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

Assessment of the activity of root caries lesions using short wavelength infrared imaging - an in vitro pilot study

OBJECTIVES

New kinetic approaches that exploit differential water absorption appear to be more effective for assessing lesion activity on root surfaces using short wavelength infrared (SWIR) imaging. The aim of this pilot study was to employ multispectral time-resolved SWIR imaging to assess the activity of root caries.

METHODS

A SWIR imaging array and SWIR light sources at 1040 and 1470 nm were used to assess the activity of ten arrested and ten active root caries lesions on extracted teeth during forced air drying for 60 s. Cross-polarization optical coherence tomography (CP-OCT) was used to assess the presence of a highly mineralized transparent surface zone that was used to indicate lesion activity. Thermal imaging of matching lesion areas was also used for comparison. Multiple kinetic parameters were extracted from the time vs intensity SWIR dehydration curves and used to assess lesion activity.

RESULTS

Kinetic parameters extracted from the SWIR dehydration curves showed large and significant differences between active and arrested lesion areas. The ratio of the means of the exponential decay constant for the time vs intensity 1040/1470 difference curves between active and arrested lesions was highest and it was similar to the ratio measured for the heat loss using thermal imaging.

CONCLUSIONS

This study demonstrates that time-resolved SWIR reflectance imaging has great potential for the assessment of lesion activity on root surfaces in addition to other tooth surfaces.

CLINICAL SIGNIFICANCE

Improved methods for the assessment of lesion activity are expected to reduce the number of unnecessary cavity preparations.

Zirconia-reinforced glass ionomer restorations in molar incisor hypomineralization: a randomized controlled clinical trial

OBJECTIVES

This study aimed to evaluate the effectiveness of zirconia-reinforced glass ionomer (ZrGI), in reducing pain and sensitivity, and to assess its clinical success in comparison to glass-hybrid glass ionomer (GhGI) in hypomineralized permanent first molars (HPFM) following the Atraumatic Restorative Treatment (ART) approach.

MATERIALS AND METHODS

This randomized controlled clinical trial included 7-10-year-old children. Eighty-eight HPFMs with evidence of caries, with or without hypersensitivity were included. These molars scored (2a), (2b), (4a), or (4b) according to the MIH Treatment Need Index (MIH-TNI). Selective caries removal was performed using the ART protocol. The test group received ZrGI (Zirconomer®) restorations, and the control group received GhGI (Equia Forte®) restorations. Pain and sensitivity were assessed pre-operatively, using the Visual Analogue Scale (VAS), then re-assessed post-operatively after 1 week and after 3,6,9, and 12 months (M). Clinical success was evaluated, starting from the 3-month visit, using the ART evaluation criteria.

RESULTS

After 12M, the median pain scores for the ZrGI gp., (Q1-Q3; 0.00 - 0.00) and GhGI gp., (Q1-Q3; 0.00 - 0.00) showed no statistically significant difference, (p = 0.329). Median sensitivity scores for the ZrGI gp., (Q1-Q3; 0.00 - 5.00) and the GhGI gp., (Q1-Q3;0.00 - 3.50), also showed no statistically significant difference, (p = 0.344). No significant difference was found between the 12M success rate of ZrGI (86.4%) and GhGI (84.1%), (p = 0.765).

CONCLUSION

Regarding the reduction of pain and sensitivity, and clinical success, zirconia-reinforced GIC was as effective as glass hybrid GIC in restoring HPFM, using the ART approach.

CLINICAL SIGNIFICANCE

Zirconia-reinforced glass ionomer cement may be a promising restorative material due to its favorable physical properties and acceptable clinical results, as shown in this study. It may be used as an interim restoration in hypomineralized permanent first molars and holds potential for even wider applications in clinical pediatric dentistry.

TRIAL REGISTRATION

Please refer to this study by its ClinicalTrials.gov identifier: NCT05494749.

Longitudinal assessment of factors associated with dental caries on the first permanent molars: a prospective clinical study in Brazilian children

PURPOSE

The first molars are frequently the first permanent teeth to erupt in the oral cavity, and their premature loss can significantly affect a child's oral health. This study aimed to identify determinants of dental caries on the first permanent molars among schoolchildren.

METHODS

A longitudinal study was conducted with 122 mother-child pairs from the Brazilian city of Diamantina. The children were evaluated at three instants: first, between 1 and 3 years of age (T1), then, 3 years after the initial assessment (T2), and finally, 6 years after the initial assessment (T3). Socioeconomic data, child habits, visible plaque, and dental caries (assessed through International Caries Detection and Assessment System [ICDAS-II]) were collected at all three time points.

RESULTS

The incidence of dental caries in the first permanent molars was 70.5% and was associated with the presence of caries at T1 (RR = 1.41; 95% CI 1.08-1.84) and T2 (RR = 1.58; 95% CI 1.12-2.22). The following variables at both T1 and T2 were also significantly associated with caries incidence: a high number of income dependents (RR = 1.66; 95% CI 1.17-2.35) and low brushing frequency (RR = 1.77; 95% CI 1.27-2.46). Yet, the persistence of low brushing frequency from T2 to T3 (RR = 1.32; 95% CI 1.05-1.65) was also associated with the incidence of caries.

CONCLUSIONS

The incidence of dental caries in the first permanent molars was associated with prior caries experience, low toothbrushing frequency, and schoolchildren belonging to families with a high number of income dependents. These findings highlight the importance of early preventive interventions and socioeconomic considerations in addressing childhood dental caries.

Individual and contextual factors associated with orofacial dysfunction in schoolchindren

To investigate individual and contextual factors associated with orofacial dysfunction in schoolchildren. A cross-sectional study was conducted with 739 children eight to ten years of age. The children answered questionnaires addressing orofacial dysfunction and anxiety. Guardians provided information on sociodemographic characteristics, sleep disturbances, and family cohesion. Examiners investigated the presence of orofacial dysfunction, dental caries, malocclusion, and traumatic dental injuries (Andreasen criteria) (Kappa>0.80). The type of school and average monthly income of the school neighborhood were the contextual variables. Descriptive statistics were performed to characterize the sample. Unadjusted and adjusted (p <0.05) multilevel Poisson regression models were run. The prevalence of orofacial dysfunction was 33.3%. After adjustment by the contextual variables, a lower family income, a larger quantity of carious teeth, the presence of traumatic dental injury, severe/very severe malocclusion, the presence of sleep disturbances, and anxiety remained associated with orofacial dysfunction, whereas definite malocclusion was a protection factor. In terms of context, attending a public school was associated with orofacial dysfunction. Orofacial dysfunction was influenced by a lower family income, a larger quantity of carious teeth, and the presence of traumatic dental injury, sleep disturbances, and anxiety. Moreover, attending a public school was the contextual determinant that played a significant role in the outcome.

A prospective randomized clinical trial and an in vitro evaluation of the microtensile bond strength of a chlorhexidine-containing dentin bonding agent and a bulk fill composite material in primary teeth

OBJECTIVES

This study aimed to assess the microtensile bond strength of a chlorhexidine-containing dentin bonding agent compared with a standard adhesive, and to investigate its clinical success in Class II cavities in primary teeth, with a 12-month follow-up.

MATERIALS AND METHODS

The study consisted of two parts: a prospective, single-blind, split-mouth randomized controlled clinical trial and an in vitro laboratory evaluation. Ethical approval were obtained for the both parts of the study. Forty pediatric patients (aged 5-9 years) with primary molars requiring Class II restorations were included in the clinical trial, where bulk-fill restorations bonded with a chlorhexidine-containing adhesive and a standard adhesive were evaluated based on FDI criteria at 3-month intervals for 12 months. he in vitro study examined the microtensile bond strength (µTBS) of immediate and thermally aged specimens prepared with bulk-fill composite materials and adhesives with or without chlorhexidine.The data were analyzed using Mann Whitney U test for in-vivo, ANOVA test followed by Tukey's post hoc and Chi-square test for in-vitro study (p = 0.05).

RESULTS

Clinically, both adhesives showed similar success rates (%100) across all FDI evaluation parameters after 12 months (p > 0.05). The chlorhexidine-containing adhesive demonstrated significantly higher microtensile bond strength than the standard adhesive in both immediate and aged samples (p < 0.05).

CONCLUSIONS

The chlorhexidine-containing adhesive showed promising clinical success and improved bond strength compared to the standard adhesive. Longer follow-ups are needed to confirm its long-term durability."Incorporating chlorhexidine simplifies restorative procedures without compromising performance.

CLINICAL RELEVANCE

Chlorhexidine-containing adhesives may improve bond durability and procedural efficiency in pediatric dentistry, offering a practical and effective alternative for restoring primary molars.

TRIAL REGISTRATION

Invivo part of the study was registered in a public trial registry, www.

CLINICALTRIALS

gov (#NCT06257108). Registration Date 2nd. May 2024 (Retrospectively registered).

Causal effect of molar incisor hypomineralisation on oral health-related quality of life of Australian children aged 7-16 years

PURPOSE

Molar incisor hypomineralisation (MIH) is a qualitative defect of enamel characterised by demarcated opacities. Aesthetic and functional sequelae of MIH may manifest as reduced oral health related quality of life (OHRQoL). This study aims to investigate the impact of the presence and severity of MIH on children's OHRQoL.

METHODS

This cross-sectional study recruited children aged 7-16 years-of-age attending specialist paediatric dental clinics in Melbourne, Australia. Clinical examination utilised the modified European Academy of Paediatric Dentistry index to quantify the presence and severity of MIH. OHRQoL data was collected via the Child Perception Questionnaire, Parent-Caregiver Perception Questionnaire and Family Impact Statement. Causal analysis used quantile regression and included poor medical health as a confounding variable. Sensitivity analysis used the same model and different strata of MIH lesion location and severity.

RESULTS

131 participants with complete self-reported OHRQoL data were included in the causal analysis. The estimated average causal effect after adjusting for poor medical health showed the estimated difference in medians of child-reported OHRQoL was 6 (CI = 2.62, 12.25, p = 0.02) in the MIH group compared to the unaffected group. The estimated difference in medians of self-reported OHRQoL after adjusting for poor medical health was 7 (CI = 1.87, 11.99, p = 0.01) for severe MIH group and - 1 (CI = - 5.16, 3.62, p = 0.63) for the mild group compared to those unaffected. The estimated difference in medians of self-reported OHRQoL after adjusting for poor medical health was 5.16 (CI = - 2.42, 10.99, p = 0.15) for participants with MIH-affected incisors compared to the rest of the cohort.

CONCLUSIONS

MIH impacts children's OHRQoL as reported by self and parent/caregiver.

