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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

CLINICAL SIGNIFICANCE

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

Molecular insights into antibiofilm inhibitors of Streptococcus mutans glucosyltransferases through in silico approaches

Streptococcus mutans, a primary cariogenic bacterium, plays a central role in dental caries, one of the most widespread chronic diseases globally. Glucosyltransferases (GTFs) are key virulence factors in this process, as they synthesize extracellular polysaccharides that contribute to biofilm formation and pathogenicity. Targeting GTFs has emerged as a promising strategy for preventing dental caries, with previous studies demonstrating its potential efficacy. This study builds on our prior work by providing detailed molecular insights into the binding modes of previously identified GTF inhibitors. Using computational tools, including density functional theory, molecular docking, and molecular dynamics simulations, we examined the binding interactions and structural stability of selected inhibitors. All investigated candidates demonstrated superior binding behavior compared to the reference ligand, acarbose, as indicated by multiple structural parameters. Structural dynamics analysis revealed significant stability in the binding interactions of Complex III and V, with average deviations of 2.06 ± 0.38 and 2.07 ± 0.30 Å, respectively. Similarly, a trend in structural compactness was observed, with gyration values of 32.98 ± 0.23 and 33.01 ± 0.24 Å, respectively. Principal component analysis indicated that the constructed pattern approaches zero with the achievement of a global energy minimum, particularly for Complex III and V. Furthermore, MM/PBSA free energy calculations identified Compound V as the most favorable binder, with a binding free energy of -24.20 kcal/mol. Our findings provide valuable molecular-level insights into the inhibitory mechanisms of GTF-targeting compounds, strengthening their potential as anti-cariogenic agents. By elucidating key binding interactions, this study contributes to the ongoing search for improved scaffolds that may hinder biofilm-mediated infections and advance therapeutic strategies against dental caries.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

New insights into the correlation between bone mineral density and dental caries in NHANES 2011-2016

OBJECTIVES

Investigate the relationship between bone mineral density (BMD) at various body sites and dental caries.

MATERIALS AND METHODS

Based on the National Health and Nutrition Examination Survey (NHANES) database from 2011 to 2016, the correlation between BMD at various body sites and the DMFS index among 7044 adults aged 20-59 years was analyzed. Multiple linear regression, restricted cubic splines (RCS), piecewise linear regression, logistic regression, weighted quantile sum regression (WQS) and mediation effects analysis were integrated to explore the relationship between BMD and dental caries.

RESULTS

Under the linear assumption, except for arm BMD, the BMDs of all other sites are negatively correlated with the DMFS index of dental caries. RCS analysis indicates a U-shaped relationship between head BMD and the DMFS index (p for nonlinear < 0.0001). WQS analysis indicates that mixed BMD is significantly negatively correlated with the DMFS index for dental caries (estimate, - 0.023; 95% CI, - 0.025 ~ - 0.020), and head BMD has the most significant impact on the DMFS index (weight = 91.4%). Simple mediation analysis of the effect of dental caries on BMD levels mediated by inflammation levels showed negative results, suggesting that dental caries may not influence BMD through inflammation levels.

CONCLUSION

Monitoring BMD should be combined with appropriate oral healthcare and caries management strategies to effectively address these interconnected health issues, and particular attention should be paid to the monitoring of head BMD.

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

Objective

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

Methods

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

Results

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

Conclusion

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

Analyzing the anti-caries effect of fluoride varnish containing tricalcium phosphate using PIXE/PIGE

This study evaluated the effect of tricalcium phosphate-containing fluoride varnish on the prevention of root caries using an in-air micro-proton induced X-ray/gamma-ray emission system and microcomputed tomography. Either fluoride varnish (FV) or tricalcium phosphate-containing fluoride varnish (WV) was applied to root dentin, whereas dentin without varnish were considered controls. After immersion in saline, dentin sections were prepared, and concentration of fluoride ion was measured. These specimens were demineralized, and the mineral loss was measured. Caries inhibition in sound and demineralized dentin was observed in both FV and WV groups compared to the control group. Significantly low mineral loss was found especially in the demineralized dentin, which is probably due to the combination effect of calcium and fluoride ions at a concentration range of 100,000 ppm, as supplied by the varnish. The use of calcium-containing fluoride varnish, especially in demineralized dentin, is effective in arresting initial dentin caries.

