An In Vivo Comparative Evaluation of Effect on Two Dental Varnishes In the Prevention of ECC

Introduction: One of the best aspects of healthcare reform is it starts to emphasize prevention. Early childhood caries can begin early in life, progresses rapidly in those who are at high risk, and often goes untreated. Its consequences can affect the immediate and long-term quality of life of the child’s family and can have significant social and economic consequences beyond the immediate family as well. Culture studies have demonstrated strong association of Streptococcus mutans with Severe ECC along with significant associations with S.salivarius, S.parasanguinis, Lactobacillus casei and A.viscosus. These bacteria produce metabolites which reduce the pH of the oral environment. When the Ph reduces below 5.5, Hydroxyl H+ ions produced by the bacterial metabolites cause Enamel dissolution, termed as demineralization, which marks the beginning of early enamel caries.

Aims & Objectives: The present study was done to evaluate the effect of chlorhexidine varnish and fluoride varnish with CPP-ACP on salivary streptococcus mutans count in prevention of early childhood caries.

Materials And Methods: A total of 40 subjects of age group 3-6 participated in the study. The samples were randomly divided
into 2 equal groups via Group I: Chlorhexidine Varnish with 20 subjects. Group II: Fluoride Varnish
with CPP-ACP with 20 subjects each. Varnish application was done and patients were called for
intervention at 2 weeks, 4 weeks, 6 weeks follow up for salivary collection.1ml of unstimulated
saliva was collected by suction method and put into the test tube and were subjected to microbial
analysis. The streptococcus mutans colony was identified by gram staining using light microscope and sorbitol fermentation test. The number of colony forming units (CFU) of
streptococcus mutans in saliva was determined.

Statistical Analysis: The data were subjected to statistical test using SPSS software 20.0 (SPSS Inc., Chicago, IL, USA) and were subjected to the following tests.
• Unpaired ‘t’ test for comparison of Streptococcus mutans colony count at baseline.
• Unpaired ‘t’ test for comparison of Streptococcus mutans colony count at baseline, 2 weeks, 4 weeks and 6 weeks.
• Bonferroni multiple comparison test for inter group comparison of Streptococcus mutans colony count at baseline, 2 weeks, 4 weeks and 6 weeks

Results: The mean follow up time for both the groups was 6 weeks . The statistical package for social sciences (SPSS21) software was used for data analysis. There was no statistically significant difference between the groups with respect to age and DMFT/ deft scores. Unpaired t-test revealed no statistically significant difference ( p value 0.102*) at baseline for all the three groups but, at 2 weeks, 4 weeks and 6 weeks time interval there was a significant reduction seen with all the three groups in respect to S. mutans CFU/mL of saliva.( p<0.001*) Bonferroni multiple comparison test indicates that there is statistically significant difference (p<0.001*) between the baseline count as compared to the count at 2 weeks, 4 weeks and 6 weeks in both the groups. Results show both groups have similar efficacy.

Conclusion: The use of varnishes can intercept the growth of microorganisms and hence prevent the occurrence of caries at an initial level. The results of this study prove that both the varnishes chlorhexidine varnish and fluoride varnish with CPP-ACP have good potential to inhibit demimeralisation caused by bacteria causing early childhood caries mainly Streptococcus mutans. Thus, these varnishes can be used in the prevention of early childhood caries as they are easy to apply, non cumbersome and well tolerated by children. Dental varnish and parental counselling should be recommended as part of caries prevention programs targeting infants and toddlers. The limitations of the study are small sample size and duration of study. Also, only children of Belagavi district were included. Hence, a large geographical area should be covered to substantiate the present study.