Disadvantage starts early: academy football has high levels of oral disease

ABSTRACT

Objectives

We have previously reported high levels of oral disease in professional senior team footballers in England and Wales. In this study, we aimed to determine the prevalence of oral disease in professional academy footballers, to identify if problems start earlier and to inform health promotion strategies.

Method

Professional academy football clubs in England (footballers aged 16-18 years) were invited to participate. Questionnaires were used to collect oral health behaviours and self-reported impacts and validated clinical outcomes to assess oral health.

Results

160 academy footballers were recruited from 10 English academy football clubs, of whom 86.8% (n=139) were men and 13.2% (n=21) were women, with a median age of 16.9 years. We identified high levels of oral disease: 31.2% (n=50) had dental caries requiring treatment; 76.8% (n=123) had gingivitis; and 22.5% (n=36) had periodontitis. Tooth wear affecting up to at least 50% of tooth structure was present in 15.5% (n=25) of participants. While 76.2% (n=122) self-reported brushing their teeth twice a day, 15.5% (n=25) brushed once or less a day and 21% (n=34) had not attended the dentist for >2 years. There was a general perception that oral health issues impacted the sporting performance of participants.

Conclusion

In this study, the prevalence of oral diseases among professional academy footballers in England was high and greater than found in national surveys of a similar age demographic. Urgent action is needed to embed oral health promotion in development and youth football, to reverse and prevent the disadvantages that will have lifelong consequences for treatment burden, quality of life and sporting performance.

Glass ionomer fissure sealants versus fluoride varnish application on children's behaviour: a randomised controlled trial

PURPOSE

Glass ionomer fissure sealant (GIS) and fluoride varnish (NaFV) are two preventive interventions applicable to pre-school children. However, their application effects on young children's behaviour are understudied. The study compared the effects of GIS and NaFV applications on dental anxiety (DA), cooperativeness and pain level in pre-school children when applied to primary second molars in outreach settings.

METHODS

Four hundred and thirteen children were recruited for the study, out of which 228 were allocated to NaFV group whilstand 185 allocated to the GIS group. One calibrated examiner screened and randomly allocated the children into either group. Another calibrated examiner recorded the children's DA level and cooperativeness with Frankl Behaviour Rating Scale (FBRS) and Venham Behaviour Rating Scale (VBRS) throughout the treatment period. Subjects self-reported their pain levels using Wong-Baker Faces Scale (WBFS).

RESULTS

Significant difference in postoperative anxiety was found using VBRS, with children in NaFV group having more positive scores post-treatment (p = 0.016). Only the type of preventive interventions significantly affected postoperative DA and patient cooperation (p = 0.032), whereas no other clinical findings and socio-demographic factors significantly influenced the children's behaviour postoperatively.

CONCLUSION

NaFV application is associated with less DA and more cooperative behaviour in pre-school children compared to GIS application although similar pain levels were recorded.

Global Research Trends in the Detection and Diagnosis of Dental Caries: A Bibliometric Analysis

This study aims to provide an overview of the global research trends in the detection and diagnosis of dental caries in the past 20 years. A literature search was conducted in the Scopus Database to retrieve studies on the diagnostic approaches for dental caries published from January 2003 to December 2023. The diagnostic approaches in the retrieved studies were examined and the studies were categorized according to the diagnostic approaches investigated. Bibliometric data including journals, countries, affiliations, authors, and numbers of citations of the publications were summarised. The publications' keyword co-occurrence was analysed using VOSviewer. This bibliometric analysis included 1879 publications investigating seven categories of caries diagnostic approaches, including visual and/or tactile (n = 459; 19%), radiation-based (n = 662; 27%), light-based (n = 771; 32%), ultrasound-based (n = 28; 1%), electric-based (n = 51; 2%), molecular-based (n = 196; 8%) diagnostic approaches, as well as AI-based diagnostic interpretation aids (n = 265; 11%). An increase in the annual number of publications on caries diagnostic approaches was observed in the past 20 years. Caries Research (n = 103) presented the highest number of publications on caries diagnostic approaches. The country with the highest number of publications was the United States (n = 1092). The University of São Paulo was the institution that published the highest number of articles (n = 195). The publication with the highest citation has been cited 932 times. VOS viewer revealed that the most frequently occurring keywords were 'Deep Learning', 'Artificial Intelligence', 'Laser Fluorescence' and 'Radiography'. This bibliometric analysis highlighted an emerging global research trend in the detection and diagnosis approaches for dental caries in the past 20 years. An evident increase in publications on molecular-based caries diagnostic approaches and AI-based diagnostic interpretation aids was perceived over the last 5 years.

Validating Caries Risk Assessment Tools in High-Prevalence Filipino Toddlers

INTRODUCTION AND AIMS

Caries risk assessment is an essential part of the diagnostic process. Many studies have assessed these tools, proving their effectiveness in reducing future caries risk in developed countries with low caries prevalence. However, Filipino children have consistently registered high caries prevalence rates in successive official surveys. This prospective study aimed to compare the validity of available caries risk assessment tools in predicting future caries among a high-caries-prevalent population in the Philippines.

METHODS

From the vaccination registry of community health centres in Caloocan City, Philippines, children aged 4-24 months underwent oral examinations according to modified International Caries Detection and Assessment System (ICDAS) criteria, and their primary caregivers were interviewed using a structured questionnaire. Baseline caries risk categories were evaluated using 3 available tools, without biological tests. Caries incidence was recorded during the follow-up visit after 2 years.

RESULTS

Baseline oral examinations in 703 toddlers (mean age: 13.3 months, standard deviation (SD) 2.4) revealed a high caries prevalence of 29.2%. Of the 654 eligible children without cavitated caries at baseline, 323 (mean age: 35.6 months, SD 5.1) attended the 2-year follow-up visit, with a caries incidence (cavitated and non-cavitated) of 76.5%. Caries-risk Assessment Form (CrAF) demonstrated high sensitivity but low specificity scores (93.1% and 3.9%), while Caries Management by Risk Assessment (CAMBRA) showed similar patterns (71.7% and 34.2%). Conversely, Cariogram exhibited low sensitivity but high specificity (23.5% and 80.3%).

CONCLUSION

Among CrAF, CAMBRA or Cariogram, no assessment tool came close (sensitivity + specificity < 160) to effectively identify toddlers highly at risk of caries development.

CLINICAL RELEVANCE

Current CRA tools lack sufficient accuracy in predicting caries development in high-risk populations like Filipino children. Refinement or development of more valid tools is crucial for implementing effective caries prevention strategies at both individual and population levels.

Comparative evaluation on the masking ability of different tooth colored restoration over blackish discoloration caused by 38% silver diamine fluoride: an in -vitro study

BACKGROUND

The application of Silver diamine fluoride is an effective approach in controlling dental caries. But the black discoloration caused by its application is unaesthetic and is of greater concern to the parents.

AIM

To assess the potential color masking ability of tooth colored restorative material over discoloration caused by 38% SDF using a UV‒VIS-NIR spectrophotometer.

MATERIAL AND METHODS

20 extracted teeth were taken and randomly divided into 4 groups: Group A: 38% SDF + GIC; Group B: 38% SDF + RMGIC; Group C: 38% SDF+ Composite; Group D: 38% SDF+ Cention N. Two readings were recorded, one on application of 38% SDF and second after application of test materials using a UV‒VIS-NIR spectrophotometer.

RESULT

The intragroup comparison for color masking ability (ΔE) for all four restorative materials revealed no statistically significant differences, with a test value of 1.168 and a p value of 0.353, and the highest mean was observed in Group A, i.e., 38% SDF + GIC (9.171966) Significant differences in color were observed, with more shifts toward yellow in group A (2.488 ± 2.957) and group D (1.686 ± 0.559) and more shifts toward green in groups B (-0.088 ± 0.34) and C (-0.062 ± 0.5). The mean lightness was greatest for Group C, i.e., the composite group (86.396 ± 3.741), and least for Group A, i.e., the GIC group (76.664 ± 8.213).

CONCLUSION

All 4 restorative materials were equally effective in terms of color masking over 38% SDF discoloration.

Assessment of the correlation between fluorescence-featured intraoral scanner, laser fluorescence and spectrophotometric analyses in caries-affected dentin: an in-vitro diagnostic accuracy study

To investigate the relation between the caries scoring system of the fluorescence intraoral scanner (IOS) Trios 4 (3Shape, Denmark)a red laser light-induced fluorescence device DIAGNOdent Pen (Kavo, Germany), and the color parameters (L*a*b*) by a clinical contact type hybrid spectrophotometer Rayplicker (Borea, France) in the assessment of caries affected dentin tissue. Caries lesions were minimally invasively removal from 186 extracted molars. Teeth were scanned using Trios4, and the integrated software scored the cavity floor regarding the colors (yellow, initial caries; red, moderate-extensive caries) depending on the fluorescence features. Then the DIAGNOdent measurements were obtained from each cavity's deep and discolored surface points following the previously obtained Trios4 colors. Thus, the Trios4 reading could be quantitatively assessed. Cross-polarization photographs were using the Rayplickerand L*a*b color parameters, and 3D Master (VITA) color mapping was obtained by using the RayPlicker's software. Spearman's Rho Correlation, Kappa, Mann Whitney-U, One-way Analysis-of-Variance, and Kruskal Wallis tests were used for the statistical analyses (P < 0.05). Sensitivity, specificity and AUC were calculated. Trios4 and DIAGNOdent were positively correlated (r = 0.733;P < 0.001). The L*parameter by Rayplicker and Trios4 was negatively correlated(r=-0.742;P < 0,001). The a*parameter by Rayplicker and Trios4 scoring positively correlated(r = 0.552;P < 0.001). No significant correlation was observed between b*parameter by Rayplicker and Trios4 (r = 0.023; P = 0.760). DIAGNOdent readings according toTrios4 scorings were significant (P < 0.001). The teeth without caries scored by the Trios4 corresponded to the median value of 29 in DIAGNOdent readings, and 88 for the teeth with caries (by Trios4 / yellow-red). The agreement between the Trios4 and DIAGNOdent was 52.2% for the specimens with no residual caries. The presence of caries scores by the Trios 4 corresponded to the DIAGNOdent readings of %100 for all the teeth evaluated. Regarding the RayPlicker assessments, 33% of the sound cavities corresponded to 2M3 color, and 73% corresponded to 5M3 color. Trios4 scorings presented 0.782 AUC, 56.30% sensitivity, and 100% specificity in DIAGNOdent reference. Trios4 scoring was considered coherent with the DIAGNOdent Pen. DIAGNOdent readings and the Level of L* and a* parameters in the dentin tissue might be considered interrelated. Fluorescence-featured scanner devices can be useful clinical tools to evaluate remaining dentin tissue during the caries removal procedure.

