Assessment of Autofluorescence to Detect the Remineralization Capabilities of Sodium Fluoride, Monofluorophosphate and Non-Fluoride Dentifrices

Therapeutic effect of a novel bioactive glass-ceramics on early caries lesions: a single-center, randomized controlled clinical trial

OBJECTIVES

To investigate the therapeutic effect of a novel bioactive glass-ceramics (BGC) called Huaxi BGC (HX-BGC) on early caries lesions.

MATERIALS AND METHODS

A total of 195 patients who meeting inclusion criteria were recruited and randomized to three groups in a 1:1:1 ratio. The patients in the treatment group received fluoride varnish which contained 5% sodium fluoride (NaF) or distilled water which contained 7.5% HX-BGC once a month for 3 months, and the control group received placebos. Quantitative light-induced fluorescence (QLF) images were taken at baseline and at the 1-month and 3-month follow-ups.

RESULTS

The three groups had similar baseline characteristics, including age, gender, and QLF parameters (ΔF, area, and ΔQ). Compared with baseline, the ΔQ values were significantly decreased in the HX-BGC and NaF groups at 1 and 3 months (p<0.005), while no statistically significant changes were found in that of the control group. After adjusting for baseline measurements, both of the 5% NaF and 7.5% HX-BGC showed a significant therapeutic effect in the treatment of initial enamel lesions at 1 month and 3 months, when compared to those receiving placebos (ΔQ, p<0.05). Moreover, the ΔQ value of the HX-BGC group decreased by a slightly more amount than that of the NaF group at 1 month (p=0.048). Similar trends were also found for the values of ΔF and area.

CONCLUSION

Our results suggest that HX-BGC may serve as a promising bioactive material for the treatment of early caries lesions.

CLINICAL RELEVANCE

HX-BGC holds a great promise to be used as a novel bioactive material for the treatment of early caries lesions.

In vitro remineralization of primary teeth with a mineralization-promoting peptide containing dental varnish

Mineralization-promoting peptides are attractive candidates for new remineralization systems. In previous studies, peptides have been applied as aqueous solutions, which is not a clinically relevant form.

OBJECTIVE

This study aims to investigate the efficiency of a mineralization-promoting peptide, applied in varnish, on remineralizing artificial caries on primary teeth.

METHODOLOGY

55 primary molars were collected. Specimens were immersed in a demineralizing solution for 7 days and then, divided into 7 groups: Baseline: No-remineralization, Placebo: Blank colophony, F: Colophony 5% fluoride, P: Colophony 10% peptide, P+F: Colophony 5% fluoride and 10% peptide, Embrace: Embrace™ varnish, Durashield: Durashield™ varnish. A mixture of 35% w/v colophony varnishes were prepared in ethanol and applied accordingly. Specimens were immersed in a remineralization solution for 4 weeks and it was evaluated using PLM and SEM. Lesion depth reduction was examined by one-way ANOVA.

RESULTS

There was no significant difference in mean lesion depths between baseline (147.04 ± 10.18 μm) and placebo groups (139.73 ± 14.92 μm), between F (120.95 ± 12.23 μm) and Durashield (113.47 ± 14.36 μm) groups and between P (81.79 ± 23.15 μm) and Embrace (90.26 ± 17.72 μm) groups. Lesion depth for the P+F group (66.95±10.59 μm) was significantly higher compared to all other groups. All groups contained samples with subsurface demineralized regions. Number of subsurface demineralized regions were higher in fluoride-containing groups.

CONCLUSIONS

We conclude that the mineralization-promoting peptide (MPP3) is effective in this in vitro study and the peptide shows benefits over fluoride as it yields less subsurface demineralized regions.

Assessment of non-cavitated root caries lesions by quantitative light-induced fluorescence-An in vivo feasibility study

OBJECTIVES

To evaluate the reproducibility of quantitative light-induced fluorescence (QLF) for the detection and assessment of demineralization states of non-cavitated root surfaces and to determine the correlation between visual inspection and QLF-analysis.