Engineering peptide-polymer hybrids for targeted repair and protection of cervical lesions

By 2060, nearly 100 million people in the U.S. will be over age 65 years. One-third of these older adults will have root caries, and nearly 80% will have dental erosion. These conditions can cause pain and loss of tooth structure that interfere with eating, speaking, sleeping, and quality of life. Current treatments for root caries and dental erosion have produced unreliable results. For example, the glass-ionomer-cement or composite-resin restorations used to treat these lesions have annual failure rates of 44% and 17%, respectively. These limitations and the pressing need to treat these conditions in the aging population are driving a focus on microinvasive strategies, such as sealants and varnishes. Sealants can inhibit caries on coronal surfaces, but they are ineffective for root caries. For healthy, functionally independent elders, chlorhexidine varnish applied every 3 months inhibits root caries, but this bitter-tasting varnish stains the teeth. Fluoride gel inhibits root caries, but requires prescriptions and daily use, which may not be feasible for some older patients. Silver diamine fluoride can both arrest and inhibit root caries but stains the treated tooth surface black. The limitations of current approaches and high prevalence of root caries and dental erosion in the aging population create an urgent need for microinvasive therapies that can: (a) remineralize damaged dentin; (b) inhibit bacterial activity; and (c) provide durable protection for the root surface. Since cavitated and non-cavitated root lesions are difficult to distinguish, optimal approaches will treat both. This review will explore the multi-factorial elements that contribute to root surface lesions and discuss a multi-pronged strategy to both repair and protect root surfaces. The strategy integrates engineered peptides, novel polymer chemistry, multi-scale structure/property characterization and predictive modeling to develop a durable, microinvasive treatment for root surface lesions.

Does Early Childhood Caries Increase Caries Development among School Children and Adolescents? A Systematic Review and Meta-Analysis

The aim of this paper is to systematically review the literature to determine whether early childhood caries (ECC) is significantly associated with caries development in permanent teeth among school children and adolescents, and to identify the association of other risk factors over 24 months. A systematic literature search was performed in four electronic databases and via a manual search from inception to 28 July 2022. Independent study selection and screening, data extraction, evaluation of risk of bias using ROBINS-I tool and certainty of evidence with GRADE were performed. Ten cohort studies were included, all of which identified that ECC significantly increased the risk of caries in permanent teeth. Meta-analysis suggested children with ECC were three times more likely to develop caries in their permanent teeth (OR, 3.22; 95% CI 2.80, 3.71; p < 0.001), especially when the lesions were in primary molars and progressed to dentine. However, the certainty of evidence was substantially compromised by serious risk of bias and inconsistency between studies. There were inconsistent findings between socioeconomic or behavioural factors on caries development, which could not be pooled for meta-analyses. ECC significantly increases the likelihood of caries development in permanent teeth. Evidence on the association of socioeconomic and oral health behavioural factors is weak.

Impact of direct restorative dental materials on surface root caries treatment. Evidence based and current materials development: A systematic review

This systematic review provides an update on the development and efficacy of direct restorative dental materials for root caries interventions from in vitro and clinical studies. PubMed, Embase, and Web of Science were searched using specific MeSH keywords. Full articles from September 1990 to October 2021 were collected. Additional articles were identified by reference retrieval and manual searching. Studies not related to restorative materials for root caries treatment, case reports, non-original articles, and/or articles not written in English were excluded. Bias risk assessment was performed for the clinical studies. Forty-two articles (eleven clinical studies and thirty-one in vitro studies) were included for analysis. Most in vitro studies indicated an excellent cariostatic effect of glass ionomer cement. Resin-modified glass ionomer restorations also presented reduced recurrent caries activity but had a lower efficacy than glass ionomer cement restorations. For composite resin restorations, the main material development strategies are to strengthen the tooth structure and integrate antimicrobial activity. The clinical studies offered limited data, so the most appropriate material for surface root caries treatment is still inconclusive. However, atraumatic restorative treatment (ART) is an alternative treatment for patients with limiting conditions. Further clinical studies are required to confirm the efficacy of bioactive materials.

Systematic Review of the Literature on Dental Caries and Periodontal Disease in Socio-Economically Disadvantaged Individuals

Dental caries and periodontal disease represent a health problem and a social cost for the entire population, and in particular for socio-economically disadvantaged individuals who are less resistant to disease. The aim of this review is to estimate the prevalence and severity of the two dental pathologies, caries and periodontal disease, in the different classes of socio-economically disadvantaged subjects and to understand which of them are most affected. A systematic search of the literature was performed in MEDLINE (via PubMed), EMBASE and Web of Science after establishing a suitable search strategy for each database, using keywords related to socio-economically vulnerable classes and health outcomes. Socio-economically disadvantaged individuals are more susceptible to tooth decay and periodontal disease (with relative tooth loss) than non-vulnerable people. Additionally, when multiple vulnerabilities are combined in the same subject, these oral diseases worsen. There is no type of vulnerability more affected by caries and periodontitis than others, since overall they all have severe disease indices. The data from this systematic literature review might be useful for health policy makers looking to allocate more resources and services to socially disadvantaged individuals, resulting in making them more resilient to oral disease due to their social marginalization.