Determinant Factors of Dental Pain in Preschool Brazilian Children: Three-Year Cohort

BACKGROUND

Dental pain is a public health problem that exerts a negative impact on the quality of life of children.

AIM

To determine the causal factors of dental pain in preschool children.

DESIGN

A prospective cohort study was conducted with a random sample of 151 children aged from one to three and their parents/guardians for a period of 3 years in Brazil. Dental pain was investigated using the Brazilian version of the Dental Discomfort Questionnaire (DDQ-B) at baseline and follow-up for the calculation of incidence. The participants were examined clinically for dental caries using the International Caries Detection and Assessment System (ICDAS) and traumatic dental injury was investigated using the criteria proposed by Andreasen. Sociodemographic, economic and food consumption characteristics were investigated during baseline and in the three-year follow-up. Data analysis involved descriptive statistics and Poisson regression analyses.

RESULTS

The incidence of dental pain was 14.6%. The incidence of caries (RR = 3.47; 95% CI: 1.05-11.47) and the absence of dental treatment (RR = 2.81; 95% CI: 1.33-5.97) were associated with a higher incidence of dental pain.

CONCLUSION

The incidence of dental caries and the lack of dental treatment recommended at baseline were risk factors for a greater incidence of dental pain in preschool children.

In vivo comparison of initial caries lesions using the enamel decalcification index and quantitative light-induced fluorescence measurement during orthodontic therapy

OBJECTIVES

To compare two quantitative assessment methods - visual-tactile examination and fluorescence measurement - for detecting of initial caries lesions in adolescents undergoing treatment with a multibracket appliance (MB).

MATERIALS AND METHODS

This study included 28 subjects (14 males, 14 females), treated with MB in both the maxilla and mandible. Data collection occurred at three times points: prior to treatment (T0), six months after MB insertion (T1), and one year post-insertion (T2). The Enamel Decalcification Index (EDI; 0-3 scale) and quantitative light-induced fluorescence (QLF) were employed for assessment.

RESULTS

At T0, four subjects (14%) exhibited no lesions, while only two (7%) remained lesion-free at T1, and again at T2. The kappa coefficient for agreement between the two diagnostic methods across all time points was 0.71.

CONCLUSIONS

Both the QLF and EDI methods yielded similar results, with only minor discrepancies. To determine the most appropriate method for each individual case, considerations of cost, benefit and time should be made.

CLINICAL RELEVANCE

The similarity in outcomes for the QLF and EDI methods indicates that both diagnostic methods are effective and reliable. However, QLF may be prone to interference, which must be accounted for during its application.

Risk prediction models for dental caries in children and adolescents: a systematic review and meta-analysis

OBJECTIVE

This study aimed to systematically evaluate published predictive models for dental caries in children and adolescents.

DESIGN

A systematic review and meta-analysis of observational studies.

DATA SOURCES

Comprehensive searches were conducted in PubMed, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database (VIP) and SinoMed for relevant studies published up to 18 January 2024. The search focused on caries prediction models in children and adolescents.

ELIGIBILITY CRITERIA

Eligible studies included observational research (cohort, case-control and cross-sectional designs) that developed risk prediction models for dental caries in children and adolescents aged ≤18 years. Each model was required to include a minimum of two predictors. Studies were excluded if they were not available in English or Chinese, primarily focused on oral microbiome modelling, or lacked essential details regarding study design, model construction or statistical analyses.

RESULTS

A total of 11 studies were included in the review. All models demonstrated a high risk of bias, primarily due to inappropriate statistical methods and unclear applicability resulting from insufficiently detailed presentations of the models. Logistic regression, random forests and support vector machines were the most commonly employed methods. Frequently used predictors included fluoride toothpaste use and brushing frequency. Reported area under the curve (AUC) values ranged from 0.57 to 0.91. A combined predictive model incorporating six caries predictors achieved an AUC of 0.79 (95% CI: 0.73 to 0.84).

CONCLUSIONS

Simplified predictive models for childhood caries showed moderate discriminatory performance but exhibited a high risk of bias, as assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Future research should adhere to PROBAST guidelines to minimise bias risk, focus on enhancing model quality, employ rigorous study designs and prioritise external validation to ensure reliable and generalisable clinical predictions.

PROSPERO REGISTRATION NUMBER

CRD42024523284.

Performance of atraumatic restorative treatment in primary care: A study in the elderly with home-based dental care

OBJECTIVE

To assess the performance of atraumatic restorative treatment (ART) in primary care among an elderly population in need of home-based dental care.

METHODOLOGY

It is an observational clinical study, more specifically a descriptive cohort study. The status of these restorations was evaluated1 year after placement. The analysis of ART's clinical performance was conducted through the direct clinical evaluation method, following criteria previously defined in earlier studies. Data were tabulated into sets of descriptive categories, allowing classification into a frequency distribution according to the evaluation score. Success and failure results underwent statistical evaluation using the chi-square test, with a significance level set at 5%.

RESULTS

Elderly individuals (n = 35) participated in the study, where 103 restorations were performed in the home environment. The majority of participants were women (68.6%) with an average age of 72.3 years, and 54.3% faced difficulties in motor mobility. All received dental care exclusively at home, and 45.7% used dentures. There was a statistically significant difference (p = 0.0156) between the percentage of failures and successful cases (73.8%) without the need for ART replacement. The majority of ART interventions were on occlusal surfaces (44.9%), showing the highest percentage of restorations in good condition (84.8%), followed by mesio-occlusal (81.3%), while disto-occlusal cavities exhibited the highest failure rate (38.4%).

CONCLUSION

The ART demonstrates satisfactory survival rates in elderly patients after 1 year. This restoration can be a viable alternative for the treatment of older adults, especially in situations that require domiciliary dental care.

Household income trajectory effect on oral health-related quality of life during the transition from childhood to adolescence

OBJECTIVE

To measure the effect of household income trajectory on oral health-related quality of life (OHRQoL) during the transition from childhood to adolescence over 10-years.

METHODS

This cohort study assessed 639 children aged 1-5 years in 2010 in Santa Maria, southern Brazil. After 10 years, the same participants were re-evaluated. Familiar household income was collected in both assessments. Four groups with different income trajectories were created by cluster analysis: "stable low income", "decreasing income", "increasing income", and "stable high income". OHRQoL was measured at follow-up using the short version of CPQ11-14. Demographic, and oral health-related information were also collected. A negative binomial regression analysis with robust variance was conducted.

RESULTS

A total of 351 (54.9 % of the original sample) participants with household income data at the baseline and follow-up were analyzed. Socioeconomic mobility and income remained the same for most of the participants over the 10 years. Participants belonging to the "stable high income" category presented 37 % less risk of having a worse OHRQoL than participants belonging to the "stable low income" category. Groups that experienced changes in their income trajectories did not show significant changes in OHRQoL.

CONCLUSIONS

Individuals with stable high income over time were protected from having impacts on their OHRQoL. Worsening or improvement in income over time do not influence OHRQoL.

CLINICAL SIGNIFICANCE

Our findings indicate that socioeconomic factors impact subjective patient outcomes, which are considered a fundamental aspect of clinical practice.

Training protocol and calibration of the International Caries Detection and Assessment System in a school-based clinical trial of elementary school-age children

OBJECTIVES

This paper demonstrates International Caries Detection and Assessment System (ICDAS) training procedures and inter/intra-examiner reliability for lesion severity, activity, and filling criteria in an elementary school setting.

METHODS

ICDAS training was conducted in December 2021 prior to a school-based cluster-randomized controlled trial. A total of 59 children (6-8 years old) in grades 1-2 from one school in Houston, Texas were recruited. Two licensed dentists received a 5-day training from an ICDAS trainer at the participating school. Thirty-eight children were evaluated at least once by each dental trainee, and 18 had repeat examinations. The ICDAS criteria were used to classify dental caries lesion severity (0-6), lesion activity (active/inactive), and filling material (0-9) of all visually available primary and permanent tooth surfaces. Inter and intra-examiner reliability between each dental trainee and the "gold standard" trainer was evaluated using Kappa statistics.

RESULTS

For lesion severity, the examination indicated an inter-rater weighted Kappa of 0.77 (95% CI 0.71-0.82) and 0.82 (95% CI 0.77-0.87) for each trainee examiner compared to the gold standard examiner. The Kappas increased slightly from the first to second examinations (lesion-weighted Kappa: 0.76 to 0.84 and 0.82 to 0.84). The intra-rater reliability indicated excellent reliability for lesion and filling (0.83 to 0.94) and moderate for activity (0.58).

CONCLUSIONS

ICDAS training/calibration were essential to ensure accuracy and reliability of dental caries measurements. The study demonstrated that ICDAS training of dentists with no prior criteria experience is feasible in a community setting and can lead to high reliability and repeatability.

Dietary Factors and Dental Caries among Adolescents: Eight-Year Follow-up Study

OBJECTIVE

The aim of this study was to conduct a longitudinal investigation of the associations between changes in dietary factors and changes in caries experience among Finnish children and adolescents participating in the Physical Activity and Nutrition in Children (PANIC) study.

METHODS

Among 487 children included at baseline at the age of 6 to 8 y, 406 were reexamined at 2-y follow-up and 202 at 8-y follow-up. Food consumption, nutrient intake, and eating frequency were assessed using 4-d food records; diet quality was assessed using the Baltic Sea Diet Score; and eating behavior was evaluated using the Children's and Adult's Eating Behaviour Questionnaires. At baseline and 2-y follow-up, caries findings were recorded using the World Health Organization guidelines and at 8-y follow-up using the International Caries Detection and Assessment System criteria. Generalized linear mixed-effects regression analyses were used.

RESULTS

Over 8 y from childhood to adolescence, improved diet quality (β = -0.017, P = 0.046) and increased consumption of butter and butter-oil mixtures (β = -0.009, P = 0.044) were associated with decreased caries experience. Increased number of snacks (β = 0.072, P = 0.032), increased consumption of sour milk products (β = 0.001, P = 0.039) and salty snacks (β = 0.006, P = 0.010), and increased calcium intake (β = 2.41 × 10-4, P = 0.022) were associated with increased caries experience. However, the latter association was explained by the consumption of sour milk products (β = 1.88 × 10-4, P = 0.090). Increased enjoyment of food was associated with decreased caries experience (β = -0.121, P = 0.046), and increased slowness in eating (β = 0.113, P = 0.051) and food fussiness (β = 0.140, P = 0.009) were associated with increased caries experience.

