Risk predictors of dental root caries: A systematic review

Development of a nomogram for root caries risk assessment in a Chinese elderly population

BACKGROUND

Root caries is a common oral disease among the elderly, and its prevalence increases year by year with the deepening of population aging. Existing caries risk assessment models do not fully consider the specific risk factors for root caries in the elderly population. This study aims to develop a predictive model for root caries risk in the elderly to facilitate early identification and personalized intervention.

METHODS

This study included 310 individuals over the age of 60. Data on oral health status, frailty level, cognitive function, and sociodemographic factors were collected through oral examinations and six questionnaires, including the Fried Frailty Phenotype, MMSE, Barthel Index, SXI, OHIP-14, and a demographic questionnaire. A root caries prediction model was constructed using multivariate logistic regression analysis, and the model's performance was evaluated using the Hosmer-Lemeshow test, ROC curves, and Decision Curve Analysis (DCA).

RESULTS

Key risk factors for root caries included age, history of coronal caries, secondary caries, use of removable partial dentures, and the number of exposed root surfaces. The nomogram model demonstrated good predictive accuracy and clinical utility in both the training cohort (AUC=0.840) and the validation cohort (AUC=0.834).

CONCLUSION

The nomogram developed in this study provides an effective tool for the early assessment of root caries risk in the elderly. Future studies should conduct larger sample and multicenter validation research. The study was retrospectively registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn/) with the registration number ChiCTR2500099297.

CLINICAL SIGNIFICANCE

This nomogram prediction model can help clinicians identify high-risk elderly patients and take early preventive measures, enhancing personalized oral health management and improving the oral health of the elderly population.

Association Between Diabetes Status, Glycaemic Control and Untreated Root Caries Among United States Adults

PURPOSE

This study explored the association between self-reported diabetes mellitus, glycaemic control, measured by glycohaemoglobin (HbA1c) levels, and untreated root caries among U.S. adults, exploring the impact of diabetes status and glycaemic control levels on root caries risk.

MATERIALS AND METHODS

Analysing data from the National Health and Nutrition Examination Survey (NHANES) 2015 to 2018, we included 7490 participants aged 30 and above. We investigated the association between self-reported diabetes, glycaemic control, and untreated root caries, adjusting for demographic and health-related variables. Weighted logistic regression models estimated untreated root caries odds by diabetes status and HbA1c cutoffs (6.5-9%), adjusting for demographics, health behaviours, BMI, diet, oral health factors.

RESULTS

A significant association was found between higher HbA1c levels and an increased risk of untreated root caries (odds ratio [OR]: 1.11, 95% CI: 1.01-1.22, p < .05). Self-reported diabetes was not significantly linked to untreated root caries after adjusting for HbA1c and other factors. Glycaemic control thresholds (HbA1c ≥8%) among diabetic participants were associated with higher odds of untreated root caries.

CONCLUSIONS

Poorly controlled diabetes appears to be associated with untreated root caries among U.S. adults. This highlights the greater impact of glycaemic control versus self-reported diabetes on dental health and the need for regular oral screenings for patients with poor glycaemic control.

Frontiers of Global Research Trend on Root Caries: A Bibliometric Analysis

OBJECTIVE

This study aimed to examine the global research trend and frontiers in the field of root caries.

METHODS

Two independent investigators searched the Web of Science Core Collection to include journal articles published on root caries from 1994 to 2023. They examined citation trends of the selected publications and performed bibliometric analysis using VOSviewer. Cooccurrence and cocitation analysis were used to calculate the burst strength of the most cited keywords and the most cited publications.

RESULTS

This study included 1144 publications (1004 scientific research articles and 140 review articles) for bibliometric analysis. The number of publications from 2018 to 2023 was 404, accounting for 35% (404/1144) over the last 30 years. The annual citation count showed a gradual upward trend with a surge from 2018. The cooccurrence analysis classified the publications into four clusters which were in vitro studies, prevention, microbiology, and epidemiology. Cocitation analysis revealed silver diamine fluoride, systematic review, and randomized clinical trial were the three main keywords; and their citation burst strength (period) were 17.2 (2017-2023), 9.4 (2015-2023), and 6.9 (2018-2023), respectively. Noninvasive treatment of root caries (narrative review), aetiology of root caries (narrative review), and use of silver diamine fluoride in arresting root caries (clinical trial) were the topics (publication type) of the three most cited publications; and their burst strength (period) were 8.9 (2017-2020), 5.9 (2017-2021), and 4.7 (2015-2018), respectively.

CONCLUSION

This study highlights the recent growing research interest in root caries, particularly on its microbiology, prevention, and the use of silver diamine fluoride.

Global and regional trends in prevalence of untreated caries in permanent teeth: Age-period-cohort analysis from 1990 to 2019 and projections until 2049

OBJECTIVES

This study aims to update the relevant epidemiological information of untreated caries in permanent teeth.

METHODS

Data were derived from the Global Burden of Disease (GBD) study 2019. We described temporal trends in age-standardized prevalence rate (ASPR) of untreated caries in permanent teeth by gender and region from 1990 to 2019. Age-period-cohort (APC) model was utilized to analyze age, period and cohort effects on prevalence, and we used the Bayesian age-period-cohort (BAPC) model to make projections of prevalence between 2020 and 2049.

