Applying Social Practice Theory to Explore Australian Preschool Children's Oral Health

INTRODUCTION

Despite substantial research and provision of dental care, significant morbidity remains for children's oral health. Guided by social practice theory (SPT), this research moves away from the often-ineffective focus on changing individual behavior to rethinking the centrality of the social world in promoting or undermining oral health outcomes. We define social practice as a routinized relational activity linking and integrating certain elements (competence, materials, and meanings) into the performance of a practice that is reproduced across time and space.

OBJECTIVE

To investigate oral health in preschool children in Perth, Western Australia, using social practice theory.

METHODS

With no definitive methodology for investigating SPT, we chose focused ethnography as a problem-focused, context-specific approach using mainly interviews to investigate participants' experience caring for their children's oral health. The focus of analysis was the practice of oral health care, not individual behavior, where themes identified from participants' transcripts were organized into categories of elements and performance.

RESULTS

Eleven parents, all of whom were married or partnered, were interviewed in 2021. Findings identified social practices relevant to oral health within parenting and family relations linked to routine daily activities, including shopping, consumption of food and beverages, and toothbrushing. Oral health literacy was reflected in integrating competence, materials, and meanings into performing oral health care, notably preferences for children to drink water over sugary beverages and information often being sourced from social media and mothers' groups rather than health providers.

CONCLUSION

Focusing on social practices as the unit of analysis offers a more layered understanding of elements in young children's oral health care that can indicate where the problem may lie. Findings provide an opportunity to consider future research and policy directions in children's oral health.

KNOWLEDGE TRANSFER STATEMENT

Examining social practices related to young children's oral health care identifies parents/carers' knowledge about, for example, toothbrushing, the resources required, and why toothbrushing is important. Analyzing these separate elements can reveal both enablers and barriers to oral health care. This provides researchers, clinicians and policymakers an opportunity to focus on not changing individual behavior but understanding how social context impacts parents/carers' capacity to make optimum decisions around young children's oral health.

Professionally applied fluorides for preventing and arresting dental caries in low- and middle-income countries: Systematic review

OBJECTIVES

This systematic review aimed to review the safety and effectiveness of professionally applied fluorides for preventing and arresting dental caries in low- and middle-income countries (LMICs).

METHODS

Randomized controlled trials conducted in LMICs, in which professionally applied fluorides were compared with placebo/no treatment/health education only or usual care with a minimum one-year follow-up period, were included. Any topically applied fluoride agents such as sodium fluoride (NaF), acidulated phosphate fluoride, silver diamine fluoride (SDF), and nano silver fluoride (NSF) were included. Five databases (PubMed, Embase, Scopus, Web of Science, and Cochrane Library) were searched in May 2022. Meta-analysis was conducted using a random effect model.

RESULTS

This review included 33 studies for qualitative synthesis, encompassing 16,375 children aged between 1.5 and 14 years. Nevertheless, the meta-analysis focused on only 17 studies, involving 4067 children. Fourteen papers assessed potential adverse events, none of which was reported as major adverse events. SDF and NSF were identified as effective in arresting caries on primary teeth (p < 0.05) compared with a placebo or no treatment. Fluoride varnish and gel were identified as effective in reducing new caries development on primary teeth (p < 0.05) but not on permanent teeth (p > 0.05). The certainty of the generated evidence obtained is low.

CONCLUSION

The review provides valuable insights into the use of professionally applied fluorides in LMICs and contributes to recommendations for their use. However, the limited rigorous evidence suggests the need for further research to strengthen these findings and draw more robust conclusions.

Dental caries and developmental defects of enamel in cerebral palsy: A meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to compare the occurrence of dental caries and developmental defects of enamel (DDE) in individuals with and without cerebral palsy (CP).

MATERIALS AND METHODS

We conducted searches across five databases and the grey literature. Data were organized using EndNote 20. Reporting followed the MOOSE checklist. A random-effects model meta-analyses were conducted using RStudio, presenting results as mean difference (MD), odds ratio (OR), and 95% confidence interval (CI). The risk of bias of studies was analyzed using the Newcastle-Ottawa Scale, and the certainty of evidence was assessed using GRADE.

RESULTS

Among 1336 identified records, 25 studies involving 59,997 participants (mean age: 11.1 years) were included. Data of 12 were pooled into meta-analyses. No significant differences were found between CP and non-CP individuals across indices: DMFT (k = 7) (MD = 0.31; 95% CI [-0.42-1.05]), dmft (k = 4) (MD = 0.31; 95% CI [-0.50-1.14]), DMFS (k = 2) (MD = -0.61; 95% CI [-20.56-19.33]), dmfs (k = 3) (MD = 0.54; 95% CI [-1.09-2.17]), and DDE (k = 3) (OR = 0.80, 95% CI [0.09-7.31]). The certainty of evidence was very low.

CONCLUSION

Individuals with CP do not appear to differ significantly from those without CP in terms of dental caries experience and DDE.