CONCLUSIONS

A healthy diet is vital for oral health among children and adolescents. Dietary behaviors developing from childhood to adolescence seem to be associated with caries experience in adolescence. Dietary counseling aimed at improving dental health from childhood to adolescence should include avoiding frequent snacking, strengthening healthy eating behavior, and composing good overall diet quality.

KNOWLEDGE TRANSFER STATEMENT

Results of this longitudinal study showed how crucial a healthy diet is for oral health among growing children. Eating behaviors and enjoyment of food play also a role in maintaining good oral health. Research results can be used when planning dietary recommendations and health education for children and adolescents.

Structural equation modeling of the association between oral health literacy and dental caries in children

The aim of this study was to explore the association between oral health literacy (OHL) and dental caries in children, evaluating the direct and indirect effects of brushing frequency, obesity, and socioeconomic factors. A cross-sectional study was conducted with 739 schoolchildren aged eight to ten years and their parents/caregivers who answered a questionnaire addressing sociodemographic characteristics and oral hygiene habits as well as the OHL - Adult Questionnaire. Cavitated dental caries in the schoolchildren was evaluated using International Caries Detection and Assessment System criteria. Descriptive analysis was performed, followed by structural equation modeling into the theoretical model (95% CI). Goodness-of-fit indices were considered satisfactory (root mean square error of approximation < 0.06; comparative fit index > 0.90-0.95; standardized root mean square residual < 0.10 and Tucker-Lewis Index > 0.90-0.95). Mother's age (standardized coefficient [SC]: -0.08; p < 0.01), caregiver's schooling (SC: -0.22; p < 0.01), obesity (SC: 0.13; p < 0.01), and brushing frequency (SC: -0.09; p < 0.01) had a direct effect on dental caries, whereas OHL had an indirect influence on the outcome. Mother's age, caregiver's schooling, brushing frequency, and obesity directly affected the occurrence of cavitated carious lesions in children in the mixed dentition phase, whereas OHL had an indirect effect on this clinical outcome.

Assessment of two methods for detecting carious dentin: an in vitro study

BACKGROUND

The objective of this study was to compare, in vitro, two dentinal caries lesion detector methods, Caries Finder and BlueCheck, to determine if they were substantially equivalent in their ability to aid visualization of demineralized dentin and to also to compare their performance compared to the traditional visual/tactile method of dentinal caries lesion detection in vitro.

METHODS

Sixty-five extracted human teeth containing lesions rated as ICDAS 4,5 or 6 were chosen and then randomly assigned to two groups. Specimens were then evaluated in standard operatory conditions by three evaluators using the traditional visual and tactile method, the Caries Finder method, and the BlueCheck method of detection. The study employed a parallel, randomized controlled study design. To test the equivalence claim, a "two-one sided test" (TOST) approach was utilized.

RESULTS

As compared to the traditional method, the Caries Finder method had a 0.9742 accuracy, 95% confidence interval [0.9578, 0.9855], 94.80% sensitivity, 98.53% specificity, 96.47% positive predictive value, 97.82% negative predictive value, 0.938 Kappa value, p < 2.2e-16). The BlueCheck method had a 0.9821 accuracy, 95% confidence interval [0.9682, 0.9910], 96.02% sensitivity, 99.09% specificity, 97.69% positive predictive value, 98.42% negative predictive value, 0.956 Kappa value, p < 2.2e-16). Inter-rater reliability and intra-rater reliability ratings were good to excellent.

CONCLUSIONS

The results of this study support the conclusion that the Caries Finder and BlueCheck methods compare favorably with the traditional method of carious dentin detection. Caries Finder and BlueCheck detection methods were found to have comparable performance in their ability to differentiate carious dentin from healthy tooth structure in vitro; however further in vivo validation is required to confirm clinical equivalence. Both show good to excellent inter-rater and intra-rater reliability.

Sports dentistry intricacies with season-related challenges and the role of athlete-centered outcomes

Sports dentistry is an emerging field focusing on the prevention, treatment, and management of oral health issues in athletes. This review critically examines the current state of sports dentistry, emphasizing the integration of oral health care into athletes' overall health management. The high prevalence of dental caries, erosion, and periodontal problems among athletes is linked to diet, habits, and increased risk of orofacial injuries. Routine oral health evaluations, particularly during the preseason, are recommended to tailor prevention strategies and address potential issues early on. The recently proposed Universal Screening Protocol for Dental Examinations in Sports is discussed, noting its potential limitations in terms of time and complexity. The review explores the challenges posed by athletes' demanding training and competition schedules, stressing the importance of incorporating oral health care into the medical team. Future research should investigate the feasibility and validity of self-reported questionnaires for screening oral health conditions, potentially simplifying the process for athletes. The review highlights the use of athlete-reported outcomes and self-reporting in sports dentistry as crucial for evaluating dental care effectiveness and monitoring long-term health outcomes. It concludes by emphasizing the need for streamlined, universally applicable protocols that fit athletes' schedules while providing comprehensive care, and the importance of further research to explore innovative screening tools and self-reported measures to transform routine care practices and reduce barriers to dental health for athletes.

Caries lesions progression in adults: A prospective 2-year cohort study

OBJECTIVE

Dental caries is one of the most prevalent chronic non-communicable diseases worldwide. There is a lack of evidence, especially in adult populations, documenting caries disease progression considering lesion severity, activity and tooth surface-level characteristics. The study aimed to investigate the extent to which primary active caries lesions in adults affect caries lesions progression compared with inactive caries lesions over a 2-year follow-up period, considering their severity, surface and tooth type.

METHODS

A prospective study data set from a cohort of workers in a factory in Belarus were used. Participants aged 18-64 years with 20 or more natural teeth were included in the study. The participants were clinically examined twice within an interval of 2 years and completed a self-reported questionnaire. One calibrated examiner evaluated caries lesions using the International Caries Detection and Assessment System (ICDAS) and the Nyvad system. The primary outcome was caries lesions' progression. The lesion was classified as 'progressed' if it turned to a more advanced severity stage, was restored or missing/extracted due to caries. A multilevel Poisson regression was used to estimate the association between baseline caries lesions' characteristics and caries lesion progression.

RESULTS

Out of 495 participants, 322 people completed clinical examinations at baseline and 2 years later, with an attrition rate of 35%. The prevalence of active DS1-6 and DS5-6 lesions at the baseline was 83.8% and 64.8%, respectively. In 2 years, 24% of active non-cavitated and 31% of active micro-cavitated/shadowed caries lesions progressed, while 15% of inactive caries lesions, non- or micro-cavitated/shadowed, progressed. The adjusted rate ratio (RR) for ICDAS3 + 4 caries lesions progression was 1.41 (CI 95% 1.16, 1.70) than ICDAS1 + 2 lesions. The RR for ICDAS1 + 2, active and ICDAS3 + 4, active lesions was 1.78 (CI 95%, 1.40, 2.27) and 1.97 (CI 95%, 1.53, 2.55), respectively than ICDAS1 + 2, inactive lesions. The RR for caries lesions progression on proximal surfaces and on pits and fissures was 1.57 (CI 95%, 1.30, 1.89) and 1.37 (CI 95%, 1.11, 1.67), respectively than smooth surface lesions.

CONCLUSION

In caries active adults over 2 years, most non- and micro-cavitated/shadowed active and inactive caries lesions did not progress. Among caries lesions that showed progression, more severe lesions were more likely to progress than less severe lesions; active lesions were more likely to progress than inactive lesions. Pit and fissure caries lesions and proximal lesions were more likely to progress than smooth surface lesions.

Area-Level Factors of Dental Caries in Children and Adolescents in European Neighborhoods - a Systematic Review

The WHO emphasizes the importance of taking area-level factors into account when formulating public health interventions. The aim of this systematic review was to identify which area-level factors are associated with children's dental caries in Europe and might therefore be a suitable starting point for public health interventions. We conducted a systematic review based on a search in PubMed, Web of Science, and Cochrane Library including all European studies on caries in children and their area-level factors published since the year 2000 in English or German. We included 39 studies and identified 13 area-level factors investigated in the literature: degree of urbanization, deprivation, mean housing price, gross-national product, mean level of education, unemployment proportion and income, density of supermarkets, snack bars and dental offices, health, diet, and crime. Rural residency and higher unemployment were weakly associated with poorer oral health regarding dental caries. Deprivation showed a stronger (inverse) association. For income, findings were ambiguous; studies showed associations in both directions. For the other determinants, the included studies found no association. Many studies reported associations between place of residence and children's dental caries, but the mediators on this causal path are still not clearly established. The area-level factors analyzed in this review seem to play a role, but more studies with designs that allow causal interpretation of findings are needed to establish solid robust evidence that can be used in the formulation of future health policies.

Decision Making on Caries Management in Children and Adolescents Among Thai Dentists

BACKGROUND

The International Caries Classification and Management System (ICCMS) advocates for nonsurgical approaches in early carious lesions and minimally invasive restorations in advanced cases.

AIM

This study investigated Thai dentists' adherence to ICCMS guidelines for managing caries in children and adolescents and explored factors influencing their decisions.

DESIGN

A web-based questionnaire collected demographic information and routine treatment preferences for various stages of carious lesions from participants. Descriptive statistics and regression analyses were employed to examine relationships between management strategies and demographics.

RESULTS

A total of 442 dentists participated. Their agreement with ICCMS guidelines for occlusal caries ICDAS 2, 3, and 4 in primary dentition was 39.6%, 53.9%, and 42.5%, respectively, and in permanent dentition was 34.4%, 46.8%, and 39.6%, respectively. The agreement rate with ICCMS guidelines for approximal caries RA1, RA2, RA3, and RB4 in primary dentition was 69.6%, 78.0%, 12.4%, and 99.5%, respectively, and in permanent dentition was 70.8%, 68.3%, 19.0%, and 97.7%, respectively. Factors associated with restorative treatment decisions included years since graduation, postgraduate education, and practice type.

CONCLUSIONS

Participants did not comply well with ICCMS recommendations for occlusal caries, some employed destructive techniques instead of noninvasive approaches. However, most participants followed ICCMS guidelines for approximal caries, except for RA3 stage.

Dental Caries, Tooth Erosion and Nutritional Habits in a Cohort of Athletes: A Cross-Sectional Study

BACKGROUND/OBJECTIVES

this study aimed to study the association of dental caries and erosion in athletes with dietary and oral health habits.

METHODS

An observational cross-sectional study was conducted at the Sports Dentistry department of a university clinic. Intraoral examination included the International Caries Detection and Assessment System (ICDAS II) index and the Basic Erosive Wear Examination (BEWE). A questionnaire was completed with sociodemographic data, and dietary and oral hygiene habits. An inferential and multivariable regression analysis was performed to study the association of dental caries and erosion with confounding variables.

