Dental Outlook, PO Box 275, Camperdown, NSW 1450, Australia.
BMC Oral Health. 2013 Dec 28;13:73. doi: 10.1186/1472-6831-13-73.
An advantage of using silver fluoride treatments for carious primary teeth in outreach programs especially where dental resources are limited is that the treatments can be carried out by dental auxiliaries. One limitation to date is that assessments of lesion status have been based on a tactile test where a sharp probe or explorer is drawn across the surface of a lesion to assess its hardness. This is a technique-sensitive step and has the potential for iatrogenic damage, especially when a lesion is deep. This study was undertaken to determine whether an alternative, non-invasive, visual assessment could be a reliable indicator of lesion status. The approach was based on the retention, or otherwise, of a black surface deliberately created at the time of initial treatment.
A total of 88 lesions in the primary molars of 45 children, aged 5 to 10 years, were treated with a one-minute application of 40% silver fluoride. The surface of the lesions was then deliberately turned black by the application of 10% stannous fluoride as a reducing agent. All lesions were on an approximal or occlusal surface of a first or second primary molar. The presence or absence of a continuous black surface at 6 months and any changes in radiographic depth that had occurred in that period were determined from digitized photographs and bitewing radiographs.
The retention of an uninterrupted black surface was associated with minimal or no caries progression whereas lesions with an incomplete or lost black surface were 4.6 times more likely to have progressed. Use of the Datta and Satten Rank-Sum Test to account for any clustering effect showed that the difference was statistically significant (p < 0.0001). The sensitivity and specificity of the approach were 80% and 81% respectively.
The retention of a continuous black surface after the application of silver fluoride followed by a reducing agent on carious lesions in primary molars can provide a useful visual indicator of lesion progression and so be relevant for use in dental outreach programs.
在资源有限的外展项目中，使用氟化银治疗龋齿的主要优势在于治疗可以由牙医助理进行。迄今为止，该治疗存在一个局限，即病变状况的评估是基于触诊，即用尖锐的探针或牙探针划过病变表面，以评估其硬度。这种技术是敏感的，并且有导致医源性损伤的风险，尤其是当病变较深时。本研究旨在确定是否可以采用一种替代的、非侵入性的视觉评估方法作为病变状况的可靠指标。该方法基于初始治疗时故意在表面上形成的黑色表面的保留与否。
共有 45 名 5 至 10 岁儿童的 88 颗乳磨牙接受了一分钟的 40%氟化银应用治疗。然后，通过应用 10%的亚锡氟化物作为还原剂，故意将病变表面变成黑色。所有病变均位于第一或第二乳磨牙的近中或咬合面。从数字化照片和咬合片确定 6 个月时是否存在连续的黑色表面以及在此期间发生的任何放射深度变化。
保持不间断的黑色表面与最小或无龋齿进展相关，而具有不完整或失去黑色表面的病变则有 4.6 倍的可能性进展。使用 Datta 和 Satten 秩和检验来解释任何聚类效应，表明差异具有统计学意义（p<0.0001）。该方法的灵敏度和特异性分别为 80%和 81%。
在龋齿的乳磨牙上应用氟化银后，再应用还原剂，如果黑色表面保持连续，则可以为病变进展提供有用的视觉指标，因此在外展项目中具有应用价值。
