The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries

Stress levels of a group of dentists while providing dental care under clinical, deep sedation, and general anesthesia

OBJECTIVES

Professionals in the health sector have higher stress than others. The aim of this study was to evaluate the stress levels of dentists while treating with children under clinical, deep sedation, and general anesthesia.

MATERIALS AND METHODS

Blood pressure (systolic, diastolic), pulse value, and O₂ saturations were measured. Saliva samples were taken by the dentists 10 min before the treatment, at the 25th min of the treatment, and 30 min after the treatment under clinical, deep sedation, and general anesthesia. Salivary cortisol was measured by the electrochemiluminescence method. All data were analyzed statistically.

RESULTS

Cortisol values under the sedation were higher than clinical and general anesthesia (P < 0.05). As a result of the applied Dentist Job Stress Questionnaire, the stress level of dentists under sedation was higher than the clinical and general anesthesia (P < 0.05). Under sedation, systolic and diastolic blood pressures measured during the procedure were found to be high (P < 0.05).

CONCLUSIONS

Dentists who care for pediatric patients are more stressed when applying treatment under deep sedation. The results suggest the need for more training and practice to strengthen the education given on general anesthesia/sedation in pediatric dentistry training.

CLINICAL REVELANCE

To increase the health and treatment quality of the dentists, who spend most of the day with the dental treatment of children, should be taken precautions.

Clinical effectiveness of alkasite versus nanofilled resin composite in the restoration of occlusal carious lesions in permanent molar teeth of children: a randomized clinical trial

PURPOSE

To evaluate and compare the clinical effectiveness of alkasite with nanofilled resin composite restorations for occlusal caries lesions in permanent molar teeth of children, at one-year follow-up.

METHODS

In this randomized controlled clinical trial with parallel design, 38 children aged 7-13 years with occlusal caries lesions on 59 first permanent molars were randomly allocated into two groups, Group 1: Filtek™ Z350XT (nanocomposite) and Group 2: Cention N^® (alkasite resin composite). The restorations were evaluated at one year using the United States Public Health Service (USPHS) criteria. Data were analyzed using Chi-square or Fisher's exact test.

RESULTS

All restorations had either Alpha or Bravo scores at one-year follow-up. In Group 1, all restorations scored Alpha, while one restoration each (3.6%) in Group 2 scored Bravo for fracture and marginal adaptation. All restorations in both groups scored Alpha for retention, secondary caries, and post-operative sensitivity. For anatomic form, all restorations in Group 1 scored Alpha, while three (10.7%) restorations in Group 2 had Bravo scores. For marginal discolouration, three restorations in both groups scored Bravo (11.5% and 10.7%, respectively). For surface roughness, one restoration (3.8%) in Group 1 and three restorations in Group 2 (10.7%) scored Bravo. The comparative results between the two groups for all the variables in the USPHS criteria were not statistically significantly different.

CONCLUSIONS

The performances of the nanofilled composite and alkasite were clinically acceptable and comparable. Alkasite can be an alternative material for the restoration of occlusal caries lesions in permanent molars of children.

CLINICAL TRIAL REGISTRATION

The clinical trial was registered at Clinical Trials Registry-India (CTRI Reg no: CTRI/2020/12/029830 Dated: 15/12/2020).

Evaluation of a novel caries detecting oral rinse

AIM

LumiCare™ Caries Detection Rinse (LC Rinse), a starch-based rinse, illuminates active initial caries (positive response) using dental curing light, thus augmenting the dentist's visual examination. This clinical study investigated if active caries as assessed by the International Caries Detection and Assessment System (ICDAS) were more likely to have positive LC Rinse response than sound surfaces and inactive caries.

METHODS

25 subjects participated in the study. Caries was assessed on selected teeth and the entire dentition, firstly using ICDAS and then by fluorescence evaluation after LC Rinse application. Data were statistically analyzed using Diagnostic Odds Ratio (OR) and Chi-square test X2 (α = 0.05). Sensitivity (Se), specificity (Sp), and Diagnostic accuracy (DA) were calculated.

RESULTS

With selected teeth, active caries were 638.6 times (60.05 with full dentition) more likely to have positive LC Rinse response than sound surfaces and inactive caries combined (X2, p < 0.01) and 191.67 times (18.35 with full dentition) than inactive lesions only (X2, p < 0.01). With combined sound surfaces and inactive caries, Se, Sp, and DA of LC Rinse assessment were 0.94, 0.98, and 0.96 respectively.

CONCLUSIONS

LC Rinse can distinguish between active caries, inactive caries and hypomineralization, and can augment caries detection with high sensitivity, specificity, and diagnostic accuracy.

Classification of a patient's caries activity based on lesion activity assessment among adults: findings from a prospective cohort study

OBJECTIVE

To investigate whether the classification of a patient's caries activity based on lesion activity assessment can predict the increment and progression of coronal and root caries lesions among adults.

METHODS

This population-based prospective cohort study followed 413 individuals (mean age 54.1) from southern Brazil for 4 years. Data collection included a questionnaire and clinical examination to record coronal/root caries and gingival recession. The main outcomes were caries increment measured as decayed, missing and filled tooth surfaces (DMFS) and caries progression (surface-level analysis). The main predictor variable was patients' caries activity at baseline ("caries-inactive" or "caries-active"). Negative binomial regression models (unadjusted and adjusted) were used.

RESULTS

Caries-active individuals were more likely to present DMFS increment than caries-inactive ones when migrations among DMFS components were considered (IRR [incidence risk ratio] = 1.26, 95%CI [confidence interval] = 1.01-1.58). On the other hand, no such association was found when these migrations were disregarded. The risk for coronal caries progression on filled surfaces was 90% higher among caries-active patients (IRR=1.9; 95%CI=1.4-2.6). In addition, patient's caries activity was able to predict higher risk for root caries progression in newly exposed root surfaces (IRR=1.9; 95%CI=1.0-3.6).

CONCLUSION

The classification of a patient's caries activity based on lesion activity was able to foresee lesion progression on the coronal and root surfaces more susceptible to caries among adults. Clinical relevance Classifying a patient's caries activity is a useful tool for the clinical management of dental caries in adults.

Caries risk assessment-related knowledge, attitude, and behaviors among Chinese dentists: a cross-sectional survey

OBJECTIVES

To investigate caries risk assessment (CRA)-related knowledge, attitudes, and practices among dentists in China, to describe their subjective ratings of the significance of specific caries risk factors and to identify factors associated with the level of knowledge, attitudes, and use of CRA in routine clinical practice.

MATERIALS AND METHODS

A cross-sectional anonymous online questionnaire survey was performed. The questionnaire was distributed via WeChat (Tencent, Shenzhen, China) to practicing dentists between November 25 and December 25, 2021. For participant recruitment, we employed purposive and snowball sampling techniques. Data were collected using a specialized web-based survey tool ( www.wjx.cn ) and analyzed with descriptive statistics and regression analyses.

RESULTS

A total of 826 valid questionnaires were collected. Only 292 (35.4%) respondents used CRA in routine practice, among whom a majority (243, 83.2%) did not use a specific CRA tool. The routine use of CRA was associated with the type of practicing office, attendance of caries-related lectures, the habit of reading caries-related literature, geographic location, and the total knowledge score. The mean total knowledge score was 3.13 (score range: 0 to 6). Knowledge levels were related to several sociodemographic characteristics, including geographic location, the type of practicing office, attendance of caries-related lectures and the habit of reading caries-related literature. The risk factor deemed most important was "current oral hygiene."

CONCLUSIONS

Caries risk assessment has not widely entered clinical practice in China. The level of CRA-related knowledge among dentists was generally suboptimal.

CLINICAL RELEVANCE

Strengthening CRA-related education may allow practitioners to develop a better understanding of caries risk assessment and hence promote its implementation.

Occlusal caries detection on 3D models obtained with an intraoral scanner. A validation study

OBJECTIVES

To evaluate the diagnostic performance of visual caries assessment on 3D dental models obtained using an intraoral scanner and to compare it with the performance of the clinical visual inspection.

METHODS

Fifty-three permanent posterior teeth scheduled for extraction were randomly selected and included in this study. One to three independent examination sites on the occlusal surface of each tooth were clinically inspected using International Caries Detection and Assessment System (ICDAS) criteria. Afterwards, the examined teeth were scanned intraorally with a 3D intraoral scanner (TRIOS 4, 3Shape TRIOS A/S, Copenhagen, Denmark) using white and blue-violet light (415 nm wavelength) to capture the colour and fluorescence signal from the tissues. Six months after the clinical examination, the same examiner conducted the on-screen assessment of the obtained 3D digital dental models at the selected examination sites using modified ICDAS criteria. Both tooth colour and fluorescence texture with high resolution were assessed. Lastly, an independent examiner conducted the histological examination of all teeth after extraction. Using histology as the reference test, Sensitivity (SE), Specificity (SP), Accuracy (ACC), area under the Receiver Operating Characteristic (ROC) curve, and Spearman's correlation coefficient were calculated for the clinical and on-screen ICDAS assessments.

