الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Dental caries is the most common chronic multifactorial infectious disease, early childhood caries in preschool children had a major public health burden in both developed and developing countries. The concept of minimal invasive dentistry needs to be applied to minimize or delay the restorative treatment to preserve hard tooth structure, minimize patient anxiety as well as costs.
Fluoride products include fluoride gels, fluoride varnishes and fluoride solutions including silver diamine fluoride professionally used in moderate and high caries risk populations as primary preventive measures for early childhood caries. The SDF offers an easy and highly efficient nonsurgical alternative treatment to traditional restorative dental treatment in young children and has great potential to aid the dental public health community to address dental caries in high-risk populations.
Dental caries had an impact on the children, their family and the society as children with caries suffer from pain, eating, growth, and sleeping dysfunctions, loss of attentiveness at school, reduced academic performance and morbidity associated with treatment. As well as their parents lose sleep, need to take time off work and in some countries have to pay towards treatment. So, the whole society is affected with an ideally completely preventable disease.
The aim of the study:
Study the prevalence of dental caries among preschool children in Alexandria and the effect of silver diamine fluoride in arresting active caries.
Specific objectives:
1- To estimate the prevalence of caries in primary teeth among preschool children in Alexandria.
2- To evaluate the effect of silver diamine fluoride solution in arresting active caries in primary teeth among preschool children compared to sodium fluoride varnish.
3- To assess parental satisfaction with silver diamine fluoride.
4- To assess the effect of silver diamine fluoride on the oral health of the preschool children.
The study was conducted in two setting, the first setting was the governmental primary schools (KG section) in Alexandria where a cross sectional study was done. The second setting was the outpatient clinic of pediatric and preventive departments, Alexandria Dental Research Center, affiliated with Ministry of Health and Population (MOHP), Alexandria Governorate, Egypt, where an intervention study (a randomized controlled clinical trial) was conducted. The cross-sectional phase contained 400 children who were preschool children < 6 years old attending governmental public primary schools (KG section), Alexandria. And for the intervention phase 200 recruited children <6years old and attending outpatient pediatric clinic, Alexandria dental research center (ADRC), Alexandria.
Data was gathered for the cross-sectional phase through a predesigned interviewing questionnaire plus a brief clinical examination to assess the child’s caries prevalence, oral hygiene status, his or her caries experience and nutritional habits.
As for the intervention phase: 200 Participants aging 2-6 years were equally and randomly allocated into two parallel groups: group I (Test group): received 38% SDF solution to be applied on active caries surfaces biannually at; baseline and six months. And group II (Control group): received 5% NaF varnish to be applied on active caries surfaces at; baseline and six months. Caries severity and activity were determined using ICDASII Caries Detection System and Activity Criteria for Coronal Primary Caries. Teeth with scorings 5 or 6 were active and included in the study.
A predesigned structured interviewing questionnaire used to collect data from the children’s parents as a base line about their socio-demographic data, medical history, oral hygiene practices and dietary habits. Also, a predesigned 5 – level Likert – scale satisfaction questionnaire was used to measure satisfaction of Parents/caregivers of children after treatment with SDF application in the 6-month visit using four questions to assess their satisfaction toward the ease of the application, comfort with discoloration, feeling pain and taste acceptance following the SDF application. And for change in oral health impact change a predesigned questionnaire was used twice, at base line and after 6 months for both SDF and NaF applications to assess the impact of change in the children’s oral health following interventions.
The study revealed the following main results:
Section I
1. A total of 400 children, age ranged from 4.5-6.9 years. Slightly more than half of them were males (53.75%) were recruited.
2. Half of the males did not entirely brush their teeth 47.9% as well as 41.6% of the females.
3. The males showed better results with using toothpaste during brushing than females almost half of them (48.4%) and (45.6%) in the females.
4. Visible plaque was seen in more than half the males (55.3%) and half of the females (49.2%).
5. Eating un healthy snacks like sweets and chips more than 3 times /day were reported in males (61.4%) as well as, (63.2%) in females.
6. One quarter of males ate sweets twice a day (26.1%) and one third of the females (30%) were the same.
7. Gender is not statistically significant regarding oral hygiene habits such as frequency of tooth brushing, using tooth paste, and dietary habits as frequency of eating unhealthy snacks and prevalence of dental caries (Caries experiences).
8. The mean of the decay component (dt) was almost the same in boys as well as girls (2.5± 2.7 and 2.4 ±2.2) respectively.
9. The mean± SD of missing teeth component (mt) 0.12±0.5, 0.07±0.3 and filling components for boys and girls were 0.3±0.9, and 0.2±0.6 respectively.
10. Gender was not a determinant factor for dental caries (p = 0.5).
11. Children who eat sweets twice daily had six times the odds of having dental caries than those who were taking sugar once or less (OR 6.12, CI: 3.0-12.5) (p = 0.001).
12. Children who were taking sugar more than twice daily are nine times the odds of having caries (OR 9.4, CI: 5.2-17.2) (p = 0.001).
13. Dental caries was eleven times more likely to be among children who brushed their teeth less than once daily than those who brushed their teeth three times (OR 11.2,
CI: 4.4-28.5) (p = 0.001).
14. Dental caries was three times among those children who brushed their teeth once daily (OR 2.8, CI: 1.2-6.7) (p = 0.01).
15. The risk of dental caries was fourteen and half times more likely to be among children who had dental plaque comparing with those who did not (OR 14.5, CI: 7.7-27.3) (p = 0.001).