RESULTS

A total of 80 athletes were included. The prevalence of dental caries and erosion was 50.0% and 40%, respectively. Significant associations were observed between self-perceived oral health and caries lesions, with "Good" (-5.01, p < 0.001) and "Very good" (-5.46, p < 0.001) perceptions linked to fewer lesions. BEWE scores revealed significant associations with meal frequency uncertainty (-12.56, p = 0.014) and uncertainty about the last dental visit (8.82, p = 0.014). Self-perceived oral health as "Good" or "Very good" was associated with lower dental erosion (p < 0.010). Other demographic and behavioral factors were not significantly associated with caries or erosion.

CONCLUSIONS

this cohort of athletes exhibited a high prevalence of dental caries and erosion, with associated dietary and oral hygiene habits. These results highlight the need for targeted dietary counseling and oral health education for athletes, whose nutritional needs may lead to increased consumption of sugar-rich diets.

Streptococcus mutans serotyping, collagen-binding genes and Candida albicans in dentin carious lesions: a molecular approach

OBJECTIVES

This cross-sectional study aimed to evaluate the occurrence of Streptococcus spp., Streptococcus mutans, its serotypes (c, e, f, and k), collagen-binding genes (cnm/cbm), and Candida albicans in medium deep (D2) and deep (D3) dentin carious lesions of permanent teeth.

MATERIALS AND METHODS

Carious dentin was collected from D2 (n = 23) and D3 (n = 24) lesions in posterior teeth from 31 individuals. DNA was extracted and analyzed using polymerase chain reaction (PCR).

RESULTS

Streptococcus spp. exhibited a high prevalence in both D2 and D3 lesions, with a 100% occurrence rate in D3. Although S. mutans was prevalent in both lesion types, serotype distribution highlighted differences in complexity. Serotype e was the most frequently detected in D2 samples. Serotype c was absent in D2 but present in 19.0% of D3; serotype k was exclusively found in multi-serotype D3 alongside f, c, and e. The cbm gene and undetermined serotypes were detected only in D3. Candida albicans was not found in any samples, regardless of lesion depth.

CONCLUSION

Dentinal lesions exhibited a complex array of S. mutans serotypes, with a notable prevalence of the genus Streptococcus and an overall S. mutans prevalence of approximately 35%. Candida albicans was absent. In addition, a high diversity of serotypes was observed, including multiple and indeterminate serotypes, along with the presence of the collagen-binding cbm gene.

CLINICAL RELEVANCE

The identification of diverse Streptococcus mutans serotypes and the cbm gene in carious dentin from permanent teeth offers insights into microbial factors potentially linked to dentinal caries lesions. Additionally, the absence of Candida albicans suggests a limited role in this context.

Parent-Targeted Oral Health Text Messaging for Underserved Children Attending Pediatric Clinics: A Randomized Clinical Trial

Importance

Caries is the most common chronic childhood disease, with substantial health disparities.

Objective

To test whether parent-targeted oral health text (OHT) messages outperform child wellness text (CWT) messages on pediatric caries increment and oral health behaviors among underserved children attending pediatric well-child visits.

Design, Setting, and Participants

The parallel randomized clinical trial, Interactive Parent-Targeted Text Messaging in Pediatric Clinics to Reduce Caries Among Urban Children (iSmile), included participants who were recruited during pediatric medical clinic visits at 4 sites in Boston, Massachusetts, that serve low-income and racially and ethnically diverse (herein, underserved) populations. English-speaking or Spanish-speaking caregivers of children younger than 7 years with at least 1 tooth were eligible. The study, which had a dose-matched design, was conducted from March 9, 2018, to February 28, 2022, with a 24-month follow-up. Text messages were sent for 4 months, plus a 1-month booster at 12 months.

Intervention

Text messages were bilingual, automated, interactive, customized, and gamified. OHT messages focused on child toothbrushing and preventive dental visits. CWT messages focused on reading and child safety. Both included a choice of other content topics pertinent to their randomized arm.

Main Outcomes and Measures

The primary outcome was 24-month caries increment assessed by calibrated examiners. Secondary outcomes were oral health behaviors known to predict pediatric caries (eg, toothbrushing, sugar-sweetened beverages, diet, fluoride toothpaste use, and preventive dental visits), which were assessed by self-report, and participant satisfaction with the text message program. Caries examinations occurred at baseline and 12 and 24 months later. Self-report surveys occurred at these time points and at the end of the text message program (4 months).

Results

Among 1388 caregivers who were approached for eligibility, 969 were eligible. Of these, 754 caregivers (mean [SD] age, 32.9 [7.2] years; 713 female [94.6%]) and 754 children (mean [SD] age, 2.9 [1.7] years; 377 female [50.0%]) were randomized (77.8%); 449 of 657 participants (68.3%) were below the poverty line. Responses to text messages were high (OHT group: 67.9%; CWT group: 69.6%). There were no significant group differences in caries increment (OHT group: 43.0% vs CWT group: 42.7%; adjusted odds ratio, 0.99 [95% CI, 0.63-1.56]). Children in the OHT messaging group were significantly more likely to meet toothbrushing guidelines (odds ratio [OR], 1.77 [95% CI, 1.13-2.78]), have preventive dental visits (pooled OR, 1.51 [95% CI, 1.18-1.94]), and use fluoride toothpaste (pooled OR, 1.46 [95% CI, 1.06-2.01]) compared with those in the CWT messaging group over 24 months. OHT messages had a significant effect on caregivers' own toothbrushing (pooled mean difference, 0.48 [95% CI, 0.03-0.92]).

Conclusion and Relevance

The findings of this randomized clinical trial including underserved children and their caregivers suggest that OHT messages had significant and sustained effects on preventive dental behaviors known to reduce caries among both caregivers and children, but had no effect on caries increment in children. Highly appealing and low-burden text messages coupled with evidence of change in oral health behaviors may be important in reducing oral health disparities.

Trial Registration

ClinicalTrials.gov Identifier: NCT03294590.

Relationship among different levels of individual and community social capital with oral health related-quality of life among adolescents

AIM

To evaluate the relationship of different levels of social capital with oral health-related adolescents' quality of life (OHRQoL).

METHODS

This is a cross-sectional study nested in a cohort study started in 2010 with a sample of children 1 to 5 years old from Brazil. Individuals were followed after 10 years, data which was considered in this study (11 to 15 years old). OHRQoL was evaluated by the short version of CPQ11-14. Individual social capital (ISC) was assessed through the presence of individual social networks and social trust. Community social capital (CSC) was assessed through the presence of voluntary institutions, community cultural centers or residents' associations. For both ISC and CSC, the participants were classified as with high social capital (at least one source) or low social capital (absence of any source). Adjusted Poisson Regression analysis was performed to verify the interaction of different levels of social capital and OHRQoL. Results are present in Rate Ratio (RR) and 95 % confidence interval (95 % CI).

RESULTS

A total of 429 adolescents were evaluated. Adolescents with low CSC and low ISC presented CPQ11-14 scores 36 % higher (RR 1.36 95 %CI 1.15-1.62) than counterparts who presented higher social capital levels. The interaction among high and low levels of social capital was not associated with CPQ11-14 scores, indicating that no level stands out over the other.

CONCLUSION

Only the total absence of both levels of social capital negatively related with OHRQoL, indicating the importance of the presence of at least one source of social capital.

CLINICAL RELEVANCE

The findings show that social capital affects OHRQoL, a crucial psychosocial aspect considering the clinical practice.

Enamel caries lesions, with and without initial cavitation, in relation to anatomical areas of the proximal surface in deciduous molars

OBJECTIVE

proximal enamel caries lesions (PEC) are believed to initiate and progress to cavitation below the proximal contact area (PCA), but no evidence exists on the location of initial carious cavitation on the proximal surface with functional PCA. This study aimed to test the association of anatomical areas of the proximal surface with the severity of PEC and the frequency of cavitation in PEC in primary molars DESIGN: laboratory, observational, transversal study. Exfoliated primary molars (n = 33) with functional PCA (biofilm-free PCA surrounded by biofilm) had their proximal surfaces (one/tooth) divided anatomically into up to nine areas: 3 areas based on the occlusal/cervical PCA boundaries (areas I, II, and III; occluso-cervically) and 3 areas based on the bucco/lingual PCA boundaries (A, B, and C), with area IIB representing the PCA and area IIIB as the sub-PCA (below the PCA). PEC (ICDAS scores 1 and 2-3) and cavitation in PEC were quantified in all areas using stereomicroscopy and microCT. PEC volume was quantified in areas IIB and IIIB under microCT RESULTS: PEC severity increased occluso-cervically. PCA and sub-PCA presented different PEC severities (higher in sub-PCA) and similar PCE volumes, but the odds of carious cavitation were much higher (Odds ratio = 197.4; 95 % CI: 8.7/4480.7) in the PCA than in the sub-PCA (no cavitation).

CONCLUSION

PCA presented lower PEC severity and similar PEC volume compared to sub-PCA, but PCA concentrated all cavitations in PEC, supporting a new model for the pathogenesis of PEC.

Erosive tooth wear, dental decay, and periodontal health in obese and normal weight children and adolescents

AIM

This study aimed to compare the oral health status between normal weight (NW) and obese weight (OW) children/adolescents.

METHODS

Eighty-two participants aged 6-16 years were included in this cross-sectional study. The children/adolescents were classified according to the body mass index (BMI): NW (n = 41) and OW (n = 41). Caries experience was assessed by the International Caries Detection and Assessment System (ICDAS-II), decay, missing, filling teeth (dmft) for the primary teeth and (DMFT) for the permanent teeth, erosive tooth wear using Basic Erosive Wear Examination (BEWE), Plaque Index (PI) and Gingival Index (GI), probing depth (PD). Also, the relationship between procalcitonin (PCT), C-reactive protein (CRP), parathyroid hormone (PTH), and 25(OH)D blood biochemistry and oral health was evaluated in obese children/adolescents.

RESULTS

Evaluation was made of a sum of 82 children/adolescents, comprising 43 females and 39 males, with a median age of 14 years in the obese group and 13 years in the NW group. Significant differences were determined between patients with NW and those who were obese, particularly in BMI, family income level, and tooth brushing habits. The results of the study indicate that individuals with obesity tend to exhibit significantly higher scores for PI, and GI as compared to those with NW (p < .05) CONCLUSION: Oral hygiene in children with systemic diseases should be treated with a multidisciplinary approach and under regular control by a pediatrician and pediatric dentist, as it may also affect the medical health of the children/adolescents.

