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

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
1. Introduction
So far, the field of pediatric dentistry has used several
methods to prevent dental caries, such as applying fluoride to
strengthen teeth and to promote remineralization and using
sealants to fill pits and fissures [1e3]. However, fluoride
application does not stay on tooth surfaces for a long time,
and sealants have only local effects on pits and fissures. For
children with abnormalities in enamel formation or tooth
morphology that are at a high risk of dental caries, neither of
these can be considered a perfect preventive treatment.
Herein, we report our investigation of the PRG Barrier Coat
(Shofu Inc., Kyoto, Japan), a tooth-surface coating material
developed with pre-reacted glass-ionomer (PRG) technology
that, unlike previous materials, can coat the entire tooth
surface and can be expected to have a strong preventive effect
on dental caries. The PRG Barrier Coat is a Giomer dental ma-
terial that contains surface PRG (S-PRG) filler, to which PRG
technology had been applied. It is characterized by its bioac-
tive functions because of the gradual release of multiple ions.
The PRG technology reacts to glass-containing acid-reactive
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
S-PRG filler manufactured with this technology.
S-PRG filler possesses a three-layer structure with a stabi-
lized glass-ionomer-like structure surrounding multifunctional
glass fillers, with an external hard glass layer. This enables the
filler to have great physical strength and to release fluoride (F)
and five other ions (Na, sodium; B, borate; Al, aluminum; Si,
silicate; and Sr, strontium) without deteriorating the properties
of the material. By releasing these ions, this material can be
expected to have an acid-buffer effect, remineralization, and
have an antibacterial action by suppressing the adherence and
proliferation of bacteria on the tooth surface [5e8].
Similar to glass-ionomer cements, materials containing
this filler possess a high capability for sustained fluoride
release. Additional increases in the fluoride concentration in
the oral cavity owing to fluoride-containing dentifrice or gel
would recharge fluoride ions in the oral cavity [3,9e12].
This technology has already been applied to filling mate-
rials such as composite resin [4,12e14], adhesion systems,
temporary cement, and orthodontic resin, but the tooth-
surface coating material used in this study had the S-PRG
filler but with a filler size that was even more miniaturized.
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
survey its ability to prevent dental caries in actual cases in a
pediatric dentistry department of a university hospital.
2. Materials and methods
2.1. Measurement of released ion species of the tooth-
surface coating material
The tooth-surface coating material used in this study was the
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
material consists of Base and Active (Table 1). Base and Active
of the tooth-surface coating material were mixed, and the
mixture was filled in a mold (15-mm diameter, 1-mm thick-
ness), light-cured (3 min) using a light-curing unit (Solidilite;
Shofu Inc.) to obtain disc specimens. Specimens prepared in
the above manner were immersed in distilled water (5 mL
each, 37
C) and removed from the water at a given time point,
and immersed again in fresh distilled water (5 mL). This im-
mersion procedure was repeated up to Day 30. Each immer-
sion liquid was subjected to analysis of elemental
concentration (Na, B, Al, Si, and Sr) using inductively coupled
plasma atomic emission spectroscopy (ICPS-8000; Shimadzu
Co., Kyoto, Japan). Analysis was conducted after preparing
calibration curves corresponding to each element (in ppm: Na
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,
50). Analysis of F concentration involved the use of a fluoride
ion electrode (Orion 9609BN; Thermo Fisher Scientific Inc.,
Waltham, MA, USA) after preparing its calibration curves
(0 ppm, 0.1 ppm, 1 ppm, 5 ppm, 10 ppm). For the analysis of F
ions, an ionic strength adjuster (TISAB III; Thermo Fisher
Scientific Inc.) was added in the proportion of 0.1 mL of ionic
strength adjuster to 1 mL of test solution.
2.2. pH change in lactic acid solution containing the
cured tooth-surface coating material
Base and Active of the PRG Barrier Coat were mixed, and the
mixture was filled in a mold (15-mm diameter, 1-mm thick-
ness), light-cured (3 min) using a light-curing unit (Solidilite)
to obtain disc specimens. Specimens prepared in the above
manner were immersed in 5 mL of lactic acid solution (pH 4.0)
for various time periods (0.5 h, 1 h, 3 h, 5 h, 7 h, 9 h, 11 h, 24 h).