RESULTS

The ACC values of the evaluated methods varied between 0.59-0.79 for initial caries lesions and 0.77-0.99 for moderate-extensive caries lesions. Apart from SE values corresponding to caries in the inner half of enamel, no significant difference was observed between clinical visual inspection and on-screen assessment. In addition, no difference was found in the assessment of 3D models with tooth colour alone or supplemented with fluorescence for all the evaluated diagnostic measures.

CONCLUSIONS

On-screen visual assessment of 3D digital dental models with tooth colour or fluorescence showed a similar diagnostic performance to the clinical visual inspection when detecting and classifying occlusal caries lesions on permanent teeth.

CLINICAL SIGNIFICANCE

3D intraoral scanning can aid the detection and classification of occlusal caries as part of patient screening and can potentially be used in remote caries assessment for clinical and research purposes.

Evaluation of an Artificial Mouth for Dental Caries Development

This study validated a microbial caries model (artificial mouth) for dental caries development to determine the optimal time to create early caries suitable for evaluation of the efficacy of caries therapeutic agents. In all, 40 human enamel blocks were placed in an artificial mouth at 37 °C and 5% CO2 and were exposed to brain heart infusion broth inoculated with S. mutans in continuous circulation (0.3 mL/min). The culture medium was replaced three times daily. Samples were exposed to 10% sucrose for 3 min, 3 times daily to promote biofilm growth. Five samples were harvested from the chamber after 3, 4, 5, 6, 7, 14, 21, and 28 days. At the end of experiment, samples were assessed visually by ICDAS criteria, while lesion depth (LD) and mineral loss (ML) were measured using polarizing light microscopy and transverse microradiography. Data were analyzed by Pearson correlation, ANOVA, and Tukey comparison test (p < 0.05). Results showed significant and strong positive correlation (p < 0.01) between all variables and biofilm growth time. LD and ML profiles of 7-day lesions seem to be the most suitable for remineralization studies. In conclusion, using the evaluated artificial mouth, early-stage caries suitable for products’ evaluation studies was produced within 7 days of exposure to microbial biofilm.

Impact of the use of dental services on dental pain according to adolescents' skin colour: a 10-year cohort

OBJECTIVE

Evaluate the association of the interaction between the use of dental services and the skin colour on the occurrence of dental pain over time.

MATERIAL AND METHODS

This study is a cohort with 10 years of follow-up, started in 2010 with a sample of 639 preschool children (1-5 years old). The use of dental services, race and the presence of dental pain were self-reported by the individuals according to predefined criteria. Multilevel logistic regression analysis was performed to assess the interaction between skin colour and use of dental services in the occurrence of dental pain over time.

RESULTS

About 449 and 429 were reassessed in 2017 and 2020, respectively. The occurrence of dental pain across the cohort was 60.7%. Caucasian individuals who used dental services throughout the cohort had a 51% lower chance of having a dental pain than those who used dental services but were non-white (OR 0.49; 95% IC 0.27-0.90).

CONCLUSION

There was a racial inequity in the occurrence of dental pain among individuals who managed to make use of dental services throughout the follow-ups.

CLINICAL RELEVANCE

The differences found should serve as a warning to the way how individuals with different characteristics are treated and must be used to combat this inequity. Individuals should receive resolute and personalized treatments according to their clinical condition and not according to their socioeconomic characteristics.

Active Surveillance of Root Caries in Vivo with CP-OCT

The active surveillance of root caries lesions to monitor potential remineralization or decay progression is challenging for the clinician, due to unreliable diagnostic information. The conventional visual and tactile methods for assessing the lesion activity are not reliable, and the clinician is often unable to determine if the lesion is progressing or has been arrested. An important marker of an arrested lesion is a highly mineralized transparent surface zone (TSL) that forms when the mineral is deposited in the outer layer of the lesion. The purpose of this study was to determine if cross-polarization optical coherence tomography (CP-OCT) could be used to detect changes in the lesion severity and activity during active monitoring. In total, 18 subjects with 22 suspected active root caries lesions were evaluated using CP-OCT at the baseline, 3 months, and 6 months. All subjects were instructed to use a high fluoride dentifrice at the baseline. The results showed that CP-OCT was able to discriminate the active from the arrested lesions by identifying the presence of a TSL on arrested lesions. The results also indicated that the mean TSL thickness increased significantly (p < 0.05) for the nine lesion areas. In addition, CP-OCT was able to show the progression of demineralization, erosion, and changes in gingival contours in scanned areas. CP-OCT was valuable for monitoring the activity and severity of root caries lesions in vivo. CP-OCT can be used to assess the activity of root caries lesions at a single time point by detecting the presence of a TSL at the lesion surface indicative of the lesion arrest.

Comparative evaluation of caries prevalence among group of Egyptian adolescents using DMFS and ICDASII methods: a cross-sectional study

BACKGROUND

Limited data is available regarding the prevalence of dental caries as a chronic disease among adolescents using different caries assessment indices. The aim of this study was to compare and describe the prevalence of dental caries among group of Egyptian students using two caries assessment indices; DMFS and ICDAS II.

METHODS

This descriptive, cross-sectional epidemiological study included 2760 public secondary school students with age range from 15 to 18 years with permanent dentition and good general health. Presence of; retained teeth, congenital or developmental anomalies in the permanent dentition, orthodontic treatments, systematic conditions, smoking and general health problems were considered the exclusion criteria in this study. Participants were selected randomly from 8 public secondary schools in the Great Cairo, Egypt. The examination was achieved by 6 trained and previously calibrated examiners using sets of diagnostic mirrors, compressed air, a WHO probe and cotton rolls. DMFS index and ICDAS II system were used as caries detection methods. In DMFS index; the number of decayed (D), missing (M) and filled (F) surfaces was recorded, while in the ICDAS II index, the assessment of both cavitated and non-cavitated carious, missed and filled teeth with restorations /sealants was recorded. The examiners performed the oral examination using both scoring systems in an alternating manner. The collected data were explored for normality using Kolmogorov-Smirnov and Shapiro-Wilk tests. Chi square test was used to analyze the frequencies.

RESULTS

There was a statistical significant difference between the DMFS and ICDAS II methods results regarding the recorded number of caries affected teeth and cavitated teeth surfaces. The prevalence of dental caries among the investigated secondary school students was (69.56%) and (78.29%) for DMFS and ICDAS II, respectively.

CONCLUSIONS

The prevalence of dental caries among Egyptian adolescent is high. ICDAS scoring system revealed higher caries prevalence values than DMFS method. ICDAS method is the best choice for the preventive goals, while DMFS is sufficient for clinical purposes.

Emotional distress and risk of dental caries: Evaluating effect modification by chronic conditions among low-income African American caregivers in Detroit, Michigan

Background/aim

Limited research has been conducted regarding the association between mental illness and dental caries. We studied the impact of emotional distress on current and new dental caries among low-income African-American caregivers in Detroit, Michigan and if this association was mediated by poor oral hygiene and sugar consumption and modified by a chronic health condition.

Methods

Data came from Detroit Dental Health Project, a prospective cohort study of low-income African American caregivers and their children. We focused on baseline (n = 1,021) and 4-year follow-up participants (n = 614). Dental caries were assessed using the International Caries Detection and Assessment System. The study outcomes included two baseline caries outcomes (counts of non-cavitated lesions, baseline counts of cavitated lesions) and two outcomes of new caries over 4 years (new cavitated lesions and new non-cavitated lesions). The exposure was emotional distress. We performed multivariable quasi-Poisson regression analysis to test the association between emotional distress and caries. We tested effect modification by stratifying data by chronic health conditions and performed causal mediation analysis to test an indirect effect of oral hygiene and sugar consumption.

Results

Ninety six percent of the caregivers were female, and their average age was 28 years old. Thirteen percent reported emotional distress at baseline. After accounting for potential confounding, emotional distress was positively associated with cavitated lesions at baseline (IRR = 1.36, 95% CI = 1.08, 1.70). Among those with a chronic health condition, stronger association was observed (IRR = 1.73, 95% CI = 1.27, 2.35). After 4 years, those with emotional distress and chronic health conditions had an increased risk of developing non-cavitated carious lesions (IRR = 1.41, 95% CI = 1.06, 1.88). Poor oral hygiene explained 51% of the association between emotional distress and baseline cavitated lesions (natural indirect effect = 1.16, 95% CI = 1.02, 1.33), but there was no evidence for an indirect effect of sugar consumption.

Conclusion

In this group of young, African-American caregivers with low socioeconomic status, dental caries was associated with emotional distress. This association was explained by poor oral hygiene and strengthened among those who reported a chronic health condition.