Do progression rates of initial and moderate caries lesions and sound surfaces of primary teeth increase significantly after 7 years?

BACKGROUND

Initial caries lesions in primary teeth have presented a low progression rate after 2 years, but it could be higher in longer follow-ups.

AIM

To evaluate the progression rates of sound surfaces and initial and moderate caries lesions after 7 years.

DESIGN

This prospective 7-year cohort study included 639 preschool children aged 1-5 years in 2010. In 2017, 449 children were reassessed (70.3% retention rate). Dental caries was collected using the International Caries Detection and Assessment System (ICDAS) in both assessments. Incidence rate (IR) per 100 surface-years estimated the progression rates of sound surfaces and initial and moderate lesions for worse conditions. Cox regression with shared frailty evaluated the possible risk factors.

RESULTS

IR was 1.0% for sound surfaces, 2.8% and 4.2% for ICDAS scores 1 and 2, respectively, and about 17.0% for moderate lesions. The most significant risk factor for the progression was the presence of cavitated lesions in other teeth. The type of surface and tooth also influenced the outcome.

CONCLUSION

The progression rate of initial caries lesions in primary teeth remains low even after 7 years, but cavitated caries lesions in other teeth increase this risk. Moderate lesions demonstrate a higher risk of progression when compared to sound surfaces and initial caries lesions.

High Anticholinergic Burden and Dental Caries: Findings from Northern Finland Birth Cohort 1966

INTRODUCTION

Anticholinergic drugs propose a threat for oral health by causing dry mouth. The aim of this cross-sectional study was to investigate whether a high anticholinergic burden was associated with the presence of initial caries lesions, manifested caries lesions, dental fillings, or tooth loss among 46-y-old people.

METHODS

The study population consisted of 1,906 participants from the Northern Finland Birth Cohort 1966 who underwent an oral health examination in 2012-2013. Socioeconomic and medical data were collected from questionnaires, medical records, and national registers. Nine previously published anticholinergic scales were combined and used to measure the high anticholinergic burden from the participants' medication data. Cariological status was determined according to the International Caries Detection and Assessment System, and the number of missing teeth (excluding third molars) was used as an indicator for tooth loss. The decayed, missing, and filled surfaces index was used to depict caries experience. Negative binominal regression models were used to estimate prevalence rate ratios (PRRs) and confidence intervals (CIs).

RESULTS

Fourteen percent of the participants (n = 276) used at least 1 anticholinergic drug and about 3% had a high anticholinergic burden (n = 61). After adjusting for confounding factors, participants with a high anticholinergic burden had a higher likelihood of having manifested carious lesions needing restorative treatment (PRR, 1.60; CI, 1.11-2.29) and more missing teeth (PRR, 1.59; CI, 1.13-2.24) when compared to participants without any or with a lower anticholinergic burden.

CONCLUSIONS

High anticholinergic burden was associated with a present caries experience and with tooth loss among the general middle-aged population.

KNOWLEDGE TRANSFER STATEMENT

The findings of this study suggest that middle-aged patients with a high anticholinergic burden may have a heightened risk of dental caries. These patients may benefit from targeted caries preventive regimes.

Young people's and adults' views and experiences of decision-making to manage compromised first permanent molars: a qualitative study

BACKGROUND

Little information on young people's and adults' views and experiences on decision-making for managing compromised first permanent molars (cFPM) exists.

AIM

To establish young people's and adults' views and experiences of decision-making for managing cFPM.

DESIGN

Face-to-face (online) semi-structured interviews were undertaken using an iteratively designed topic guide. Participants aged 12-65 were purposively sampled with recruitment from different dental clinics (three primary care, an out-of-hours emergency and one dental hospital). Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.

RESULTS

Three themes were generated from young people's interviews (n = 9): (i) influencing factors; (ii) long-term considerations; and (iii) shared decision-making. Three themes were generated from adults' interviews (n = 13): (i) influences that affect decisions; (ii) perceptions of the specialist's role; and (iii) importance of shared decision-making for children and young people.

CONCLUSION

Several factors influenced decision-making; for young people, professional opinions were important, and parental/peer influences less so. For adults, it was based on decisions on their prior experiences. Adults felt young people were abnormal if referred to a specialist. Young people wanted autonomy in decision-making to be respected; in reality, their views were rarely heard. There is potential to increase young people's involvement in shared decision-making for cFPM, which aligns with their aspirations.

Observational Diagnostics: The Building Block of AI-Powered Visual Aid for Dental Practitioners

Artificial intelligence (AI) has gained significant traction in medical image analysis, including dentistry, aiding clinicians in making timely and accurate diagnoses. Radiographs, such as orthopantomograms (OPGs) and intraoral radiographs, along with clinical photographs, are the primary imaging modalities employed for AI-powered analysis in the dental field. In this review, we discuss the most recent research and product developments concerning the clinical application of AI as a visual aid in dentistry and introduce the concept of Observational Diagnostics (ODs) as a structured method to standardise image analysis. ODs serve as foundational elements for AI-driven diagnostic aids and have the potential to improve the consistency and reliability of diagnostic data used in treatment planning. We provide illustrative examples to demonstrate how ODs not only represent a significant advancement towards more precise diagnostic aids but also provide the basis for the generation of evidence-based treatment recommendations. These OD-based algorithms have been integrated into chairside AI applications to streamline clinical workflows to improve consistency, accuracy, and efficiency.

Effect of Fluoride Varnishes on Demineralization and Acid Resistance in Subsurface Demineralized Lesion Models

This study aimed to clarify the effects of high-concentration fluoride varnish application on the inhibition of the progression of initial enamel caries. Remineralization capacity and acid resistance following high-concentration fluoride varnish application were compared with untreated models and models treated with fluoride mouthwash. Bovine enamel was used to create a model of initial enamel caries. The high-concentration fluoride varnishes Enamelast and Clinpro White Varnish and the fluoride mouthwash Miranol were used. Specimens were evaluated using Contact Microradiography (CMR) and an Electron Probe Micro-Analyzer (EPMA). While a single application of high-concentration fluoride varnish and short-term fluoride mouthwash use did not appear to cause remineralization in the subsurface demineralized layer, improvements in acid resistance were observed, leading to reduced demineralization under subsequent acidic challenges.

Mouth breathing is associated with a higher prevalence of anterior dental caries in preschool children

This cross-sectional study aimed to investigate the association between anterior dental caries and the predominant type of breathing in preschoolers. The research involved a sample of 257 children aged between 3 and 5 years, who were enrolled in public daycare centers and preschools in the city of Diamantina, MG, Brazil. A questionnaire was applied to parents/guardians to collect sociodemographic data, habits, oral health, and a dietary diary used to calculate the Sucrose Consumption Index. The predominant type of breathing, whether nasal or through the mouth, was determined through direct observation. Dental caries was assessed using the International Caries Detection and Assessment System (ICDAS). Descriptive analyses and the Poisson regression were conducted to analyze the data. The results revealed a higher prevalence of anterior dental caries among children who predominantly breathed through the mouth (PR = 1.57; 95%CI: 1.01-2.46; p = 0.047), who exhibited a higher frequency of sucrose consumption (PR = 4.02; 95%CI: 2.03-7.95; p < 0.001), and had mothers with lower educational levels (PR = 1.53; 95%CI: 1.01-2.32; p = 0.043). Pacifier use was associated with a lower prevalence of anterior dental caries (PR = 0.57; 95%CI: 0.34-0.96; p = 0.035). In conclusion, this investigation demonstrated an association between carious lesions in the anterior teeth and predominantly mouth breathing in preschoolers.

Psychosocial determinants of oral health outcomes in young children

Objective

To examine the social determinants of early childhood caries (ECC), one of the greatest public health risks affecting children, and examine alternative pathways of influence.

Methods

A physically healthy, socio-demographically high-risk sample of initially caries-free children, aged 1-4 years, was prospectively studied for 2 years. At 6-month intervals, assessments were made of caries presence from a standard dental exam; oral microbiology was assayed from saliva samples; oral hygiene behaviors and psychological and psychosocial risk exposure were derived from interviews and questionnaires.

Results

189 children were enrolled; ECC onset occurred in 48 children over the 2-year study period. A composite measure of psychosocial risk was significantly associated with ECC onset over the course of the study (1.57, 95% CI 1.12-2.20, p < .001) and significantly associated with multiple risks for ECC, including poor diet/feeding (.92; 95% CI. 22-1.61, p < .01), poor oral hygiene (.39; 95% CI .09-.68), p < .05), and higher concentrations Lactobacilli (.96; 95% CI .43-1.49, p < .001). Multivariable regression analyses provided indirect support for the hypothesis that psychosocial risk exposure predicts ECC onset via behavioral and oral hygiene pathways.

Conclusions

The study provides novel evidence that psychosocial factors influence many of the purported risks for ECC and strong evidence that there are social and psychological determinants of ECC onset.

Overdiagnosis of dental caries in South Korea: a pseudo-patient study

BACKGROUND

To evaluates the tendency of South Korean dentists to over-diagnose clinically healthy teeth in pseudo-patients.

METHODS

We conducted a pseudo-patient, cross-sectional study in 196 private dental clinics with 58 pseudo-patients in South Korea between August and December 2018. Trained pseudo-patients with no previous oral diseases, including dental caries, diagnosed by two experienced dentists, were sent to each dental clinic. Before visiting each private dental clinic, participants were instructed to state, "I have no symptoms, but I would like to have a dental caries examination". The oral examination was performed using visual and tactile inspection methods only. The interactions between the dental clinic staff and the pseudo-patient were documented on a data collection form shortly after each visit.

RESULTS

In 33.2% (65/196) of these interactions, the pseudo-patients were diagnosed as having no dental caries. 11.7% (23/196), 12.8% (25/196), 10.7% (21/196), and 10.7% (21/196) of the sample were diagnosed with dental caries in one, two, three, and four teeth, respectively. Dentists diagnosed five or more dental caries in 20.9% (41/196) of the sample. 196 dental clinics diagnosed a total of 503 dental caries. Of these, 392 were in molars. Small solo practice dentists diagnosed 3.54 dental caries and large group practice dentists 1.57, but the difference was not significant (p = 0.07). The recommendation rate for dental caries treatment was highest among 43 (55.1%) large solo practices, and lowest in 7 (33.3%) large group practices. However, small solo practices had the lowest rate of preventive care recommendations at 12 (30.8%) and 10 (47.6%) in large group practices. The data shows that preventive care recommendations increased as the practice size increased.