METHODS

46 exposed non-cavitated root surfaces of 12 participants were classified in three scores: sound (0), lesion ≤ 5 mm (1a), lesion > 5 mm in diameter (1b). Three examiners imaged every root surface three times using QLF (QRayCam) and measured fluorescence loss (ΔF) and lesion volume (ΔQ). The QLF-images were analyzed by three examiners. The intra- and interexaminer reproducibilities were calculated (intraclass correlation coefficient, ICC). The correlation between the scores of root caries and QLF-analysis was determined (rank correlation coefficient, Spearman-Rho ρ).

RESULTS

Intra- and interexaminer reproducibility (ICC) was 0.98 and 0.95 for ΔF, 0.94 and 0.91 for ΔQ, respectively. A significant correlation was observed between the scores and ΔF (ρ = -0.53, p < 0.01).

CONCLUSION

QLF as a reproducible diagnostic tool enables non-invasive detection and differentiation of non-cavitated root caries lesions on root surfaces in vivo. It can be recommended in addition to the clinical evaluation for prospective follow-up examinations of demineralization states of exposed root surfaces.

Fluoride toothpastes of different concentrations for preventing dental caries

BACKGROUND

Caries (dental decay) is a disease of the hard tissues of the teeth caused by an imbalance, over time, in the interactions between cariogenic bacteria in dental plaque and fermentable carbohydrates (mainly sugars). Regular toothbrushing with fluoride toothpaste is the principal non-professional intervention to prevent caries, but the caries-preventive effect varies according to different concentrations of fluoride in toothpaste, with higher concentrations associated with increased caries control. Toothpastes with higher fluoride concentration increases the risk of fluorosis (enamel defects) in developing teeth. This is an update of the Cochrane Review first published in 2010.

OBJECTIVES

To determine and compare the effects of toothpastes of different fluoride concentrations (parts per million (ppm)) in preventing dental caries in children, adolescents, and adults.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 15 August 2018); the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 7) in the Cochrane Library (searched 15 August 2018); MEDLINE Ovid (1946 to 15 August 2018); and Embase Ovid (1980 to 15 August 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials (15 August 2018). No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

Randomised controlled trials that compared toothbrushing with fluoride toothpaste with toothbrushing with a non-fluoride toothpaste or toothpaste of a different fluoride concentration, with a follow-up period of at least 1 year. The primary outcome was caries increment measured by the change from baseline in the decayed, (missing), and filled surfaces or teeth index in all permanent or primary teeth (D(M)FS/T or d(m)fs/t).

DATA COLLECTION AND ANALYSIS

Two members of the review team, independently and in duplicate, undertook the selection of studies, data extraction, and risk of bias assessment. We graded the certainty of the evidence through discussion and consensus. The primary effect measure was the mean difference (MD) or standardised mean difference (SMD) caries increment. Where it was appropriate to pool data, we used random-effects pairwise or network meta-analysis.

