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LETTERS TO THE EDITOR

¹ Dept. Pediatric Dentistry, School of Dentistry, Yeditepe University, Istanbul, Turkey; caglares{at}yahoo.com

To the Editor:

The design of the study by Llodra et al. [Llodra JC, Rodriguez A, Ferrer B, Menardia V, Ramos T, Morato M (2005). Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial. J Dent Res 84:721–724] seems to be questionable. Today, we are aware that, ethically, it is unacceptable to establish a study where no attempt was made to remove decayed tissue from deciduous teeth. It is also our duty to apply this under the Helsinki Declaration. It seems that, in the present study, some children were neglected for up to 36 months, since the data show that some endodontic treatments were necessary at the end of the trial.

A second point arises from the authors’ statement that they rinsed the fluoridated dental site after the application of silver diamine fluoride. However, it has been stated that, when fluoride varnish has been applied, no other liquid, such as rinses, should be used for at least 45 min after the varnish application. It was pointed that there had been mucosal irritation; however, it was also noted that the application was on occlusal surfaces. Further preventive techniques, such as OptraDam usage, should be encouraged for the safety of children, and since the present paper was planned to be published in one of the leading journals in dentistry.

The authors reply

² University of Granada (Spain); jllodra{at}hotmail.com

Regarding the letter by Dr. Esber Caglar, our answer is as follows:

1. It should be considered that, in Cuba, dental care is free for the whole population, and children are especially prioritized. Nevertheless, the lack of economic and material resources means that deciduous teeth are treated only in urgent cases (extraction), so that priority can be given to the permanent dentition. In this clinical trial, no child (in either the Control or Test group) was excluded from receiving the dental treatment for deciduous teeth as available under the Cuban Health System. Thus, we disagree with the concern for ethical issues raised by Dr. Caglar.
   
2. We agree that a water rinse after the application of fluoride varnish is not recommended. However, the silver diamine fluoride used in this study was a solution, and, according to the manufacturer, it is highly recommended to rinse with water (or a saline solution) after application, because of the alkaline pH of the product.
   

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