Current knowledge about early childhood caries in the gulf cooperation council with worldwide reflection: Scoping review of the scientific literature (2010-2021)

Early childhood caries (ECC) is one of the most prevalent chronic childhood diseases affecting the primary teeth of children younger than 6 years of age. The disease etiology is complex and includes social, biological, and dietary factors. This review aims to explore the knowledge of ECC prevalence globally and locally within the Gulf Cooperation Council (GCC) countries during the years 2010-2021. Another aim is to explore oral health promotion programs with more focus on the GCC region. A search was conducted in PubMed, Medline, Scopus, the Cochrane Collaboration database, and Google Scholar to identify relevant studies published between 2010 and 2021 using specific keywords. Studies that utilized both the World Health Organization criteria and International Caries Detection and Assessment System for dental caries assessment were included. The included studies indicated considerable variation in the reported prevalence of ECC. While developed countries show low prevalence, countries in the GCC and other Arab countries show a high prevalence of ECC. Many oral health promotion programs were identified globally including oral health education, nutritional programs, the use of fluoride and pit-and-fissure sealants, and inter-professional population-based oral health promotion and prevention programs such as school-based oral health programs, motivational interviewing, and anticipatory guidance. ECC remains a significant problem in many parts of the world including the GCC region. Oral health prevention programs have been established within the GCC region. Nevertheless, the GCC region has some unique characteristics that need to be investigated to contextualize the western model of the dynamics of ECC prevention and promotion programs locally.

Geographically weighted generalized poisson regression model with the best kernel function in the case of the number of postpartum maternal mortality in east java

This study proposes a Geographically Weighted Generalized Poisson Regression (GWGPR) model with the best kernel function to obtain a model of the number of postpartum maternal mortality in East Java Province in 2020 and determine the factors that affect the number of maternal postpartum mortality in East Java in 2020. The kernel functions used in this study are fixed bisquare kernel, fixed tricube kernel, and adaptive bisquare kernel. Optimum bandwidth selection using the Cross-Validation (CV) method. The results obtained the best model is the GWGPR model with a fixed bisquare kernel because it produces the smallest AIC value of 194.92. Variables significantly affecting the number of maternal postpartum mortality in East Java in 2020 vary in each district/city where there are three regional groups. The percentage of pregnant women who had a pregnancy visit K1, the percentage of pregnant women who had a pregnancy visit K4, the percentage of households receiving cash assistance, and the ratio of hospitals and health centres have a significant effect on Kabupaten Blitar, Mojokerto, Gresik, Bangkalan, Blitar City, Mojokerto City, Surabaya City. While the five predictor variables together significantly affect districts/cities included in group 3, such as Ponorogo, Trenggalek, Tulungagung, Kediri, Malang, Lumajang, Jember, Banyuwangi, Bondowoso and so on. Some of the highlights of the proposed approach are:•Generalized Poisson regression model using the maximum likelihood estimation (MLE) method.•The kernel functions used in the Geographically Weighted Generalized Poisson Regression (GWGPR) model to determine bandwidth are fixed bisquare, fixed tricube, and adaptive bisquare kernel functions selected using the Cross Validation (CV) method.•The computation procedure is easy to implement.

Impact of dental bullying on bruxism associated with poor sleep quality among adolescents

This study aimed to investigate the impact of school bullying and oral health-related verbal bullying on the occurrence of bruxism associated with poor sleep quality among adolescents. This cross-sectional study was nested in a cohort study performed with a sample of children from southern Brazil. Possible sleep bruxism was determined by the question: "Has anyone told you that you grind your teeth in your sleep?" Sleep quality was determined by answering the following question: "How would you classify the quality of your sleep?". The outcome was created by combining occurrence of sleep bruxism and poor sleep quality. The Sense of Coherence (SOC) was assessed using the SOC-13 scale. Bullying was investigated using the victim scale of the Olweus Bullying Questionnaire and oral health-related verbal bullying using an item from the Child Perceptions Questionnaire-11-14. Demographic, socioeconomic, psychosocial, and clinical data were also collected. Poisson regression models with robust variance were used. Results were expressed as prevalence ratio (PR) and 95% confidence intervals (95% CI). A total of 429 adolescents with a mean age of 12.6 (standard deviation 1.3) years were evaluated. The prevalence of bruxism associated with poor sleep quality was 23.7%. Victims of school bullying (PR 2.06; 95%CI: 1.01-4.22) and oral health-related verbal bullying (PR 1.87; 95%CI: 1.18-2.95) presented higher prevalence of bruxism associated with poor sleep quality. Factors such as skin color and SOC were also associated with the outcome. These findings suggest an association between episodes of bullying and bruxism related to poor sleep quality.

The association of maternal smoking and other sociobehavioral factors with dental caries in toddlers: A cross-sectional study

Background

Severe early childhood caries (S-ECC) is a form of dental caries in toddlers, which can strongly affect general health and quality of life. Studies on factors that can contribute to the development of caries immediately after tooth eruption are sparse. The aim of this study was to assess the role of sociobehavioural factors and pre- and postnatal exposure to tobacco smoke in the aetiology of dental caries in children up to 3 years old.

Methods

A cross-sectional study was conducted between 2011 and 2017 to assess oral health and teething in urban children 0-4 years of age. The number of teeth and surfaces with white spot lesions (d_1,2), as well as decayed (d), missing (m), and filled (f) teeth classified according to ICDAS II was evaluated in a dental office setting. d_1,2dmft and d_1,2dmfs were calculated. Severe early childhood caries was diagnosed for d_1,2dmfs > 0. Parents completed a self-administered questionnaire on socioeconomic factors, maternal health, course of pregnancy, child's perinatal parameters, hygiene and dietary practices, as well as maternal smoking during and after pregnancy. Data on children aged 12-36 months were collected and analysed statistically using the t-test, Spearman rank correlations and Poisson regression. Significance level was set at 0.05.

Results

Dental caries was found in 46% of 496 children aged 12-36 months. Mean d_1,2dmft and d_1,2dmfs were 2.62 ± 3.88 and 4.46 ± 8.42, respectively. Tobacco smoking during and after pregnancy was reported by 8.9% and 24.8% of women, respectively. Spearman's rank correlation analysis confirmed a relationship between S-ECC and parental education, maternal smoking, bottle feeding, avoiding springy foods, number of meals, and the age of tooth brushing initiation. Pre- and postnatal exposure to tobacco smoke increased the risk of S-ECC especially in children in age 19-24 months. Maternal smoking was correlated with the level of education and dietary practices.

Conclusion

Our study confirmed that prenatal smoking is associated with increased risk of severe-early childhood caries (S-ECC) while the association with post-natal smoking is also evident, the increase in risk is not statistically clear. Both maternal smoking and the child's tooth decay are associated with poor parental education and other improper oral health behaviours. The positive impact of quitting smoking on the oral health in children should be part of anti-smoking advice.

Caries-preventive effectiveness of two different fluoride varnishes: A randomised clinical trial in patients with multi-bracketed fixed orthodontic appliances

BACKGROUND

Patients with multi-bracketed fixed orthodontic appliances are at a higher risk of developing enamel demineralisation.

AIM

To compare the efficacy of the quarterly application of two varnishes in preventing white spot lesions (WSLs) during multi-bracketed fixed orthodontic treatment.

DESIGN

Ninety-nine patients were randomly allocated into three intervention groups: Group A-standard oral hygiene instructions (OHI); Group B-5% sodium fluoride (NaF) varnish with standard OHI; and Group C-NaF plus tricalcium phosphate varnish with standard OHI. The outcome was assessed at 6-monthly intervals using a quantitative laser fluorescence device, clinical evaluation and photographic evaluation on six maxillary anterior teeth. A logistic regression model using generalised estimating equations with the intervention group, time and their interaction was used to compare the occurrence of WSLs, whereas the independent-samples Kruskal-Wallis test was used to compare the means of fluorescent values among different groups at p = .05.

RESULTS

Generalised estimating equations (with intervention and time as predictors) showed that only the effect of time was found to be significant (p < .001), whereas there was no significant difference among the three intervention groups (p = .305) using clinical assessment or photographic assessment (p = .599). At the 18-month follow-up, sodium fluoride (NaF) varnish with standard OHI was shown to reduce the odds of WSLs by 55% (p = .200), and NaF plus tricalcium phosphate varnish with standard OHI by 42% (p = .327).

CONCLUSION

The study failed to demonstrate that the quarterly application of both the study varnishes with OHI provided additional benefits compared with standard OHI alone in preventing WSLs, taking the effect of time of follow-up into consideration. There were higher odds of developing WSLs with an increased duration of orthodontic treatment.

Effectiveness of applying proximal enamel caries with fluoride-releasing sealant and fluoride varnish on caries progression in permanent teeth: A 12-month split-mouth randomized clinical trial

BACKGROUND

Few studies report on managing initial proximal caries with sealants, and no reports focus on fluoride-releasing sealants.

AIM

To compare the effectiveness between applications of a fluoride-releasing sealant and fluoride varnish on proximal enamel caries to control caries progression in permanent teeth.

DESIGN

This was a split-mouth randomized controlled trial in forty-four 11- to 16-year-old children with radiographic caries in at least one contralateral pair of teeth with proximal enamel caries. The lesions were evaluated using DIAGNOdent and were also assessed visually after tooth separation. The lesions in each subject were randomly sealed with a fluoride-releasing sealant (Helioseal® F) or applied with fluoride varnish (Duraphat®). The fluoride varnish-treated lesion was reapplied at 3 and 6 months. Clinical examination, bitewing radiograph evaluation, and DIAGNOdent assessment were performed at 6 and 12 months. The caries progression outcome variables were regression, no change, and progression. The data were analyzed with the McNemar-Bowker test.

RESULTS

Radiographic examination and DIAGNOdent assessment demonstrated no significant differences in the percentages of regression, no change, or progression at the 12-month follow-up (p > .05).

