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Available online at www.sciencedirect.com

Pediatric Dental Journal


journal homepage: www.elsevier.com/locate/pdj

Original Article

Application of a tooth-surface coating material


containing pre-reacted glass-ionomer fillers for
caries prevention

Mayu Suzuki 1, Aya Yamada**,1, Kan Saito, Ryoko Hino, Yu Sugawara,


Mariko Ono, Masahiro Naruse, Makiko Arakaki, Satoshi Fukumoto*
Division of Pediatric Dentistry, Department of Oral Health and Development Sciences, Tohoku University Graduate
School of Dentistry, Sendai 980-8575, Japan

article info abstract

Article history: Purpose: Several methods have been used to prevent dental caries, including fluoride
Received 28 April 2015 application to strengthen teeth and promote remineralization and the use of sealants to fill
Received in revised form pits and fissures in pediatric dentistry. However, none of these methods alone can be
11 August 2015 considered a perfect preventive treatment. For caries prevention, we evaluated pre-reacted
Accepted 13 August 2015 glass-ionomer (PRG) Barrier Coat (Shofu Inc., Kyoto, Japan), a tooth-surface coating mate-
Available online xxx rial developed using PRG technology that contains high levels of controlled-release
fluoride.
Keywords: Methods: The tooth-surface coating material was applied clinically as a new method of
Caries prevention preventing dental caries. Its effect on plaque adhesion, along with its preventive effect on
Ion release dental caries was investigated in actual cases treated in a pediatric dentistry department of
Surface pre-reacted glass-ionomer a university hospital.
Tooth-coating material Results: PRG Barrier Coat was shown to have suitable adhesive strength and to be a safe
material that does not fracture the adherend. Actual ion release and acid buffering were
confirmed, and when clinically applied, continuous fluoride release and recharge occurred,
as did the release of the other ions. This suggests that this material promoted dentin
remineralization, suppressed plaque adherence, and had a preventive effect on dental
caries.
Conclusion: This material promoted enamel remineralization, suppressed plaque adher-
ence, and had a preventive effect on dental caries. These results suggest that this coating
material is appropriate for young children at high risk of dental caries.
Copyright © 2015 The Japanese Society of Pediatric Dentistry. Published by Elsevier Ltd. All
rights reserved.

* Corresponding author.
** Corresponding author.
E-mail addresses: yamada-a@dent.tohoku.ac.jp (A. Yamada), fukumoto@dent.tohoku.ac.jp (S. Fukumoto).
1
These authors contributed equally to this work.
http://dx.doi.org/10.1016/j.pdj.2015.08.003
0917-2394/Copyright © 2015 The Japanese Society of Pediatric Dentistry. Published by Elsevier Ltd. All rights reserved.

Please cite this article in press as: Suzuki M, et al., Application of a tooth-surface coating material containing pre-reacted glass-ionomer
fillers for caries prevention, Pediatric Dental Journal (2015), http://dx.doi.org/10.1016/j.pdj.2015.08.003
2 p e d i a t r i c d e n t a l j o u r n a l x x x ( 2 0 1 5 ) 1 e7

