Saudi Cultural Missions Theses & Dissertations
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Item Restricted Fluoride-Impregnated Traditional Chewing Sticks and Oral Health: A Literature Review(Saudi Digital Library, 2025) Aloraini, Abdulmalik Abdulrahman; Michelle, StennettABSTRACT BACKGROUND Dental caries remains one of the most prevalent chronic diseases worldwide and a major public health concern, particularly in low- and middle-income countries. Fluoride is widely recognized as an effective preventive agent against caries, most commonly through methods such as fluoridated water, toothpaste, gels, and varnishes. Traditional chewing sticks (TCS) have been used for centuries across different cultures for mechanical plaque removal and oral hygiene. More recently, fluoride impregnation of TCS has been explored as a novel, culturally acceptable, and potentially cost-effective vehicle for fluoride delivery. However, the current evidence base on their effectiveness and safety is limited and fragmented. AIM This dissertation aims to systematically review and critically synthesize the existing literature on fluoride-impregnated TCS, focusing on their effectiveness, safety, and potential role in caries prevention and gingival health improvement within public health strategies. METHODS A systematic literature review was conducted to identify experimental studies (in vitro and in vivo) and clinical studies evaluating fluoride-impregnated TCS. Searches were carried out across electronic databases including Medline, Embase, Google Scholar, Web of Science, and Scopus, supplemented by manual screening of reference lists. Eligible studies were assessed for fluoride release, caries preventive effects, antibacterial activity, and potential adverse outcomes. Data were extracted, tabulated, and summarized narratively due to heterogeneity across studies. RESULTS A total of 10 eligible studies were identified in the review. The majority of them were short term and laboratory-based, still, some of them incorporated clinical and population-level data. Studies have suggested evidence that fluoride-impregnated TCS, all impregnated with sodium fluoride (NaF) could free fluoride at levels of 0.1-0.5% NaF (450-2250 ppm), which was adequate to modulate remineralization of enamel and suppress cariogenic bacteria without approaching safety limits. In vitro experiments articulated greater enamel resistance to demineralization whereas in vivo and clinical trials indicated increased salivary fluoride concentrations, plaque lessening, and decreases in white spots lesions in contrast with non-impregnated sticks. The findings do not indicate that population-level strategies were directly assessed in any of the studies, but the evidence indicates that fluoride-impregnated TCS may have a role to play as a cultural-appropriate addition to traditional fluoride-based caries-thwarting programs, especially in low-resource countries. However, methodological variability and lack of large-scale, long-term trials restrict generalizability of findings. CONCLUSION Fluoride-impregnated TCS show promise as a culturally relevant, adjunct for caries prevention, particularly in communities with limited access to conventional dental care. Nevertheless, the absence of systematic reviews and robust clinical trials highlights the need for further research to establish their long-term effectiveness, safety, and feasibility in public health programs.8 0Item Restricted FLUORIDE CONTENT OF INFANT FORMULA COMMERCIALLY AVAILABLE IN CENTRAL INDIANA(Saudi Digital Library, 2025) Altamimi, Ayman; Lippert, FrankBACKGROUND Fluorides have a well-established role in dental caries prevention. Fluoride content in infant formula has raised concerns about whether it is within safe levels for the developing teeth. There is a large number of products on the market with likely varying fluoride concentrations, and these products’ fluoride content will differ depending on whether, for example, fluoridated water was used during manufacturing or reconstitution. Several studies have been published on infant formula containing fluoride and the associated risk of developing enamel fluorosis. However, few recent studies in the US have determined whether liquid or powder infant formula fall within safe/recommended levels. Purpose: This study measured the fluoride content of infant formula sold in grocery stores in central Indiana, prepared using three types of water (Purified, Nursery, and Tap) to determine if they fall within safe levels. Alternative hypotheses: There is a significant difference in the concentration of fluoride between different brands of infant formula. Material & Methods: We analyzed twenty different infant formula products sold in grocery stores in the Indianapolis, Indiana area for their fluoride content. Samples were reconstituted with Nursery water (containing approx. 