Tetracyclic homoisoflavanoid (+)-brazilin: a natural product inhibits c-di-AMP-producing enzyme and Streptococcus mutans biofilms

The tenacious biofilms formed by Streptococcus mutans are resistant to conventional antibiotics and current treatments. There is a growing need for novel therapeutics that selectively inhibit S. mutans biofilms while preserving the normal oral microenvironment. Previous studies have shown that increased levels of cyclic di-AMP, an important secondary messenger synthesized by diadenylate cyclase (DAC), favored biofilm formation in S. mutans. Thus, targeting S. mutans DAC is a novel strategy to inhibit S. mutans biofilms. We screened a small NCI library of natural products using a fluorescence detection assay. (+)-Brazilin, a tetracyclic homoisoflavanoid found in the heartwood of Caesalpinia sappan, was identified as one of the 11 "hits," with the greatest reduction (>99%) in fluorescence at 100 µM. The smDAC inhibitory profiles of the 11 "hits" established by a quantitative high-performance liquid chromatography assay revealed that (+)-brazilin had the most enzymatic inhibitory activity (87% at 100 µM) and was further studied to determine its half maximal inhibitory concentration (IC50 = 25.1 ± 0.98 µM). (+)-Brazilin non-competitively inhibits smDAC's enzymatic activity (Ki = 140.0 ± 27.13 µM), as determined by a steady-state Michaelis-Menten kinetics assay. In addition, (+)-brazilin's binding profile with smDAC (Kd = 11.87 µM) was illustrated by a tyrosine intrinsic fluorescence quenching assay. Furthermore, at low micromolar concentrations, (+)-brazilin selectively inhibited the biofilm of S. mutans (IC50 = 21.0 ± 0.60 µM) and other oral bacteria. S. mutans biofilms were inhibited by a factor of 105 in colony-forming units when treated with 50 µM (+)-brazilin. In addition, a significant dose-dependent reduction in extracellular DNA and glucan levels was evident by fluorescence microscopy imaging of S. mutans biofilms exposed to different concentrations of (+)-brazilin. Furthermore, colonization of S. mutans on a representative model of enamel using suspended hydroxyapatite discs showed a >90% reduction with 50 µM (+)-brazilin. In summary, we have identified a drug-like natural product inhibitor of S. mutans biofilm that not only binds to smDAC but can also inhibit the function of smDAC. (+)-Brazilin could be a good candidate for further development as a potent therapeutic for the prevention and treatment of dental caries.IMPORTANCEThis study represents a significant advancement in our understanding of potential therapeutic options for combating cariogenic biofilms produced by Streptococcus mutans. The research delves into the use of (+)-brazilin, a natural product, as a potent inhibitor of Streptococcus mutans' diadenylate cyclase (smDAC), an enzyme crucial in the formation of biofilms. The study establishes (+)-brazilin as a non-competitive inhibitor of smDAC while providing initial insights into its binding mechanism. What makes this finding even more promising is that (+)-brazilin does not limit its inhibitory effects to S. mutans alone. Instead, it demonstrates efficacy in hindering biofilms in other oral bacteria as well. The broader spectrum of anti-biofilm activity suggests that (+)-brazilin could potentially serve as a versatile tool in a natural product-based treatment for combating a range of conditions caused by resilient biofilms.

Anticaries and Antigingivitis Properties of Cannabinoid-Containing Oral Health Products: A Review

To evaluate the anticaries and antigingivitis properties of cannabinoid-containing oral health products. A systematic research strategy was employed. Specific search terms were used, including "Cannabinoids AND dental caries," "Cannabinoids AND oral health," "Cannabinoids AND dental plaque," "Cannabinoids AND gingivitis AND periodontitis," "Cannabinoids AND S. mutans," "Cannabidiol AND oral health," and "Cannabidiol AND oral biofilm." The search was conducted in PubMed, Cochrane, and EBSCO Host databases. The search yielded a total of 73 articles, out of which 15 articles (20.5%) were relevant to the scope of this systematic review. Among the relevant articles, only eight (10.9%) directly addressed the research question. The findings from these articles suggest that cannabinoids have the potential to reduce the metabolism of cariogenic bacteria, specifically Streptococcus mutans, and decrease the number of bacterial colonies in dental plaque. In vitro studies also demonstrated a significant inhibitory effect of cannabinoids on oral biofilms and create a considerable inhibitory zone of growth when investigated on oral biofilms in vitro. Furthermore, CBD exhibited antibacterial properties against Porphyromonas gingivalis, a primary pathogen associated with periodontal disease. The current review shows insufficient data to conclude on the anticaries and antigingivitis effects of cannabinoids. Despite extensive research on their systemic therapeutic benefits, their oral health impact remains underexplored, lacking clinical trials and primary research.

A systematic review of the association between food insecurity and behaviours related to caries development in adults and children in high-income countries

OBJECTIVES

To synthesize and appraise the evidence regarding the relationship between food insecurity and behaviours associated with dental caries development in adults and children in high-income countries.

METHODS

A systematic review including observational studies assessing the association between food insecurity and selected dietary (free sugar consumption) and non-dietary factors (tooth brushing frequency; use of fluoridated toothpaste; dental visiting; oral hygiene aids; type of toothbrush used; interdental cleaning frequency and mouthwash use) related to dental caries development in adults and children in high-income countries. Studies specifically looking at food insecurity during the COVID-19 pandemic were excluded. Searches were performed in MEDLINE, Embase, Global Health and Scopus from inception to 25 May 2023. Two authors screened the search results, extracted data and appraised the studies independently and in duplicate. Study quality was assessed using the Newcastle-Ottawa Scale (with modifications for cross-sectional studies). Vote counting and harvest plots provided the basis for evidence synthesis.