MAIN RESULTS

We included 96 studies published between 1955 and 2014 in this updated review. Seven studies with 11,356 randomised participants (7047 evaluated) reported the effects of fluoride toothpaste up to 1500 ppm on the primary dentition; one study with 2500 randomised participants (2008 evaluated) reported the effects of 1450 ppm fluoride toothpaste on the primary and permanent dentition; 85 studies with 48,804 randomised participants (40,066 evaluated) reported the effects of toothpaste up to 2400 ppm on the immature permanent dentition; and three studies with 2675 randomised participants (2162 evaluated) reported the effects of up to 1100 ppm fluoride toothpaste on the mature permanent dentition. Follow-up in most studies was 36 months.In the primary dentition of young children, 1500 ppm fluoride toothpaste reduces caries increment when compared with non-fluoride toothpaste (MD -1.86 dfs, 95% confidence interval (CI) -2.51 to -1.21; 998 participants, one study, moderate-certainty evidence); the caries-preventive effects for the head-to-head comparison of 1055 ppm versus 550 ppm fluoride toothpaste are similar (MD -0.05, dmfs, 95% CI -0.38 to 0.28; 1958 participants, two studies, moderate-certainty evidence), but toothbrushing with 1450 ppm fluoride toothpaste slightly reduces decayed, missing, filled teeth (dmft) increment when compared with 440 ppm fluoride toothpaste (MD -0.34, dmft, 95%CI -0.59 to -0.09; 2362 participants, one study, moderate-certainty evidence). The certainty of the remaining evidence for this comparison was judged to be low.We included 81 studies in the network meta-analysis of D(M)FS increment in the permanent dentition of children and adolescents. The network included 21 different comparisons of seven fluoride concentrations. The certainty of the evidence was judged to be low with the following exceptions: there was high- and moderate-certainty evidence that 1000 to 1250 ppm or 1450 to 1500 ppm fluoride toothpaste reduces caries increments when compared with non-fluoride toothpaste (SMD -0.28, 95% CI -0.32 to -0.25, 55 studies; and SMD -0.36, 95% CI -0.43 to -0.29, four studies); there was moderate-certainty evidence that 1450 to 1500 ppm fluoride toothpaste slightly reduces caries increments when compared to 1000 to 1250 ppm (SMD -0.08, 95% CI -0.14 to -0.01, 10 studies); and moderate-certainty evidence that the caries increments are similar for 1700 to 2200 ppm and 2400 to 2800 ppm fluoride toothpaste when compared to 1450 to 1500 ppm (SMD 0.04, 95% CI -0.07 to 0.15, indirect evidence only; SMD -0.05, 95% CI -0.14 to 0.05, two studies).In the adult permanent dentition, 1000 or 1100 ppm fluoride toothpaste reduces DMFS increment when compared with non-fluoride toothpaste in adults of all ages (MD -0.53, 95% CI -1.02 to -0.04; 2162 participants, three studies, moderate-certainty evidence). The evidence for DMFT was low certainty.Only a minority of studies assessed adverse effects of toothpaste. When reported, effects such as soft tissue damage and tooth staining were minimal.

AUTHORS' CONCLUSIONS

This Cochrane Review supports the benefits of using fluoride toothpaste in preventing caries when compared to non-fluoride toothpaste. Evidence for the effects of different fluoride concentrations is more limited, but a dose-response effect was observed for D(M)FS in children and adolescents. For many comparisons of different concentrations the caries-preventive effects and our confidence in these effect estimates are uncertain and could be challenged by further research. The choice of fluoride toothpaste concentration for young children should be balanced against the risk of fluorosis.

Clinical Evaluation of Two Different Prevention Programs in Adults Depending on Their Caries Risk Profile: One-year Results

The aim of this study was to investigate the management of incipient caries lesions in adults with two preventive protocols. A total of 44 adult patients with high, moderate and low caries risk with 516 incipient caries took part in the study. These patients were assessed for caries with International Caries Detection and Assessment System (ICDAS) criteria and were then divided into three groups depending on their caries risk profile: a high-risk group (group A), a moderate-risk group (group B), and a low-risk group (group C). Participants in each group were further divided randomly into two subgroups. In subgroups A1, B1, and C1, an intensive preventive protocol was applied, while in subgroups A2, B2, and C2, the protocol consisted only of instructions in oral hygiene. The invasive-intensive protocol included the topical application of fluoride, brushing with 5000-ppm fluoride toothpaste, use of amorphous calcium phosphate-casein phosphopeptide, applications of sealants for occlusal lesions (ICDAS code 2), and minimal resin restorations for occlusal lesions (ICDAS code 3). There was no statistically significant difference in the number of lesions (baseline and after one year) in the high-risk and moderate-risk groups that received the intensive protocol (groups A1 and B1), while the control groups were statistically significant different (groups A2 and B2). In the low-risk group, there was no statistically significant difference in the number of lesions (groups C1 and C2). The two different preventive protocols in the high- and moderate-risk groups presented differences in effectiveness, while in the low-risk group, no significant difference was demonstrated.