CONCLUSION

The study findings indicate that Korean dentists tend to over-diagnose dental caries, which could pose a threat to public health both in Korea and worldwide. Therefore, it is important to carefully consider strategies to improve the correct diagnosis and standard of care for dental caries by private dentists.

Alterations in salivary profile in individuals with dental caries and/or obesity: A systematic review and meta-analysis

OBJECTIVES

To investigate current evidence on the association of salivary profile with dental caries and obesity.

DATA/SOURCES

A comprehensive search was conducted on PubMed, Web of Science, Embase, ProQuest Medical Database, ProQuest Sci-Tech Premium, and Cochrane Library up to June 2024. Observational studies comparing salivary profiles in individuals with dental caries and/or obesity were included. The risk of bias was evaluated using the Newcastle-Ottawa Scale. Meta-analysis was utilised to estimate the overall weighted or standardised mean differences (WMD or SMD).

STUDY SELECTION

Fifty studies were included, comprising 47 cross-sectional studies and three longitudinal studies with only baseline data extracted. Meta-analysis demonstrated that individuals with caries had higher total antioxidant capacity (SMD: 1.78, P<0.001) and elevated levels of interleukin-6 (SMD: 3.41, P=0.004) and tumour necrosis factor-α (SMD: 0.61, P=0.005) in unstimulated whole saliva (UWS) compared to caries-free controls. Individuals with overweight/obesity, when compared to normal-weight counterparts, showed decreased UWS pH (WMD: -0.14, P=0.009), unstimulated and stimulated salivary flow rates (WMD: -0.09 mL/min, P=0.001 and WMD: -0.35 mL/min, P<0.001, respectively), phosphorus/phosphate levels in stimulated whole saliva (SWS) (SMD: -0.36, P=0.004), and peroxidase levels in both UWS (SMD: -1.56, P<0.001) and SWS (SMD: -1.10, P<0.001). Additionally, they exhibited higher salivary levels of mutans streptococci (SMD: 0.47, P<0.001), secretory immunoglobulin A (WMD: 14.51 μg/mL, P=0.020), and total antioxidant capacity in UWS (SMD: 0.67, P<0.001).

CONCLUSION

Although individuals with dental caries and/or obesity have altered salivary profiles, the quality of evidence remains low. Further high-quality studies are required to investigate the triadic associations in depth.

CLINICAL SIGNIFICANCE

Monitoring salivary parameters and biomarkers could serve as a relatively simple and non-invasive method for identifying, predicting, controlling, and monitoring individuals at high risk of dental caries and obesity. This knowledge can inform the development of tailored oral health promotion programs for individuals with obesity.

Clinical evidence of caries prevention by hydroxyapatite: An updated systematic review and meta-analysis

OBJECTIVES

A systematic review and meta-analysis were undertaken to update our 3-year-old meta-analysis to include RCTs, in vivo, and in situ clinical evidence that showed hydroxyapatite in oral care products can reduce dental caries.

DATA

Using the PICO guide, published clinical trials were searched where subjects (P) of all ages, with primary, mixed or permanent dentitions, using toothpastes, mouthwashes or gels containing hydroxyapatite as an active ingredient (I) were compared to subjects who used placebo or no intervention, or fluoride-containing positive controls (C), and the outcomes (O) were direct measurement of reduced dental caries or suitable proxy for reduced caries risk.

SOURCES

PubMed, Scopus, EMBASE, and Web of Science databases were searched using search terms from previous searches.

STUDY SELECTION

All authors collectively agreed which studies to include after applying the exclusion/inclusion criteria. Eighteen studies were retrieved and analyzed. The studies were graded according to a National Institutes of Health grading system. Three authors decided on the final list of publications suitable for meta-analysis, and the meta-analysis was carried out using the public domain R statistical program.

RESULTS

After applying more specific inclusion criteria and assessment, out of 18 retrieved studies, 5 clinical trials and 8 in situ trials were included in the meta-analysis.

CONCLUSIONS

The evidence for the effectiveness of fluoride-free, hydroxyapatite-containing oral care products in reducing dental caries, both from RCTs and in situ clinical trials, has expanded. More studies now show that hydroxyapatite is effective as an anti-caries active ingredient in the absence of fluoride.

CLINICAL SIGNIFICANCE

As a sole active ingredient, considered safe if swallowed, hydroxyapatite is an ideal substitute for fluoride in toothpaste and mouthwash tailored for young children, and new data as presented in this review, demonstrated that hydroxyapatite-based oral care products can be used by people of all ages.

Assessment of overall caries risk and mode of birth delivery in infants and children with and without ECC: a cross-sectional study

PURPOSE

 The study assessed the caries risk in infants and children with and without early childhood caries (ECC) using American Academy of Pediatric Dentistry Caries Risk Assessment Tool (AAPD CRAT) and identified the association between caries risk and mode of birth delivery.

METHODS

 This cross-sectional study included 96 infants and children with all maxillary and mandibular primary anterior teeth and at least two primary molars erupted clinically in the oral cavity. The details on the mode of birth delivery were noted in a preformed template along with the demographic details, followed by caries risk assessment (CRA) to assess the caries risk of an individual. The outcome assessment for overall caries risk was performed for the ECC and non-ECC group and compared against the mode of birth delivery. Descriptive statistics were performed for all the study variables (gender, overall caries risk, mode of birth delivery, and term of delivery). The Chi-square test was used to compare the categorical variables between the two groups (ECC and non-ECC groups).

RESULTS

 The high caries risk category contributed to 52.1% and 68.8% in the ECC and non-ECC groups, respectively. The prevalence of vaginal mode of delivery was 41.7% and 52.1% in the ECC and non-ECC groups, respectively. Caries risk increases with increasing age and the non-ECC group shows more risk (68.8%) than the ECC group. In comparison with the variables against the groups (ECC and non-ECC), Chi-square test revealed that only the term of delivery (p value = 0.035) and overall caries risk (p = 0.045) showed statistically significant difference.

CONCLUSION

 The proportion of high caries risk subjects was significantly more in the non-ECC groups. Children delivered by the C-section mode showed high caries risk (66.7%) when compared with the vaginal mode of delivery (53.3%). A validated CRAT for predicting caries risk is required.

Validity assessment of a third-generation light-induced fluorescence device in detecting proximal and occlusal caries lesions: A cross-sectional study

OBJECTIVES

The objective of this study was to evaluate the efficacy of a quantitative light-induced fluorescence (QLF) device (QrayCam Pro, AIOBIO, Seoul, Republic of Korea) in detecting and differentiating the severity of posterior proximal and occlusal primary caries.

MATERIALS AND METHODS

The study included a total of 120 teeth in 60 patients (of both genders, aged between 21 and 38 years) between January and March 2024, one carious tooth and one sound tooth were selected at random in each patient. All occlusal surfaces were evaluated in accordance with the International Caries Detection and Assessment System (ICDAS) Nyvad Criteria, using the visual tactile method. The ICDAS employs a scoring system ranging from 0 to 6, while the Nyvad Criteria employs a similar scoring system. Addionally, the depth of the proximal lesions was scored (0-6) using bite-wing radiography. The quantitative values representing the maximum loss of fluorescence (∆Fmax) and the maximum change in the ratio of red and green fluorescence (∆Rmax) were obtained using the Q-ray Clinical software v 1.45. To assess the validity, the sensitivity, specificity, and area under the receiver operating characteristics curve (AUROC) were calculated. Spearman correlation coefficient was used to investigate the correlation between the findings of the traditional and QLF examination methods.

RESULTS

The AUROC values for both ∆Fmax and ∆Rmax were found to be excellent. The sensitivity of QrayCam Pro was found to be 84-88.6%, while the specificity was 100%. The correlation analysis demonstrated a strong correlation between scores obtained from the traditional examination and the QLF values.

CONCLUSIONS

Based on the findings of this study, QrayCam Pro exhibits potential as a valuable additional tool for not only detecting caries but also for assessing their severity and activity.

CLINICAL RELEVANCE

This study revealed that QrayCam Pro might be suggested as a precise tool for enhancing caries detection and assessment compared to traditional methods. By providing quantitative data on caries severity and activity, it enables more informed treatment decisions, potentially optimizing outcomes for patients.

Oral foci of infection and their relationship with hospital stay after haematopoietic cell transplantation

PURPOSE

Oral focus screening is recommended before HCT (haematopoietic cell transplantation). Acute foci are generally treated pre-HCT. However, it is unclear whether chronic foci should be treated pre-HCT. This study aimed to evaluate the association between number of foci and early post-HCT morbidity and mortality.

METHODS

Patients who received an oral screening pre-HCT at Radboudumc between 2013 and 2023, with a recent panoramic radiograph, were included. Foci were defined as teeth or implants with deep pockets, furcation radiolucencies, periapical radiolucencies, deep caries, partial eruption or retained roots. Dental interventions were provided pre-HCT if deemed necessary and possible. Hospital length of stay (LOS), mortality and oral exacerbations were assessed in the first hundred days post-HCT. Hospital LOS was log-transformed to normalize its skewed distribution. Multivariate regression analyses were performed.

RESULTS

Five hundred patients were included (median age 58 years, 37% female, 56% allogeneic). Four acute foci in two patients remained untreated pre-HCT. Forty-eight percent had at least one untreated chronic focus pre-HCT (mostly furcation radiolucencies and post-endodontic periapical lesions). Mean LOS was 22 days; 20 patients died, and four patients had an oral exacerbation before HCT day + 100. After adjustment for conditioning intensity, age, socioeconomic status and number of teeth, HCT recipients with ≥ 3 foci had five additional days in the hospital compared to those without foci (ratio of means 1.21; 95% CI 1.00 - 1.46). The number of foci was not associated with early post-HCT mortality.

CONCLUSION

The presence of ≥ 3 oral foci is associated with extended hospital LOS in the first hundred days post-HCT.

Inequalities in oral health: estimating the longitudinal economic burden of dental caries by deprivation status in six countries

BACKGROUND

The recent World Health Organization (WHO) resolution on oral health urges pivoting to a preventive approach and integration of oral health into the non-communicable diseases agenda. This study aimed to: 1) explore the healthcare costs of managing dental caries between the ages of 12 and 65 years across socioeconomic groups in six countries (Brazil, France, Germany, Indonesia, Italy, UK), and 2) estimate the potential reduction in direct costs from non-targeted and targeted oral health-promoting interventions.

METHODS

A cohort simulation model was developed to estimate the direct costs of dental caries over time for different socioeconomic groups. National-level DMFT (dentine threshold) data, the relative likelihood of receiving an intervention (such as a restorative procedure, tooth extraction and replacement), and clinically-guided assumptions were used to populate the model. A hypothetical group of upstream and downstream preventive interventions were applied either uniformly across all deprivation groups to reduce caries progression rates by 30% or in a levelled-up fashion with the greatest gains seen in the most deprived group.