RESULTS

Searches identified 880 references, which led to the inclusion of 71 studies with a total of 526 860 participants. The majority were cross-sectional studies, conducted in the USA and reported free sugar consumption. Evidence for the association between food insecurity and free sugar intake from 4 cohort studies and 61 cross-sectional studies including 336 585 participants was equivocal, particularly in the sugar-sweetened beverage (SSB) consumption post-hoc subgroup, where 20 out of 46 studies reported higher SSB consumption in food insecure individuals. There was consistent, but limited, evidence for reduced dental visiting in adults experiencing food insecurity compared to food secure adults from 3 cross-sectional studies including 52 173 participants. The relationship between food insecurity and dental visiting in children was less clear (3 cross-sectional studies, 138 102 participants). A single cross-sectional study of 3275 children reported an association between food insecurity and reported failure to toothbrush the previous day.

CONCLUSIONS

This review did not identify clear associations between food insecurity and behaviours commonly implicated in the development of dental caries that would explain why individuals experiencing food insecurity are more likely to have dental caries than those who have food security. There was some evidence of decreased dental visiting in adults experiencing food insecurity. Common methodological weaknesses across the evidence base related to the selection of participants or control of potentially confounding variables. Consequently, the quality of evidence for all outcomes was downgraded to very low. More research is needed to explore access to oral hygiene products and household environments conducive to habitual oral self-care in food insecure populations.

The Older Adults' Intention to Use Silver Diamine Fluoride for Dental Caries Treatment

Purpose

This study aimed to determine the intention of older adults to use silver diamine fluoride (SDF) for treating tooth decay.

Patients and Methods

A group of Thai-speaking individuals between the ages of 60 and 90 were asked to participate in the study. They were provided with information about SDF and then asked to complete a questionnaire based on the Theory of Reason Action (TRA). The questionnaire consisted of 23 questions divided into seven constructs aimed at determining the determinants of the intention to use SDF. These constructs were behavioral belief, evaluation of behavioral outcome, normative belief, motivation to comply, attitude towards behavior, subjective norm, and intention. The responses were rated on a 4-point Likert scale ranging from 1 (Strongly disagree) to 4 (Strongly agree). The characteristics and TRA scores of the participants were analyzed and compared based on their intention to use SDF, using the Chi-square test and t-test. Multiple logistic regression was employed to determine the determinants of the intention to use SDF.

Results

The study involved 588 participants, with an average age of 65.3 years (SD= 5.53). Of the participants, 52.7% were women, 58.1% were unemployed or retired, 80.8% lived with family, 63.4% had less than sixth-grade education, 62.9% had a monthly family income of less than 10,000 baht, and 63.6% had underlying diseases. The study found that 82.7% of the participants intended to use SDF for dental caries treatment, with an average score of 2.86 out of 4. The study also found that age, family income, underlying diseases, dental health problems, and fear of the dentist significantly affected their intention. Behavioral beliefs and evaluations of behavioral outcomes significantly affected the intention to use SDF treatment.

Conclusion

Most older adults in the study intended to use SDF for dental caries treatment.

Diet-derived circulating antioxidants, periodontitis and dental caries: A Mendelian randomization study

BACKGROUND AND OBJECTIVE

Given the potential association between oxidative stress, periodontitis and dental caries, whether dietary supplementation with antioxidants is beneficial for periodontitis and dental caries has been widely reported, but remains controversial. This study aims to clarify these relationships through two-sample Mendelian randomization (MR) analysis.

METHODS

Circulating antioxidants (copper, selenium, zinc, ascorbate, β-carotene, lycopene, retinol and vitamin E) were derived from absolute circulating antioxidants and circulating antioxidant metabolites. Summary data of periodontitis and dental caries were obtained from two separate databases, respectively. We performed inverse-variance weighted (IVW) analysis separately in different databases, followed by meta-analysis. The robustness of results was examined by sensitivity analyses, including three complementary MR methods, heterogeneity and pleiotropy tests, and PhenoScanner query.

RESULTS

IVW analysis showed that elevated levels of absolute circulating retinol reduced the risk of periodontitis (GLIDE: OR = 0.41, 95% CI = 0.18-0.95, p = .038, power = 100%; FinnGen: OR = 0.15, 95% CI = 0.04-0.54, p = .004, power = 100%). The pooled OR for periodontitis risk per unit increase of retinol is 0.30 (95% CI = 0.15-0.61, p = .001, I2 = 40.3%, power = 100%). No significant associations were noted for genetically predicted circulating antioxidants and dental caries risk. The sensitivity analyses yielded similar estimates.

CONCLUSION

This study demonstrates that a negative causality between circulating retinol and periodontitis risk, and null linkage between circulating antioxidants and dental caries risk, suggesting potential strategies for the prevention and control of periodontitis.

Oral conditions are associated with salt taste disability among American adults

AIM

To explore the association between oral conditions and their interaction with salt taste disability among American adults.

METHODS

Data from the 2013-2014 NHANES cycle were used (n = 2373). The exposures were periodontitis, defined by the 2017 EFP-AAP classification, dental caries, missing teeth, and edentulism, as per the DMF-T index, and xerostomia. The outcome was salt taste disability, objectively assessed. Covariates included sex, age, educational level, poverty index, obesity, diabetes, smoking, alcohol consumption, and medications related to mouth dryness. Weighted multivariable logistic regression modeling was used to evaluate the relationship between oral conditions and their interaction and salt taste disability.