Barriers and facilitators of oral health care experienced by nursing home staff

Objectives to explore attitudes, perceptions, and perceived barriers to and the perceived facilitators of daily oral health care and the actual daily oral health care performances among nursing home staff. Methods A mixed methods study in 21 nursing homes was completed; a) questionnaires for nursing staff and managers; b) focus group interviews with nursing staff. Results 409 (21%) questionnaires were completed by nursing staff and 14 focus group interviews organized. Conclusions attitude was not a barrier in this study, while oral care was not performed according to guidelines. Nursing staff reported a lack of products, while toothbrushes are available. The most frequently mentioned barriers were lack of support of dental staff, oral care for clients with cognitive impairment, and a lack of education. Increasing facilitators could be; more (practical) education combined with tailored advice from internal dental staff. Where and on whom will the research have an impact? Nursing home staff, nursing home organizations/ managers and dental professionals working in nursing homes.

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

BACKGROUND

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

AIM

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

METHODOLOGY

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

RESULTS

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

CONCLUSION

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

Association between caries and periodontal diseases in a sample of employed adults in Spain: a cross-sectional study

OBJECTIVES

To study whether there is an association between caries and periodontitis in a representative sample from employed Spanish adults.

MATERIALS AND METHODS

This cross-sectional study is part of a wide epidemiological survey (WORALTH, Workers' ORAL healTH). Oral examination was carried out in 5130 dentate subjects. Periodontal status was assessed by clinical attachment level (CAL) and Community Periodontal Index (CPI) in index teeth. For caries, all teeth were classified as healthy, decayed (D), filled (F), or missed (M), and DMFT index and prevalence of cavitated caries were calculated. ANOVA, Chi-square tests, and regression models were performed.

RESULTS

DMFT increased with CAL values, being 7.8, 9.6, and 10.5 for CAL 0-3 mm, 4-5 mm, and ≥ 6 mm, respectively. After adjustment for confounders, subjects with CPI ≥ 3 showed an odds ratio of 1.6 (95% confidence interval (CI) [1.3; 1.8]; p < 0.001) for presenting cavitated caries, and patients with CAL ≥ 6 mm had 0.8 higher mean DMFT (95% CI [0.2; 1.5]; p = 0.015), and 0.3 higher mean DFR (95% CI [0.2; 0.5]; p < 0.001) than those with CAL < 6 mm.

CONCLUSIONS

The presence of CAL ≥ 6 m mm was associated with an increased DMFT and DFR, and the presence of CPI ≥ 3 was associated with a higher prevalence of cavitated caries in this representative sample.

CLINICAL RELEVANCE

There is a tendency to present higher prevalence of dental caries among patients with periodontitis. Therefore, common preventive measures in dentistry, such as oral hygiene practices, should ideally include actions aimed to prevent at the same time dental caries and periodontitis.

Inequalities in Untreated Root Caries and Affordability of Dental Services among Older American Adults

The growing geriatric population is facing numerous economic challenges and oral health changes. This study explores the relationship between affordability of dental care and untreated root caries among older American adults, and whether that relationship is independent of ethnicity and socioeconomic factors. Data from 1776 adults (65 years or older) who participated in the National Health and Nutrition Examination Survey (NHANES) were analyzed. The association between affordability of dental care and untreated root caries was assessed using logistic regression models. Findings indicated that untreated root caries occurred in 42.5% of those who could not afford dental care, and 14% of those who could afford dental care. Inability to afford dental care remained a statistically significant predictor of untreated root caries in the fully adjusted regression model (odds ratio 2.79, 95% confidence interval: 1.78, 4.39). Other statistically significant predictors were gender (male), infrequent dental visits, and current smoking. The study concludes that the inability to afford dental care was the strongest predictor of untreated root caries among older Americans. The findings highlight the problems with access to and use of much needed dental services by older adults. Policy reform should facilitate access to oral healthcare by providing an alternative coverage for dental care, or by alleviating the financial barrier imposed on older adults.

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

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

The Prevention of Infections in Older Adults: Oral Health

The oral cavity is exposed to the external environment and from a very young age is colonized by infectious agents. Under certain circumstances including poor oral hygiene, dry mouth, trauma, and the use of antibiotics, oral infections can occur. They can result in damage to the oral cavity including teeth and their support structures. Oral infections can also lead to the extension of infection into surrounding tissues and to systemic infections. Chronic oral infection is a recognized risk factor for heart disease. Older adults are at high risk for oral infections and associated complications. Tooth loss, for which infection is the most significant cause, leads to cosmetic changes and a decreased ability to masticate certain foods that can lead to malnutrition. Chronic oral infections and the manipulation of teeth and supporting structures can lead to the hematogenous spread of infection including the infection of artificial joints and endocardial implants. Good oral hygiene, the use of fluoride, regular dental care, and the appropriate use of antibiotics can all reduce oral infections and their associated complications. J Am Geriatr Soc 68:411-416, 2020.