After removing the specimens from the solutions, the pH
value in the solutions were measured using a pH meter (Twin
pH B-212; Horiba Co., Kyoto, Japan).
2.3. Evaluation of shear bond strength of the tooth-
surface coating material
Base and Active of the PRG Barrier Coat were mixed, and the
mixture was coated on a polished surface of a bovine tooth
(600-grit, enamel, and dentin) that was embedded in epoxy
resin, left undisturbed for 3 s, and then light-cured for 10 s.
With a Teflon mold (diameter: 4 mm, height: 2 mm) mounted
on the coated surface, and the mold filled with composite
Table 1 e Composition of the tooth-surface coating
material.
State Ingredients
Base Slurry Glass-filler, water,
methacrylic acid monomer
Active Liquid Phosphoric acid monomer,
methacrylic acid monomer,
bis-MPEPP, carboxylic acid
monomer, TEGDMA, photo-
initiator
Bis-MPEPP ¼ 2,20 -bis (4-methacryloxy polyethoxyphenyl) propane;
TEGDMA ¼ triethylene glycoldimethacrylate.
 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
Fig. 3 e Time-dependent pH change in lactic acid
containing cured tooth-surface coating materials. pH
change in lactic acid containing cured coating material
with or without S-PRG filler. S-PRG ¼ surface pre-reacted
glass-ionomer.
lactic acid with the PRG Barrier Coat specimen was increased.
After 9 h, it became approximately neutral. On the other hand,
the pH of the lactic acid material without S-PRG filler did not
increase. This result indicates that S-PRG filler containing
materials including the PRG Barrier Coat neutralize lactic acid
solution and have buffering capacity.
3.3. Evaluation of SBS of the tooth-surface coating
material
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
(ANOVA, Tukey's test *p < 0.05)
Fig. 4 e The shear bond strength of the tooth-surface
coating material PRG Barrier Coat to enamel and dentin.
*p < 0.05; as determined using ANOVA, Tukey's test.
PRG ¼ pre-reacted glass-ionomer; SD ¼ standard
deviation.
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
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
In Group 1, the number of teeth observed in the respective
number of cases was as follows: 74 teeth (14 cases) after 3
months; 68 teeth (13 cases) after 6 months; 28 teeth (5 cases)
after 9 months; and 28 teeth (5 cases) after 12 months (Table 2).
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
on eight teeth (10.8%) of two patients (Table 2). Staining was
observed on the labial surfaces of the bilateral maxillary de-
ciduous central incisors and deciduous lateral incisors. The
two patients who experienced staining were siblings. At 6
months, no changes were observed in any of the 68 teeth
including the stained teeth observed at 3 months. Staining of
coating materials completely disappeared at 6 months,
because of wearing by daily tooth brushing. Further, no
changes were observed in any of the 28 teeth at 9 months and
Fig. 5 e Scanning electron microscope analysis of the
fractured surface after shear bond strength test. (A) Enamel
surface fracture of the interface between the PRG Barrier
Coat and enamel. (B) Dentin surface fracture of the
interface between the PRG Barrier Coat and dentin. (C)
Enamel surface fracture of the interface between the Fuji
VII and enamel. (D) Dentin surface fracture of the interface
between the Fuji VII and dentin. PRG ¼ pre-reacted glass-
ionomer.
 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-
opment of dental caries was not observed. Regarding adhesion
of the coating, marginal fractures and shedding correspond-
ing to Scale B or Scale C of the modified USPHS-Ryge criteria
were observed in 0% of the teeth at all time points.