Reliability and validity of FluoreCam for white-spot lesion detection: An in vitro study

AIM

In the present study, we tested the reliability and validity of a new light fluorescence device, the FluoreCam.

METHODS

Twenty-five human teeth were sectioned mesiodistally into halves. Group 1 (n=30) included specimens with either sound enamel or natural white-spot lesions (WSL). Group 2 (n=20) included specimens with sound enamel used to create artificial WSL. Using the FluoreCam, baseline scans of enamel surfaces were obtained under standardized conditions. Group1 was scanned again the next day. Group 2 specimens were covered with an acid-resistant nail polish, leaving a 2 × 6-mm enamel window exposed, immersed in Queiroz-solution (64 hours, 37°C/pH5 with agitation), and then scanned again. Random error of the repeated measurements (reliability) was determined using method errors and intraclass correlations (ICC). Systematic error and the ability to detect demineralization (validity) were tested using Wilcoxon signed-rank test.

RESULTS

Method errors for Group 1 replicates were .39 mm² (area), .72 pixels (intensity), and 5.69 pixels.mm² (impact). Group 2 method errors were consistently slightly higher than those of group 1. FluoreCam showed highly reliable measurements for group 1 (ICC: 0.93-0.98) and group 2 (ICC: 0.87-0.97). There were no statistically-significant systematic errors for either group (P>.05). In group 2, enamel demineralization was statistically significant in area (P<.001), intensity (P=.001), and impact (P<.001).

CONCLUSION

FluoreCam is highly reliable and valid for in vitro assessments of enamel demineralization.

Comparative assessment of fluoride varnish and fluoride film for remineralization of postorthodontic white spot lesions in adolescents and adults over a 6-month period: A single-center, randomized controlled clinical trial

INTRODUCTION

The objective of this 3-arm parallel randomized trial was to evaluate the effects of a fluoride varnish and a fluoride film on the remineralization of white spot lesions around orthodontic brackets after orthodontic treatment.

METHODS

Patients who had recently completed orthodontic treatment were randomly assigned to the varnish, film, and control groups. Eligibility criteria included age of 12 to 25 years, good general health, and at least 1 maxillary anterior tooth with a white spot lesion. The primary outcome was the decrease in the lesion volume of each patient after 6 months of treatment; fluorescence loss and area were the secondary outcome measures. Randomization was accomplished according to a computer-generated randomization schedule, and allocation concealment was achieved with nontransparent concealed envelopes. Blinding was applicable for the treatments only. The test groups received fluoride varnish or film treatment once a month for 6 months, and the control group received a placebo treatment. All patients received oral hygiene education and were required to use fluoride toothpaste daily. Quantitative light-induced fluorescence images were taken at baseline and at the 3-month and 6-month follow-ups. A mixed-effects linear model was used to analyze quantitative light-induced fluorescence parameters with confounders integrated into the model.

RESULT

Two hundred forty patients (mean age, 16.9 years; range, 12-25 years) with 597 teeth with a white spot lesion were randomized 1:1:1 to the varnish, film, and control groups. Baseline demographics were similar between groups, and 29 patients were lost to follow-up. The primary analysis was carried out on a per-protocol basis involving 72 patients in the control group, 69 patients in the varnish group, and 70 patients in the film group who completed the study. The product of fluorescence loss and lesion area values were statistically associated with time (estimate, -4.58; 95% confidence interval [CI], -5.84 to -3.31; P <0.0001), and a significant decrease in the product of fluorescence loss and lesion area was observed in all groups after 6 months with each treatment. The interaction between group and time in the statistical analysis indicated that the product of fluorescence loss and lesion area values of the 3 groups followed different trends over time. Further pair-wise comparisons showed that the decreases in the 2 test groups were significantly greater than those in the control group (varnish vs control: estimate, -11.83; 95% CI, -15.39 to -8.26; P <0.0001; film vs control, estimate: -7.72; 95% CI, -11.34 to 4.10; P <0.0001) in the analysis for 6 months. In addition, the decrease in the varnish group was significantly greater than that in the film group (estimate, 4.11; 95% CI, 0.48 to 7.73; P = 0.0266) in the analysis for 6 months. No serious adverse effects associated with the use of the tested varnish, film, or placebo occurred.