1.0 ppm fluoride), Tap water (approx. 0.7 ppm fluoride) and Purified water (negligible fluoride content). A sample for the tests was taken from each preparation and the concentrations of fluoride of all samples was determined using the fluoride microdiffusion method. The statistical analysis of results was carried out using two-way ANOVA. Results: When comparing the mean (SD) fluoride concentration among the three types of infant formula reconstitution with water, tap water had significantly higher fluoride concentration mean than both Nursery water and purified water (P <.001 at α=.050 level). Nursery water also had significantly higher fluoride concentration mean than purified water (P <.001 at α=.050 level). When the three types of water were used for reconstitution of the 20 infant formula brands, the overall highest fluoride concentration mean was seen when tap water was used for reconstitution (0.950) followed by nursery water (0.789) while the least fluoride concentration was in purified water (0.102). Conclusion: Within the study's limitations, it can be concluded that apart from one formula none of the tested infant formulas sold in central Indiana grocery stores when reconstituted with purified water were found to decrease the chance of infants exceeding UL levels for both age groups but were found to increases the chance exceeding the AI levels for infants aged 0–6 months. All tested infant formulas reconstituted with nursery and tap water were found to increase the chance of infants exceeding the UL, and the AI levels for both groups resulted in increasing the chance of fluoride concentrations exceeding the recommended/safe levels. Thus, the type of water used for reconstitution rather than the type of formula appears to be the determining factor for the levels of fluoride intake associated with infant formula. Clinical Significance: With the recent increase in the utilization of infant formula, different brands with varying fluoride concentrations and the different modes of reconstitution must be evaluated to determine if their fluoride concentrations will fall within safe/recommended levels and thus increase the risk of enamel fluorosis development.41 0Item Restricted Rapid Review of Interventional Studies to Reduce Inequalities in Caries Among Children(King's College London, 2024-08) Alsindi, Razan Sadaka J; Sabbah, WaelAim: This review aims to assess and synthesize evidence from intervention studies to decrease socioeconomic inequalities regarding dental caries for children. Materials and Methods: A review of the literature up to July 2024 was done to find intervention studies that demonstrated a reduction in socioeconomic inequality in children. The following keywords were used: children, caries, intervention studies, and socioeconomic inequality. Any preventive or health promotion techniques aimed at lowering inequality in dental caries were considered interventions. Any groups that did not receive the intervention or that received an alternative intervention were included in the comparison. We used PubMed, Ovid, and Cochrane as our three databases. All 15 of the identified articles were evaluated for risk of bias using the Cochrane criteria. The rapid review process will be described using the Khangura et al. (2012) to update the findings on interventions to reduce inequalities in dental caries. Results: The 15 identified intervention studies encompassed fluoride varnish applications, health education and promotion initiatives in schools, and the fluoridation of water supplies, due to several methodological limitations. Specifically, some of the studies lacked confirmation of blinding for participants or providers and did not adequately conceal allocation, hence the quality of identified studies is considered moderate. Finally, the use of fluoride in the whole population and target population interventions showed a better impact on inequalities in caries. Conclusion: This review identified a scarcity of studies addressing interventions aimed