Pioneering Studies in Cavities Affecting Young Teeth

Pioneering Studies in Cavities Affecting Young Teeth

In a significant move to combat Severe Early Childhood Caries (S-ECC), a condition affecting approximately 240 children aged 2-5 in the U.S., a new research trial has been launched. The Povidone Iodine Efficacy Study (PIES) is a single-centre, randomised, double-blind, placebo-controlled trial, aiming to assess the efficacy of povidone iodine (PVPI) in preventing new cavities following treatment.

The trial, led by Dr. Eli Eliav, DMD, PhD, director of the Eastman Institute for Oral Health, has received substantial funding as part of a commitment to reduce health disparities among underserved communities. Co-investigators from the University of Rochester School of Medicine and Dentistry include Dr. Steve Gill, Dr. Michael McDermott, and Dr. Michael Sohn.

Children enrolled in the study will be randomly assigned to receive either PVPI and fluoride varnish or a placebo and fluoride varnish. The team will measure the severity and incidence of new dental caries in children with S-ECC following oral rehabilitation who are receiving quarterly topical 10% PVPI or placebo.

While there is no direct evidence supporting the routine use of topical iodine as an anti-microbial agent for reducing recurrent tooth decay in young children treated for S-ECC, some relevant points can be drawn from the available literature.

Recent systematic reviews confirm that antiseptic mouthwashes, including chlorhexidine and essential oils, are effective in reducing gingival inflammation and plaque accumulation in adults. However, these reviews focus on periodontal and peri-implant diseases in adults, not on primary teeth or the prevention of recurrent caries in young children with S-ECC.

The available research does not address iodine's use for recurrent caries prevention in children treated for S-ECC. Moreover, evidence for iodine (povidone-iodine) as an antiseptic is largely from adult periodontology; extrapolation to young children is not validated.

Fluoride remains the cornerstone of prevention for childhood caries, with clear evidence of effectiveness and cost-efficiency, especially in high-risk populations. Chlorhexidine and essential oils are more studied than iodine for adjunctive plaque control, but their use in young children—especially for caries prevention—is not strongly supported by current evidence.

The safety and acceptability of regular iodine use in the oral cavities of young children have not been established, especially given the risk of iodine absorption and potential systemic effects.

The PIES study aims to fill these gaps in the evidence, investigating the effect of topical 10% PVPI on diversity and composition of oral microbiota, including cariogenic species, over a period of up to 24 months. The study agents will be reapplied every three months.

The study's conclusion is that there is currently no research supporting the use of topical iodine as an anti-microbial agent to reduce recurrent tooth decay in young children treated for S-ECC. However, the trial promises to shed light on the potential role of PVPI in pediatric caries prevention.

Until robust pediatric evidence for iodine or other antiseptics emerges, clinicians should rely on established fluoride therapies for caries prevention in children with S-ECC.

References: 1. American Academy of Pediatric Dentistry. Early Childhood Caries Fact Sheet.

1. The new research trial, Pies, focuses on science, addressing Severe Early Childhood Caries (S-ECC) in young children.
2. The trial is led by Dr. Eli Eliav, who directs the Eastman Institute for Oral Health.
3. The University of Rochester School of Medicine and Dentistry contributes co-investigators to the study.
4. Children enrolled in the study will receive either povidone iodine (PVPI) and fluoride varnish or a placebo and fluoride varnish.
5. The research aims to assess the efficacy of PVPI in preventing new cavities following treatment.
6. While direct evidence for the routine use of topical iodine as an anti-microbial agent is lacking, some relevant points can be drawn from available literature.
7. Antiseptic mouthwashes, including chlorhexidine and essential oils, are effective in reducing gingival inflammation and plaque accumulation in adults.
8. However, these reviews focus on periodontal and peri-implant diseases in adults, not primary teeth or the prevention of recurrent caries in young children with S-ECC.
9. The available research does not address iodine's use for recurrent caries prevention in children treated for S-ECC.
10. Evidence for iodine as an antiseptic is largely from adult periodontology; extrapolation to young children is not validated.
11. Fluoride remains the cornerstone of prevention for childhood caries, with clear evidence of effectiveness and cost-efficiency.
12. Chlorhexidine and essential oils are more studied than iodine for adjunctive plaque control, but their use in young children—especially for caries prevention—is not strongly supported by current evidence.
13. The safety and acceptability of regular iodine use in the oral cavities of young children have not been established.
14. The Pies study investigates the effect of topical 10% PVPI on the diversity and composition of oral microbiota over a period of up to 24 months.
15. The study agents will be reapplied every three months.
16. The trial does not currently support the use of topical iodine as an anti-microbial agent to reduce recurrent tooth decay in young children treated for S-ECC.
17. However, the trial promises to shed light on the potential role of PVPI in pediatric caries prevention.
18. Until robust pediatric evidence for iodine or other antiseptics emerges, clinicians should rely on established fluoride therapies for caries prevention in children with S-ECC.
19. The study received substantial funding as part of a commitment to reduce health disparities among underserved communities.
20. Workplace-wellness programs could benefit from the potential findings of the Pies trial to promote oral health and wellness in their initiatives.
21. Medical-conditions like chronic diseases, cancer, respiratory conditions, and digestive health issues can be exacerbated by poor oral health.
22. Eye-health, hearing, and skin-care are additional aspects of health and wellness that could be impacted by oral health.
23. Fitness and exercise, sexual health, and mental health are other important areas that may be influenced by oral health.
24. Autoimmune disorders such as Crohn's disease or lupus can be affected by oral health.
25. Climate change poses threats to various industries, including manufacturing, agriculture, and retail, necessitating innovative solutions and adaptability.
26. Addressing environmental science and implementing sustainable practices can contribute to the industry's resilience and long-term success.
27. Finance plays a crucial role in mental-health care, men's health, and women's health, as people may face financial barriers in seeking treatment for these conditions.
28. With a focus on health and wellness, entrepreneurs can explore opportunities in therapies and treatments, nutrition, aging, skin care, and personal-finance services to meet the diverse needs of consumers.

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