RESULTS

The global ASPR of untreated caries in permanent teeth presented a decreasing trend from 1990 to 2019 (26593.58/105 vs. 25625.53/105), with females exceeding males annually. Negative correlation was observed between ASPR and Socio-demographic Index (SDI) levels. APC analyses showed that net drift was -0.16 % globally and generally below 0 across all SDI regions. The overall global peak in prevalence occurred in the 20-24 years group (36319.99/105), and there was a decrease trend in the overall global period rate ratio (RR). Compared to younger birth cohorts, prior birth cohorts had higher prevalence risks globally and across all SDI regions. Significant upward trends was predicted in the global ASPR of untreated caries in permanent teeth for both genders from 2020 to 2049.

CONCLUSIONS

Age-period-cohort effects exerted a significant impact on the prevalence of untreated caries in permanent teeth during the study period.

CLINICAL SIGNIFICANCE

The ASPR of untreated caries in permanent teeth may increase in the next 30 years by projections. And the disease burden of untreated caries in permanent teeth may be affected by population ageing. It is essential to implement targeted prevention and control policies to disadvantaged groups and attempt to reduce caries inequalities.

Comparative analysis of microbiome in coronal and root caries

BACKGROUND

The global rise in the elderly population has increased the prevalence of root caries. Streptococcus mutans, Lactobacilli and Actinomyces are considered the primary pathogens of dental caries in culture-based studies. This study aimed to investigate bacterial profiles in coronal and root caries lesions and determine the association of specific bacterial genera at each site.

METHODS

Dentine samples from carious lesions were collected from 22 extracted teeth using an excavator. Microbial DNA was extracted from the samples using a protocol developed for this study. 16S rRNA gene amplicon sequencing was employed for microbial analysis. PCR amplification targeted the V3-V4 region of the bacterial 16S rRNA, and the amplicon sequencing used an Illumina MiSeq system (2 × 300 bp paired-end reads). Statistical analysis was performed by the Phyloseq and DESeq2 packages in R.

RESULTS

In coronal caries, Olsenella, Lactobacillus and Prevotella were the most prevalent genera, comprising approximately 70% of the microbiome community. In the root caries, however, although Olsenella, Prevotella and Lactobacillus remained the dominant genera, they accounted for only half of the microbiome community. This study identified significant differences in alpha diversity indices between the coronal and root caries. LEfSE analysis revealed several unique genera in each caries lesion.

CONCLUSION

The microbiome of root caries lesions was richer and more complex than the coronal caries microbiota. The results suggest that lesion-related variations in the oral microflora may be detected in carious dentine.

Accumulation and removal of Streptococcus mutans biofilm on enamel and root surfaces in vitro

Objective

This study aimed to quantitatively investigate the accumulation of Streptococcus mutans biofilm on enamel and root surfaces and assess the amount of biofilm removal using (1) experimental toothpaste and (2) water, in a closed system of flow chamber.

Methods

Eight sound premolars were embedded in epoxy resin and polished with silicon carbide grinding papers to display enamel and root surfaces. To mimic biofilm, cultures of Streptococcus mutans were prepared and grown on the tooth surfaces over night before they were exposed to either 2 liters of Milli Q water or 2 liters of 40% experimental toothpaste in the flow chamber. The amount of biofilm was measured and quantified in Fluorescence microscopy. Mean fluorescence values were recorded and analysed using Microsoft® Excel® (MS Excel 2016).

Results

The ability to grow biofilm was equally present at both the enamel and root surfaces. The use of water and 40% experimental toothpaste showed a significant reduction of areas covered with biofilm on both enamel and root dentin in comparison to untreated surfaces (p < 0.01). Significantly more biofilm was removed from enamel compared to root surfaces when treated with either water and toothpaste (p < 0.01). Slightly less biofilm was removed by the use of water compared to toothpaste on both enamel and root dentin surfaces, although the differences were not statistically significant.

Conclusion

The results indicate that less biofilm is removed from the root surfaces than enamel by the use of water and 40% experimental toothpaste in flow chamber. Assessing oral biofilm accumulation and monitoring biofilm formation on enamel and root dentin surfaces give oral health professionals important directions that could strenghten the significance of dental caries prevention. Improving older individuals' oral hygiene practices should therefore be considered an important measure to prevent root caries.

The association between smoking and smokeless tobacco use with dental caries among Pakistani patients

BACKGROUND

Tobacco use is widely recognised as a significant risk factor for oral cancer and periodontal diseases. However, the relationship between various types of tobacco use and dental caries has been inconsistent. This study aimed to determine the association between smoking and smokeless tobacco and dental caries among patients in a tertiary care hospital in Quetta, Pakistan.

METHODS

This cross-sectional study was conducted from November 2020 to March 2021 among patients in a tertiary care hospital in Quetta, Pakistan. Oral examinations and interviews were performed according to the WHO Oral Health Survey basic methods (5th edition) to determine dental caries status, tobacco use, and oral health behaviours. The odds ratio and binary logistic regression were analysed to assess the association between the types (smoking tobacco, smokeless tobacco, and use of both types), duration, and frequency of tobacco use and high caries level (DMFT ≥ 5).

RESULTS

Four hundred participants aged 18-65 were included, and 67.8% were tobacco users. Use of both smoking and smokeless tobacco (aOR = 14.7, 95%CI = 1.87-115.96, p = 0.011), smokeless tobacco only (aOR = 5.90, 95%CI = 1.89-18.37, p = 0.002), and smoking only (aOR = 2.18, 95%CI = 1.23-3.88, p = 0.008) were associated with significantly increased risk of high caries. Using tobacco for longer periods and more frequently daily also significantly increases the risk of high caries.

CONCLUSION

Smoking and smokeless tobacco are significantly associated with high dental caries after adjusting for other factors. Due to the high severity of dental caries and the high prevalence of tobacco use among Pakistani patients in this study, it is highly recommended to strengthen policies aimed at reducing tobacco usage, including smokeless forms.