material consists of Base and Active (Table 1). Base and Active
1. Introduction of the tooth-surface coating material were mixed, and the
mixture was filled in a mold (15-mm diameter, 1-mm thick-
So far, the field of pediatric dentistry has used several ness), light-cured (3 min) using a light-curing unit (Solidilite;
methods to prevent dental caries, such as applying fluoride to Shofu Inc.) to obtain disc specimens. Specimens prepared in
strengthen teeth and to promote remineralization and using the above manner were immersed in distilled water (5 mL
sealants to fill pits and fissures [1e3]. However, fluoride each, 37  C) and removed from the water at a given time point,
application does not stay on tooth surfaces for a long time, and immersed again in fresh distilled water (5 mL). This im-
and sealants have only local effects on pits and fissures. For mersion procedure was repeated up to Day 30. Each immer-
children with abnormalities in enamel formation or tooth sion liquid was subjected to analysis of elemental
morphology that are at a high risk of dental caries, neither of concentration (Na, B, Al, Si, and Sr) using inductively coupled
these can be considered a perfect preventive treatment. plasma atomic emission spectroscopy (ICPS-8000; Shimadzu
Herein, we report our investigation of the PRG Barrier Coat Co., Kyoto, Japan). Analysis was conducted after preparing
(Shofu Inc., Kyoto, Japan), a tooth-surface coating material calibration curves corresponding to each element (in ppm: Na
developed with pre-reacted glass-ionomer (PRG) technology 0, 5, 20, 50; B 0, 10, 50, 100; Al 0, 0.5, 5, 10; Si 0, 0.5, 1, 5; Sr 0, 5, 20,
that, unlike previous materials, can coat the entire tooth 50). Analysis of F concentration involved the use of a fluoride
surface and can be expected to have a strong preventive effect ion electrode (Orion 9609BN; Thermo Fisher Scientific Inc.,
on dental caries. The PRG Barrier Coat is a Giomer dental ma- Waltham, MA, USA) after preparing its calibration curves
terial that contains surface PRG (S-PRG) filler, to which PRG (0 ppm, 0.1 ppm, 1 ppm, 5 ppm, 10 ppm). For the analysis of F
technology had been applied. It is characterized by its bioac- ions, an ionic strength adjuster (TISAB III; Thermo Fisher
tive functions because of the gradual release of multiple ions. Scientific Inc.) was added in the proportion of 0.1 mL of ionic
The PRG technology reacts to glass-containing acid-reactive strength adjuster to 1 mL of test solution.
fluoride with application of a polyacrylic acid aqueous solu-
tion to create stable, glass-ionomer-like structures inside the
glass particles [4]. The tooth-surface coating material contains 2.2. pH change in lactic acid solution containing the
S-PRG filler manufactured with this technology. cured tooth-surface coating material
S-PRG filler possesses a three-layer structure with a stabi-
lized glass-ionomer-like structure surrounding multifunctional Base and Active of the PRG Barrier Coat were mixed, and the
glass fillers, with an external hard glass layer. This enables the mixture was filled in a mold (15-mm diameter, 1-mm thick-
filler to have great physical strength and to release fluoride (F) ness), light-cured (3 min) using a light-curing unit (Solidilite)
and five other ions (Na, sodium; B, borate; Al, aluminum; Si, to obtain disc specimens. Specimens prepared in the above
silicate; and Sr, strontium) without deteriorating the properties manner were immersed in 5 mL of lactic acid solution (pH 4.0)
of the material. By releasing these ions, this material can be for various time periods (0.5 h, 1 h, 3 h, 5 h, 7 h, 9 h, 11 h, 24 h).
expected to have an acid-buffer effect, remineralization, and After removing the specimens from the solutions, the pH
have an antibacterial action by suppressing the adherence and value in the solutions were measured using a pH meter (Twin
proliferation of bacteria on the tooth surface [5e8]. pH B-212; Horiba Co., Kyoto, Japan).
Similar to glass-ionomer cements, materials containing
this filler possess a high capability for sustained fluoride 2.3. Evaluation of shear bond strength of the tooth-
release. Additional increases in the fluoride concentration in surface coating material
the oral cavity owing to fluoride-containing dentifrice or gel
would recharge fluoride ions in the oral cavity [3,9e12]. Base and Active of the PRG Barrier Coat were mixed, and the
This technology has already been applied to filling mate- mixture was coated on a polished surface of a bovine tooth
rials such as composite resin [4,12e14], adhesion systems, (600-grit, enamel, and dentin) that was embedded in epoxy
temporary cement, and orthodontic resin, but the tooth- resin, left undisturbed for 3 s, and then light-cured for 10 s.
surface coating material used in this study had the S-PRG With a Teflon mold (diameter: 4 mm, height: 2 mm) mounted
filler but with a filler size that was even more miniaturized. on the coated surface, and the mold filled with composite
The purpose of this study was to apply the tooth surface
coating material clinically as a new method for dental caries
prevention, investigate its effect on plaque adhesion, and Table 1 e Composition of the tooth-surface coating
survey its ability to prevent dental caries in actual cases in a material.
pediatric dentistry department of a university hospital. State Ingredients
Base Slurry Glass-filler, water,
methacrylic acid monomer
2. Materials and methods Active Liquid Phosphoric acid monomer,
methacrylic acid monomer,
bis-MPEPP, carboxylic acid
2.1. Measurement of released ion species of the tooth-
monomer, TEGDMA, photo-
surface coating material initiator

