sodium monofluorophosphate (MFP) or sodium fluoride (NaF) in either sound or demineralized enamel in vivo. Volunteer students, wearing mouth appliances holding enamel blocks, rinsed their mouths with MFP or NaF solution (1,000 ppm F-) three times a day. The amount of loosely-bound and acquired fluoride was determined after an experimental period of five days in plaque-covered, demineralized (PCD); clean, demineralized (CD); plaque-covered, sound (PCS); and clean sound enamel (CS). While no measurable loosely-bound fluoride could be found after MFP treatment, NaF caused deposition of a significant amount of alkali-soluble fluoride in all experimental groups. After MFP rinses, fluoride concentration in the enamel was increased in the following order: CS, PCS, CD, and PCD. After NaF treatment, demineralized enamel exhibited a higher fluoride acquisition when compared with sound enamel. Plaque had a minor effect on F- acquisition. It is concluded that demineralization of enamel enhances F- uptake from both NaF and MFP solutions. In the presence of plaque, F- acquisition was additionally increased only after MFP rinses in vivo.
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The effect of a preventive program was studied in 12-14-yr-old children. 104 children (test group) participated in this program. After four visits in the first 6 wk, the children visited the oral hygienist five times a year to receive professional oral prophylactic treatment and instructions. Additionally a fluoride application (Duraphat) was given two times a year. Children of a control group (n = 117) received no prophylactic treatment. Diet was not controlled in either test or control group. After 2 yr mean caries increment amounted to 2.7 +/- 2.8 new DFS in the test group and 5.0 +/- 4.2 new DFS in the control group, respectively. The most pronounced differences between the two groups could be found on the proximal surfaces. In all, caries was reduced by 46% during the 2-yr period. Plaque accumulation and frequency of gingivitis were significantly reduced only in the test group (67% and 55%, resp.). The data revealed that the program reduced both caries and gingivitis to a remarkable extent.
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The amount of alkali-soluble and alkali-insoluble fluoride was determined in human enamel after one- and six-hour treatments with Duraphat. The application was carried out on: (1) slightly demineralized enamel covered with artificial plaque, (2) cleaned, slightly demineralized enamel, and (3) sound enamel without pre-treatment. After a single Duraphat treatment lasting six hours, fluoride uptake was higher than after Duraphat treatment for just one hour in all experimental groups. More fluoride was acquired in both slightly demineralized, plaque-covered and slightly demineralized, cleaned enamel than in sound enamel. Plaque significantly hampered the formation of alkali-soluble fluoride precipitation on demineralized enamel, but its influence on the amount of fluoride taken up by the enamel was minor.
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