CONCLUSION

Applications of a fluoride-releasing sealant and of fluoride varnish three times resulted in a nonsignificant difference in caries progression of initial proximal caries at the 12-month follow-up.

Evaluation of Reliability and Validity of Occlusal Caries Detection by Direct Visual, Indirect Visual and Fluorescence Camera Using ICDAS II (Codes 0, 1, and 2): An In Vivo Study

Introduction

Early detection of carious lesions paves the way for the preservation of tooth structures by remineralization strategies. Visual examination using international caries detection and assessment system (ICDAS) II has been validated with the gold standard of histological classification. A fluorescence camera is yet another diagnostic aid for the early detection of carious lesions based on the autofluorescence of the enamel and dentin. This study was done to evaluate the validity of the fluorescence camera (Soprocare and Acteone) in detecting early carious lesions.

Materials and methods

A total of 690 occlusal surfaces of non-cavitated premolars and molars were examined by examiners 1 and 2, trained in the ICDAS II grading system. The photographs of the occlusal surface and the fluorescence images, which were taken using a Soprocare (Acetone) intraoral camera, were examined by examiners 3 and 4. The scoring was tabulated and correlated.

Results

The κ values for interexaminer reproducibility of indirect visual was 0.841 (good), and his fluorescence camera was 1.00, which is very good. The correlation analysis revealed that there was a higher correlation between direct visual and indirect visual for both examiners when compared to direct and fluorescence cameras. There was a positive relationship between indirect visual and fluorescence cameras for both the experimenter). The indirect visual method for the detection of carries has high sensitivity and specificity irrespective of the examiner. Examination by fluorescence camera has a low sensitivity and high specificity.

Conclusion

The specificity of the caries detection method by indirect visual examination based on ICDAS II coding that of the Soprocare fluorescence camera was consistent and reliable, whereas indirect visual examination had a high sensitivity for detecting ICDAS codes 1 and 2. Soprocare showed a very low sensitivity in detecting ICDAS code 1 and 2 lesions.

How to cite this article

Dhanavel C, Sai CK, Neelamurthy PS, et al. Evaluation of Reliability and Validity of Occlusal Caries Detection by Direct Visual, Indirect Visual and Fluorescence Camera Using ICDAS II (Codes 0, 1, and 2): An In Vivo Study. Int J Clin Pediatr Dent 2023;16(1):74-78.

Evaluation of fissure sealant retention rates using Isolite in comparison with rubber dam and cotton roll isolation techniques: A randomized clinical trial

BACKGROUND

Clinical studies comparing retention rates of pit and fissure sealants placed under Isolite, rubber dam, and cotton roll combined have not been conducted until now.

AIM

To evaluate the retention rate of pit and fissure sealants (PFS) placed under three different isolation techniques (Isolite system [IS], rubber dam isolation [RDI], and cotton roll isolation [CRI]).

DESIGN

One hundred and forty-four teeth from 48 children aged 6-15 years attending paediatric dental clinics at King Saud University in Saudi Arabia were randomized to receive three PFS using three isolation techniques. The children that met the inclusion criteria were randomized by a simple block random allocation method. All PFS were placed by an operator and evaluated by a blinded evaluator. The evaluation scores were recorded at baseline and followed up over a period of 12-22 months.

RESULTS

The children's mean age was 8.58 ± 1.93 years. Seven patients were lost to follow-up. A total of 123 teeth were clinically evaluated; of these teeth, 22% had completely retained sealants, whereas approximately 66% had a partial loss of sealants, and approximately 12% had a complete loss of sealants. There were, however, no significant differences between the three isolation techniques on the retention rate of pit and fissure sealant.

CONCLUSION

The types of isolation had no impact on the retention rate of pit and fissure sealant.

Is oral rehydration therapy associated with early childhood caries in children resident in Ile-Ife, Osun State, Nigeria?

BACKGROUND

Oral rehydration therapy may increase the risk of early childhood caries (ECC) because of reduced pH in the oral environment.

AIM

To investigate associations between the use of oral rehydration therapy and the prevalence and severity of ECC in children resident in the Ife Central Local Government Area of Osun State, Nigeria.

DESIGN

This observational study assessed the prevalence and severity of caries, using the International Caries Detection and Assessment System (ICDAS) II index. The outcome variables were the prevalence and severity of ECC. The explanatory variable was the use of oral rehydration solution for the management of diarrhea in the 12 months preceding the study. A multivariable logistic regression analysis was conducted to determine associations between the explanatory and outcome variables.

RESULTS

Only 217 (14%) of the 1564 children had used oral rehydration solution for the management of diarrhea. Seventy-three (4.7%) children had ECC. The use of oral rehydration solution was not significantly associated with the prevalence and severity of ECC.

CONCLUSION

The study findings suggest that the use of oral rehydration therapy in the management of diarrhea may not be a risk factor for ECC in communities with low prevalence and severity of ECC and high prevalence of gastroenteritis.

Antibacterial effect and impact on caries activity of nanosilver fluoride and silver diamine fluoride in dentin caries of primary teeth: a randomized controlled clinical trial

BACKGROUND

The use of silver diamine fluoride (SDF) in caries treatment in children has increased despite the disadvantage of causing tooth discoloration. Nanosilver fluoride (NSF) is a possible alternative. This study aimed to assess the antibacterial effect of NSF and SDF and their impact on the activity of dentin caries in primary teeth.

METHODS

Synthesis and characterization of the physical and biological properties of NSF were conducted. Fifty children aged 4-6 years with dentin caries (active caries corresponding to ICDAS code 5) in deciduous teeth were randomly assigned to treatment by NSF or SDF. Baseline assessment of Streptococcus mutans (S. mutans) and lactobacilli counts as CFU/mL in caries lesions was done, followed by the application of the agents. After one month, microbiological samples were recollected, and lesion activity was reassessed. Groups were compared using Mann-Whitney and Chi-Square tests, while intragroup comparisons were done using Wilcoxon and McNemar tests. Multilevel logistic regression analysis was used to assess the effect of different variables on the outcomes.

RESULTS

There were 130 teeth in 50 children; mean ± SD age = 4.75 ± 0.76 years, 63% were posterior teeth. At the one-month follow-up appointment, both groups showed a significant decrease from baseline bacterial counts. There was a significant difference in the reduction of S. mutans between NSF and SDF (21.3% and 10.5%, respectively, p = 0.002), while not in lactobacilli (13.9% and 6.0%, respectively, p = 0.094). In both groups, there was a significant reduction in the number of active caries from baseline (p < 0.0001) with no significant difference between groups (percentage inactive = 64.4% and 63.4%, p = 0.903). Multilevel regression revealed non-significant differences in S. mutans and lactobacilli counts (AOR 1.281, p = 0.737 and 1.888, p = 0.341, respectively), and in the number of inactive lesions (AOR 1.355, p = 0.731) between groups.

CONCLUSION

The short-term antibacterial efficacy of NSF was similar to that of SDF. In both groups there was a significant reduction of S. mutans and lactobacilli counts in active dentin caries, and two-thirds of the lesions became inactive with no differences between the two interventions. Further research is needed to investigate the long-term efficacy of NSF and its suitability for clinical use in caries management.

TRIAL REGISTRATION

This trial was prospectively registered on the clinicaltrials.gov registry with ID: NCT05221749 on 03/02/2022.

Reframing perceptions in operative dentistry relating evidence-based dentistry and clinical decision making: a cross-sectional study among Jordanian dentists

BACKGROUND

The aim of the current study was to investigate current dental practice in operative dentistry in Jordan, and the relationship between evidence-based dentistry in caries research and decision making in clinical practice in operative dentistry.

MATERIALS AND METHODS

This cross-sectional study was conducted through a survey of dentists in Jordan. The survey aimed to explore the degree of knowledge and practice of evidence-based dentistry in caries research the dentists possess regarding clinical decision making in operative dentistry. The sample size was composed of (5811) dentists whom registered in Jordan Dental Association database. Descriptive statistics were generated and Chi-square test was used to examine associations between the different variables and the significance level was set at P < 0.05.

RESULTS

4000 responses were collected from the web-survey, response rate (68.83%). Nearly half of the surveyed dentists focus on the chief complaint of their patients (n = 2032, 50.8%) rather than doing full mouth assessment. Nearly two-thirds of dentists (n = 2608, 65.2%) treat lesions confined to enamel with operative treatment. Half of dentists use operative treatment when asked about the routine management of radiographically detected proximal caries confined to enamel. When treating incipient lesions, the majority (n = 3220, 80.5%) use preventive treatment. Three-quarters of dentists (n = 2992, 74.8%) treat deep dentinal caries by removing just the soft infected carious dentin, and treated old failed restorations with replacement.

CONCLUSION

In operative dentistry, the evidence-based research is not implemented clinically. To optimize relationship between evidence-based dentistry and clinical decision-making, dental curriculum has to be updated and modified constantly.

Dental caries at enamel and dentine level among European adolescents - a systematic review and meta-analysis

BACKGROUND

In contrast with the last century, caries epidemiology has begun integrating enamel caries into determinations of caries prevalence and experience. The objective of the present systematic review and meta-analysis was to assess the caries status including estimations of enamel caries, of European adolescents.