Bis-MPEPP ¼ 2,20 -bis (4-methacryloxy polyethoxyphenyl) propane;


The tooth-surface coating material used in this study was the
TEGDMA ¼ triethylene glycoldimethacrylate.
PRG Barrier Coat (Shofu Inc.). The tooth surface coating

Please cite this article in press as: Suzuki M, et al., Application of a tooth-surface coating material containing pre-reacted glass-ionomer
fillers for caries prevention, Pediatric Dental Journal (2015), http://dx.doi.org/10.1016/j.pdj.2015.08.003
p e d i a t r i c d e n t a l j o u r n a l x x x ( 2 0 1 5 ) 1 e7 3

resin (BEAUTIFIL II; Shofu Inc.), the specimen was light-cured


for 20 s, stored in water at 37  C for 24 h, and subjected to shear
bond strength (SBS) testing using a universal testing machine
(Instron 5567; Instron Co., Canton, MA, USA). Fuji VII (GC Co.,
Tokyo, Japan) as control material was mixed using a capsule
mixer for 10 s at high speed. With the Teflon mold mounted on
the tooth surface, and the mold filled with the mixture, the
specimen was light-cured for 30 s, stored in water, and sub-
jected to SBS. Enamel and dentin surfaces were then observed
and analyzed with a scanning electron microscope (VE-7800;
Keyence, Osaka, Japan) under gold-evaporated conditions.

2.4. Clinical application of the tooth-surface coating


material

The PRG Barrier Coat was applied to the front maxillary teeth
Fig. 1 e The upper panel shows examples of the clinical
of 21 children (114 teeth; age 2e5 y) who desired dental caries
case oral photograph (Group 1: children without dental
prevention under the informed consent from all parents. The
caries, notable malalignment, or other abnormalities;
patients were treated at the pediatric dentistry department of
Group 2: children with cleft lip and palate and malaligned
Tohoku University Hospital (Miyagi, Japan). The patients were
or hypoplastic teeth). The lower table is the Modified
divided into two groups: Group 1 comprised children without
United States Public Health Service (USPHS)-Ryge criteria
dental caries, notable malalignment, or other abnormalities
used in the clinical evaluation of the PRG Barrier Coat.
(14 cases; 74 teeth); and Group 2 comprised children with cleft
PRG ¼ pre-reacted glass-ionomer; USPHS ¼ United States
lip and palate and malaligned or hypoplastic teeth (7 cases; 40
Public Health Service.
teeth).
The tooth surfaces of the teeth were cleaned with a low-
speed cone brush and dried with air. One drop of the Active
was placed on the Base of the blister and then mixed with the
attached brush. The mixture was then applied to the tooth ions from tooth-surface coating materials. F release from the
surface with the brush. It was left in place for 3 s or more and material was higher than that from flowable resin containing
irradiated for 10 s using a visible-light curing unit (Pencure; S-PRG filler as previously reported [4]. Ion release from the
Morita, Tokyo, Japan), and nonpolymerized layers were material without S-PRG filler was not detectable (data not
removed with an alcohol swab. For the clinical evaluation of shown).
the PRG Barrier Coat, the oral cavity was photographed before
and after treatment and then once every 3e4 months for 3.2. Effect of the tooth-surface coating material for acid
about 1 year; the PRG Barrier Coat adhesion status (presence of neutralization
shedding or fracturing), the presence of dental caries, plaque
adhesion, and staining were examined. Hypoplastic teeth and The pH value of the lactic acid solution with tooth-surface
cases in which cloudiness was observed on the tooth surface coating material blocks is shown in Fig. 3. The pH of the
were examined to determine whether demineralization had
progressed or if any dental caries existed.
The PRG Barrier Coat adhesion status was evaluated using
a modification of the United States Public Health Service
(USPHS)-Ryge criteria (Fig. 1) [4,15]. Marginal fracture, shed-
ding, and wear out of materials were judged under micro-
scope. The case, which was difficult to judge under
microscope, was examined using replica as previously re-
ported [16].