RESULTS

Participants who reported xerostomia were more likely to have salt taste disability (OR 2.42; 95%CI 1.44-4.07), especially those older than 60 years (OR 3.63; 95%CI 1.72-7.63). Among participants aged 40-59, xerostomia increased the chance of salt taste disability; however, the confidence interval included the null value. The interactions between xerostomia and edentulism increased the chance of salt taste disability.

CONCLUSION

Oral conditions seem to influence the ability to taste salt. Dental professionals may help identify individuals with taste alterations and raise their awareness of the risk of systemic diseases that require the reduction of salt intake.

Oral health of individuals with cerebral palsy in Saudi Arabia: A systematic review

OBJECTIVE

This systematic review aimed to comprehensively summarize and critically assess studies conducted on oral health outcomes among individuals with cerebral palsy (CP) in Saudi Arabia.

METHODS

This study followed the Participants, Exposure, Control and Outcomes (PECO) framework to formulate a focused research question. We conducted an extensive literature search across multiple databases, including PubMed, Medline, Scopus and Embase, in addition to clinical trial registers. Inclusion criteria encompassed clinical studies conducted in either English or Arabic, focusing on CP as defined by the International Classification of Diseases 10 (ICD10), and examining various oral health conditions and parameters. Nonclinical studies, commentaries, other systematic reviews and letters to the editor were excluded. Data extraction included comprehensive information about the study characteristics, oral health outcomes (dental, oral or periodontal disease; changes in standardized indices; dental trauma and other types of oral diseases) and an assessment of the risk of bias using the Appraisal Tool for Cross-Sectional Studies (AXIS).

RESULTS

The initial search yielded a total of 879 articles, ultimately resulting seven studies that met our stringent inclusion criteria. All of these studies were conducted as cross-sectional investigations in different cities within Saudi Arabia. The sample sizes ranged from 46 to 400 participants, all falling within the age range of 2-18 years. Notably, the prevalence of dental caries among individuals with CP in these studies varied significantly, with rates ranging from 52.9% to as high as 98.6%. Additionally, a substantial portion of CP patients exhibited poor oral hygiene, with figures ranging between 34.6% and 66.2%, and dental trauma was reported in 47.5% of the cases. Moreover, these studies underscored the influence of motor function and intellectual disabilities on the oral health status of CP individuals. Furthermore, various secondary outcomes, including periodontal parameters and oral health-related quality of life, were also assessed. However, it is essential to acknowledge that several sources of bias were identified within these studies, raising questions about the generalisability of their findings.

CONCLUSION

In conclusion, the systematic review revealed a concerning pattern of high dental caries prevalence and other oral health issues among individuals with CP in Saudi Arabia. Nevertheless, the need for comparative studies between CP patients and those without CP is evident to establish a definitive understanding of the oral health status of CP individuals. Initiating early interventions such as oral hygiene education, preventive dentistry programs, and orthodontic interventions could potentially contribute to improved oral health outcomes for individuals with CP in Saudi Arabia.

Fit for Purpose? The Suitability of Oral Health Outcome Measures to Inform Policy

KNOWLEDGE TRANSFER STATEMENT

Oral health research and program evaluation should consider alternative outcome measures for population oral health other than the DMFT index.

Behavioral Outcomes of a Pragmatic Early Childhood Caries Management Trial

OBJECTIVES

To evaluate a preventative behavioral intervention for managing early childhood caries (ECC) in a cohort of high-risk children.

METHODS

This pragmatic trial of the MySmileBuddy Program (MSB) evaluated preventive behavioral outcomes in a 1-y community health worker-delivered intervention to prevent ECC progression. Pre-/postintervention surveys assessed parent-reported child engagement in therapeutic toothbrushing (i.e., adult-assisted brushing with fluoridated toothpaste twice daily) and caries-related dietary behaviors and barriers. Generalized linear model with identity link for continuous variables and logit link for dichotomous outcomes evaluated pre-/postintervention comparisons and generalized estimating equations accounted for within-participant correlation (α = 0.05).

RESULTS

Among 1,130 children with postintervention data, the average age was 3.97 y, 99% were Medicaid insured, and 88% were Hispanic. Most parents (95%) were mothers/grandmothers, married or in a committed partnership (75%), unemployed (62%), and with modest education (80% high school degree or less). The odds of reported therapeutic brushing nearly doubled (n = 864; odds ratio [OR] = 1.79, 95% confidence interval [CI] = 1.46, 2.20, P < 0.001); day and night bottle/sippy cup frequencies dropped 0.29 units (n = 871; 95% CI = -0.37, -0.33, P < 0.001) and 0.22 units (n = 1,130; 95% CI = -0.30, -0.15, P < 0.001); nighttime breastfeeding reduced 0.15 units (n = 870; 95% CI = -0.21, -0.10, P < 0.001); sharing utensils reduced 0.30 units (n = 572; 95% CI = -0.39, -0.21, P < 0.001); not using sugary foods to calm child improved 0.37 units (n = 664; 95% CI = 0.31, 0.44, P < 0.001); odds of eating meals and snacks at a table increased (n = 572; OR = 1.57, 95% CI = 1.28, 1.93, P < 0.001; n = 572; OR = 1.80, 95% CI = 1.50, 2.15, P < 0.001) respectively; and reducing barriers to behaviors improved 0.38 units for toothbrushing (n = 666; 95% CI = 0.31, 0.44, P < 0.001) and 0.33 units for diet (n = 668; 95% CI = 0.29, 0.38, P < 0.001).

