Dental Caries
Conditions
Keywords
caries, prevention, laser, fluoride
Brief summary
The objective of this clinical study is to evaluate whether the use of the new CO2 - 9.3μm short-pulsed laser increases the caries resistance of occlusal pit and fissure surfaces in patients in addition to fluoride therapy. This will be quantified by visual exams with the International Caries Detection and Assessment System (ICDAS II), SOPROLIFE daylight and blue fluorescence, and DIAGNOdent Laser Light-induced Fluorescence. This is a randomized, single blind, prospective, split mouth controlled, clinical trial over 12 months.
Detailed description
The study is designed as randomized, single blind, prospective, split mouth controlled, clinical trial over 12 months. The subjects for this study will be recruited from the UCSF School of Dentistry. Patients meeting the inclusion criteria from the UCSF Predoctoral, Postgraduate Pediatric Dental and Postgraduate orthodontic clinics will have the study explained to them and be invited to participate. Young patients with moderate/high caries risk will be invited to enroll into the study. They will have to have a pair of two molars which have not been treated so far and are caries free and not sealed. The molar on patient's dominant side (right or left) will be randomly assigned to either the test or the control group with the contralateral non-dominant side receiving the other treatment. The test tooth will be treated with CO2 laser irradiation and fluoride varnish; the control tooth will receive fluoride varnish treatment alone. A baseline visual inspection using ICDAS II, white and blue light digital photographs (SOPROLIFE), and DIAGNOdent assessments will be made by a dentist prior to treatment. The patient will be asked to return for a 6-month and a 12-month follow up exam, at which time visual inspection with all testing methods will be conducted by the dentist who originally completed the baseline exam. The endpoint of the study for each participant will be when either the control or test tooth is found to have significant demineralization by ICDAS assessment (ICDAS code 3 - localized enamel breakdown without clinical visual signs of dentinal involvement) or at the 12 month exam, whichever comes first. The control and test teeth might be sealed with a dental sealant at the end of the study. All data obtained will be analyzed for statistical significance.
Interventions
DEVICELaser
CO2 - 9.3μm short-pulsed laser irradiation will occur on the occlusal enamel surface. This results in changes in crystal composition and structure, which increase the resistance of dental mineral to dissolution by acid and will work to better prevent dental caries in the occlusal surface of vital teeth when compared to fluoride therapy alone over 12 months.
OTHERFluoride
The Fluoride varnish is painted on the occlusal surface of the tooth. Fluoride varnish makes enamel more acid resistant.
Sponsors
University of California, San Francisco
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
6 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* age 6 or older, in good general health * subject is of moderate or high caries risk according to CAMBRA * has at least one pair of unsealed molars in at least one jaw with need for a sealant * teeth with an ICDAS code 0, 1 and 2 with deep grooves and fissures providing an anatomical stick for an explorer * willing to comply with all study procedures and protocols * must be able to read and understand English * have an understanding of the study * residing in San Francisco or other nearby locales with community water fluoridation (to eliminate water fluoridation as a potential confounding variable) * patient and parent/guardian able to provide written informed consent in English * willing to sign the Authorization for Release of Personal Health Information and Use of Personally Unidentified Study Data for Research form; data will only be used for research.
Exclusion criteria
* show evidence of extremely poor oral hygiene * subjects suffering from systemic diseases, significant past or medical history with conditions that may affect oral health or oral flora (i.e. diabetes, HIV, heart conditions that require antibiotic prophylaxis), * taking medications that may affect the oral flora or salivary flow (e.g. antibiotic use in the past three months, drugs associated with dry mouth / xerostomia \[extreme high caries risk\]) * other conditions that may decrease the likelihood of adhering to study protocol * subjects who will leave the area and are unable to complete the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| International Caries Detection and Assessment System (ICDAS II) - Number of Molars With ICDAS Score of 3 or More - ICDAS Score 3, Cavity - | 1 year | Difference in number of lesion changes into ICDAS score 3 (signifying a cavity) between matched case and control teeth (within patient) from baseline to 6 months and baseline to 12 months. The International Caries Detection and Assessment System (ICDAS) is a visual assessment of the caries levels. The ICDAS score ranges from 0 to 6, with score 0 meaning no demineralization at all, score 3 means a first physical loss of enamel, and score 6 means a huge cavity. |
| Change in ICDAS Scores - International Caries Detection and Assessment System (ICDAS II) - | 1 year | Differences in change in ICDAS scores between matched case and control teeth (within patient) from baseline to 6 months and baseline to 12 months. The International Caries Detection and Assessment System (ICDAS) is a visual assessment of the caries levels. The ICDAS score ranges from 0 to 6, with the score 0 meaning no demineralization at all, score 3 means a first physical loss of enamel, and score 6 means a huge cavity. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in SOPROlife Scores | 1 year | Differences in change in SOPROlife scores between matched case and control teeth (within patient) from baseline to 6 months and baseline to 12 month. The SOPROlife score (name of the intraoral camera system) is a visual assessment of the caries levels. The SOPROlife score ranges from 0 to 6, with score 0 meaning no demineralization at all, and score 6 means a huge cavity. |
Countries
United States
Participant flow
Recruitment details
This study was performed between February 2018 and November 2019 at the University of California, San Francisco (UCSF) School of Dentistry.