METHOD

Four databases (Medline Ovid, Embase, CINAHL, and SweMed+) were systematically searched from 1 January 2000 through 20 September 2021 for peer-reviewed publications on caries prevalence and caries experience in 12-19-year-olds; that also included evaluations of enamel lesions. Summary estimates were calculated using random effect model.

RESULTS

Overall, 30 publications were selected for the systematic review covering 25 observational studies. Not all studies could be used in the meta-analyses. Caries prevalence was 77% (n = 22 studies). Highest prevalence was reported in the age groups 16-19 years, and in studies where caries examinations were done before 2010. The overall mean DMFT score was 5.93 (n = 14 studies) and it was significantly lower among Scandinavian adolescents than among other European adolescents (4.43 vs. 8.89). The proportion of enamel caries (n = 7 studies) was 50%, and highest in the lowest age group (12-15 years). Results from the present systematic review reflected the caries distribution to be skewed at individual-, tooth- and surface levels; at tooth and surface level, also changed according to age.

CONCLUSIONS

Although studies in which the caries examinations had been done in 2010 or later documented a reduction in caries prevalence, caries during adolescence still constitutes a burden. Thus, the potential for preventing development of more severe caries lesions, as seen in the substantial volume of enamel caries during early adolescence, should be fully exploited. For this to happen, enamel caries should be a part of epidemiological reporting in national registers.

Validation of the Malay Oral Impacts on Daily Performances and Evaluation of Oral Health-Related Quality of Life in a Multi-Ethnic Urban Malaysian Population: A Cross-Sectional Study

Oral Impacts on Daily Performances (OIDP) can be used as a generic or condition-specific oral health-related quality of life (OHRQoL) instrument. It offers different contexts on how dental conditions affect OHRQoL. This cross-sectional study aimed to validate a newly translated Malay OIDP (OIDP-M), compare OHRQoL, decayed, missing, or filled teeth (DMFT) in Malaysians, and investigate factors associated with OHRQoL. A total of 368 Malaysians were surveyed and examined for DMFT. Short-form oral health impact profile-Malaysia [S-OHIP(M)] and OIDP-M were used to measure OHRQoL. The OIDP-M was tested for reliability and validity. DMFT, S-OHIP(M), and OIDP-M between ethnicities were compared. Associations between ethnicity, DMFT, S-OHIP(M), and OIDP-M of Malays and Chinese were evaluated through partial correlation. Malays and Chinese had more filled teeth and DMFT compared with Indians. Malays reported worse OHRQoL through S-OHIP(M). Decayed teeth were positively associated with S-OHIP(M), physical, psychological, social disabilities, and handicap. For OIDP-M, decayed teeth were positively associated with OIDP-M, working, and sleeping. Missing teeth and ethnicity were positively associated with eating and speaking. Filled teeth were negatively associated with cleaning teeth. The OIDP-M was reliable and valid for evaluating OHRQoL. There were differences in DMFT and OHRQoL between ethnicities. Ethnicity affects OHRQoL, where Malays experienced worse OHRQoL due to dental problems.

Caries detection with tooth surface segmentation on intraoral photographic images using deep learning

BACKGROUND

Intraoral photographic images are helpful in the clinical diagnosis of caries. Moreover, the application of artificial intelligence to these images has been attempted consistently. This study aimed to evaluate a deep learning algorithm for caries detection through the segmentation of the tooth surface using these images.

METHODS

In this prospective study, 2348 in-house intraoral photographic images were collected from 445 participants using a professional intraoral camera at a dental clinic in a university medical centre from October 2020 to December 2021. Images were randomly assigned to training (1638), validation (410), and test (300) datasets. For image segmentation of the tooth surface, classification, and localisation of caries, convolutional neural networks (CNN), namely U-Net, ResNet-18, and Faster R-CNN, were applied.

RESULTS

For the classification algorithm for caries images, the accuracy and area under the receiver operating characteristic curve were improved to 0.813 and 0.837 from 0.758 to 0.731, respectively, through segmentation of the tooth surface using CNN. Localisation algorithm for carious lesions after segmentation of the tooth area also showed improved performance. For example, sensitivity and average precision improved from 0.890 to 0.889 to 0.865 and 0.868, respectively.

CONCLUSION

The deep learning model with segmentation of the tooth surface is promising for caries detection on photographic images from an intraoral camera. This may be an aided diagnostic method for caries with the advantages of being time and cost-saving.

Assessment of demineralized tooth lesions using optical coherence tomography and other state-of-the-art technologies: a review

Tooth demineralization is one of the most common intraoral diseases, encompassing (1) caries caused by acid-producing bacteria and (2) erosion induced by acid of non-bacterial origin from intrinsic sources (e.g. stomach acid reflux) and extrinsic sources (e.g. carbonated drinks). Current clinical assessment based on visual-tactile examination and standardized scoring systems is insufficient for early detection. A combination of clinical examination and technology is therefore increasingly adapted. This paper reviews various procedures and technologies that have been invented to diagnose and assess the severity of tooth demineralization, with focus on optical coherence tomography (OCT). As a micron-resolution non-invasive 3D imaging modality, variants of OCT are now available, offering many advantages under different working principles for detailed analytical assessment of tooth demineralization. The roles, capabilities and impact of OCT against other state-of-the-art technologies in both clinical and research settings are described. (139 words).

Severe Periodontitis Is a Major Contributory Factor to Unmet Dental Healthcare Needs among Rheumatoid Arthritis Patients in Hong Kong

Objective

This study aimed to examine the frequency and predictive factors of adverse oral and dental outcomes in patients with rheumatoid arthritis (RA) with the goal to address their unmet dental healthcare needs in the metropolitan city of Hong Kong.

Methods

238 RA patients followed up at local public hospitals were recruited in this cross-sectional study. A full dental examination was performed. Data were compared with the retrospective data collected from age-matched control groups in the community conducted in a territory-wide oral health survey in 2011. Predictive factors for severe periodontitis including various demographic and disease-specific factors were examined by multiple logistic regression analysis.

Results

Loose teeth and gum bleeding were frequent dental complaints. Only 85.0% of RA patients had >20 natural teeth. Total edentulism was observed in 3.8% of patients, which was higher among adult (22-64 years) and elderly (>65 years old) RA patients than their respective age-matched community control groups. RA patients had a higher decayed, missing, and filled tooth score. Adult RA patients had a 5.3-fold increase in risk of severe periodontitis than their community counterparts. The plaque index was the main predisposing factor for severe periodontitis (odds ratio 17.5, p=0.001), which was worse among the 22-34 age group of patients. More RA patients required tooth extraction compared to dental filling for their community controls.

Conclusion

Severe periodontitis is a major cause of unmet dental healthcare needs among RA patients in Hong Kong. It is recommended that dental care plans for RA patients be commenced early among newly diagnosed patients.

A proposed community caries index of treatment need derived from the international caries detection and assessment system

OBJECTIVE

To examine the accuracy of a short version of the International Caries Detection and Assessment System (ICDAS) in predicting caries treatment need for children.

METHODS

The study is a validation study using data from three previously published cross-sectional studies. Participants were children with different dentitions from Kuwait, Brazil, and Spain. Children were clinically examined using ICDAS criteria. Children were classified into preventive, non-operative, and operative categories. Sensitivity and specificity, predictive values, likelihood ratios, and the area under the receiver operating characteristic (ROC) curve were used to measure the discriminative and diagnostic accuracy of the proposed short version of ICDAS compared to the full ICDAS.

RESULTS

Clinical dental examination data from a total of 3076 children aged 1-15 years were used. The proposed short ICDAS and the full ICDAS showed a very good agreement on caries treatment need determination with Kappa scores of more than 0.833 in all dentitions. The short ICDAS showed excellent operating characteristics in all dentitions. The area under the ROC was more than 90% in primary dentition, 89% in permanent dentition, and 86% in mixed dentition in different populations. Lowest area under ROC and sensitivity values were observed when discriminating between non-operative and operative treatment categories.

CONCLUSIONS

The proposed short version of the ICDAS showed good diagnostic accuracy in classifying children according to their caries treatment need. By reducing the number of surfaces examined and the time needed for clinical assessment, the short version of the ICDAS is a convenient alternative to the full ICDAS to be used in community settings.

Systematic review on dental caries preventive and managing strategies among type 2 diabetic patients

Purpose

The purpose of this systematic review was to evaluate current evidence to prevent and manage dental caries in patients with type 2 diabetes mellitus (T2DM).

Methods

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the Participants, Intervention, Comparison, Outcomes and Study Design (PICOS) strategy was used to formulate a structured search: systematic search of PubMed, Cochrane Library, MEDLINE via Ovid, EMBASE, Scopus, Web of Science, and Lilacs without any date limit and/or language restrictions. Two independent reviewers performed data extraction and risk of bias assessments in the included studies. Data homogeneity was assessed according to interventions for treating dental caries in T2DM. Statistical analyses were performed with JMP®.