CONCLUSIONS

After removal of the orthodontic brackets, some natural remineralization of white spot lesions occurred, and daily use of fluoride toothpaste may be helpful for this process. However, not all patients experienced this remineralization, and treatment with fluoride varnish or fluoride film induced greater remineralization of white spot lesions. In addition, our results suggest that fluoride varnish may be slightly more effective than fluoride film. However, further similar clinical trials with more patients are needed to definitively determine which fluoride treatment is most effective.

REGISTRATION

This trial was registered on the Chinese Clinical Trial Register, number ChiCTR-TRC-13003764.

PROTOCOL

The details of the trial protocol are posted online at: http://apps.who.int/trialsearch/Trial.aspx?TrialID=ChiCTR-TRC-13003764.

Effect of Fluoride Varnish on Enamel Remineralization in Anterior Teeth with Molar Incisor Hypomineralization

OBJECTIVE

The objective of this study was to investigate the effect of fluoride varnish on remineralization of anterior teeth affected by Molar-Incisor Hypomineralization (MIH) by means of Quantitative Light-Induced Fluorescence- QLF.

STUDY DESIGN

Fifty-one healthy 9 - 12- year-old children were selected according to different clinically diagnosed levels of MIH, proposed by the European Academy of Pediatric Dentistry (2003) (considering the most severe lesion per patient, n= 51 lesions), and randomly divided into two groups: (1) four applications of 5% NaF varnish, with one-week interval, and (2) usual home care- control. At each visit, the mean change in fluorescence and area of lesion were measured by QLF. The data were analyzed by repeated measures ANOVA and Tukey's test.

RESULTS

All patients showed enamel alterations in first permanent molars and incisors, frequently with two molars affected by MIH (41.1%). There was no statically significant difference in the mean of fluorescence and area of lesion between groups over the studied time.

CONCLUSION

We observed no favorable effect on the remineralization of MIH lesions in anterior teeth after four applications of fluoride varnish.

Laser fluorescence in monitoring the influence of targeted tooth brushing on remineralization of initial caries lesions on newly erupted molar teeth - RCT

OBJECTIVE

This study aimed to monitor mineralization changes in initial caries lesions on newly erupted second molars using laser fluorescence (LF) scanning after a 1-month targeted tooth brushing intervention.

METHODS

Altogether, 124 13- to 14-year-old school children were invited to participate. Of those who fulfilled the clinical criteria (at least one initial lesion with LF value >10 in second molars), 51 gave their written consent to participate. Laser fluorescence values were registered at baseline and after 1-month follow-up period. All participants were individually taught targeted tooth brushing of their second molars and randomly provided tooth paste with 0 or 1500 ppm fluoride. Brushing frequency was investigated at baseline and after the follow-up. Change in LF values was compared considering the tooth, content of fluoride in the paste and brushing frequency.

RESULTS

In lesions with LF values ≤30 at baseline, change in LF values demonstrated improvement. Improvement was detected especially in upper molars. In lesions with LF values >30 at baseline, improvement was least detected. Brushing frequency increased slightly during the intervention.

CONCLUSIONS

Laser fluorescence is a simple method and useful in monitoring remineralization of incipient lesions even in weeks. Targeted tooth brushing seems to induce remineralization even in weeks. Laser fluorescence could be a valuable motivating tool in promoting patients' self-care.