CONCLUSION

Despite limitations inherent to pragmatic trials, significant behavioral changes suggest that MSB yielded an important salutary impact. Forthcoming mediation analyses will explore causal pathways. Findings support integration of MSB's behavior change program in caries management initiatives.

KNOWLEDGE TRANSFER STATEMENT

The results of this study can be used by clinicians, public health leaders, and researchers to inform the development and implementation of community-based, preventative behaviorally focused early childhood caries prevention programs. Study findings may enhance the understanding of the impact of behavioral interventions that engage parents of young children and could lead to more effective prevention for populations at high-risk of caries.

Dental student application of artificial intelligence technology in detecting proximal caries lesions

OBJECTIVES

This study aimed to investigate the caries diagnosis performances of dental students after training with an artificial intelligence (AI) application utilizing deep learning techniques, a type of artificial neural network.

METHODS

A total of 1200 bitewing radiographs were obtained from the institution's database and two specialist dentists labeled the caries lesions in the images. Randomly selected 1000 images were used for training purposes and the remaining 200 radiographs were used to evaluate the caries diagnostic performance of the AI. Then, a convolutional neural network, a deep learning algorithm commonly employed to analyze visual imagery problems, called "You Only Look Once," was modified and trained to detect enamel and dentin caries lesions in the radiographs. Forty dental students were selected voluntarily and randomly divided into two groups. The pre-test results of dental caries diagnosis performances of both groups were recorded. After 1 week, group 2 students were trained using an AI application. Then, the post-test results of both groups were recorded. The labeling duration of the students was also measured and analyzed.

RESULTS

When both groups' pre-test and post-test results were evaluated, a statistically significant improvement was found for all parameters examined except precision score (p < 0.05). However, the trained group's accuracy, sensitivity, specificity, and F1 scores were significantly higher than the non-trained group in terms of post-test scores (p < 0.05). In group 2 (trained group), the post-test labeling time was considerably increased (p < 0.05).

CONCLUSIONS

The students trained by AI showed promising results in detecting caries lesions. The use of AI can also contribute to the clinical education of dental students.

Control of Dental Caries in Children and Adolescents Using Fluoride: An Overview of Community-Level Fluoridation Methods

The maintenance of oral health is a crucial aspect of general well-being; however, a significant proportion of the worldwide population experiences a range of oral diseases. Dental caries is a highly prevalent non-communicable disease globally, especially in children and adolescents. Fluoride is involved in the control of dental caries, primarily by decreasing the critical pH for dental hard tissue dissolution and decreasing enamel solubility. Due to the substantial data supporting the efficacy of fluoride in controlling dental caries, many community-level fluoridation initiatives have been devised and executed as global public health preventive interventions. These initiatives encompass the fluoridation of water, salt, and milk. Water fluoridation is considered safe and effective when fluoride levels are maintained within the recommended range (0.6 to 1.1 mg/L). Salt fluoridation has a cariostatic potential similar to that of water fluoridation, and a fluoride concentration of 250 micrograms per gram in salt is not associated with an increased risk of developing dental fluorosis. However, there is currently an effort to reduce the consumption of table salt in order to mitigate the harmful effects of excessive salt consumption. It has been hypothesized that fluoride food supplementation, such as fluoridated milk, is associated with a decrease in caries experience in permanent teeth; however, the effect is not clear in primary teeth. Public-level fluoride interventions are more cost-effective than the operative care of caries lesions and limit the burden of care. The administration of fluorides should be conducted using safe methods, limiting ingestion, and adhering to the guidelines set by international and national health agencies in each country. This is particularly important when considering children with developing dentitions. Fluoride is an important tool in the control of dental caries, but it is crucial to combine it with good oral hygiene, a healthy diet, and regular visits to a dental professional to maintain long-term oral health.

Niobium oxyhydroxide as a bioactive agent and reinforcement to a high-viscosity bulk-fill resin composite

OBJECTIVE

The present in vitro study incorporated niobium oxyhydroxide fillers into an experimental high-viscosity bulk-fill resin composite to improve its mechanical performance and provide it a bioactive potential.

METHODOLOGY

Scanning electron microscopy synthesized and characterized 0.5% niobium oxyhydroxide fillers, demonstrating a homogeneous morphology that represented a reinforcement for the feature. Fillers were weighed, gradually added to the experimental resin composite, and homogenized for one minute, forming three groups: BF (experimental high-viscosity bulk-fill resin composite; control), BF0.5 (experimental high-viscosity bulk-fill resin composite modified with 0.5% niobium oxyhydroxide fillers), and BFC (commercial bulk-fill resin composite Beautifil Bulk U, Shofu; positive control). In total, 10 specimens/groups (8 × 2 × 2 mm) underwent flexural strength (FS) tests in a universal testing machine (Instron) (500N). Resin composites were also assessed for Knoop hardness (KH), depth of cure (DoC), degree of conversion (DC), elastic modulus (E), and degree of color change (ΔE). The bioactive potential of the developed resin composite was evaluated after immersing the specimens into a simulated body fluid in vitro solution and assessing them using a Fourier-transformed infrared spectroscope with an attenuated total reflectance accessory. One-way ANOVA, followed by the Tukey's test (p<0.05), determined FS, DC, KH, and ΔE. For DoC, ANOVA was performed, which demonstrated no significant difference between groups (p<0.05).