What is risk? The challenge of defining 'risk' in caries risk assessment

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Association of Interdental Cleaning and Untreated Root Caries in Adults in the United States of America

PURPOSE

This study aimed to evaluate the association between interdental cleaning and untreated root caries amongst middle-aged and older adults in the US.

MATERIALS AND METHODS

Data were obtained from the National Health and Nutrition Examination Survey (NHANES) (2015-2016 and 2017-2018). Adults aged ≥40 years who underwent full mouth examination and root caries assessment were included. Participants were classified based on their interdental cleaning frequency as none, 1-3 d/wk, and 4-7 d/wk. Associations between interdental cleaning and untreated root caries were assessed using a weighted multivariable logistic regression model adjusted for sociodemographics, general behaviour, general health condition, oral conditions, oral health behavior, and dietary factors. Subgroup analyses stratified by age and sex were performed after adjusting for covariates in the logistic regression models.

RESULTS

The prevalence of untreated root caries was 15.3% amongst 6217 participants. Interdental cleaning for 4-7 d/wk was a significant risk factor (odds ratio, 0.67; 95% confidence interval, 0.52-0.85). It was associated with a 40% reduction in the risk of untreated root caries in participants aged 40 to 64 years and a 37% reduction in women. Untreated root caries was also significantly associated with age, family income, smoking status, root restoration, number of teeth, untreated coronal caries, and recent dental visit.

CONCLUSIONS

Interdental cleaning for 4-7 d/wk was associated with fewer untreated root caries amongst middle-aged adults and women in the US. The risk of root caries increases with age. Low family income was a risk indicator for root caries amongst middle-aged adults. Additionally, smoking, root restoration, number of teeth, untreated coronal caries, and recent dental visits were common risk factors for root caries in middle-aged and older people in the US.

Effect of a single application of silver diamine fluoride on root caries after 12 months in institutionalised older adults-A randomised clinical trial

OBJECTIVE

Silver diamine fluoride (SDF) has been shown to be highly effective against caries, in particular for arresting root surface caries and for dentine caries in primary teeth. SDF may complement fluoride varnish routines for treatment of root caries in nursing home residents. The aim of this randomised, single-blinded, placebo-controlled trial was to evaluate the additive effect of a single annual application of SDF for prevention and treatment of incipient root caries in older adult nursing home residents.

METHOD

Four hundred older adult nursing home residents (≥70 years old) with at least one exposed root surface (on teeth 15, 14, 13, 23, 24, or 25) were identified during routine dental examination visits in the domiciliary dental care setting. Eligible patients, who were able to understand the implication of consenting to the study, were invited to participate. Their cleaned root surfaces were randomly allocated to treatment with SDF (Advantage Arrest Silver Diamine Fluoride 38%, Advantage Arrest, LLC, Redmond, OR 97756, USA, Lot 16 152) or with placebo (tap water), each for 1 minute.

RESULTS

Of the 400 eligible individuals, 42 declined to participate and two forms were destroyed. The remaining 356 participants (89.0%; mean age 87.7 years) were randomly allocated, with 174 going to the SDF group and 182 to the placebo group. At 1 year, 273 participants (76.7%) were available for assessment: 135 in the SDF group and 138 in the placebo group. By that time, 109 individuals (39.9%) demonstrated root caries progression or regression. Among those 118 (16.7%) of the 708 included root surfaces had developed caries There were no statistically significant differences in the primary outcome related to treatment with SDF or placebo, at either patient or root surface level.

CONCLUSION

Based on the finding of this clinical trial, it is concluded that a single SDF application to complement a risk-based preventive programme including fluoride varnish applications did not have a statistically significant additional preventive effect on root caries development in a group of older adult nursing home residents with limited caries activity and cognitive capacity to cooperate in oral care activities.

Oral Health Factors Related to Rapid Oral Health Deterioration among Older Adults: A Narrative Review

Older adults who face systemic health issues and lack adequate social support are at risk for oral health deterioration. How rapidly such changes take place depends on the severity of their medical condition and their ability to access oral health services in a timely manner. The management of dental caries and periodontal disease in this cohort is made complex by the interaction of local and host factors such as the presence of dry mouth, involvement of root surfaces, and altered wound healing. in addition to enhanced maintenance needs to avoid recurrence or progression. Tooth replacement can be beneficial in restoring oral function, allowing patients to enjoy a healthy and nutritious diet but requires careful consideration to avoid further damage to remaining dental units. Establishing a dental home for the older adult can facilitate routine surveillance, disease prevention, and patient/caregiver education to achieve oral health goals commensurate with overall health. This narrative review details oral health factors that are related to rapid oral health deterioration among older adults.

The Effect of Domiciliary Professional Oral Care on Root Caries Progression in Care-Dependent Older Adults: A Systematic Review

With care dependency, untreated root caries lesions (RCLs) and irregular dental visits are common. RCLs, if left untreated, could lead to pain, tooth loss, difficulties eating, and impact on general health. Therefore, there is a need for prevention and effective treatment for RCLs, and especially in those with care dependency. The aim of this systematic review was to investigate the effect of domiciliary professional oral care on root caries development and progression, in comparison with self-performed or nurse-assisted oral care. A literature search was conducted in four databases in November 2022. Two authors independently screened the literature throughout the review process. Five of the identified studies were found to be relevant. Four of these were assessed as having moderate risk of bias and were included in the review, while one study had high risk of bias and was excluded from further analyses. Due to heterogenicity of the included studies (and of the interventions and outcomes), no meta-analysis or synthesis without meta-analysis (SWiM) was performed. The participation of dental personnel performing mechanical plaque removal and fluoride, or chlorhexidine application seems beneficial for care-dependent older adults with risk of RCLs development and progression. However, future studies are needed.