Results

Two studies out of 909 were included in the systematic review. Only quantitative studies involving topical applications for management of dental caries in patients with T2DM were included. One study assessed the effect of intensive oral hygiene care program including toothbrushing and interdental cleaning using interproximal brushes and/or dental floss and supragingival debridement by dental hygienist with educational brochures in T2DM, while another investigated the immunologically active salivary substitutes with using Oral Hygiene Instructions (OHI), mouthwash, and moisturizing gel for 6 months. Intensive oral hygiene care program or immunologically active salivary substitutes with using OHI, mouthwash, and moisturizing gel for 6 months were reported to reverse/arrest dental caries in patients with T2DM.

Conclusion

The current randomized controlled clinical trials demonstrated that regular extensive oral health education using interdental cleaning aids, mouthwash, moistening gel, and saliva substitutes including lactoperoxidase, lysozyme, glucose oxidase, and lactoferrin could control oral inflammation and contribute to the management of dental caries in patients with T2DM.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020197507, identifier: CRD42020197507.

Family behavior theory-based intervention via mobile messaging to improve oral health of adolescents: study protocol for a cluster randomized controlled trial

Background

Due to some unique physical, social and psychological features in the adolescent population, adolescents can be a time of heightened caries activity and periodontal disease. Oral health-related behaviors can be modified to improve oral health status. The family networks and the built environment can promote or inhibit health behaviors. The aim of this study is to implement and evaluate a behavior theory-based, integrated family intervention via mobile messaging to improve oral health of adolescents.

Methods

This is a three-arm parallel-design cluster-randomized controlled trial. This trial will allocate 12 local secondary schools (clusters) in Hong Kong to three test or comparison groups with a ratio 1:1:1. The enrolled Form II to IV students (ages 12 to 15) will be eligible for participation. The intervention to three study groups will be (i) Health Belief Model (HBM)-based mobile messaging to the adolescents and their parents, which will consist of several blocks of HBM-based messages and reinforcement during 24 weeks; (ii) same HBM-based messaging to adolescents only; and (iii) delivering e-version of oral health education pamphlets to adolescents. The primary outcome will be caries increment 2 years post-intervention. Changes in oral health self-efficacy and behaviors, oral hygiene, and gingival status will be the secondary outcomes.

Discussion

No school dental care service is available to secondary school students in Hong Kong. This study will be the first to test a theory-driven and family-engaged preventive intervention among adolescents in Hong Kong. Findings will contribute to developing a low-cost, feasible, and efficient oral health preventive program for adolescents.

Trial registration

ClinicalTrials.govNCT05448664. Registered on 7 July 2022.

Training in radiographic caries detection and staging using an interactive tool

INTRODUCTION

The objective of the study was to compare a dental student's practical ability to detect and stage radiographic caries per International Caries Detection and Assessment System (ICDAS), following a traditional lecture and a lecture containing an interactive session using an audience response system (ARS). Associations between the order of instructions and student performance were also evaluated.

MATERIALS AND METHODS

Eighty-three dental students were randomly assigned to groups A and B. On the first day, group A received a traditional lecture and group B received content using the ARS. All students then took an electronic quiz (T1) identifying and staging caries on radiographs per ICDAS. For the second day, group A received the content using the ARS system and group B received a traditional lecture. All students subsequently took a second electronic quiz (T2). Two survey questions about the learning experience were also included.

RESULTS

Wilcoxon rank-sum analysis of scores from consenting students (81) showed no difference between the quiz 1 scores of two groups (p=.61). Whilst not statistically significant (p = .07), the group that had the ARS initially scored marginally higher on quiz 2. Survey results showed that most participants preferred either the ARS alone (49.38%) or a combination of the ARS and a traditional lecture (40.74%). A majority of them (80%) found the ARS helpful.

CONCLUSION

When training students in practical skills of detection and staging radiographic presence of dental caries per ICDAS, hands-on learning tools, such as an ARS, complement traditional lectures.

Prevalence, extent, risk indicators, and intraoral distribution of underlying dentin shadows (ICDAS 4) among 15-19-year-old South Brazilian adolescents

Background and Objective

This study aimed to assess the prevalence, extent, risk indicators, and intraoral distribution of underlying dentin shadows (UDS) in the occlusal surfaces of the permanent posterior teeth.

Subjects and Methods

A total of 1197 adolescents were included in the study (participation rate of 72.3%). The association between the independent variables, on the one hand, and the prevalence and extent of UDS were assessed using multilevel Poisson regression models. The prevalence ratios (PR), rate ratios (RR), and 95% confidence intervals (95% CIs) were estimated. The overall prevalence of UDS was 8.8% (95% CI = 6.0-11.5), with an overall mean of 0.13 (95% CI = 0.08-0.17) lesions per individual. Those with UDS exhibited a mean of 1.45 (95% CI = 1.28-1.62) lesions.

Results

Lower family income (PR = 1.58; 95% CI = 1.03-2.41) and caries activity (PR = 1.53; 95% CI = 1.01-2.31) were significantly associated with UDS prevalence, while age ≥17 years (RR = 1.43; 95% CI = 1.03-1.99) and caries activity (RR = 1.63; 95% CI = 1.55-2.30) were significantly associated with caries extent. The most commonly affected teeth were lower first molars, followed by upper first molars and lower second molars.

Conclusion

This study found a low prevalence and extent of UDS in the occlusal surface. Sociodemographic variables and caries activity were associated with the occurrence of UDS.

Early occlusal caries detection using targeted fluorescent starch nanoparticles

OBJECTIVES

We have previously shown fluorescent cationic starch nanoparticles (FCSNs) penetrate enamel surface porosity of active carious lesions, potentially aiding their detection. Here, we evaluate the in vitro diagnostic accuracy of FCSNs in detecting occlusal caries compared to histologic reference standard.

METHODS

100 extracted human teeth were selected with sound (50), or either non-cavitated (25) or cavitated (25) lesions. A region of interest (ROI) on the occlusal surface was assessed for fluorescence by two independent examiners, after immersion in FCSN solution, water rinse, and illumination by dental curing lamp viewed through orange UV-filter glasses. ROIs were sectioned and evaluated by histology (Downer Criteria) as a gold standard for caries presence. Cohen's Kappa was determined for inter- and intra-examiner agreement, and sensitivity, specificity, and area under the curve of Receiver Operator Curves (ROC_AUC) were calculated. The analysis was repeated for the subset of "early" lesions, defined as being limited to enamel.

RESULTS

FCSN use resulted in substantial inter-user (k=0.74±0.07), and high intra-user agreement (k=0.80±0.06; 0.94±0.03, by examiner). Sensitivity, specificity and ROC_AUC for FCSNs were 88.9%; 94.6%; 0.92±0.06 for all, and 76.9%, 94.6%, and 0.86±0.10 for early lesions. In post hoc analysis, sensitivity seemed to be greater with the FCSN than the expert visual exam, particularly for early lesions.

CONCLUSIONS/CLINICAL SIGNIFICANCE

FCSNs are a reproducible and accurate novel technology for occlusal caries detection, with high sensitivity and specificity compared to histology. Future clinical validation is necessary. FCSNs can improve early caries detection and shift treatment towards non-invasive approaches, improving oral health.

Oral-Health-Related Quality of Life as Measured with the Child-OIDP Index and Oral Health Status in Spanish Adolescents

BACKGROUND

Our aim was to analyze the relationship between OHRQoL (Oral-Health-Related Quality of Life) assessed by the C-OIDP (Child-Oral Impacts on Daily Performances) indexand oral health status in 13-15 years old Spanish population.

METHODS

A cross-sectional study was designed in a random sample of 337 adolescents. The C-OIDP and an oral health perception questionnaire were applied. ICDAS II (International Caries Detection and Assessment System) classification was used for assessing caries status, CPI (Community Periodontal Index) for periodontal status and discrepancy in the three planes for occlusal evaluation. Statistical analysis included Mann-Whitney, Kruskal-Wallis and Spearman correlation tests.

RESULTS

The prevalence of impact was 48.1%. The most frequently affected dimension was eating (21.4%). The overall mean C-OIDP index was 3.28. Higher DMFT (Decayed Missed Filled Tooth) was significantly associated with C-OIDP index (p = 0.03). Participants with CPI > 0 showed an impact index almost twice as high as those with CPI = 0 (p > 0.05). Significant association was found between quality of life and CPI for women (p < 0.01). Only the molar Angle's class was associated with the impact index (p = 0.04).

CONCLUSIONS

The OHRQoL in Spanish adolescents is good. The DMFT index had an impact on adolescents' quality of life, showing a greater impact in men than in women. Periodontal status had a greater impact in women. No association between the extent of the caries lesion and the impact index was found.

The stamp technique for direct restoration in a ICDAS 4 carious lesion: A 4-year follow-up

OBJECTIVE

This case report described the use of a stamping technique associated with a bulk fill composite to restore an ICDAS 4 carious lesion on a posterior tooth. The 4-year follow-up is also presented.