CONCLUSIONS

The high-viscosity bulk-fill resin composite with 0.5% niobium oxyhydroxide fillers showed promising outcomes as reinforcement agents and performed well for bioactive potential, although less predictable than the commercial resin composite with Giomer technology.

Probiotics-containing beverages and dental caries: A systematic review and meta-analysis

The aim was to evaluate the effect of probiotics-containing beverages on dental caries development by a systematic review and meta-analysis (PROSPERO CRD42021258010). PubMed, Embase, and Web of Science databases were assessed (up to October 2023) for randomized placebo-controlled trials that evaluated the consumption of probiotics-containing beverages having dental caries as endpoint. Risk of bias assessment (Cochrane Handbook) was performed for all studies. Risk ratio (RR), standardized mean difference (SMD) and 95% confidence interval (CI), were calculated for caries prevalence and caries increment, respectively. Meta-analysis was performed. Qualitative analysis of more than 2000 individuals aged from 1 to 84 years (9 studies) showed inconsistent effects of these probiotics-containing beverages. Synthesis of more than 1000 children and adolescents did not demonstrate a statistically significant difference in the proportion of individuals with cavitated lesions (RR 0.60 [95 % CI 0.34 to 1.08]; n = 2), but a significantly smaller increment of both cavitated and non-cavitated carious lesions (SMD -0.23 [95 % CI -0.39 to -0.08]; n = 4) was related to the consumption of probiotics-containing beverages. Certainty of evidence for caries prevalence and caries increment were moderate and low, respectively. Current evidence is not substantial to strengthen the impact of these beverages on caries development.

Ozone Treatment for the Management of Caries in Primary Dentition: A Systematic Review of Clinical Studies

Dental caries in children is a frequent and debilitating condition, whose management is often challenging. The aim of this systematic review was to investigate the effectiveness of ozone applications for the treatment of caries in primary dentition. According to PRISMA guidelines, a systematic literature search was performed up to 6 January 2024. Clinical studies using ozone to treat caries of deciduous teeth were considered for inclusion. Out of the 215 records retrieved, seven studies were eventually included in the review, all of which used gaseous ozone. Four studies were judged at high risk of bias, two at low risk, and one of some concerns. The great heterogeneity of designs, outcomes, and protocols made it impossible to conduct a meta-analysis. Despite some limitations, the evidence yielded by the included studies suggests that ozone application, regardless of the protocol applied, is comparable to other interventions in terms of clinical outcomes and anti-bacterial activity, with no reported adverse effects and good patient acceptance. Therefore, ozone application may be a non-invasive approach to treat caries in primary dentition, especially in very young and poorly cooperative patients. Further standardized and rigorous studies are, however, needed to identify the best clinical protocols for this specific field.

Genetic characterization of glyoxalase pathway in oral streptococci and its contribution to interbacterial competition

Objectives

To analyze contributions to microbial ecology of Reactive Electrophile Species (RES), including methylglyoxal, generated during glycolysis.

Methods

Genetic analyses were performed on the glyoxalase pathway in Streptococcus mutans (SM) and Streptococcus sanguinis (SS), followed by phenotypic assays and transcription analysis.

Results

Deleting glyoxalase I (lguL) reduced RES tolerance to a far greater extent in SM than in SS, decreasing the competitiveness of SM against SS. Although SM displays a greater RES tolerance than SS, lguL-null mutants of either species showed similar tolerance; a finding consistent with the ability of methylglyoxal to induce the expression of lguL in SM, but not in SS. A novel paralogue of lguL (named gloA2) was identified in most streptococci. SM mutant ∆gloA2SM showed little change in methylglyoxal tolerance yet a significant growth defect and increased autolysis on fructose, a phenotype reversed by the addition of glutathione, or by the deletion of a fructose: phosphotransferase system (PTS) that generates fructose-1-phosphate (F-1-P).

Conclusions

Fructose contributes to RES generation in a PTS-specific manner, and GloA2 may be required to degrade certain RES derived from F-1-P. This study reveals the critical roles of RES in fitness and interbacterial competition and the effects of PTS in modulating RES metabolism.

Breastfeeding, consumption of ultraprocessed foods, and dental caries at 4 years of age: A birth cohort study

BACKGROUND

Cohort studies have demonstrated an association between prolonged and/or frequent breastfeeding and early childhood caries (ECC).

AIM

To investigate the association between prolonged breastfeeding and ECC at 48 months, while considering the interaction between prolonged breastfeeding and ultraprocessed foods (UPF).

DESIGN

Data from a birth cohort study conducted in southern Brazil were used (n = 3645). Poisson regression was used to evaluate the influence of breastfeeding and UPF consumption on the prevalence and experience of caries. To measure the interaction on the additive scale between breastfeeding and UPF consumption on the prevalence and experience of ECC, the relative excess risk due to interaction (RERI) was calculated.

RESULTS

Prolonged breastfeeding was associated with higher prevalence (PR = 1.82; CI:1.59-2.08) and experience (RR = 2.47; CI:1.97-3.10) of ECC. Greater prevalence (PR = 1.16; CI: 1.04-1.30) and experience of ECC (RR = 1.22; CI: 1.00-1.48) were found in children who had high consumption of UPFs. Negative RERIs were observed for the prevalence and experience of ECC (-0.25 and -0.001).

CONCLUSION

High UPF consumption and prolonged breastfeeding were associated with ECC. No interaction, however, was observed, showing that the two exposures have independent effects. To prevent ECC, policies and programs are needed to support breastfeeding until the age of 2 years and to limit the consumption of UPF.