Dental Care for Older Adults

There is a global increase in the older population. Unfortunately, dental conditions in the older population can sometimes be poor as a result of worsened physical conditions and the cumulative damage caused by dental diseases in the past. Many suffer from oral diseases such as dental caries and periodontal disease but receive no regular dental care. Oral conditions and systemic problems are interrelated. Chronic medical problems and polypharmacy are common among them. These conditions may lead to xerostomia with or without a decrease in saliva output. Additionally, many older adults have deteriorated masticatory function associated with physical health issues such as frailty. Preventive measures are crucial to stop oral diseases from progressing and the replacement of missing teeth is needed when masticatory function is impaired. Older adults also suffer a higher risk of oral cancer because of their less resilient but more permeable oral mucosa. With the increasing need for elderly dental care, dentists should equip themselves with knowledge and skills in geriatric dentistry. They should help older adults to develop and maintain the functional ability that enables well-being in older age. This communication article aims to discuss the relevant medical conditions, common dental diseases, and dental care for older adults.

Development of Root Caries Prevention by Nano-Hydroxyapatite Coating and Improvement of Dentin Acid Resistance

There is no established method for optimizing the use of dentin to prevent root caries, which are increasing in the elderly population. This study aimed to develop a new approach for root caries prevention by focusing on bioapatite (BioHap), a new biomaterial, combined with fluoride. Bovine dentin was used as a sample, and an acid challenge was performed in three groups: no fluoride (control group), acidulated phosphate fluoride treatment (APF group), and BioHap + APF treatment (BioHap group). After applying the new compound, the acid resistance of dentin was compared with that of APF alone. The BioHap group had fewer defects and an increased surface hardness than the APF group. The BioHap group had the smallest lesion depth and least mineral loss among all groups. Using a scanning electron microscope in the BioHap group showed the closure of dentinal tubules and a coating on the surface. The BioHap group maintained a coating and had higher acid resistance than the APF group. The coating prevents acid penetration, and the small particle size of BioHap and its excellent reactivity with fluoride are thought to have contributed to the improvement of acid resistance in dentin. Topical fluoride application using BioHap protects against root caries.

How do carious root lesions develop after the end of professional preventive measures?—Preliminary findings of a randomized clinical trial

Aim of this randomized clinical trial was to assess the development of root caries lesions with and without (adjuvant) professional prevention treatment over 24 months. 20 participants with two or three non-cavitated root carious lesions were included (n = 52), whereby lesions were randomly assigned to one out of three groups depending on varnish application (CF: Cervitec F [n = 20], P: placebo [n = 20], DP: Duraphate [n = 12]). All lesions were assessed by quantitative light-induced fluorescence (QLF; QRayCam); following outcome parameters were analyzed: fluorescence loss (ΔF %), lesion volume (ΔQ %µm²) and bacterial activity (ΔR %). Professional tooth cleaning and adjuvant varnish application were performed at baseline, after 3, 6, and 9 months. A follow-up examination was performed 1 year after preventive care with varnish application 24 months after baseline. ∆F showed a significant time effect in CF (p = 0.03), which was not confirmed in post hoc analysis (p > 0.05). For P and DP, no time effect was detected (p > 0.05). ∆Q was significantly higher 12 months after baseline in CF (p = 0.02). In P, a significant time effect occurred (p = 0.01), without significant results in post hoc testing. ∆R showed higher values at baseline vs. 12 months in CF (p = 0.03) and 24 months compared to 12 months in DP (p = 0.02). Professional preventive treatment inhibited the progression of root caries lesions beyond their termination for 12 months, irrespective of an adjunctive varnish application. Preventive measures have a long-term effect on root carious lesions, even 1 year after their termination.

Evaluation of the effect of a glass ionomer cement containing fluoro-zinc-silicate glass on dentin remineralization using the ultrasonic pulse-echo method

The purpose of this study was to investigate the protective effect of a glass ionomer cement (GIC) consisting of fluoro-zinc-silicate glass on the demineralization of bovine dentin using the ultrasonic pulse-echo method. The findings were compared with those obtained using a conventional GIC. Slabs of dentin from bovine teeth were sliced, shaped into a rectangular form, and immersed in 0.5 M ethylenediaminetetraacetic acid solution at 25ºC for 6 days, followed by storage in distilled water for 3 days. After demineralization, they were immersed in artificial saliva with and without the GIC specimens. The propagation times of the longitudinal ultrasonic waves in the samples were measured. The ultrasonic velocities of the fluoro-zinc-silicate glass-containing GICs were significantly increased 2-3 days after the start of the experiment and showed an upward trend thereafter. These findings indicate that the GICs containing fluoro-zinc-silicate glass might exhibit the potential to promote remineralization in the dentin.

A retrospective comparison of the survival of vital teeth adjacent to single, bounded edentulous spaces rehabilitated using implant-supported, resin-bonded, and conventional fixed dental prostheses

OBJECTIVES

In this study, we aimed to compare the long-term survival of vital teeth adjacent to bounded edentulous spaces rehabilitated using an implant-supported prosthesis (ISP), a resin-bonded fixed partial denture (RBFPD), or a conventional fixed partial denture (CFPD). The risk factors for complications in teeth adjacent to the edentulous space (TAES) were also investigated.

METHODS

We followed-up a consecutive series of 514 patients who underwent rehabilitation of a single bounded edentulous space with vital TAES (ISP: 103; RBFPD: 216; and CFPD: 195) from 2008 to 2017. Cumulative survival rates of prosthesis and TAES, and complication-free rates of TAES, were evaluated using the Kaplan-Meier analysis and log-rank test. Risk factors were evaluated using a Cox proportional hazards model.