3. Results

3.1. Evaluation of released ion amounts from the tooth-


surface coating material

The amount of the six ions released from specimens at each


time point for a total observation period of 30 days is shown in Fig. 2 e The amount of six ions released from the PRG
Fig. 2. The release of all ions was increased until 9 days. After 9 Barrier Coat. Al ¼ aluminum; B ¼ borate; F ¼ fluoride;
days, the amount of six ions became approximately constant. Na ¼ sodium; PRG ¼ pre-reacted glass-ionomer;
High amount of B release was observed compared with other Si ¼ silicate; Sr ¼ strontium.

Please cite this article in press as: Suzuki M, et al., Application of a tooth-surface coating material containing pre-reacted glass-ionomer
fillers for caries prevention, Pediatric Dental Journal (2015), http://dx.doi.org/10.1016/j.pdj.2015.08.003
4 p e d i a t r i c d e n t a l j o u r n a l x x x ( 2 0 1 5 ) 1 e7

shear bond strengths between the PRG Barrier Coat and Fuji
VII was observed in enamel specimens (ANOVA: p < 0.05;
Fig. 4). After SBS examination, the fracture surface was
analyzed by scanning electron microscope. In the sample of
the PRG Barrier Coat bonded to the enamel and dentin, their
interface failure and coating cohesive failure were observed
(Fig. 5A and B). In the sample of Fuji VII adhered to the enamel,
enamel interface failure and cohesive failure of the Fuji VII
were observed (Fig. 5C). Further, in Fuji VII sample bonded to
the dentin, cohesive failure of the Fuji VII was observed
(Fig. 5D).

3.4. Clinical evaluation of the tooth-surface coating


material

Fig. 3 e Time-dependent pH change in lactic acid In Group 1, the number of teeth observed in the respective
containing cured tooth-surface coating materials. pH number of cases was as follows: 74 teeth (14 cases) after 3
change in lactic acid containing cured coating material months; 68 teeth (13 cases) after 6 months; 28 teeth (5 cases)
with or without S-PRG filler. S-PRG ¼ surface pre-reacted after 9 months; and 28 teeth (5 cases) after 12 months (Table 2).
glass-ionomer. Cases in which cloudiness was observed on the tooth surface
were included. After 3 months, no changes were observed in
66 teeth (89.2%), and plaque adhesion, PRG Barrier Coat
shedding, or dental caries were not observed on the areas of
the PRG Barrier Coat application. Slight staining was observed
lactic acid with the PRG Barrier Coat specimen was increased.
on eight teeth (10.8%) of two patients (Table 2). Staining was
After 9 h, it became approximately neutral. On the other hand,
observed on the labial surfaces of the bilateral maxillary de-
the pH of the lactic acid material without S-PRG filler did not
ciduous central incisors and deciduous lateral incisors. The
increase. This result indicates that S-PRG filler containing
two patients who experienced staining were siblings. At 6
materials including the PRG Barrier Coat neutralize lactic acid
months, no changes were observed in any of the 68 teeth
solution and have buffering capacity.
including the stained teeth observed at 3 months. Staining of
coating materials completely disappeared at 6 months,
3.3. Evaluation of SBS of the tooth-surface coating because of wearing by daily tooth brushing. Further, no
material changes were observed in any of the 28 teeth at 9 months and

To evaluate adhesive property, SBS of the materials was


examined. The PRG Barrier Coat showed higher SBS than the
glass ionomer cement, Fuji VII, in both enamel and dentin.
Particularly, statistically significant differences in the mean

Fig. 5 e Scanning electron microscope analysis of the


fractured surface after shear bond strength test. (A) Enamel
(ANOVA, Tukey's test *p < 0.05) surface fracture of the interface between the PRG Barrier
Coat and enamel. (B) Dentin surface fracture of the
Fig. 4 e The shear bond strength of the tooth-surface interface between the PRG Barrier Coat and dentin. (C)
coating material PRG Barrier Coat to enamel and dentin. Enamel surface fracture of the interface between the Fuji
*p < 0.05; as determined using ANOVA, Tukey's test. VII and enamel. (D) Dentin surface fracture of the interface
PRG ¼ pre-reacted glass-ionomer; SD ¼ standard between the Fuji VII and dentin. PRG ¼ pre-reacted glass-
deviation. ionomer.