In Group 2, the following numbers of teeth were observed
in the respective number of cases as follows: 40 teeth (7 cases)
after 3 months; 34 teeth (7 cases) after 6 months; 18 teeth (4
cases) after 9 months; and 18 teeth (4 cases) after 12 months
(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.)
were observed. Shedding corresponding to Scale C of the
modified USPHS-Ryge criteria was observed in one case (1
tooth, 2.5%) on the left maxillary deciduous central incisor,
which was malaligned because of cleft lip and palate. Staining
was observed on 10 teeth (25%; Table 2). The areas of staining
were the labial and proximal surface, tooth neck, and hypo-
plastic areas. After 6 months, 24 teeth (70.6%) had no observed
changes, and staining was observed on 10 teeth (29.4%). After
9 months and 12 months, 10 teeth (55.6%) had no observed
changes, and staining was observed on eight teeth (44.4%),
respectively (Table 2).
In Case 1 (Group 1), an area of cloudiness was observed in
the tooth cervical area. The tooth-surface coating material film
was confirmed on the tooth surface at 3 months and 7 months
after application. Confirmation was possible on the labial
surface from the mesial side to the proximal surface. The film
had worn off in areas that could be easily cleaned with a
toothbrush, but the film remained in difficult-to-clean areas.
Dental caries were not observed in the area of cloudiness
(Fig. 6). The film coating could not be confirmed after 14
months, but there was no obvious plaque adhesion or staining.
Development of dental caries was not observed in the area of
cloudiness.
In Case 2 (Group 2), there was malalignment because of
cleft lip and palate, as well as enamel hypoplasia. Staining of
the tooth surface was observed after 6 months, 9 months
(figure not shown), and 14 months, but plaque adhesion and
changes in the area of hypoplasia were not observed (Fig. 7).
4. Discussion
Coating materials that are currently used clinically include
Beauti Coat (Shofu Inc.) and White Coat (Kuraray Noritake
Dental Inc., Okayama, Japan), which are applied mainly for
esthetic improvement, and Shield Force Plus (Tokuyama
Dental Corp., Japan), Teethmate Disensitaizar (Kuraray
Noritake Dental Inc.), G-Coat (GC Corp., Tokyo, Japan), and
MS Coat and Hybrid Coat II (Sun Medical Co., Shiga, Japan),
which are mainly used to improve hypersensitive dentin.
The following PRG Barrier Coat characteristics were used in
this study: the release and recharge of several ions; the
ability to adhere to the tooth surface without etching; and its
ability to be a 15-mm film. This film has an adhesive strength
of about 7 MPa. While this does not compare to the adhesion
strengths of conventional phosphoric acid etching (about
40 MPa) or self-etching (about 20 MPa), the PRG Barrier Coat
adheres as a film with sufficient adhesive strength. In
observations of fracture surfaces, the PRG Barrier Coat
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
Fig. 7 e Representative clinical case of Group 2: before and
6 months and 14 months after application of the tooth-
surface coating material.
material. Thus, the PRG Barrier Coat can be considered a safe
material with an appropriate amount of adhesive strength
and one that will not fracture the adherend. Next, the
continuous, sustained release of six ionsdincluding acid-
resistant Sr and F and antimicrobial Bdwas confirmed by
measurements of the amount of ions released as shown in
Fig. 2. However, ion release from the material without S-PRG
filler was not detectable (data not shown). This result sug-
gested that S-PRG filler is important for ion release from this
material. Further, acid-neutralization measurements
showed that the pH increases with the tooth-surface coating
material containing the PRG filler and can thus act as an acid
buffer. These effects are important to inhibit the progression
of dental caries.
When the PRG Barrier Coat was used in clinical cases, the
film coating was bonded to the tooth surface in all cases
immediately after application. However, the film was not
observed over the entire tooth surface approximately 3e6
months later. As shown in the case of Group 1, it was
observed on the labial surface from the mesial side to the
proximal surface. The areas, which the film was observed to
be on all aspects, were also difficult areas for tooth brushing.