RESULTS

Cumulative complication-free rates of TAES showed no significant differences among the three groups. The cumulative survival rate of TAES in CFPD was significantly lower than that of ISP (p = 0.037); no significant differences were observed between ISP and RBFPD (p = 0.513), and RBFPD and CFPD (p = 0.076). Older age (p = 0.027) was the only independent significant risk factor for complications in TAES. Installation of CFPD (p = 0.019), ceramic prosthesis in edentulous space (p = 0.026), and deeper periodontal probing depth (p = 0.018) of TAES were significant risk factors for non-surviving TAES.

CONCLUSIONS

Rehabilitating a single bounded edentulous space with CFPD could increase the risk for TAES loss compared with ISP. Risk of TAES loss remained similar between ISP and RBFPD, which can minimize the loss of coronal tooth structure during tooth preparation.

CLINICAL SIGNIFICANCE

Teeth adjacent to edentulous space show equivalent longevity when rehabilitating a single bounded edentulous space with resin-bonded fixed partial dentures or single standing implant-supported prosthesis, at least 10 years post-installation.

Periodontal Pathogens Inhabit Root Caries Lesions Extending beyond the Gingival Margin: A Next-Generation Sequencing Analysis

We performed a comprehensive microbiome analysis of root caries lesions using 22 teeth extracted from patients with severe periodontitis. The carious lesions were mechanically collected and cryo-pulverized following tooth extraction. Differences in the microbiome were compared between independent lesions at the supragingival site (SG) and lesions extending beyond the gingival margin (GCB). DNA was extracted and the microbiome was characterized on the basis of the V3-V4 hypervariable region of the 16S rRNA gene using paired-end sequencing on an Illumina MiSeq device. The microbiota in root caries lesions showed compositionally distinct microbiota depending on the location. The most abundant OTUs in the SG group were Streptococcus (26.0%), Actinomyces (10.6%), and Prevotella (7.6%). GCB presented Prevotella (11.1%) as the most abundant genus, followed by Fusobacterium (9.6%) and Actinomyces (8.7%). The SG group showed a lack of uniformity in microbiota compared with the GCB group. The bacterial profiles of GCB varied considerably among patients, including periodontal pathogens such as Porphyromonas, Selenomonas, Filifactor, Peptococcus, and Tannerella. Periodontal pathogens inhabit root caries lesions that extend beyond the gingival margin. This study provides a new perspective for elucidating the microbial etiology of root caries.

Effect of TiF4/NaF and chitosan solutions on biofilm formation and prevention of dentin demineralization

OBJECTIVE

This study evaluated the effect of experimental solutions containing TiF₄/NaF and chitosan on bacterial species of microcosm biofilm and on dentin demineralization.

DESIGN

Microcosm biofilm was produced from human saliva mixed with McBain medium (0.2% sucrose) on bovine dentin for 5 days, under 5% CO₂ and 37 °C. From the 2nd day to 5th day, the treatments were applied (1×60s/day) as following: (1) NaF (500 ppm F^-, positive control); (2) TiF₄ and NaF (TiF₄: 190 ppm Ti⁴⁺ and 300 ppm F^-; NaF: 190 ppm F^-); (3) similar to 2 plus 0.5% chitosan (Ch 500 mPa.s, 75% deacetylation); (4) phosphate buffer solution (negative control); and (5) 0.5% chitosan (Ch 500 mPa.s, 75% deacetylation). CFU counting was performed for total microorganism, total streptococci, total lactobacilli and mutans streptococci. Dentin demineralization was measured by transverse microradiography-TMR. The data were compared using ANOVA/Tukey or Kruskal-Wallis/Dunn tests (p < 0.05).

RESULTS

No differences were found between the treatments with respect to CFU counting (p > 0.05). Dentin treated with TiF₄/NaF plus chitosan solution presented the lowest demineralization compared to the negative control and pure chitosan solution. On the other hand, this experimental solution did not significantly differ from TiF₄/NaF solution, being both able to significantly reduce mineral loss.

CONCLUSION

TiF₄/NaF plus chitosan solution, at suitable pH to be clinically applicable, had no antimicrobial effect, but it was able to reduce dentin caries development under this model.

Ultrasonic measurement of dentin remineralization effects of dentifrices and silver diamine fluoride

OBJECTIVE

This study investigated the dentin remineralization effect of the application of a functionalized tri-calcium phosphate (fTCP) dentifrice and a silver diamine fluoride (SDF) solution.

MATERIAL AND METHODS

The materials used were: a fluoride-containing dentifrice with fTCP (fTCP＋), a fluoride-containing dentifrice without fTCP (fTCP-) and a 38% SDF solution. Following treatment, the dentin slabs were immersed in a 0.1-M lactic acid buffer solution and then placed in artificial saliva. This procedure was repeated three times daily for 28 days. The propagation time of longitudinal ultrasonic velocities (UV) and the Knoop hardness (KH) of the samples were measured. The samples were also observed using scanning electron microscopy.

RESULTS

The SDF and fTCP＋ groups showed higher UV than the fTCP - group regardless of the application method. The F-SDF group at 28 days showed significantly higher UV (4121 ± 102 m/s) than the F-fTCP + group (3731 ± 65 m/s) (p < .05). The F-SDF group at 28 days showed significantly higher KH (47.4 ± 2.2) than the F-fTCP＋ group (43.3 ± 1.0) and the F-fTCP - group (42.9 ± 2.1) (p < .05). Closure of the dentinal tubules and crystal precipitation was detected on the surface of the fTCP＋ group to a greater extent than the fTCP - group.