Participants by arm
| Arm | Count |
|---|---|
| Laser & Fluoride In the split mouth design the molar on one side of the mouth receives the intervention CO2 9.3 μm short pulsed laser treatment and fluoride varnish (experimental side) in the occlusal fissure areas.
Laser: CO2 - 9.3μm short-pulsed laser irradiation will occur on the occlusal enamel surface. This results in changes in crystal composition and structure, which increase the resistance of dental mineral to dissolution by acid and will work to better prevent dental caries in the occlusal surface of vital teeth when compared to fluoride therapy alone over 12 months. | 60 |
| Laser & Fluoride In the split mouth design the molar on one side of the mouth receives the intervention CO2 9.3 μm short pulsed laser treatment and fluoride varnish (experimental side) in the occlusal fissure areas.
Laser: CO2 - 9.3μm short-pulsed laser irradiation will occur on the occlusal enamel surface. This results in changes in crystal composition and structure, which increase the resistance of dental mineral to dissolution by acid and will work to better prevent dental caries in the occlusal surface of vital teeth when compared to fluoride therapy alone over 12 months. | 60 |
| Fluoride Alone In the split mouth design this arm (this side in the mouth - the contralateral tooth to the experimental site in the same jaw) will receive only fluoride varnish treatment. In the split mouth design this opposite side of the jaw is functioning as control.
Fluoride: The Fluoride varnish is painted on the occlusal surface of the tooth. Fluoride varnish makes enamel more acid resistant. | 60 |
| Fluoride Alone In the split mouth design this arm (this side in the mouth - the contralateral tooth to the experimental site in the same jaw) will receive only fluoride varnish treatment. In the split mouth design this opposite side of the jaw is functioning as control.
Fluoride: The Fluoride varnish is painted on the occlusal surface of the tooth. Fluoride varnish makes enamel more acid resistant. | 60 |
| Total | 240 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 5 | 5 |
Baseline characteristics
| Characteristic | Fluoride Alone | Total | Laser & Fluoride |
|---|---|---|---|
| Age, Categorical <=18 years | 60 Participants | 120 Participants | 60 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Continuous | 13.1 years STANDARD_DEVIATION 1.4 | 13.1 years STANDARD_DEVIATION 1.4 | 13.1 years STANDARD_DEVIATION 1.4 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 right or left second molar | 0 right or left second molar | 0 right or left second molar |
| Race (NIH/OMB) Asian | 16 right or left second molar | 32 right or left second molar | 16 right or left second molar |
| Race (NIH/OMB) Black or African American | 9 right or left second molar | 18 right or left second molar | 9 right or left second molar |
| Race (NIH/OMB) More than one race | 0 right or left second molar | 0 right or left second molar | 0 right or left second molar |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 right or left second molar | 0 right or left second molar | 0 right or left second molar |
| Race (NIH/OMB) Unknown or Not Reported | 4 right or left second molar | 8 right or left second molar | 4 right or left second molar |
| Race (NIH/OMB) White | 31 right or left second molar | 62 right or left second molar | 31 right or left second molar |
| Region of Enrollment United States | 60 right or left second molar | 120 right or left second molar | 60 right or left second molar |
| Sex: Female, Male Female | 32 Participants | 64 Participants | 32 Participants |
| Sex: Female, Male Male | 28 Participants | 56 Participants | 28 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 60 | 0 / 60 |
| other Total, other adverse events | 0 / 60 | 0 / 60 |
| serious Total, serious adverse events | 0 / 60 | 0 / 60 |
Outcome results
Primary
Change in ICDAS Scores - International Caries Detection and Assessment System (ICDAS II) -
Differences in change in ICDAS scores between matched case and control teeth (within patient) from baseline to 6 months and baseline to 12 months. The International Caries Detection and Assessment System (ICDAS) is a visual assessment of the caries levels. The ICDAS score ranges from 0 to 6, with the score 0 meaning no demineralization at all, score 3 means a first physical loss of enamel, and score 6 means a huge cavity.