PARENTAL EDUCATION, CARIES EXPERIENCE, PLAQUE ACCUMULATION, AND Mutans Streptococci COUNT MAY PREDICT THE INCREMENT OF EARLY CHILDHOOD CARIES IN PRESCHOOL CHILDREN OVER 24 MONTHS

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

RISK PREDICTORS OF EARLY CHILDHOOD CARIES INCREMENT-A SYSTEMATIC REVIEW AND META-ANALYSIS. Lam PPY, Chua H, Ekambaram M, Lo ECM, Yiu CKY. J Evid Based Dent Pract. 2022 Sep;22(3):101732.

SOURCE OF FUNDING

Government TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Impact of Orthodontic Treatment on the Incidence of Dental Caries in Adolescents: A Prospective Cohort Study

BACKGROUND

Orthodontic treatment is a widely embraced intervention aimed at enhancing dental aesthetics and correcting malocclusions among adolescents. However, concerns persist regarding its potential impact on oral health, particularly on the development of dental caries. This study aimed to systematically investigate the relationship between orthodontic treatment and the incidence of new carious lesions among adolescents.

METHODS

A prospective cohort design involving adolescents aged 12-18 years was employed. A total of 82 patients met the inclusion criteria. In addition, an age-matched control group of 82 participants who did not undergo orthodontic treatment was included. The study included both a treatment group undergoing orthodontic treatment (braces or aligners) and an age-matched control group that did not undergo any orthodontic intervention. Demographic characteristics, orthodontic treatment details, and oral hygiene practices were documented at baseline and throughout the study period. Dental examinations at six-month intervals post-treatment were conducted to track the incidence and progression of carious lesions.

RESULTS

The demographic characteristics, baseline oral health status, orthodontic treatment details, and oral hygiene practices were comparable between the treatment and control groups. Post-orthodontic treatment assessment revealed a slightly higher incidence of new carious lesions in the treatment group (14.6%) than in the control group (9.8%), although this difference was not statistically significant (p = 0.15). Dental examinations at six-month intervals demonstrated a gradual increase in caries incidence over time in both groups, with no substantial disparities observed.

CONCLUSIONS

This study provides a comprehensive examination of the relationship between orthodontic treatment and the incidence of new carious lesions among adolescents. While a trend towards higher caries incidence in the treatment group was observed, the difference was not statistically significant. These findings contribute to the existing body of knowledge and emphasize the need for ongoing research to guide clinical practice.

Effectiveness of fluorides in root caries prevention, Department of Veterans Affairs (2009-2018)

AIMS

The aim of this study was to examine the effectiveness of topical fluorides in prevention of root caries-related treatment in high caries risk Veterans.

METHODS

This retrospective analysis of longitudinal data examined the effectiveness of professionally applied or prescription (Rx) fluoride treatment, in VHA clinics from FY 2009-2018. Professional fluoride treatments included 5% Sodium Fluoride (NaF) varnish (22 600 ppm fluoride), 2% NaF gel/rinse (9050 ppm fluoride), and 1.23% APF gel (12 300 ppm fluoride). The Rx for daily home use was 1.1% NaF paste/gel (5000 ppm fluoride). Outcomes studied were new root caries restorations or extractions and percent of patients with treatment over 1 year. Logistic regressions were adjusted for age, gender, race, ethnicity, chronic medical or psychiatric conditions, number of medication classes, anticholinergic drugs, smoking, baseline root caries treatment, preventive care, and time between first-last restoration in the index year.

RESULTS

Root caries at baseline was associated with a high risk for new root caries. Veterans without root caries during the index year who received a fluoride gel/rinse intervention were 32-40% less likely to receive caries-related treatment for root caries during the follow-up period. Once Veterans had root caries, fluorides did not exhibit a positive effect.

CONCLUSION

In older adults with high caries risk, early fluoride prevention is key, before root caries requires treatment.

PRO-biotics? Are pre- and probiotics a valuable adjunct to fluoridated toothpaste in the battle against dental decay?

DESIGN

An investigator and participant masked, parallel-group randomised control trial examining the tooth surfaces of 288 children aged 5-9 years (n = 141 in the intervention group, n = 147 in the control group). Children in the intervention group were provided a daily lozenge containing 2% arginine (prebiotic), Lacticaseibacillus rhamnosus and Lactobacillus paracasei subsp. paracasei (probiotics). Children in the control group were provided with a placebo lozenge. Parents of participants were also provided with 1450 ppm fluoride toothpaste and advised to brush their children's teeth twice daily. Clinical and radiographic examinations were undertaken at baseline and 10-12 months assessing caries activity, progression and regression at a tooth surface level. A modified ICDAS and radiographic scoring system were used to record presence and extent of carious lesions.

CASE SELECTION

Of 343 children who met the inclusion criteria, 21,888 tooth surfaces were examined in 288 low caries risk children aged between 5-9 years. Fifty-four participants withdrew consent (n = 31 for intervention group, n = 24 for control group) and 1 child was excluded as they were pre-cooperative for their dental examination. Participants were recruited from four municipalities in Denmark. To be eligible to participate, children had to be medically healthy, cooperative for clinical and radiographic examination, and able to ingest a daily lozenge.