CONCLUSIONS

The fTCP-containing dentifrice and SDF solution effectively enhanced bovine dentin remineralization.

Common Medical and Dental Problems of Older Adults: A Narrative Review

The advancement of medicine has reduced the rate of mortality and older adult population is increasing. Among the 7,700,000,000 world population in 2019, 1 in 11 people were at the age of 65 or more. The population is expected to increase to 1 in 6 people by 2050. Older adults have degenerative changes that become more severe with age. This study used the World Health Organization’s websites and PubMed and Google Scholar databases to review current global oral and systemic health issues. Studies generally reported that many older adults have no regular dental checkup. Common oral diseases such as dental caries particularly root caries and periodontal disease are highly prevalent among them. These oral diseases are often interrelated with their systemic problems. A meta-analysis reported diabetes increases the incidence and progression of periodontitis by 86%. A decrease in salivary output is common among older adults having polypharmacy. A review reported the caries risk in older adults increases by 60% with low resting pH and low stimulated salivary flow rate. Many older adults suffer from dementia and depression which complicates the delivery of dental treatment. Proper oral hygiene practice and dental care at supine position are often difficult to be carried out if they have rheumatoid arthritis. With the increasing need of elderly dental care, dentists and other dental personnel should understand interlaced oral and general health in order to provide a successful dental care plan for older adults. The aim of this study is to give an overview of the common medical conditions and dental problems and their impacts on older adults.

Risk factors for dental caries in Latin American and Caribbean countries

Identifying the risk factors for dental caries is vital in epidemiology and clinical practices for developing effective preventive strategies, both, at the individual and collective levels. Different causality/determination models have been proposed to understand the development process of dental caries. In the present review, we designed a model inspired by the world-known social determinants models proposed in the 90s and more recently in the 10s, wherein the contextual factors are placed more externally and encompass the individual factors. The contextual factors included those related to the cultural and societal values, as well as the social and health government policies. The individual factors were classified into the following categories: socioeconomic (social class, occupation, income, and education level), demographic characteristics (age, sex, and ethnicity), behavioral factors (non-use of fluoride dentifrice, sugar consumption, poor oral hygiene, and lack of preventive dental care), and biological factors (recent caries experience/active caries lesions, biofilm retentive factors, developmental defects of the enamel, disabilities, saliva amount and quality, cariogenic biofilm). Each of these variables was addressed, while focusing on the current evidence from studies conducted in Latin American and Caribbean countries (LACC). Based on the proposed model, educational aspects were addressed, and individual caries risk assessment and management decisions were proposed; further, implications for public health policies and clinical practice were described. The identification of modifiable risk factors for dental caries should be the basis for multi-strategy actions that consider the diversity of Latin American communities.

Is there a preferable management for root caries in middle-aged and older adults? A systematic review

Aim This systematic review aimed to critically summarise the results of clinical studies investigating agents able to: stop the progression of carious lesions; stop the development of new root carious lesions; preserve the vitality of the infected dental tissues; and increase the surface hardness or change of surface texture, in middle-age and older adults.Methods PubMed, Scopus, and Web of Science were searched systematically, following PRISMA guidelines. Clinical trials published from 2011 to 2020 (March) were included. This systematic review is registered in the PROSPERO database (CRD42018104399). Languages were restricted to English.Results Thirteen of 312 studies were eligible for this review. Eight agents were identified in the studies and their efficacy was assessed using different methods. The agents that presented valuable results on preventing or arresting root caries were 38% silver diamine fluoride (SDF), arginine-containing toothpaste and high-fluoride toothpastes.Conclusions Based on the selected studies' findings, annual applications of 38% SDF could be the most effective treatment for root caries in older adults. In addition, the daily use of a 1.5% arginine toothpaste or a high-fluoride toothpaste could also be recommended. More research on root caries-specific diagnostic methods, especially at very early stages, is necessary.

Association between procrastination in childhood and the number of remaining teeth in Japanese older adults

BACKGROUND

Procrastination is associated with stress and unhealthy behaviors. The oral condition reflects the long-term history of an individual's stress exposure and oral health behaviors; however, empirical studies on the association of procrastination in childhood with remaining teeth in older age are limited. We investigated the association of procrastination in childhood with the number of remaining teeth among community-dwelling older Japanese adults.

METHODS

In total, 1616 community-dwelling senior residents of Wakuya City (Miyagi Prefecture, Japan) who were enrolled in the National Health Plan & the Medical Care System for the Elderly completed a self-administered questionnaire on the number of teeth. Procrastination was measured using a single binary question about timing of holiday homework completion in childhood. The number of remaining teeth was assessed via a questionnaire with response options of ≥20, 10-19, 1-9, and 0 teeth. Ordered logistic regression models with potential confounders (sex, age, maternal education, childhood socioeconomic status (SES), childhood maltreatment, conscientiousness trait) and mediators (adulthood SES, smoking history, alcohol use history) were estimated.

RESULTS

Forty-six percent of participants reported a higher tendency to procrastinate in childhood. The proportions of participants with ≥20, 10-19, 1-9, and 0 teeth were 39.6, 22.7, 24.0, and 13.7%, respectively. After adjusting for all covariates, a higher tendency to procrastinate in childhood was significantly associated with having fewer remaining teeth (odds ratio = 1.28; 95% confidence interval = 1.05-1.57).

CONCLUSION

A higher tendency to procrastinate in childhood was associated with having fewer remaining teeth in later life.