On the tooth surface that was easy to clean, the film wore off
with brushing, but the film did not wear off in areas that
tended not to be cleaned sufficiently and remained on the
tooth surface. In difficult-to-clean areas with the film
remaining, fluoride release and recharge, as well as the
release of several other ions, could continue. This suggests a
preventive effect against dental caries through the promotion
of dentin remineralization and the suppression of plaque
adherence. Even if there was cloudiness in the tooth cervical
area, dental caries did not develop after application, sug-
gesting the teeth were remineralized, and dental caries were
prevented in this area. Further, although the coating material
was only applied once in this study, if it could prevent dental
caries and promote remineralization, repeated applications
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
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
applied at an appropriate thickness. It is also thought that
shedding can be kept to a minimum if burrs and other risks
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
Coat is thought to lower the risk of shedding and fracturing.
If a coating material fractures, a step is created between that
area and the tooth surface, which raises the risk of dental
caries and staining. However, as the PRG Barrier Coat very
seldom fractures and exhibits a smooth transition between
the film and the tooth surface, it can be considered to have a
low risk of dental caries.
Staining was observed on areas of the PRG Barrier Coat
application in 10.8% of the cases in Group 1 and in
25.0e44.4% of those in Group 2 (Table 2). When the coating
material was applied, the guardians were told that the
children should avoid foods that could cause staining (curry,
coffee, black tea, grape juice, etc.) for 3 days and to pay
attention to what the children ate and drank. When staining
was observed, the guardians were questioned in as much
detail as memory allowed about what the children ate and
drank after application. In Group 1, the cases that experi-
enced staining were siblings who mostly consumed the
same foods and drinks. The children's guardian tried not to
feed them items that would cause pigment deposits. How-
ever, 2 or 3 days after application they ate noodles fried in a
dark sauce that the guardian felt caused some staining.
Additionally, during the day, the children ate lunches and
snacks supplied by their nursery school. The guardian
checked the school's menu and scheduled the applications
on a day when curries or other foods that could cause
staining were not being served but did not pay attention as
to whether the foods on the menu for the other days could
cause staining. In addition, the children regularly drank
green tea. In Group 2, the guardians of the children who
exhibited staining also said they paid attention to the chil-
dren's foods and drinks for 3 days after application. How-
ever, in one case, the child was in the habit of eating
pumpkin almost every day, and in another, the child's
grandparents often gave the child chocolate when the
guardian was not around. The child was in the habit of
 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
drinking green tea and milk, while another case did not use
toothpaste. Most children in both groups used children's
toothpaste (low abrasiveness). Considering this, the in-
cidences of staining were thought to have been caused by
external pigment deposits and that the coating and stains
would gradually wear off with regular brushing. Staining
observed after 6 months or more was thought to be on the
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-
tion to prevent staining of the coating material; however,
the extension may have helped to provide better stain pre-
vention. The length of an appropriate period is a topic that
requires further investigation. Moreover, switching from
foods listed in the supplemental documents that could
cause staining to foods and beverages that children are
likely to eat, as well as explaining these instructions, might
help to provide better stain prevention. Further, in order to
observe the longterm course of the PRG Barrier Coat after
application, tooth surface polishing and reapplication
midway through the observation period were not per-
formed. When the material is actually used to prevent
dental caries in the future, it is thought that its ease-of-
removal characteristic would allow for a coat to be reap-
plied that could be a good way of dealing with staining.
Further, the staining of the coating material was believed to
be related to pigment deposits on the unpolymerized layer.
To prevent this, an alcohol swab was used to remove this
layer after the area was exposed to light, but it is unknown
how much of the unpolymerized layer remained. This is
another topic for future study.
The PRG Barrier Coat is easy to apply, and the operation can
be finished quickly. It is thus not burdensome for young
children and can be applied easily in this patient population.
