Discussion
WSLs
DENTAL CARIES
This study showed that after one application of P11-4, there were no active lesions after 3 months with significantly lower Diagnodent readings than NaF at all follow-up periods. Also, the number of active lesions decreased steadily after one application of NSF and stabilized after 3 months with Diagnodent readings lower than NaF. However, the adjusted analysis showed that the reduction in ICDAS scores in the P11-4 and NSF groups was not significantly different from the NaF group. Thus, there is no support for rejecting the null hypothesis. Our study fills a knowledge gap by providing evidence on whether there are differences between P11-4 and NSF compared to NaF in remineralizing WSLs in permanent teeth. The findings may support the use of two applications of NaF, one application of NSF or P11-4 to control WSLs in permanent teeth depending on availability of agents and patient compliance although longer follow up periods may shed further light on the sustainability of the effects of the three agents.In the present study, a longer follow up period was used than in most previous studies assessing the remineralization effect of the studied agents and an adjusted analysis was used that also accounted for clustering of teeth within persons. Because of these features, direct comparison with previous studies is difficult. For example, in the present study, there were no differences between the percentage of lesions with reduction of ICDAS scores after P11-4 or NSF compared to NaF after 12 months. This disagrees with Ali et al. [The present study showed that there were significantly fewer active lesions in the P11-4 and NSF groups than the NaF. This agrees with Ali et al. [In the present study, there were significantly lower median Diagnodent readings in the NSF than the NaF group. This agrees with the only published clinical trial [Future clinical trials are needed to support the present findings. Further trials are also needed to examine the effects of the studied agents on occlusal and proximal surfaces which are common sites for dental caries in primary and permanent teeth. Studies with longer follow-up periods are also needed.