CLINICAL CONSIDERATIONS

A 32-year-old patient presented a carious lesion on tooth 36 with an underlying dark shadow at the dentin seen from the noncavitated enamel occlusal surface, which was compatible with an ICDAS 4 carious lesion. The lesion was radiographically detected and the caries disease was treated with dietary and hygiene habits orientations. Before accessing the lesion and selectively removing the carious tissue, an occlusal stamp was made by applying a flowable resin composite to copy the anatomy of the noncavitated enamel surface. The cavity was restored using a bulk fill resin composite (Opus Bulk Fill, FGM) with 4-mm-thick increments. Before curing the last increment, a Teflon band was adapted at the uncured bulk fill composite surface and the occlusal stamp made with the flowable composite was pressed against it to reproduce the natural characteristics and initial occlusal anatomy. The top surface was light-activated for 40 s. After 4 years, small wear could be seen in the restoration, but still within clinically acceptable levels.

CONCLUSION

The occlusal stamp technique allows reproduction of the natural anatomy of teeth affected by ICDAS 4 carious lesions with good clinical longevity over 4 years.

CLINICAL SIGNIFICANCE

This case report presents the use of the stamp technique to restore a tooth affected by an ICDAS 4 lesion, in which a carious process reached the dentin and the enamel anatomy was still preserved. The bulk fill resin composite associated with the occlusal stamp was chosen to quickly restore the cavity with clinical predictability. Bulk fill composites allow the insertion of up to 4-mm-thick increments and offer lower shrinkage stress, good clinical longevity and a less time-consuming procedure in cases of posterior teeth, especially if associated with the stamp technique.

Premature Primary Tooth Loss and Oral Health-Related Quality of Life in Preschool Children

The present study aimed to evaluate the association between premature primary tooth loss and oral health-related quality of life (OHRQoL) in preschool children. A cross-sectional study was conducted in 769 5-year-old preschool children. The children and their parents or guardians answered the Brazilian version of the Scale of Oral Health Outcomes for 5-Year-Old Children for the assessment of OHRQoL. Meanwhile, clinical examinations were performed for the assessment of premature primary tooth loss. Unadjusted and adjusted multilevel Poisson regression models were utilized to investigate the associations between the variables. In the parental version of the scale, premature posterior primary tooth loss (rate ratio [RR] = 2.65; 95% confidence interval [CI] = 1.51-4.68), weak sense of coherence (RR = 2.25; 95% CI = 1.62-3.11), and visit to a dentist (RR = 1.61; 95% CI = 1.04-2.52) were associated with OHRQoL. Based on the children's perceptions, only the preschool type was associated with OHRQoL (RR = 1.92; 95% CI = 1.21-3.05). Premature posterior primary tooth loss had a greater impact on OHRQoL based on the parents' perception, whereas only the preschool type was associated with OHRQoL based on the children's perception.

Patient Satisfaction with Resin Infiltration Treatment for Masking Noncavitated White Spot Lesions on Anterior Maxillary Teeth: Two Case Reports

Aim

We assessed patient satisfaction with resin infiltration treatment outcomes for masking postorthodontic treatment noncavitated white spot lesions on anterior maxillary teeth.

Background

White spot lesions (WSLs) are opaque white areas of demineralization. The lesion may remineralize over time, but the opaque color usually remains, retaining the undesirable tooth color. Case Description: Resin infiltration (RI) was administered to two patients with a total of 10 anterior maxillary teeth diagnosed with noncavitated WSLs. Immediately after treatment, patients were asked about their comfort during the RI treatment and their level of satisfaction with treatment outcomes. Two weeks post-treatment, the two patients were asked again about their level of treatment outcome satisfaction and if they thought they needed a second treatment. Both reported that they were comfortable during the treatment and were extremely satisfied with the achieved treatment outcomes immediately and two weeks after the treatment and did not feel that they would need to seek further treatment to reach the desired outcome.

Conclusion

Resin infiltration is a comfortable, conservative treatment option providing satisfactory outcomes in masking noncavitated WSLs on anterior maxillary teeth after orthodontic treatment. Clinical Significance. Resin infiltration is a conservative treatment option to mask noncavitated WSLs after orthodontic treatment.

Impact of community and individual social capital during early childhood on oral health-related quality of life: A 10-year prospective cohort study

AIM

To evaluate the impact of community and individual social capital during early childhood on oral health-related quality of life (OHRQoL) over a 10-year follow-up period.

METHODS

A prospective cohort study was conducted in the southern Brazil. Baseline (T1) data collection occurred in 2010 with preschool children aged 1-5 years. Participants were assessed in 2012 (T2), 2017 (T3), and 2020 (T4). OHRQoL was assessed using the B-ECOHIS at T1 and T2 and through CPQ8-10 at T3 and CPQ11-14 at T4. Community social capital was evaluated through the presence of formal institutions in the neighbourhood and individual social capital by social networks, both at T1. Demographic and socioeconomic characteristics were also evaluated. Multilevel Poisson regression analysis was performed to estimate the impact of social capital measures on OHRQoL.

RESULTS

Of the 639 children assessed at T1, 469 were followed at T2 (73.3% response rate), 449 at T3 (70.3% response rate), and 429 at T4 (67.1% response rate). Individuals living in neighbourhoods with the presence of social class associations at T1 had higher OHRQoL at T3 and T4. Individuals whose families visit friends and neighbours less than once a month or never at T1 had lower OHRQoL at T1, T3 and T4. Attending religious meetings less than once a month or never at T1 was associated with lower OHRQoL at T2 and T4.

CONCLUSION

Social capital at the community level had a long-term effect on OHRQoL, especially during adolescence, while individual social capital levels impacted OHRQoL across the assessments.

CLINICAL SIGNIFICANCE

The findings indicate that psychosocial variables can impact OHRQoL, a fundamental aspect of clinical practice.

Efficiency of ER:YAG laser therapy in combination with behaviour management technique in reducing anxiety among paediatric dental patients - a study protocol for a randomised clinical trial

INTRODUCTION

When providing dental care to children with a high level of dental anxiety, the range of approaches is divided into two sections: use of behaviour management techniques (BMTs) and application of alternative methods for caries removal. In an attempt to reduce dental anxiety, they can be mixed and matched in accordance with the dentists' choice. Owing to its promoted advantages, erbium-doped yttrium aluminium garnet (Er:YAG) laser turns into an ideal alternative technique for hard dental tissue therapy in anxious paediatric patients. The aim of the study is to assess the efficacy of a modified version of the BMT 'Latent inhibition' in combination with Er:YAG laser for achieving a reduction of dental anxiety in paediatric dental patients.

METHODS AND ANALYSIS

This is a protocol for a randomised controlled clinical trial. The participants will be children aged 6-9 years, requiring conservative treatment of occlusal carious lesion on a second primary molar. Patients will be randomly assigned to the experimental or control group via a computer-generated sequence. In both groups, 'Latent inhibition' will be used as an anxiety-management technique. In the experimental group, caries treatment will be performed with Er:YAG laser, whereas that in the control group it will be performed with conventional rotary instruments. Outcome measures will be dental anxiety felt before and after the treatment, reported by the patient on a modified version of the Faces Scale by LeBaron et al., and the dynamics of heart rate, registered during the treatment session, which will be measured with a mobile pulse oximeter. Data will be analysed by independent sample t-test and paired t-test (p˂0.05).

ETHICS AND DISSEMINATION

The study protocol has been approved by the Committee for Scientific Research Ethics, Medical University-Plovdiv, Bulgaria (reference number P-2839, protocol of approval number 3/30.04.2015) and registered on a publicly accessible database. This research received institutional funding from the Medical University-Plovdiv, Bulgaria. The results will be presented through peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

NCT04924452.

Evaluation of different methods for the diagnosis of primary caries lesions: Study protocol for a randomized controlled clinical trial

Background

According to the World Health Organization (WHO), dental caries is considered one of the greatest pediatric health problems in the world, due to its high prevalence and incidence. Therefore, the early diagnosis of caries lesions is a fundamental procedure for planning treatment aimed at prevention, minimal intervention and promotion of oral health. The present study aims to evaluate, through a randomized and controlled clinical study, which is the best strategy for diagnosing primary caries lesions located in the interproximal region.

Materials and methods

Eighty patients, aged between 4 and 10 years will be randomized and allocated into 2 groups for analysis and comparison of methods for diagnosing caries lesions. The following diagnostic methods will be analyzed and compared: visual clinical examination using ICDAS (International Caries Detection and Assessment System), the iTero Element 5D System (intraoral scanner with near infrared imaging (NIRI) technology) and bitewing radiography (BWX). All evaluations will be carried out by 02 examiners. Examiners will be trained and calibrated to use the visual and radiographic criteria and also to use the iTero 5D intraoral scanner, following the manufacturer’s instructions.

Trial registration

NCT04900246 in ClinicalTrial.gov. First released in 05/11/2021 and last updated in 10/06/2021.

Risk prediction models for erosive wear in preschool-aged children: a prospective study

Background

Despite increasing prevalence, age-specific risk predictive models for erosive tooth wear in preschool-age children have not been developed. Identification of at-risk groups and the timely introduction of behavioural change or treatment will stop the progression of erosive wear in the permanent dentition. This study aimed to identify age-specific risk factors for erosive wear. Distinct risk prediction models for 3-year-old and 5-year-old children were developed.