Time frame: 1 year
| Arm | Measure | Group | Value (COUNT_OF_UNITS) |
|---|---|---|---|
| Laser & Fluoride | Change in ICDAS Scores - International Caries Detection and Assessment System (ICDAS II) - | ICDAS score change +2 | 1 right or left molar |
| Laser & Fluoride | Change in ICDAS Scores - International Caries Detection and Assessment System (ICDAS II) - | ICDAS score change 0 | 34 right or left molar |
| Laser & Fluoride | Change in ICDAS Scores - International Caries Detection and Assessment System (ICDAS II) - | ICDAS score change -1 | 4 right or left molar |
| Laser & Fluoride | Change in ICDAS Scores - International Caries Detection and Assessment System (ICDAS II) - | ICDAS score change +1 | 12 right or left molar |
| Fluoride Alone | Change in ICDAS Scores - International Caries Detection and Assessment System (ICDAS II) - | ICDAS score change -1 | 0 right or left molar |
| Fluoride Alone | Change in ICDAS Scores - International Caries Detection and Assessment System (ICDAS II) - | ICDAS score change +2 | 10 right or left molar |
| Fluoride Alone | Change in ICDAS Scores - International Caries Detection and Assessment System (ICDAS II) - | ICDAS score change +1 | 28 right or left molar |
| Fluoride Alone | Change in ICDAS Scores - International Caries Detection and Assessment System (ICDAS II) - | ICDAS score change 0 | 13 right or left molar |
Primary
International Caries Detection and Assessment System (ICDAS II) - Number of Molars With ICDAS Score of 3 or More - ICDAS Score 3, Cavity -
Difference in number of lesion changes into ICDAS score 3 (signifying a cavity) between matched case and control teeth (within patient) from baseline to 6 months and baseline to 12 months. The International Caries Detection and Assessment System (ICDAS) is a visual assessment of the caries levels. The ICDAS score ranges from 0 to 6, with score 0 meaning no demineralization at all, score 3 means a first physical loss of enamel, and score 6 means a huge cavity.
Time frame: 1 year
| Arm | Measure | Value (COUNT_OF_UNITS) |
|---|---|---|
| Laser & Fluoride | International Caries Detection and Assessment System (ICDAS II) - Number of Molars With ICDAS Score of 3 or More - ICDAS Score 3, Cavity - | 0 right or left second molar |
| Fluoride Alone | International Caries Detection and Assessment System (ICDAS II) - Number of Molars With ICDAS Score of 3 or More - ICDAS Score 3, Cavity - | 13 right or left second molar |
Secondary
Change in SOPROlife Scores
Differences in change in SOPROlife scores between matched case and control teeth (within patient) from baseline to 6 months and baseline to 12 month. The SOPROlife score (name of the intraoral camera system) is a visual assessment of the caries levels. The SOPROlife score ranges from 0 to 6, with score 0 meaning no demineralization at all, and score 6 means a huge cavity.
Time frame: 1 year
| Arm | Measure | Category | Value (COUNT_OF_UNITS) |
|---|---|---|---|
| Laser & Fluoride | Change in SOPROlife Scores | change -1 | 2 right or left second molar |
| Laser & Fluoride | Change in SOPROlife Scores | change 0 | 47 right or left second molar |
| Laser & Fluoride | Change in SOPROlife Scores | change +1 | 1 right or left second molar |
| Laser & Fluoride | Change in SOPROlife Scores | change +2 | 2 right or left second molar |
| Fluoride Alone | Change in SOPROlife Scores | change +2 | 2 right or left second molar |
| Fluoride Alone | Change in SOPROlife Scores | change -1 | 0 right or left second molar |
| Fluoride Alone | Change in SOPROlife Scores | change +1 | 30 right or left second molar |
| Fluoride Alone | Change in SOPROlife Scores | change 0 | 19 right or left second molar |