Arrest of root carious lesions via sodium fluoride, chlorhexidine and silver diamine fluoride in vitro

Abstract

Objective: To compare the root carious lesion arrest of chlorhexidine (CHX) and silver diamine fluoride (SDF) varnishes and/or sodium fluoride rinses (NaF) in vitro. Background: Effective and easily applicable interventions for treating root carious lesions are needed, as these lesions are highly prevalent amongst elderly individuals. Methods: In 100 bovine dentin samples, artificial root carious lesions were induced using acetic acid and a continuous-culture Lactobacillus rhamnosus biofilm model. One quarter of each induced lesion was excavated and baseline dentinal bacterial counts assessed as Colony-Forming-Units (CFU) per mg. Samples were allocated to one of four treatments (n = 25/group): (1) untreated control; (2) 38% SDF or (3) 35% CHX varnish, each applied once, plus 500 ppm daily NaF rinse in the subsequent lesion progression phase; and (4) daily NaF rinses only. Samples were re-transferred to the biofilm model and submitted to a cariogenic challenge. After six days, another quarter of each lesion was used to assess bacterial counts and the remaining sample was used to assess integrated mineral loss (ΔZ) using microradiography. Results: ΔZ did not differ significantly between control (median (25th/75th percentiles): 9082 (7859/9782) vol % × μm), NaF (6704 (4507/9574) and SDF 7206 (5389/8082)) (p < 0.05/Kruskal-Wallis test). CHX significantly reduced ΔZ (3385 (2447/4496)) compared with all other groups (p < 0.05). Bacterial numbers did not differ significantly between control (1451 (875/2644) CFU/μg) and NaF (750 (260/1401)) (p > 0.05). SDF reduced bacterial counts (360 (136/1166)) significantly compared with control (p < 0.05). CHX reduced bacterial counts (190 (73/517)) significantly compared with NaF and control (p < 0.05). Conclusion: CHX varnish plus regular NaF rinses arrested root carious lesions most successfully.