at reducing socioeconomic inequalities in dental caries among children. Nevertheless, it highlighted that broad population-level interventions, especially community water fluoridation, were more effective and consistently impactful in diminishing these inequalities than targeted measures.29 0Item Restricted Comparison of an experimental single application two-step 25600 ppm Ammonium Fluoride / 34100 - 48600 ppm Nano-Calcium Fluoride solution vs. a one-step 7700 ppm Ammonium Fluoride varnish for Preventing Enamel Loss from Erosion and Attrition in vitro(King’s College London, 2024) Almejrad, Lamya; Austin, Rupert; Bartlett, DavidIntroduction: The potential for high-fluoride treatments to prevent progression of erosion and attrition is not fully understood. This thesis investigated the effect of an experimental two-step ammonium fluoride/nano-calcium fluoride formulation (25600 ppm NH4F plus 34100 - 48600 ppm CaF2) versus a single-application one-step 7700 ppm ammonium fluoride (NH4F) varnish on step height loss (μm) of polished and natural human enamel undergoing erosion and attrition in vitro. Material and methods: Three restorative dental materials and human enamel (Occlusal vs. Buccal) samples were used to validate the attrition simulation method. Samples were subjected to attritional wear using leucite-reinforced CAD/CAM ceramic antagonists in an electrodynamic wear simulator (200 cycles, 80 N load, 0.7 mm horizontal slide). Following validation, polished and natural (unpolished) enamel samples were pre-treated with either deionized water (DIW negative control), NH4F varnish (positive control) or a two-step NH4F/CaF2 solution. After surface wiping, samples were subjected to erosion (0.3% citric acid solution immersion, pH 3.8, for 5, 10, 15, 20 and 60 minutes) and attrition (200 strokes). Enamel wear was measured using non-contact laser profilometry (NCLP). Enamel surface and sub-surface mechanical testing was conducted using micro- and nanoindentation. Enamel surface and sub-surface qualitative examination was conducted using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). Results: The attrition method revealed that the glass ionomer material experienced the most wear, measuring 177.8 μm (±16.9). This was significantly more than the fine particle composite, which showed 22.2 μm (±1.3) of wear, and the micro-filled composite, which had the least wear at 13.6 μm (±1.02) (P < 0.001). Enamel samples from buccal vs. occlusal sources experienced non-significantly different step height enamel wear (P<0.05). The attrition wear generation was consistent with co-efficient of variation <10%. Polished enamel samples treated with surface fluoride treatments showed significantly reduced step height enamel loss vs. control (p<0.001): Mean (SD) enamel loss for DIW treatment was 1.97 μm (±0.14) after erosion and 36.55 μm (±1.79) after erosion/attrition. NH4F treatment reduced loss to 0.58 μm (±0.08) after erosion and 32.71 μm (±2.63) after erosion/attrition (p<0.001). NH4F/CaF2 treatment further reduced loss to 0.41 μm (±0.06) after erosion and 24.08 μm (±3.15) after erosion/attrition (p<0.001). This was supported by the microhardness data: fluoride-treated enamel experienced reduced hardness changes following both erosion and erosion/attrition vs. non-fluoride treated enamel (p<0.001). For natural enamel, the experimental NH4F/CaF2 solution significantly reduced enamel loss after all erosion durations (5, 20, 60 minutes) and after 200 strokes of attrition. After 5 minutes of erosion, enamel loss compared to DIW was significantly reduced (p<0.001). Mean (SD) enamel loss in the NH4F/CaF2 treated group was reduced to 0.21 μm (±0.13) after erosion and 9.82 μm (±1.46) after erosion/attrition in comparison with DIW treated groups which was 0.79 μm (±0.32) after erosion and 15.58 μm (±2.49) after erosion/attrition. The surface and sub-surface SEM and EDS data supported these findings. Conclusion: The two-step ammonium fluoride solution (NH4F/CaF2) reduced step height enamel loss and hardness changes occurring in polished and natural enamel during simulated erosion and attrition in vitro.18 0Item Restricted EFFECT OF BOTTLED WATER AND FLUORIDE TOOTHPASTE USAGE ON CARIES LESION REMINERALIZATION.