Children with malaligned or hypoplastic teeth who are at
high risk of dental caries need preventive therapy at an early
stage. In this respect, this material can be considered a
preventive treatment for dental caries that can be used even
in young children. Additionally, as many children with
malaligned or hypoplastic teeth also have disabilities, tooth
brushing might be performed by the patients themselves or
by their guardians and may sometimes be performed insuf-
ficiently. Such children often need to be physically
restrained during treatments for dental caries, which adds
an additional layer of risk. For these reasons, it is thought
that early use of easy-to-apply PRG Barrier Coat in such
children would help improve their quality of life. Outside the
field of pediatric dentistry, this material could also help
prevent dental caries in healthy adults and serve as a simple
and effective means of maintaining a good oral environment
in adults with disabilities or in the elderly, especially those
who require nursing care. Moreover, in patients that use
denture-type devices, the device can act as a breeding
ground for bacteria that could enable easy adherence of
plaque to the tooth surface and increase the risk of dental
caries. However, it is thought that applying a coating to the
tooth surface would suppress plaque adhesion. It is also
thought that applying this material around brackets or to
areas of demineralized dentin after bracket removal would
promote remineralization.
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
7
5. Conclusion
The results from the present study indicate that the tooth-
surface coating material would be effective in a variety of
cases and would be a useful tool for the field of pediatric
dentistry for actively preventing dental caries.
Conflicts of interest
None of the authors has any conflicts of interest that should
be declared.
references
[1] Margolis HC, Moreno EC, Murphy BJ. Effect of low levels of
fluoride in solution on enamel demineralization in vitro. J
Dent Res 1986;65:23e9.
[2] ten Cate JM, van Loveren C. Fluoride mechanisms. Dent Clin
North Am 1999;43:713e42.
[3] Shimazu K, Ogata K, Karibe H. Evaluation of the ion-releasing
and recharging abilities of a resin-based fissure sealant
containing S-PRG filler. Dent Mater J 2011;30:923e7.
[4] Nakamura N, Yamada A, Iwamoto T, et al. Two-year clinical
evaluation of flowable composite resin containing pre-
reacted glass-ionomer. Pediatr Dent J 2009;19:89e97.
[5] Saku S, Kotake H, Scougall-Vilchis RJ, et al. Antibacterial
activity of composite resin with glass-ionomer filler particles.
Dent Mater J 2010;29:193e8.
[6] Tamura D, Saku S, Yamamoto K, et al. Adsorption of salivary
protein to resin composite containing S-PRG filler. Jpn J
Conserv Dent 2010;53:191e206 [in Japanese].
[7] Idono T, Saku S, Yamamoto K. The application of glass filler
with fluorine to tooth coating materials. Jpn J Conserv Dent
2009;52:237e47 [in Japanese].
[8] Ito S, Iijima M, Hashimoto M, et al. Effects of surface pre-
reacted glass-ionomer fillers on mineral induction by
phosphoprotein. J Dent 2011;39:72e9.
[9] Kamijo K, Mukai Y, Tominaga T, et al. Fluoride release and
recharge characteristics of denture base resins containing
surface pre-reacted glass-ionomer filler. Dent Mater J
2009;28:227e33.
[10] Itota T, Carrick TE, Yoshiyama M, et al. Fluoride release and
recharge in giomer, compomer and resin composite. Dent
Mater 2004;20:789e95.
[11] Preston AJ, Higham SM, Agalamanyi EA, et al. Fluoride
recharge of aesthetic dental materials. J Oral Rehabil
1999;26:936e40.
[12] Tokunaga Y, Nakano T, Kato K, et al. Fluoride release and
recharge capabilities of orthodontic resin containing S-PRG
filler. Jpn J Ped Dent 2013;51:1e7 [in Japanese].
[13] Tateyama G, Yanagi T, Hirose Y, et al. Properties of fluoride
releasing temporary cement containing PRG filler. J Jpn Soc
Dent Prod 2010;24:17e21 [in Japanese].
[14] Horiuchi S, Kaneko K, Mori H, et al. Enamel bonding of self-
etching and phosphoric acid-etching orthodontic adhesive in
simulated clinical conditions: debonding force and enamel
surface. Dent Mater J 2009;28:419e25.
[15] Cvar JF, Ryge G. Criteria for the clinical evaluation of dental
restorative materials. Clin Oral Investig 2005;9:215e32.
[16] Hashimura T, Yamada A, Iwamoto T, et al. Application of a
tooth-surface coating material to teeth with discolored
crowns. Pediatr Dent J 2013;23:44e50.