Please cite this article in press as: Suzuki M, et al., Application of a tooth-surface coating material containing pre-reacted glass-ionomer
fillers for caries prevention, Pediatric Dental Journal (2015), http://dx.doi.org/10.1016/j.pdj.2015.08.003
p e d i a t r i c d e n t a l j o u r n a l x x x ( 2 0 1 5 ) 1 e7 5

Table 2 e Results of the clinical application of the tooth-surface coating material.


Group Patient Tooth Plaque Staining Shedding Dental Change of
no. no. adhesion caries hypoplastic tooth
G1 G2 G1 G2 G1 G2 G1 G2 G1 G2 G1 G2 G1 G2
3 Months 14 7 74 40 0 0 8 (10.8%) 10 (25.0%) 0 1 (2.5%) 0 0 0 0
6 Months 13 7 68 34 0 0 0 10 (29.4%) 0 0 0 0 0 0
9 Months 5 4 28 18 0 0 0 8 (44.4%) 0 0 0 0 0 0
12 Months 5 4 28 18 0 0 0 8 (44.4%) 0 0 0 0 0 0

12 months (Table 2). Tooth surface cloudiness or the devel- (Fig. 6). The film coating could not be confirmed after 14
opment of dental caries was not observed. Regarding adhesion months, but there was no obvious plaque adhesion or staining.
of the coating, marginal fractures and shedding correspond- Development of dental caries was not observed in the area of
ing to Scale B or Scale C of the modified USPHS-Ryge criteria cloudiness.
were observed in 0% of the teeth at all time points. In Case 2 (Group 2), there was malalignment because of
In Group 2, the following numbers of teeth were observed cleft lip and palate, as well as enamel hypoplasia. Staining of
in the respective number of cases as follows: 40 teeth (7 cases) the tooth surface was observed after 6 months, 9 months
after 3 months; 34 teeth (7 cases) after 6 months; 18 teeth (4 (figure not shown), and 14 months, but plaque adhesion and
cases) after 9 months; and 18 teeth (4 cases) after 12 months changes in the area of hypoplasia were not observed (Fig. 7).
(Table 2). After 3 months, no changes were observed in 29
teeth (72.5%), and no instances of plaque adhesion, dental
caries, or hypoplastic tooth changes (demineralization, etc.) 4. Discussion
were observed. Shedding corresponding to Scale C of the
modified USPHS-Ryge criteria was observed in one case (1 Coating materials that are currently used clinically include
tooth, 2.5%) on the left maxillary deciduous central incisor, Beauti Coat (Shofu Inc.) and White Coat (Kuraray Noritake
which was malaligned because of cleft lip and palate. Staining Dental Inc., Okayama, Japan), which are applied mainly for
was observed on 10 teeth (25%; Table 2). The areas of staining esthetic improvement, and Shield Force Plus (Tokuyama
were the labial and proximal surface, tooth neck, and hypo- Dental Corp., Japan), Teethmate Disensitaizar (Kuraray
plastic areas. After 6 months, 24 teeth (70.6%) had no observed Noritake Dental Inc.), G-Coat (GC Corp., Tokyo, Japan), and
changes, and staining was observed on 10 teeth (29.4%). After MS Coat and Hybrid Coat II (Sun Medical Co., Shiga, Japan),
9 months and 12 months, 10 teeth (55.6%) had no observed which are mainly used to improve hypersensitive dentin.
changes, and staining was observed on eight teeth (44.4%), The following PRG Barrier Coat characteristics were used in
respectively (Table 2). this study: the release and recharge of several ions; the
In Case 1 (Group 1), an area of cloudiness was observed in ability to adhere to the tooth surface without etching; and its
the tooth cervical area. The tooth-surface coating material film ability to be a 15-mm film. This film has an adhesive strength
was confirmed on the tooth surface at 3 months and 7 months of about 7 MPa. While this does not compare to the adhesion
after application. Confirmation was possible on the labial strengths of conventional phosphoric acid etching (about
surface from the mesial side to the proximal surface. The film 40 MPa) or self-etching (about 20 MPa), the PRG Barrier Coat
had worn off in areas that could be easily cleaned with a adheres as a film with sufficient adhesive strength. In
toothbrush, but the film remained in difficult-to-clean areas. observations of fracture surfaces, the PRG Barrier Coat
Dental caries were not observed in the area of cloudiness exhibited cohesive failure, which is ideal for an adhesion

Fig. 6 e Representative clinical case of Group 1: before and 3 months, 7 months, and 14 months after application of the tooth-
surface coating material.