16. The prevalence of dental caries in the recruited preschoolers was 73.5%.
17. The dental caries prevalence was high in both male and female students with (73%), (74.1%) respectively.
18. The mean ±SD dmft score of 2.8±2.6.
19. The regression analysis showed that there was inverse relation between dental caries and oral hygiene practices and the frequency of sugary intakes as well as presence of visible plaque and there were statistically significant differences.
Section II
1- The 6 months follow up visit the SDF group showed a 95% success rate, and 90% in the NaF group overall success rate in arresting active caries (p=0.007).
2- After 12 months, SDF and NaF groups showed87%and 66.3% overall success respectively (p=0.001). Success of anterior teeth were 91.4%, and 81.4%in SDF and NaF respectively (p=0.001). Success of Posterior teeth were 80.8%, and 47.4%in SDF and NaF respectively (p=0.001).
3- The oral hygiene practices as tooth brushing , using tooth paste and presence of dental plaque plus dietary habits as night nursing or feeding ,frequency of snack intake were statistically significant differences in relation to caries experience (p=0.001).
4- The results of the current study showed that parents were satisfied with SDF. where 94% agreed with the easiness of the application process, 53% agreed on accepting the esthetics, 96 % reported that it was pain free and 60.5% agreed that it had an accepted taste.
5- The effect of oral health on the quality of the child life improved from mean ±SD of 19.7±7.8 to 10.1±5.1 in the SDF arm with a statistically significant difference of (P=0.001).
6- The effect of oral health on the quality of child’s life stayed the same in the NaF arm and statistically significant difference between groups (P=0.001).
7- The family psychological and financial quality improved where the mean ±SD score reduced from 10.8 ± 2.9into 3.4±2.1 in the SDF group and on the contrary increased from 7.6±4.0 into 8.1±3.1 statistically significant difference between groups (P=0.001).
8- The total (ECOHIS)The mean score improved in the SDF group from 30.5± 9.7into 12.3 ±6.5 and
9- The total mean (ECOHIS) score remained the same amount in the NaF group with a statistically difference of (P=0.001).
6.2 Conclusions
Based on the results of the present study, the following can be concluded:
1- The prevalence of dental caries among preschoolers of public school is high.
2- High caries experience and mean dmft score in children under 6 y.
3- Very high decay component in dmft and very small amount of the filling component indicating patient unmet needs.
4- Patients with severe early childhood caries fairly accepted the SDF solution black staining esthetic and didn’t complain about the metallic taste.
5- ECC has a good impact on the quality of life of both children and their families.
6- High scores of the ECOHIS were recorded before fluoride treatment which means poor quality of life, while these scores were dramatically decreased after SDF application with a significant improvement in the quality of life.
7- Silver diamine fluoride (38%) when placed on carious tooth tissue, promote carious lesion arrest in children who are high caries-risk or having progressing carious lesions, those who are unable to tolerate invasive treatment.
6.3 Recommendations
Providing and implementing preventive, therapeutic, and informative programs for controlling dental caries at individual, family, and school levels are necessary for local health policymakers Therefore, the following recommendations based on the results of the current study should be added to the policy measures to promote the reduction of dental caries prevalence in Egypt
Recommendations for pediatric dentists
1- The use of silver diamine fluoride in dental treatment has been drawing increasing attention; it is used for caries arrest so, we recommended topical application of SDF as a noninvasive, quick and simple dental procedure.
2- As, silver diamine fluoride is more effective than other fluoride agents to halt the caries process it should be used on wild spread.
3- Dentist should balance the value of silver diamine fluoride as a safe, effective, efficient caries control measure and its esthetics issue.
Recommendations for Faculties of dentistry
1- Introduce silver diamine fluoride indications and protocol of application as a topical caries arresting agent in the dental curriculum.
2- There is a need for developing a standardized evidence-based protocols for silver diamine fluoride uses in dental clinics.
Recommendations for Ministry of Health and Population
1- Maximize the use of silver diamine fluoride on wild scale to gain the benefit of the low cost as an inexpensive treatment for arresting caveated caries lesions in a minimal invasive procedure.
2- Communication channels with the public to increase their acceptance for using silver diamine fluoride as caries arresting and anti-hypersensitivity noninvasive agent.
3- Based on these results, we recommend that local health staff in remote communities receive training and support in the delivery of a comprehensive program to prevent dental caries. Further studies are needed to identify additional interventions that may reduce the burden of disease even further. More resources should be allocated to identifying healthy initiatives.
4- Awareness campaigns should be carried out to encourage the parents to brush their children’s teeth and to encourage the children to brush their own teeth.
5- Candies and crackers should be prohibited for children before 12 years old in school grounds.
6- Children should be encouraged to eat fruits and vegetables.
7- Community-based preventive programs targeting expectant mothers during pregnancy and later in early childhood is imperatively needed.
8- Oral hygiene in children must be integrated from the first months of life in order to avoid plaque accumulations that can promote the onset of carious lesions over time
Recommendation for researchers
1- Assessment of pediatric dentist’s knowledge, attitudes and educational experience towards SDF as inexpensive treatment for arresting caveated caries lesions in a minimal invasive procedure.
2- Further studies are needed to overcome the esthetic barriers that preventing maximum use of silver diamine fluoride.
3- Further research is necessary to find a protocol that is effective in arresting dental caries yet avoids or minimizes the staining problem of SDF.