Methods

A prospective cohort study included school-based clinical examinations and parent administered questionnaires for consented 3 and 5-year-old healthy children. Calibrated examiners measured the following health parameters under standardised conditions: erosion, using the Basic Erosive Wear Examination Index (BEWE), caries using the International Caries Detection and Assessment System (ICDAS), plaque and calculus according to the British Association for the Study of Community Dentistry (BASCD) scores, dental traumatic injuries and soft tissue lesions, salivary testing and BMI. Other health conditions were collected via a parent-administered questionnaire that explored oral- and general-health. Non parametric tests were utilised to explore the temporal relation of erosion with, demographic factors, oral hygiene habits, general health and dietary habits. Variables showing significance with a difference in BEWE cumulative score over time were utilised to develop two risk prediction models. The models were evaluated by Receiver Operating Characteristics analysis.

Results

Risk factors for the 3-year-old cohort (N = 336) included erosive wear (χ²(1, 92) = 12.829, p < 0.001), district (χ²(5, 92) = 17.032, p = 0.004) and family size (χ²(1, 92) = 4.547, p = 0.033). Risk factors for the 5-year-old cohort (N = 441) also included erosive wear (χ²(1, 144) = 4.768, p = 0.029), gender (χ²(1, 144) = 19.399, p < 0.001), consumption of iced tea (χ²(1, 144) = 8.872, p = 0.003) and dry mouth (χ²(1, 144) = 9.598, p = 0.002).

Conclusions

Predictive risk factors for 3-year-old children are based on demographic factors and are distinct from those for 5-year-old children based on biological and behavioural factors. Erosive wear is a risk factor for further wear in both age cohorts.

The antibacterial effect of nanosilver fluoride in relation to caries activity in primary teeth: a protocol for a randomized controlled clinical trial

BACKGROUND

Minimally invasive dentistry is a highly convenient and efficient method of managing caries in pediatric patients. Silver diamine fluoride (SDF) is commonly used to arrest active caries lesions. However, the associated black stain, possibility of soft tissue injury, and unpleasant taste often limit its use. Recently, nanosilver fluoride (NSF) emerged as a promising topical fluoride agent with potent cariostatic and antibacterial potentials. This novel anticaries agent has gained attention as an alternative to overcome the drawbacks of SDF in caries arrest.

OBJECTIVES

To assess the antibacterial effect of NSF in relation to caries activity in dentin caries lesions, as well as to investigate the change in saliva bacterial levels in primary teeth in comparison to SDF after 1 and 3 months.

MATERIALS AND METHODS

Fifty children aged 4 to 6 years old with active dentin caries lesions (score 5 according to International Detection and Assessment System (ICDAS II) criteria) will be enrolled in the study. They will be equally and randomly allocated into 2 groups: a group receiving NSF and a control group receiving SDF treatment. Microbiological samples will be collected from the carious lesions and from unstimulated saliva at the baseline and at the 1 and 3 months' follow-up appointments. Bacterial counts will be assessed using Mitis Salivarius agar (selective culture media for S. mutans) and Rogosa agar (selective culture media for lactobacilli), and the results will be expressed in colony-forming units. Data regarding the children's oral health will be collected and their dmf index will be scored. The arrest of active carious lesions will be measured at the follow-up appointments according to ICDAS II criteria.

RESULTS

The relation between bacterial colony counts and lesion activity for both groups will be assessed, as well as the change in salivary bacterial counts. The collected data will be statistically evaluated and tabulated. This clinical trial has been registered on ClinicalTrials.gov in January 2022 (original version) with ID: NCT05221749.

Orofacial dysfunction, nonnutritive sucking habits, and dental caries influence malocclusion in children aged 8-10 years

INTRODUCTION

Malocclusion is one of the most prevalent oral health problems and can affect self-esteem, social relations, and oral health-related quality of life. The present study aimed to evaluate associations between malocclusion and orofacial dysfunction, nonnutritive sucking habits, cavitated carious lesions, and anxiety in Brazilian children.

METHODS

An analytical cross-sectional study was conducted with a representative sample of 739 children aged 8-10 years. Parents or guardians provided sociodemographic data and information on the nonnutritive sucking habits of the children. The children answered the Revised Children's Manifest Anxiety Scale. Four trained examiners examined the children for the diagnosis of malocclusion (dental aesthetic index), dental caries (International Caries Detection and Assessment System), and orofacial dysfunction (Nordic Orofacial Test-Screening). The control variables were selected using a directed acyclic graph. Descriptive statistics were performed, followed by unadjusted and adjusted robust logistic regression analysis (P <0.05).

RESULTS

The following variables remained associated with the occurrence of malocclusion in the final model: nonnutritive sucking habits (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.25-4.08), orofacial dysfunction (OR, 1.56; 95% CI, 1.13-2.17), and cavitated carious lesion (OR, 1.39; 95% CI, 1.03-1.89).

CONCLUSIONS

Nonnutritive sucking habits, orofacial dysfunction, and cavitated carious lesions were associated with the presence of malocclusion in children aged 8-10 years.

Outcome of vital pulp therapy in deeply carious molars affected with molar incisor hypomineralisation (MIH) defects: a randomized clinical trial

PURPOSE

To evaluate clinical and radiographic outcomes of vital pulp therapy (VPT) in deeply carious young permanent first molars (PFM) affected with MIH over 24 months.

METHODS

In this prospective randomized clinical trial, n = 50 children with deeply carious young PFM affected with MIH, and diagnosed with reversible or irreversible pulpitis were randomized into 2 groups: indirect pulp treatment (IPT) and pulpotomy (partial or complete). Teeth were followed up clinically and radiographically for 24 months. Statistical analysis was done using Chi-square test; P ≤ 0.05 was considered significant.

RESULTS

A total of  n = 50 teeth/patients (n = 26 females (52%), n = 24 males (48%)) were included, and 14 upper and 36 lower PFM were treated. Mean age was 11 ± 3.2 years. Clinical and radiographic success rates were: 96% for IPT, 90% for PP and 82% for CP (and 86% for both types of pulpotomy combined) over 24 months. There were no significant differences in outcomes between treatment groups. Age, gender and tooth location/jaw were found to have no statistically significant difference in outcomes among treatment groups, nor did pulpal status or root maturity, regardless of type of VPT and follow up period.

CONCLUSIONS

VPT is a valid treatment option in deeply carious young permanent first molars affected with MIH over 24 months. IPT had a higher clinical and radiographic success rate (96%) than partial or cervical pulpotomy (total 86%), but the difference was not statistically significant. Future randomized clinical trials on VPT for teeth affected with MIH are recommended with larger sample size and longer follow-up.

Remineralization of early enamel lesions with a novel prepared tricalcium silicate paste

To evaluate the remineralization potential of prepared tricalcium silicate (TCS) paste compared to silver diamine fluoride-potassium iodide (SDF-KI) and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on artificial enamel lesions. Thirty permanent sound molars were collected for the study. After cleaning, root cutting, and applying acid-resistant nail varnish, leaving a 4 × 4 mm buccal window, the teeth were subjected to demineralization process. The teeth were divided into three treatment groups (n = 10). In each group, the teeth were sectioned buccolingually to obtain two halves (30 self-control and 30 experimental halves). The self-control halves were subjected to cross-sectional microhardness (CSMH), energy-dispersive X-ray spectroscopy at 50, 100, and 150 µm from the external enamel surface, and micromorphological analysis at the superficial enamel surface. The experimental halves were subjected to the same tests after 30 days of remineralization. Three-way analysis of variance (ANOVA) outcomes showed no significant difference in CSMH after treatment among the three different groups at the different levels (p > 0.05). Meanwhile, three-way ANOVA outcomes showed a significant difference in calcium/ phosphate ratio after treatment among the three different groups at the different levels. (p < 0.05). The tricalcium silicate paste used in this study showed potential remineralization in subsurface enamel lesions.

Sociodemographic, behavioral, and clinical indicators for added value of radiography in caries diagnosis in adolescents: A cross-sectional study

OBJECTIVE

The aim was to assess the value of sociodemographic, behavioral, and clinical characteristics in identifying adolescents who would benefit from radiographs for dental caries detection in a high-caries experience population.

STUDY DESIGN

In total, 356 adolescents answered a validated questionnaire on sociodemographic characteristics and oral health behavior and were clinically and radiographically examined for caries. The outcome was the benefit arising from radiographs for caries detection at the patient level, defined as the number of surfaces clinically classified as sound but presenting radiolucency.

RESULTS

A total of 169 participants (47.5%) benefited from radiographs. One-third of approximal lesions were detected clinically, whereas two-thirds, mostly initial lesions, were detected radiographically only. Adolescents who reported frequent consumption of soft drinks and sugary food, those with D₁MFS (noncavitated and cavitated caries experience) ≥12, D₅MFS (cavitated caries experience) ≥1, clinically detected approximal lesions, and active caries were significantly more likely to benefit from radiographs (P ≤ .002). Although some indicators showed moderate-to-good sensitivity (consumption of sugary food, caries activity) or specificity (absence of clinically diagnosed approximal lesions), the accuracy of indicators evaluated (isolated or combined) never reached 0.60.

CONCLUSIONS

The possibility of correctly identifying which adolescents would benefit from radiographs for caries detection purposes was limited in a population with high-caries experience.