Please cite this article in press as: Suzuki M, et al., Application of a tooth-surface coating material containing pre-reacted glass-ionomer
fillers for caries prevention, Pediatric Dental Journal (2015), http://dx.doi.org/10.1016/j.pdj.2015.08.003
6 p e d i a t r i c d e n t a l j o u r n a l x x x ( 2 0 1 5 ) 1 e7

every 3e6 months could produce an even more beneficial


effect.
In one case, shedding of the tooth-surface coating ma-
terial was observed 3 months after application, but
compared to other cases, a somewhat larger amount of the
coating material was applied in this case, forming a thicker
film and creating a step in the tooth cervical area. There
were cases in which the process advanced positively, had
extremely thin films, tooth surface luster was visible to the
naked eye, and there was a smooth transition between the
material and the tooth surface. This indicated shedding or
marginal fractures could occur if the film was not of a proper
thickness. Data on Beauti Coat, an esthetic material made
with the same PRG technology, indicate that this material
experienced 0% natural shedding 3 months after application
and 13.9% fracturing 1 week after application, 29.0% after 1
month, and 32.0% after 3 months [16]. Compared to this
material, the PRG Barrier Coat exhibited 0% fracturing,
indicating a low possibility of fracturing if the material were
Fig. 7 e Representative clinical case of Group 2: before and
applied at an appropriate thickness. It is also thought that
6 months and 14 months after application of the tooth-
shedding can be kept to a minimum if burrs and other risks
surface coating material.
can be avoided. Beauti Coat requires a thicker film of
0.2e0.3 mm, which is thought to lead to a greater amount of
fracturing. In contrast, the 15-mm film of the PRG Barrier
material. Thus, the PRG Barrier Coat can be considered a safe Coat is thought to lower the risk of shedding and fracturing.
material with an appropriate amount of adhesive strength If a coating material fractures, a step is created between that
and one that will not fracture the adherend. Next, the area and the tooth surface, which raises the risk of dental
continuous, sustained release of six ionsdincluding acid- caries and staining. However, as the PRG Barrier Coat very
resistant Sr and F and antimicrobial Bdwas confirmed by seldom fractures and exhibits a smooth transition between
measurements of the amount of ions released as shown in the film and the tooth surface, it can be considered to have a
Fig. 2. However, ion release from the material without S-PRG low risk of dental caries.
filler was not detectable (data not shown). This result sug- Staining was observed on areas of the PRG Barrier Coat
gested that S-PRG filler is important for ion release from this application in 10.8% of the cases in Group 1 and in
material. Further, acid-neutralization measurements 25.0e44.4% of those in Group 2 (Table 2). When the coating
showed that the pH increases with the tooth-surface coating material was applied, the guardians were told that the
material containing the PRG filler and can thus act as an acid children should avoid foods that could cause staining (curry,
buffer. These effects are important to inhibit the progression coffee, black tea, grape juice, etc.) for 3 days and to pay
of dental caries. attention to what the children ate and drank. When staining
When the PRG Barrier Coat was used in clinical cases, the was observed, the guardians were questioned in as much
film coating was bonded to the tooth surface in all cases detail as memory allowed about what the children ate and
immediately after application. However, the film was not drank after application. In Group 1, the cases that experi-
observed over the entire tooth surface approximately 3e6 enced staining were siblings who mostly consumed the
months later. As shown in the case of Group 1, it was same foods and drinks. The children's guardian tried not to
observed on the labial surface from the mesial side to the feed them items that would cause pigment deposits. How-
proximal surface. The areas, which the film was observed to ever, 2 or 3 days after application they ate noodles fried in a
be on all aspects, were also difficult areas for tooth brushing. dark sauce that the guardian felt caused some staining.
On the tooth surface that was easy to clean, the film wore off Additionally, during the day, the children ate lunches and
with brushing, but the film did not wear off in areas that snacks supplied by their nursery school. The guardian
tended not to be cleaned sufficiently and remained on the checked the school's menu and scheduled the applications
tooth surface. In difficult-to-clean areas with the film on a day when curries or other foods that could cause
remaining, fluoride release and recharge, as well as the staining were not being served but did not pay attention as
release of several other ions, could continue. This suggests a to whether the foods on the menu for the other days could
preventive effect against dental caries through the promotion cause staining. In addition, the children regularly drank
of dentin remineralization and the suppression of plaque green tea. In Group 2, the guardians of the children who
adherence. Even if there was cloudiness in the tooth cervical exhibited staining also said they paid attention to the chil-
area, dental caries did not develop after application, sug- dren's foods and drinks for 3 days after application. How-
gesting the teeth were remineralized, and dental caries were ever, in one case, the child was in the habit of eating
prevented in this area. Further, although the coating material pumpkin almost every day, and in another, the child's
was only applied once in this study, if it could prevent dental grandparents often gave the child chocolate when the
caries and promote remineralization, repeated applications guardian was not around. The child was in the habit of

