Faculty Bibliography

OBJECTIVE: This study assessed the effect of an arginine bicarbonate/calcium carbonate (CaviStat)-containing dentifrice on caries development, mainly in 11- to 12-year-old Venezuelan children over a two-year period. METHODOLOGY: Children (726) with a DMFT between 3 and 6 were examined at baseline, six months, and one and two years using a mirror, probe, and DMFS scoring. Subjects who completed the study consisted of two groups; 304 test and 297 control. The test group received a CaviStat-containing dentifrice, and the controls used a commercially available 1100 ppm fluoride toothpaste. All subjects were instructed to brush three times a day for 1 minute followed by swishing for 30 seconds. RESULTS: After six months, the mean DMFS scores increased only slightly from baseline in both groups, 6.93 +/- 0.22 in the control and 6.59 +/- 0.22 in the test subjects. After one year, the mean DMFS score in the control group rose to 8.00 +/- 0.24 and leveled off at 7.92 +/- 0.30 at two years. In contrast, the mean DMFS score in the test group decreased to 5.50 +/- 0.24 after one year before rising to 6.99 +/- 0.28 at two years. DMFS difference between the two groups was highly significant (p < 0.001), but mainly due to the large difference seen at one year. Dissection of the data showed that the erupted first molars dominated the overall DMFS changes. At the beginning of this study, first molar scores started at high values and showed a pattern thereafter like that seen for the total data. In contrast, premolars/molars, which erupt 4-6 years later (and at the start of the study had a mean DMFS score slightly above zero), showed a clear rise in the DMFS score in the control group during the first year of the study, which continued to rise until the end of the investigation. In contrast, the CaviStat group showed no change in the premolar/second molar DMFS score from baseline during the first year (giving the impression of 100% inhibition at one year), but showed a delayed rise thereafter that paralleled that seen in the controls between one and two years (58.3% inhibition at two years). Reversal of the development of early dental caries lesions in the CaviStat subjects and limitations of the diagnosis of very early caries lesions with standard dental explorers was suggested for the interesting first molar, first year data. Inhibition of caries initiation and caries progression in the CaviStat group was also observed and easier to see in the premolar/second molar, second year data where the DMFS scores were very low at baseline and reversals are not a significant issue. The results were subjected to statistical analysis including analysis of covariance. Largely because of the first year and first molar data, the difference between control and experimental groups was highly significant (p < 0.001). Similar comparison with the later-erupting premolar/molar teeth showed the CaviStat effect was also significant but at a lower level (p < 0.05). The differences could not be due to examiner error since the Kappa for 10% of the subjects randomly selected and re-examined was 0.898 overall and 0.914 for the first molar data. The data also suggested CaviStat inhibition of caries progression because of a slower rate of rise of missing+filled teeth in the CaviStat vs. the control group (p < 0.05). CONCLUSION: A CaviStat-containing toothpaste was more effective both clinically and statistically in inhibiting caries initiation and progression than the fluoride toothpaste control, and manifested its effects differently in the already-erupted first molars than in the later-erupting premolars and second molars