The Eastman Institute for Oral Health (EIOH) is developing a topical antimicrobial agent based on povidone iodine designed to prevent new cavities that require surgical intervention after initial treatment and oral rehabilitation in young children with severe tooth decay.
According to the EIOH, severe tooth decay is alarmingly prevalent among minority and indigenous children in the United States. It also is difficult to treat effectively and often recurs following treatment, the EIOH said.
“Novel and more aggressive approaches are needed because clinical studies show about 40% of children treated for severe tooth decay will develop new cavities within 12 months of treatment,” said professor and principal investigator Dorota Kopycka-Kedzierawski, DDS, MPH.
The standard of care for severe tooth decay, or severe early childhood caries, in very young children involves treatment in a surgical operating suite under general anesthesia, followed by application of 5% topical fluoride varnish, family counseling regarding feeding behaviors, and oral hygiene instruction.
However, the EIOH said, these interventions have had only limited success. Also, tooth decay is the single most common chronic childhood disease, the EIOH said.
“At Eastman Institute for Oral Health, we treat more than a thousand young children age 2 to 6 in the operating room, and the number increases each year,” said Kopycka-Kedzierawski.
“Usually involving all the baby teeth, severe tooth decay among children is a devastating disease. It’s very painful and negatively affects speech, eating and nutrition, sleeping, learning, and overall quality of life,” she said.
Previous studies by Dr. Robert Berkowtiz, who was chair of pediatric dentistry at the EIOH before retiring, showed that povidone iodine, which is a commonly used pre-surgical antimicrobial agent, applied topically to the teeth could suppress growth of the bacteria most commonly associated with tooth decay.
This work suggested that povidone iodine had the potential to prevent recurrent cavities following treatment and rehabilitation. To test this hypothesis, the new study will implement a single-center, randomized, double-blind, placebo-controlled trial to assess the efficacy of povidone iodine to prevent new cavities from developing following treatment.
Children enrolled in the study will be randomly assigned to have either povidone iodine and fluoride varnish applied to their teeth or a placebo and fluoride varnish. The study agents will be applied every three months for up to 24 months.
Kopycka-Kedzierawski and her colleagues are optimistic this new approach will be effective in preventing recurrent disease and in improving long-term clinical outcomes.
The study is being funding through a $6 million grant from the National Institute of Dental and Craniofacial Research.