(Indiana University, 2023-07-17) Qaw, Masoumah; Lippert, FrankBackground: The importance of fluoride in the prevention of dental caries has been well documented in the literature, as it inhibits demineralization of the tooth structure and enhances remineralization. One of the major public health policies to prevent caries is to provide the population with an adequate amount of fluoride through community water fluoridation. Nowadays many people drink bottled water instead of tap water due to its easy access, convenience, and low cost. Besides fluoride, other minerals present in tap and bottled water, such as calcium and magnesium, are also important in decreasing dental caries prevalence. However, our knowledge of the role of bottled water in caries prevention and especially when combined with fluoride toothpaste usage is still poor. Objectives: The aim of this in-vitro study was to evaluate the effects of some bottled waters on fluoride toothpaste efficacy in enhancing caries lesion remineralization. Methodology: Early caries lesions were created in bovine enamel specimens and stratified into treatment groups based on Vickers surface microhardness (VHN). The present study followed a two (fluoride and fluoride-free toothpaste) by five (four bottled waters and tap water) factorial design. The treatment groups were bottled water with the following attributes: a) 309.9 ppm Ca/1.20 ppm F; b) 118.4 ppm Ca/0.16 ppm F; c) 1.00 ppm Ca/1.01 ppm F; d) 0.1 ppm Ca/0.04 ppm F, and tap water (48.7 ppm Ca/0.7 ppm F). The five water groups were paired either with 1100 ppm fluoride or fluoride-free toothpaste, yielding 10 groups. Specimens were pH-cycled for 10 days with the daily regimen comprised of twice daily toothpaste slurry, with four exposures to water in between. VHN was measured, again, and the difference calculated (∆VHN). Data were analyzed using two-way ANOVA at a 5-percent significance level. Results: The two-way interaction between water and toothpaste was significant (p < 0.001). All groups except fluoride-free toothpaste/bottled water with 0.1 ppm Ca/0.04 ppm F (p = 0.411) had significant increases in VHN after pH cycling (p ≤ 0.023). Fluoridated toothpaste resulted in a higher rate of remineralization compared to fluoride- free toothpaste (all p < 0.001). Bottled water with 1.20 ppm F/309.9 ppm Ca exhibited the greatest extent of remineralization within fluoride toothpaste groups (p < 0.001) and higher remineralization than lower fluoride water in fluoride-free toothpaste groups (p ≤ 0.006). Within the fluoridated toothpaste group, tap water exhibited significantly less remineralization compared to all bottled waters (all p < 0.001). Conclusion: Within the limitation of this study, bottled water with higher fluoride and calcium concentrations might improve fluoridated toothpaste efficacy by enhancing remineralization of early enamel caries-like lesions.21 0Item Restricted The Effectiveness of Silver Diamine Fluoride (SDF) on Caries Lesions in Adults: retrospective study evaluating the longevity of SDF treated teeth in adult patients using a dental school data record(2025) Al Saffer, Ala; Kolker, JustineSilver diamine fluoride (SDF) is used to treat dental caries lesions on primary teeth in children and have been found effective. Adults may also benefit from the use of SDF in treating exposed initial root caries lesions, yet such studies are lacking. The aim of this retrospective study was to determine the factors related to longevity of adult patients’ teeth after SDF treatment. Methods: Data from the University of Iowa College of Dentistry data base (AxiUm) were used for this study. Patients aged 18 years and older with one or more code D1354 between 2016 and 2021 were included. Patient variables included: age, gender, race, number of medications, smoking status, insurance status, and number of D1354 codes overall. Tooth variables included: tooth number, number of D1354 codes applied on the tooth, and subsequent treatment (restoration, root canal treatment, extraction). Operator variables included: provider type (student, post-grad, faculty) and type of clinic (geriatric vs. other). The dependent outcome variable was survival defined as not needing subsequent treatment. Statistical software was used to calculate chi-square values used for analyses to determine relationship between variables and survival. Results: Results included 1772 patients with 2985 SDF treated teeth. Patients that had significantly higher failure (p <.001 to <.05) with tobacco use. Teeth with crowns prior to SDF treatment had higher chance of failure. Multiple applications of SDF had higher chances of not failing.53 0