Quantitative light-induced fluorescence to measure enamel remineralization in vitro

The aim of this study was to compare the ability of quantitative light-induced fluorescence (QLF) and surface microhardness (SMH) to measure the remineralization of enamel subsurface lesions, using a pH-cycling model including treatment with 0-ppm, 550-ppm or 1,100-ppm sodium fluoride (NaF) dentifrices.

METHODS

Subsurface lesions were created in human enamel specimens (n = 36) and exposed to a remineralization pH-cycling model for 14 days. The pH-cycling model was performed in an automated system where specimens were subjected to a demineralizing solution for 20 min and treatment for 1 min and were then remineralized for 7 h 39 min, 3 times daily. The treatments consisted of 3 NaF, silica-containing dentifrices (0 ppm F; 550 ppm F; 1,100 ppm F). The outcome variables were: change from baseline in surface hardness and percentage change from baseline in fluorescence. An ANCOVA explored differences between different treatment groups (at the p < 0.05 level). Associations between QLF and SMH were evaluated using Spearman's correlation coefficient.

RESULTS

The percentage SMH changes were 14.9 ± 2.1%, 56.6 ± 9.6% and 103.9 ± 14.6% for the 0-, 550- and 1,100-ppm F dentifrices, respectively. The percentage fluorescence changes were 15.6 ± 7.1%, 59.8 ± 11.9% and 85 ± 13.2%, respectively. The differences between all pairwise comparisons were statistically significant for both methods (p = 0.001). QLF correlated with SMH (r = 0.67).

CONCLUSIONS

Both the SMH and QLF methods demonstrated a significant F dose response for toothpaste in this in vitro remineralization model, and both methods were able to distinguish treatments with different F levels.

Longitudinal analyses of early lesions by fluorescence: an observational study

Previous caries experience correlates to future caries risk; thus, early identification of lesions has importance for risk assessment and management. In this study, we aimed to determine if Quantitative Light-induced Fluorescence (QLF) parameters--area (A [mm(2)]), fluorescence loss (F [%]), and Q [% × mm(2)]--obtained by image analyses can predict lesion progression. We secured consent from 565 children (from 5-13 years old) and their parents/guardians and examined them at baseline and regular intervals over 48 months according to the International Caries Detection Assessment System (ICDAS), yearly radiographs, and QLF. QLF images from surfaces with ICDAS 0/1/2/3/4 at baseline that progressed (N = 2,191) to cavitation (ICDAS 5/6) or fillings and surfaces that did not progress to cavitation/fillings (N = 4,141) were analyzed independently for A, F, and Q. Linear mixed-effects models were used to compare means and slopes (changes over time) between surfaces that progressed and those that did not. QLF A, F, and Q increased at a faster rate for surfaces that progressed than for surfaces that did not progress (p = .0001), regardless of type of surface or baseline ICDAS score. AUC for ICDAS ranged from 0.65 to 0.80, but adding QLF information improved AUC (0.82-0.87, p < .0005). We concluded that faster changes in QLF variables can indicate lesion progression toward cavitation and be more clinically relevant than actual QLF values.

Caries Clinical Trial Methods for the Assessment of Oral Care Products in the 21st Century

Traditionally, caries clinical trials of oral care products have focused on the prevention of caries in children and adolescents at the “cavitation” level. Because of a general reduction in caries incidence and the use of positive control comparators, studies have grown both in size and duration to improve statistical power. Currently, they tend to be of 2 to 3 years’ duration, with up to 2,000 high-risk individuals per group. During the past decade, there has been a shift in emphasis from a restorative approach to the treatment of dental caries to a therapeutic approach focused on the remineralization of early caries lesions. However, caries clinical trials of oral care products have not often reflected this paradigm change. This manuscript reviews alternative caries clinical trial methods for oral care products. It is concluded that methods focused on the detection and monitoring of enamel caries and root caries, by visual approaches such as ICDAS and instrumental methods such as QLF, Diagnodent, and Electrical Caries Monitors, provide viable alternatives to traditional methods. In particular, such approaches more accurately reflect the modes of action of many therapeutic agents and formulations and may reduce the cost and duration of product innovation.