RESULTS

The population level direct costs of caries from 12 to 65 years of age varied between US10.2 billion in Italy to US$36.2 billion in Brazil. The highest per-person costs were in the UK at US$22,910 and the lowest in Indonesia at US$7,414. The per-person direct costs were highest in the most deprived group across Brazil, France, Italy and the UK. With the uniform application of preventive measures across all deprivation groups, the greatest reduction in per-person costs for caries management was seen in the most deprived group across all countries except Indonesia. With a levelling-up approach, cost reductions in the most deprived group ranged from US$3,948 in Indonesia to US$17,728 in the UK.

CONCLUSION

Our exploratory analysis shows the disproportionate economic burden of caries in the most deprived groups and highlights the significant opportunity to reduce direct costs via levelling-up preventive measures. The healthcare burden stems from a higher baseline caries experience and greater annual progression rates in the most deprived. Therefore, preventive measures should be start early, with a focus on lowering early childhood caries and continue through the life course.

Targeted enamel remineralization with mineral-loaded starch particles

Background

Noninvasive caries treatments work topically, which may limit efficacy. The authors hypothesized that an alternative approach using mineral-loaded particles designed to target the subsurface of noncavitated caries lesions could be advantageous. This study shows in vitro proof-of-concept.

Methods

Mineral-loaded cationic starch (MLCS) particles were prepared, containing calcium, phosphate, and fluoride to provide fluoride-plus (FP) and fluoride-free (FF) alternatives. Particles were characterized for mineral loading and release. MLCS-FP and -FF treatments vs 1,000 ppm fluoride and deionized water controls were evaluated on natural smooth-surface caries lesions (n = 15 per group) after a 20-day protocol with immersion in artificial saliva with amylase and acid challenge. Treatment efficacy was assessed by microcomputed tomography, labeled fluorescence imaging, and blinded qualitative visual assessment.

Results

In aqueous suspension and absent amylase, particles showed sustained mineral ion release. The tomographic evaluation found significant (multivariable regression analysis, P < .05) restoration of lesion mineral density by MLCS-FP and MLCS-FF (42.9% and 38.6%, respectively) vs fluoride and negative controls (7.4% and -18%, respectively), particularly for the lesion subsurface (13.8% [13.0%], 15.9% [9.4%], -2.2% [7.3%], and -1.8% [4.0%] relative hydroxyapatite density for 0.25 through 0.45 μm lesion depth for FP, FF, fluoride, and deionized water, respectively). Visually reduced white opacity (Fisher exact test, P = .038, MLCS-FF vs fluoride) and labeled fluorescence (analysis of variance, P < .05 for MLCS-FF [75.4%], MLCS-FP [75.7%], fluoride [64.1%] vs negative control [-0.2%]) were observed.

Conclusions

These foundational studies show the potential of mineral-loaded starch particles to remineralize enamel as a new approach to treating early caries by subsurface targeted mineral delivery. The in vitro study results indicated that targeted particles improved treatment efficacy, with the data supporting the superiority of MLCS-FP and FF formulations over control conditions for subsurface remineralization and visual esthetic.

Tactile sensation in relation to roughness and reflection of active initial lesions in primary (deciduous) and permanent dentition in vitro

OBJECTIVES

This study evaluated whether a relationship exist between tactile sensation, roughness and reflection intensity in active enamel lesions of primary (deciduous) and permanent dentition.

METHODS

Freshly extracted teeth of the primary (n=29) and permanent (n=60) dentition of patients who underwent serial extractions under general anesthesia due to multiple deep caries lesions showing active lesions (International Caries Detection and Assessment System scores of 2) were selected. The mean linear (Ra), area-related (Sa), volume-related (Vmc) roughness and vertical reflection intensity (VRI) of sound (S) and carious (C) areas were determined by using a 3D-laser-scanning-microscope and a multi-sensor microscope with two different chromatic-confocal optics. Furthermore, two blinded examiners evaluated the roughness by tactile examination using three different explorers (S23H,405CP11, S3C).

RESULTS

Mean differences (95%CI) between S and C for teeth of the primary dentition were: Ra:-1.9(-2.3;-0.4)µm, Sa:-31.8(-1.8;0.0)µm, Vmc:-1.8(-1.6;-0.0)ml/m2, VRI:29(20;43) and for teeth of the permanent dentition: Ra:-4.0(-2.5;-1.0)µm, Sa:-4.8(-3.0;-1.1)µm, Vmc:-4.6(-3.4;-0.5)ml/m2, VRI:34(19;44) differing significantly between S and C (p<0.05,Wilcoxon test). No significant difference was observed between 1st and 2nd dentition (p>0.05, Kruskal-Wallis test) as well as commercial and experimental optic (p>0.05). The highest positive predictive value (PPV) was achieved by examiner 1 with explorer S3C (1st dentition 67%;2nd dentition 100%;pooled dentition 88%)), while examiner 2 revealed the highest PPV with explorer S23H (89%;86%;88%).

CONCLUSION

Differences in roughness and reflectance between sound and caries-active enamel surfaces could be evaluated in both primary and permanent dentition. These differences could also be reliably detected using three different explorers with good validity. However, the most predictive explorer seems to differ between examiners.

CLINICAL SIGNIFICANCE

In both primary (deciduous) and permanent dentition active caries lesions exhibit significantly higher roughness and lower vertical reflection intensity compared with sound enamel. These differences are detectable by blind tactile examination and objective methods such as 3D-laser-scanning or multi-sensor microscopy, highlighting their utility in caries diagnosis in both dentitions.

Clinical Effectiveness of Biomaterials in Indirect Pulp Therapy Treatment of Young Permanent Molars with Deep Carious Lesions: A Case-Control Study

Aim

The present case-control study was planned to assess the comparative efficacy of resin-modified calcium silicate, resin-modified glass ionomer, and Dycal as pulp capping agents in indirect pulp therapy for deeply carious young permanent molars.

Materials and methods

Thirty deeply carious young posterior teeth were treated by indirect pulp therapy. During the treatment, the cavity floor was lined with TheraCal or resin-modified glass ionomer cement (RMGIC) in the study group and with Dycal (control group) followed by GC IX and composite restoration. The teeth were reviewed and evaluated clinically and radiographically after 6 and 12 months.

Results

None of the study subjects experienced pain in any of the three study groups up to 12 months. Maturogenesis was seen in all 30 study teeth. Maximum% gain in dentin formation was seen in group I (TheraCal), that is, 16.100 ± 2.42, followed by group II (RMGIC), that is, 11.6000 ± 1.42, and group III (Dycal), that is, 9.6000 ± 0.96, and the difference between group I and group II and group I and group III was highly significant (p < 0.0001). Dentin formation was observed earlier at 6 months in 82.5% of cases with mesio-occlusal (MO) cavities as compared to 62.5% of cases with disto-occlusal (DO) extension.

Conclusion

TheraCal LC may be preferred as a pulp capping agent in the management of deeply carious young permanent molars for better healing in less time.

How to cite this article

Altaf G, Garg S, Saraf BG, et al. Clinical Effectiveness of Biomaterials in Indirect Pulp Therapy Treatment of Young Permanent Molars with Deep Carious Lesions: A Case-Control Study. Int J Clin Pediatr Dent 2024;17(11):1199-1205.

Effectiveness of glass-ionomer sealant versus fluoride varnish application to prevent occlusal caries among preschool children over 18-24 months - A randomised controlled trial

OBJECTIVES

To compare the clinical efficacies of 5 % sodium fluoride varnish (NaFV) and glass-ionomer sealant (GIS) in preventing occlusal caries in primary second molars (PSMs).

MATERIALS AND METHODS

A total of 736 children were recruited from 18 kindergartens and randomised into either Group 1- receiving NaFV quarterly, or Group 2 - single placement of GIS at baseline. Interventions were performed on 1431 and 1264 PSMs in Group 1 and Group 2, respectively. The primary outcome was the development of ICDAS≥4 dentine caries at the occlusal surfaces of PSMs.

RESULTS

A total of 736 children (383 in Group 1; 353 in Group 2) received the intervention. After 18-24 months, 479 children with 1764 PSMs were reviewed. Despite a low GIS retention rate of 2.4 % by 18-24 months, only 17.1 % of PSM in the GIS group developed caries into dentine. No significant difference was identified when compared to the proportion of PSMs with caries into dentine in the NaFV group (17.0 %). Regression analysis with GEE revealed that only baseline dft score and plaque level had a significant influence on development of ICDAS≥4 dentine caries in PSMs.

CONCLUSIONS

Quarterly-applied NaFV and a single placement of medium viscosity GIS have similar clinical efficacies in preventing occlusal caries among preschool children.

CLINICAL SIGNIFICANCE

There is no significant difference between quarterly-applied NaFV and GIS in preventing occlusal caries at PSMs. Dental clinicians can choose to use either of these preventive methods after considering their own and parents' preferences, children's cooperation and other practical factors.

The Ways of Forming and the Erosion/Decay/Aging of Bioapatites in the Context of the Reversibility of Apatites

This study primarily focused on the acid erosion of enamel and dentin. A detailed examination of the X-ray diffraction data proves that the products of the acid-caused decay of enamel belong to the family of isomorphic bioapatites, especially calcium-deficient hydroxyapatites. They are on a trajectory towards less and less crystallized substances. The increase in Bragg's parameter d and the decrease in the energy necessary for the changes were coupled with variability in the pH. This was valid for the corrosive action of acid solutions with a pH greater than 3.5. When the processes of natural tooth aging were studied by X-ray diffraction, a clear similarity to the processes of the erosion of teeth was revealed. Scarce data on osteoporotic bones seemed to confirm the conclusions derived for teeth. The data concerning the bioapatite decays were confronted with the cycles of apatite synthesis/decay. The chemical studies, mainly concerning the Ca/P ratio in relation to the pH range of durability of popular compounds engaged in the synthesis/decay of apatites, suggested that the process of the formation of erosion under the influence of acids was much inverted in relation to the process of the formation of apatites, starting from brushite up to apatite, in an alkaline environment. Our simulations showed the shift between the family of bioapatites versus the family of apatites concerning the pH of the reaction environment. The detailed model stoichiometric equations associated with the particular stages of relevant processes were derived. The synthesis processes were alkalization reactions coupled with dehydration. The erosion processes were acid hydrolysis reactions. Formally, the alkalization of the environment during apatite synthesis is presented by introducing Ca(OH)2 to stoichiometric equations.