Perspective and practice of root caries management: A multicountry study - Part II: A deeper dive into risk factors

BACKGROUND

The potential of an improved understanding to prevent and treat a complex oral condition such as root caries is important, given its correlation with multiple factors and the uncertainty surrounding the approach/material of choice. Deeper insights into risk factors may improve the quality of treatment and reduce the formation of root surface caries.

AIM

The present work aims to gain knowledge about dentists' opinions and experiences on assessing the risk factor related to the development of root caries and to help identify any overlooked factors that may contribute to less efficacious clinical outcomes.

METHODOLOGY

A questionnaire related to root surface caries was distributed among practicing dentists in nine different countries, namely the United Kingdom, Libya, Jordan, Saudi Arabia, Egypt, Brazil, India, Malaysia, and Iraq. Questionnaire responses were analyzed, and the results were compared among the groups.

RESULTS

Dentists around the world ranked the oral hygiene status of patients as the most important factor in the development of root surface caries. Patients with poor oral hygiene, active periodontal disease, reduced salivary flow, and gingival recession are perceived to have a higher risk of developing new root surface caries. There is a greater focus on prevention in the UK and greater levels of untreated dental disease in other countries, especially those recovering from civil wars.

CONCLUSION

This work identified some overlooked factors that may have contributed to the less efficacious clinical outcomes reported in the literature. It is hoped that this deep dive into risk factors coupled with the findings presented in Part I of this study will be used as a basis for a more comprehensive investigation into the management of patients with root surface caries.

What are the main factors associated with root caries?

Data sources Medline, EMBASE, PubMed and Scopus databases were used as the data sources for the systematic review. Articles published between 1 January 1990 to 31 October 2018 were included with no language restrictions. A manual search of the references lists of the selected studies and review articles was conducted.Study selection Two independent researchers identified observational studies that investigated at least one risk factor of root caries in the study population. Studies were only included if they demonstrated statistical analysis of data on root caries, had a sample size of >100 and were in vivo. A third researcher was consulted to achieve consensus if there was disagreement. Methodological quality was evaluated via the modified Newcastle-Ottawa Scale for cross-sectional studies.Data extraction and synthesis Data was extracted and pooled into descriptive summary tables with study characteristics and results. Data on the presence and extent of root caries was recorded in addition to information on the relationship between the studied factors and root caries found in the unadjusted and adjusted data. Due to heterogeneity of key aspects among the included studies, meta-analysis was not conducted. Data were grouped under six categories - sociodemographic, general health behaviour, general health condition, fluoride exposure, oral health behaviour and oral health condition - and qualitatively analysed.Results Following screening of 984 articles, 62 were included in methodological quality assessment. Twenty-five were classified as moderate quality, 37 as low quality and 18 excluded. Of the 44 included articles which were qualitatively analysed, a higher association of dental caries was found in tobacco users and those with low socioeconomic status, gingival recession, poor oral hygiene and in older age groups.Conclusions Based on the present evidence, there are a number of factors associated with root caries. More high-quality observational analytical studies are needed in this field in future studies.

The Top 100 Most-Cited Papers in Cariology: A Bibliometric Analysis

A highly cited paper is seen as a landmark in any field and can influence both research and clinical practice. This study aimed to quali-quantitatively analyze the 100 most-cited papers in Cariology. A search strategy was first determined using specific keywords related to the field. A comprehensive search was then conducted in the Thompson Reuters Web of Science citation indexing database up to April 2019. Papers focused on any aspect of Cariology were included. A panel of 4 researchers conducted the selection of papers and extracted data on the number of citations, title, authors, country, year, journals, study design, and topic of interest. Scopus and Google Scholar were also searched to compare the number of citations. The VOSviewer software was used to generate bibliometric networks. The number of citations among the top 100 most-cited papers ranged from 168 to 1,961 with a mean of 292,66. Three papers had more than 1,000 citations. The Journal of Dental Research (20%) and Caries Research (17%) had more top papers. The oldest and the most recent papers were published in 1960 and 2015. Literature reviews (35%) and laboratorial studies (31%) were the most common study designs. The countries with the highest number of most-cited papers were the USA (40%), Sweden (10%), and Japan (9%). The most studied fields of interest were etiology/pathogenesis (41%) and prevention (20%). VOSviewer maps revealed collaborative networks between countries and organizations. The top 100 most-cited papers in Cariology were published mainly by European and Anglo-Saxon American authors and were composed mainly of literature reviews with etiology/pathogenesis as the most frequent topic of interest.

Status of dental caries and associated factors in Tibetan adults: findings from the fourth China National Oral Health Survey

Background

Tibet, a region where average elevation is above 3500 m and socio-economic development is relatively lower, was not included in National Oral Health Survey over decades. The cross-sectional study aimed to investigate the status of dental caries and associated factors in Tibetan adults.

Methods

Participants aged 35–44, 55–64 and 65–74 years were selected. Decayed, missing, and filled tooth (DMFT), decayed and filled root (DF-Root) and root canal index (RCI) were used to evaluate dental caries. Questionnaire survey on demographic information, socioeconomic status, dietary habits, and oral health knowledge and behavior was conducted. Mann-Whitney U test, logistic regression were used for the statistical analyses.