Quality of cluster randomized controlled trials in oral health: a systematic review of reports published between 2005 and 2009

OBJECTIVES

To assess the quality of methods and reporting of recently published cluster randomized trials (CRTs) in oral health.

METHODS

We searched PubMed for CRTs that included at least one oral health-related outcome and were published from 2005 to 2009 inclusive. We developed a list of criteria for assessing trial quality and reporting. This was influenced largely by the extended CONSORT statement for CRTs but also included criteria suggested by other authors. We examined the extent to which trials were consistent with these criteria.

RESULTS

Twenty-three trials were included in the review. In 15 (65%) trials, clustering had been accounted for in sample size calculations, and in 18 (78%) authors had accounted for clustering in analysis. Intraclass correlation coefficients (ICCs) were reported for eight (35%) trials; the outcome assessor was reported as having been blinded to allocation in 12 (52%) trials; 17 (74%) described eligibility criteria at individual level, but only nine (39%) described such criteria at cluster level. Sixteen of 20 trials (80%), in which individuals were recruited, reported that individual informed consent was obtained.

CONCLUSIONS

These results suggest that the quality of recent CRTs in oral health is relatively high and appears to compare favourably with other fields. However, there remains room for improvement. Authors of future trials should endeavour to ensure sample size calculations and analyses properly account for clustering (and are reported as such), consider the potential for recruitment/identification bias at the design stage, describe the steps taken to avoid this in the final report and report observed ICCs and cluster-level eligibility criteria.

Dental caries and pulpal disease

This article reviews the diagnostic process, from the first clinically evident stages of the caries process to development of pulpal pathosis. The caries diagnostic process includes 4 interconnected components-staging caries lesion severity, assessing caries lesion activity, and risk assessments at the patient and tooth surface level - which modify treatment decisions for the patient. Pulpal pathosis is diagnosed as reversible pulpitis, irreversible pulpitis (asymptomatic), irreversible pulpitis (symptomatic), and pulp necrosis. Periapical disease is diagnosed as symptomatic apical periodontitis, asymptomatic apical periodontitis, acute apical abscess, and chronic apical abscess. Ultimately, the goal of any diagnosis should be to achieve better treatment decisions and health outcomes for the patient.

Demineralization Depth Using QLF and a Novel Image Processing Software

Quantitative Light-Induced fluorescence (QLF) has been widely used to detect tooth demineralization indicated by fluorescence loss with respect to surrounding sound enamel. The correlation between fluorescence loss and demineralization depth is not fully understood. The purpose of this project was to study this correlation to estimate demineralization depth. Extracted teeth were collected. Artificial caries-like lesions were created and imaged with QLF. Novel image processing software was developed to measure the largest percent of fluorescence loss in the region of interest. All teeth were then sectioned and imaged by polarized light microscopy. The largest depth of demineralization was measured by NIH ImageJ software. The statistical linear regression method was applied to analyze these data. The linear regression model was Y = 0.32X + 0.17, where X was the percent loss of fluorescence and Y was the depth of demineralization. The correlation coefficient was 0.9696. The two-tailed t-test for coefficient was 7.93, indicating the P-value = .0014. The F test for the entire model was 62.86, which shows the P-value = .0013. The results indicated statistically significant linear correlation between the percent loss of fluorescence and depth of the enamel demineralization.