Please cite this article in press as: Suzuki M, et al., Application of a tooth-surface coating material containing pre-reacted glass-ionomer
fillers for caries prevention, Pediatric Dental Journal (2015), http://dx.doi.org/10.1016/j.pdj.2015.08.003
p e d i a t r i c d e n t a l j o u r n a l x x x ( 2 0 1 5 ) 1 e7 7

drinking green tea and milk, while another case did not use
toothpaste. Most children in both groups used children's 5. Conclusion
toothpaste (low abrasiveness). Considering this, the in-
cidences of staining were thought to have been caused by The results from the present study indicate that the tooth-
external pigment deposits and that the coating and stains surface coating material would be effective in a variety of
would gradually wear off with regular brushing. Staining cases and would be a useful tool for the field of pediatric
observed after 6 months or more was thought to be on the dentistry for actively preventing dental caries.
tooth surface, as by then, it was difficult to confirm the film
coating. As described above, avoiding substances that could
cause staining was recommended for 3 days after applica- Conflicts of interest
tion to prevent staining of the coating material; however,
the extension may have helped to provide better stain pre- None of the authors has any conflicts of interest that should
vention. The length of an appropriate period is a topic that be declared.
requires further investigation. Moreover, switching from
foods listed in the supplemental documents that could
cause staining to foods and beverages that children are references
likely to eat, as well as explaining these instructions, might
help to provide better stain prevention. Further, in order to
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application, tooth surface polishing and reapplication fluoride in solution on enamel demineralization in vitro. J
midway through the observation period were not per- Dent Res 1986;65:23e9.
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North Am 1999;43:713e42.
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[3] Shimazu K, Ogata K, Karibe H. Evaluation of the ion-releasing
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Further, the staining of the coating material was believed to [4] Nakamura N, Yamada A, Iwamoto T, et al. Two-year clinical
be related to pigment deposits on the unpolymerized layer. evaluation of flowable composite resin containing pre-
To prevent this, an alcohol swab was used to remove this reacted glass-ionomer. Pediatr Dent J 2009;19:89e97.
layer after the area was exposed to light, but it is unknown [5] Saku S, Kotake H, Scougall-Vilchis RJ, et al. Antibacterial
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Dent Mater J 2010;29:193e8.
another topic for future study. [6] Tamura D, Saku S, Yamamoto K, et al. Adsorption of salivary
The PRG Barrier Coat is easy to apply, and the operation can protein to resin composite containing S-PRG filler. Jpn J
be finished quickly. It is thus not burdensome for young Conserv Dent 2010;53:191e206 [in Japanese].
children and can be applied easily in this patient population. [7] Idono T, Saku S, Yamamoto K. The application of glass filler
Children with malaligned or hypoplastic teeth who are at with fluorine to tooth coating materials. Jpn J Conserv Dent
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areas of demineralized dentin after bracket removal would tooth-surface coating material to teeth with discolored
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Please cite this article in press as: Suzuki M, et al., Application of a tooth-surface coating material containing pre-reacted glass-ionomer
fillers for caries prevention, Pediatric Dental Journal (2015), http://dx.doi.org/10.1016/j.pdj.2015.08.003