An update on caries prevention – Flo Couper Educator and Product Specialist at CALCIVIS®

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  Posted by: Dental Design      7th October 2019

Fluoride varnish applications are usually targeted at children with a high risk of caries, or where it is considered beneficial to complement the fluoride found in water, from dietary sources and toothpaste. The preventive effect of fluoride varnish has been the subject of numerous studies conducted over many years in children, adolescents and adults.[i],[ii],[iii]There are claims that fluoride varnish can substantially reduce the incidence of caries and even reduce the number of caries related hospitalisations. However, new research published in Caries Researchin June 2019, has revealed some interesting information.

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A systematic review and meta-analysis to assess the effectiveness of fluoride varnish therapy in reducing the risk of developing new cavities and tooth decay-related hospitalisations was conducted with pre-school age children. After reviewing 20 past studies about the use of fluoride varnish, which included 13,650 children aged between 2 and 5 years, it was found that fluoride varnish resulted in caries on one fewer tooth surface per child who received treatment. At tooth level, no significant difference was observed between children that received fluoride varnish, and those that did not. The meta-analysis showed the risk of developing new dentine caries lesions was reduced to 12 percent for children when fluoride varnish was applied. This was described as a ‘rather modest benefit’ as a large number of children developed new dentine caries lesions regardless of fluoride varnish use. The researchers found that in a population of pre-school children with 50% caries incidence, fluoride varnish must be applied in 17 children to avoid new caries in just one child. They concluded that applied fluoride through varnish made hardly any difference for the risk of developing new caries in children.Furthermore, nostudy reporting on caries-related hospitalisations was found.[i]


Dental Sealants

As part of an overall prevention strategy, dental sealants may also be used to protect the teeth from caries. First developed in the 1970s and 80s, these thin plastic-coatings are used to fill depressions, pits and fissures and form a protective shield over the tooth enamel. This provides a smoother, easier surface for patients to clean and acts as a barrier from cavity forming plaque and acids. Sealants are usually applied to the chewing surfaces of the permanent molars soon after eruption (at around the age of 6 or 7 years) and last for as long as 5 to 10 years.[i]Their efficacy has been established and confirmed in various studies and a report released by the Centres for Disease and Control in 2016 stated that school-age children without sealants have almost three times more cavities than children with sealants.”[ii]

The controversy

Bisphenol A or BPA as it is commonly known as, is a chemical used for the manufacture of polycarbonate plastics, epoxy resins and methacrylate resins and is widely used in many products including dental sealants. In animal studies, a number of adverse health effects have been associated with BPA including effects on hormonal activity, asthma, diabetes, obesity, behavioural changes, cancer, infertility and genital malformations.[i]

The other major concern is that BPA may have an oestrogen effect. Animal studies have indicated that BPA iseffective in stimulating prolactin hormones from the pituitary glands and increased growth activity in cells lining the mammary glands.[ii]Nevertheless, BPA exposure from sealants is small and has been described as “negligible” as a much larger source of human exposure to BPA is from food and beverages packaging, such as cans coated with BPA based epoxies.7

Educational, evidence-based, preventive care

To support an evidence-based approach and to revolutionise the way in which dental caries are managed, a team of cariologists and industry experts have developed theCALCIVIS imaging system. This unique dental device uses a bioluminescent photoprotein to detect free calcium ions as they are released from actively demineralising tooth surfaces. By capturing this information as glowing images, it provides definitive evidence of the caries disease process at the very early stages (as the tooth enamel first begins to lose minerals). This means that preventive, non-invasive measures can be implemented to prevent further progression at a much earlier stage than has been previously possible. Equally, the engaging CALCIVIS images help to better understand their oral health status and empower them to take the necessary preventive steps to avoid further disease progression.

The effectiveness of any strategy to prevent caries can be improved by assessing the risks and educating patients. Innovation now enables dental professionals to identify these patients more easily and intervene during the initial stages of the disease process to improve the way this prolific disease is managed.

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Author: Flo Couper is an enthusiastic dental hygienist and business coach. She has worked in the dental profession for 29 years and has extensive experience in all dental settings. Flo is passionate about preventive dentistry and continually strives to increase understanding and promote its values to both dental professionals and patients. As an NLP coach she likes to explore the use of language and discover ways to encourage better communication and listening. Flo has coached many dental teams and supported them in building preventive programmes in to the dental practice. Currently, she is thriving in her role as an Educator and Product Specialist at CALCIVIS®,where she supports dental professionals with the integration of brand new biotechnology to visualise and advance the management of early caries



[1]Holm G.B. et al. The caries-preventive effect of a fluoride varnish in the fissures of the first permanent molar. Acta Odontol Scand. 1984 Aug;42(4):193-7.[Accessed 23rdJuly 2019]

[2]Marinho V.C.C et al. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD002279.[Accessed 23rdJuly 2019]

[3]Weyant R.J. et al. Topical fluoride for caries prevention. Executive summary of the updated clinical recommendations and supporting systematic review. J Am Dent Assoc. 2013 Nov; 144(11): 1279–1291.[Accessed 23rdJuly 2019]

[4]de Sousa F.S.O et al. Fluoride Varnish and Dental Caries in Pre-schoolers: A systemic review and meta-analysis. Caries Research. June 2019.[Accessed 23rdJuly 2019]

[5]NHS. Live well. Children’s teeth. Healthy body.[Accessed 23rdJuly 2019]

[6]American Dental Association. (ADA) Sealants.[Accessed 23rdJuly 2019]

[7]Becher R. et al. Presence and leaching of bisphenol a (BPA) from dental materials. Acta Biomater Odontol Scand. 2018; 4(1): 56–62.[Accessed 23rdJuly 2019]

[8]Rathee M. et al. Bisphenol A in dental sealants and its oestrogen like effect. Indian J Endocrinol Metab. 2012 May-Jun; 16(3): 339–342.[Accessed 23rdJuly 2019]





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