Caries Detection Methods Based on Changes in Optical Properties between Healthy and Carious Tissue

A conservative, noninvasive or minimally invasive approach to clinical management of dental caries requires diagnostic techniques capable of detecting and quantifying lesions at an early stage, when progression can be arrested or reversed. Objective evidence of initiation of the disease can be detected in the form of distinct changes in the optical properties of the affected tooth structure. Caries detection methods based on changes in a specific optical property are collectively referred to as optically based methods. This paper presents a simple overview of the feasibility of three such technologies for quantitative or semiquantitative assessment of caries lesions. Two of the techniques are well-established: quantitative light-induced fluorescence, which is used primarily in caries research, and laser-induced fluorescence, a commercially available method used in clinical dental practice. The third technique, based on near-infrared transillumination of dental enamel is in the developmental stages.

Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents

BACKGROUND

Caries (dental decay) is a disease of the hard tissues of the teeth caused by an imbalance, over time, in the interactions between cariogenic bacteria in dental plaque and fermentable carbohydrates (mainly sugars). The use of fluoride toothpaste is the primary intervention for the prevention of caries.

OBJECTIVES

To determine the relative effectiveness of fluoride toothpastes of different concentrations in preventing dental caries in children and adolescents, and to examine the potentially modifying effects of baseline caries level and supervised toothbrushing.

SEARCH STRATEGY

A search was undertaken on Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and several other databases. Reference lists of articles were also searched. Date of the most recent searches: 8 June 2009.

SELECTION CRITERIA

Randomised controlled trials and cluster-randomised controlled trials comparing fluoride toothpaste with placebo or fluoride toothpaste of a different concentration in children up to 16 years of age with a follow-up period of at least 1 year. The primary outcome was caries increment in the permanent or deciduous dentition as measured by the change in decayed, (missing), filled tooth surfaces (D(M)FS/d(m)fs) from baseline.

DATA COLLECTION AND ANALYSIS

Inclusion of studies, data extraction and quality assessment were undertaken independently and in duplicate by two members of the review team. Disagreements were resolved by discussion and consensus or by a third party. The primary effect measure was the prevented fraction (PF), the caries increment of the control group minus the caries increment of the treatment group, expressed as a proportion of the caries increment in the control group. Where it was appropriate to pool data, network meta-analysis, network meta-regression or meta-analysis models were used. Potential sources of heterogeneity were specified a priori and examined through random-effects meta-regression analysis where appropriate.

MAIN RESULTS

75 studies were included, of which 71 studies comprising 79 trials contributed data to the network meta-analysis, network meta-regression or meta-analysis.For the 66 studies (74 trials) that contributed to the network meta-analysis of D(M)FS in the mixed or permanent dentition, the caries preventive effect of fluoride toothpaste increased significantly with higher fluoride concentrations (D(M)FS PF compared to placebo was 23% (95% credible interval (CrI) 19% to 27%) for 1000/1055/1100/1250 parts per million (ppm) concentrations rising to 36% (95% CrI 27% to 44%) for toothpastes with a concentration of 2400/2500/2800 ppm), but concentrations of 440/500/550 ppm and below showed no statistically significant effect when compared to placebo. There is some evidence of a dose response relationship in that the PF increased as the fluoride concentration increased from the baseline although this was not always statistically significant. The effect of fluoride toothpaste also increased with baseline level of D(M)FS and supervised brushing, though this did not reach statistical significance. Six studies assessed the effects of fluoride concentrations on the deciduous dentition with equivocal results dependent upon the fluoride concentrations compared and the outcome measure. Compliance with treatment regimen and unwanted effects was assessed in only a minority of studies. When reported, no differential compliance was observed and unwanted effects such as soft tissue damage and tooth staining were minimal.

AUTHORS' CONCLUSIONS

This review confirms the benefits of using fluoride toothpaste in preventing caries in children and adolescents when compared to placebo, but only significantly for fluoride concentrations of 1000 ppm and above. The relative caries preventive effects of fluoride toothpastes of different concentrations increase with higher fluoride concentration. The decision of what fluoride levels to use for children under 6 years should be balanced with the risk of fluorosis.