Results

A total of 446 participants were enrolled in the survey. Of these: 222 (49.8%) were females, 224 (50.2%) were males; 149 (33.4%), 151 (33.9%), 146 (32.7%) were aged 35–44, 55–64 and 65–74 years respectively. The mean DMFT (SD) was 7.62 (4.84), 12.46 (8.16), and 21.38 (8.93). The filling rate was very low in all age groups (1.77%, 0.98%, 0.45%). The mean DF-Root (SD) was 0.50 (1.04), 1.04 (2.02), 1.32 (2.14), respectively. Root caries index was 42.27, 44.78 and 57.60%. Older age (65–74 age group) was positively associated with crown caries (odds ratio = 31.20, 95% confidence interval: 10.70–90.96). College degree and above and brushing teeth at least once a day were negatively associated with crown caries (odds ratio = 0.28, 95% confidence interval: 0.09–0.89; odds ratio = 0.39, 95% confidence interval: 0.21–0.72, respectively). Rural area, high income level and brushing teeth at least once a day were negatively and tooth with attachment loss was positively associated with root caries.

Conclusions

The status of dental caries in the adults in Tibet is severe and the treatment rate is very low. The study suggests a correlation between crown caries and the variables age, level of education and frequency of tooth brushing; correlation between root caries and residence, income level, frequency of tooth brushing and exposed root surfaces. These findings could be as reference to develop community based interventions to reduce the prevalence of caries in Tibet.

National Study of Adult Oral Health 2017-18: root caries

BACKGROUND

The prevalence of root caries in Australia is expected to increase due to an ageing population and increase in tooth retention. This report presents findings from the Australian National Study of Adult Oral Health 2017-18.

METHODS

A stratified random sample of 15 731 Australians aged ≥15 years participated in a telephone or online survey. Of those, 5022 dentate people underwent an oral assessment. Carious root surfaces were defined as ≥1 mm of affected dentine/cementum. Prevalence was defined as the percentage with ≥one natural tooth with untreated caries on root surfaces. Severity was measured as the mean number of root surfaces with caries.

RESULTS

Prevalence of untreated root caries in the Australian adult dentate population was 8.2% and increased with increasing age (range 2%-17.8%). Men (9.3%) compared to women (7.2%), people living in remote (18.0%) versus regional (9.3%) and major cities (7.6%), and those with the lowest household income (15.4%) compared to middle (7.6%) and highest tertile (3.2%) had untreated root caries. The average number of decayed or filled root surfaces in the Australian adult population was 1.1 (95% CI 0.9, 1.2).

CONCLUSIONS

Root caries was associated with older age, living outside a major city and lower income.

Topical Fluoride to Prevent Root Caries: Systematic Review with Network Meta-analysis

The aim of this systematic review and network meta-analysis was to summarize the direct and indirect clinical evidence on the effectiveness of professionally applied and self-applied topical fluorides in preventing dental root caries. Controlled clinical trials with any follow-up duration were included. MEDLINE, PubMed, Embase, Scopus, and Cochrane Library were searched. Two reviewers independently carried out the selection of studies, data extraction, risk-of-bias assessments, and assessment of the certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Fixed effects model and frequentist approach were used in the network meta-analyses. Nine clinical trials involving 4,030 participants were included. Five professionally applied and 7 self-applied topical fluoride agents or combinations were included in the meta-analyses. Compared to control group, 38% silver diamine fluoride solution, 5% sodium fluoride varnish, and 1.2% acidulated phosphate fluoride reduced root caries increment after 2 y (ranging from 0.59 to 0.85 mean decayed or filled root [DF-root]). Fluoride mouth rinse and fluoride toothpaste, used alone or in combination, reduced root caries increment after 1 y (ranging from 0.29 to 1.90 mean DF-root). Among the professionally applied topical fluorides reviewed, an annually applied 38% silver diamine fluoride (SDF) solution combined with oral health education is most likely to be the most effective in preventing dental root caries. Among the reviewed self-applied topical fluoride methods, daily use of a 0.2% sodium fluoride (NaF) mouth rinse is most likely to be the most effective, followed by 1100 ppm to 1500 ppm fluoride toothpaste plus 0.05% NaF mouth rinse, and 1100 ppm to 1500 ppm fluoride toothpaste.

Factors associated with development of root caries in dentition without root caries experience in a 2-year cohort study in Japan

OBJECTIVES

To investigate factors associated with the development of root caries in dentition without root caries experience and interactive relationships between risk factors.

METHODS

We conducted surveys, consisting of an oral examination (oral hygiene, assessment of the number of teeth, coronal and root caries) and a self-reported questionnaire, among employees of a company in Tokyo, Japan in 2016 and 2018. Questionnaires collected data on smoking status, oral hygiene habits, sugar intake, and frequency of dental visits. Multiple logistic regression and decision tree analyses were used to determine factors associated with the development of root caries.

RESULTS

A total of 299 participants aged 25-63 years were included in the analysis. Males, older adults, smokers/past smokers had a significantly greater risk of developing root caries. The risk of developing root caries was significantly associated with the number of teeth with gingival recession at baseline (6-9 teeth, odds ratio [OR]: 7.69, 95 % confidence interval [CI]: 2.31-25.56; 10+ teeth, OR: 9.19, 95 % CI: 2.73-30.95, relative to ≤5 teeth); and with the number of coronal decayed and filled (DF) teeth (11-13 teeth, OR: 3.21, 95 % CI: 1.12-9.24; and ≥14 teeth, OR: 3.60, 95 % CI: 1.27-10.20, relative to ≤10 teeth). Other factors associated with root caries development differed according to the number of teeth with gingival recession and included drinking sugar-sweetened beverages, and the amount of toothpaste used.

CONCLUSIONS

Gingival recession and number of coronal DF teeth were associated with the development of root caries.

CLINICAL SIGNIFICANCE

Multiple factors are associated with root caries development. The effect of risk factors such as drinking sweetened beverages and less toothpaste use is greater in individuals with greater gingival recession and more coronal decayed and filled teeth. Dental practitioners should focus on modifiable risk factors to prevent root caries.