DATA ANALYSIS

The primary outcome for this study was relative risk reduction (RRR) of caries activity, progression and regression. Although not present in this study, the main study broadly showed equality between the two groups in terms of their social demographic, dietary, oral health-related factors. The authors used modified Poisson regression to determine any surface level differences between the intervention and placebo groups. The threshold for statistical significance was set as follows: p < 0.05 was considered statistically significant. The authors describe that a power calculation was undertaken for the main study. However, none of the outcomes in this study were powered for.

RESULTS

19,950 tooth surfaces were included in the final analysis. There was no significant difference in change in caries activity between the two groups. There was a trend towards reduction in relative risk in the intervention group, with fewer active lesions (RRR: 15.3%; -6.0%, -32.4%), more caries regression (RRR: 0.3%; -0.4%, -1.0%) and reduced caries progression (RRR: 13.6%; -8.0%, -30.9%) observed than in the control group.

CONCLUSIONS

The use of a probiotic and prebiotic daily lozenges as an adjunct to 1450 ppm fluoride toothpaste and oral hygiene instruction did not result in a significantly reduced relative risk of change in caries status compared to placebo. Further research over an increased intervention time with a higher caries risk population may identify potential advantages of adjunctive pre- and probiotics fluoride toothpaste in the prevention, arrest and regression of dental caries.

Methylphenidate use and restorative treatment needs in young adults with attention deficit hyperactivity disorder

OBJECTIVE

To assess the effect and dose-response of methylphenidate (MP) use on the restorative treatment needs in young adults with attention deficit hyperactivity disorder.

PARTICIPANTS AND METHODS

This retrospective study comprises a cohort of military recruits aged 18-25 who served for 12 to 48 months between 2005 and 2017. The medical records of 213 604 participants were assessed of which: 6875 participants with ADHD who received treatment with MP, 6729 participants with ADHD who had no prescriptions for MP, and 200 000 healthy participants. The outcome was restorative treatment needs, which served as an indicator of caries: having at least one prescription for restorative treatment during the study period.

RESULTS

Frequency of prescription for restorative treatment among the treated, the untreated and the control groups was 24%, 22%, and 17%, respectively (p < .0001). On multivariate analysis, the dose-response association between MP use and the odds of having at least one restorative treatment was confirmed (OR = 1.006 for each additional 1 gr of MP; 95% CI [1.004:1.009]) CONCLUSIONS: Participants with ADHD who receive chronic treatment with MP have higher restorative treatment needs than participants with untreated ADHD and healthy participants. Our results show that chronic MP medication among young adults leads to an elevated need for restorative treatment and implies a significant impact on oral health (OH).

Sjögren's Disease and Oral Health: A Genetic Instrumental Variable Analysis

Epidemiological studies have consistently shown that Sjögren's disease (SjD) increases the risk of dental caries. Despite similar evidence indicating an elevated risk of periodontitis, SjD remains a disputed risk factor for this disease. The risk of bias in observational research is a major impediment to confirming this link. Within an instrumental variable framework, genetic variants associated with a risk factor can be used to proxy its effect on an outcome while avoiding common sources of observational study bias. In this study, we leveraged an instrumental variable approach to investigate whether SjD affects the risk of caries and periodontitis. A total of 57 genetic variants strongly associated with SjD were identified from a genome-wide association study of 2,247 European descent cases and 332,115 controls. We tested for associations of these genetic instruments with caries (measured as the number of decayed, missing, and filled surfaces in 26,792 individuals) and periodontitis (17,353 clinical periodontitis cases and 28,210 European controls). Several sensitivity analyses were used to further validate the primary inverse variance weighted (IVW) estimate. IVW analysis revealed an adverse effect of SjD on caries (β = 0.039, P = 6.3e-16) and periodontitis (odds ratio = 1.033, P = 2.3e-05). Sensitivity analyses, conducted to assess the robustness to potential violations of instrumental variable assumptions, further support these findings. Our results showed that SjD has a detrimental effect on caries and also suggest that SjD promotes periodontitis.

Viability and oxidative stress of dental pulp cells after indirect application of chemomechanical agents: An in vitro study

AIM

This study evaluated the transdentinal cytotoxic effects of enzymatic agents (EA) for chemomechanical carious tissue removal on human dental pulp cells.

METHODOLOGY

The groups were based on the performed dentine treatments (n = 8): G1: Positive Control (PC - no treatment); G2: Negative Control (NC - 35% H2 O2 for 2 min); G3: Brix 3000™ (BX) for 30 s; G4: BX for 2 min; G5: Papacarie Duo™ (PD) for 30 s; G6: PD for 2 min. The cells were evaluated for viability (VB; MTT assay) and production of reactive oxygen species (ROS; DCFH-DA assay) and nitric oxide (NO; Griess reagent). A scanning electron microscope provided morphological chemical analyses and energy-dispersive X-ray spectroscopy. The data were submitted to the one-way anova statistical test complemented by Tukey (p < .05).

RESULTS

Cell viability decreased by 21.1% and 58.4% in G5 and G6, respectively. ROS production in G3 and G4 maintained basal levels but increased by 171.2% and 75.1% in G5 and G6, respectively.

CONCLUSIONS

The Brix3000™ enzymatic agent did not cause indirect cytotoxic effects on pulp cells, regardless of the application time. Conversely, Papacarie Duo™ reduced viability and increased ROS production by pulp cells.

The complement system as a key modulator of the oral microbiome in health and disease

In this review, we address the interplay between the complement system and host microbiomes in health and disease, focussing on oral bacteria known to contribute to homeostasis or to promote dysbiosis associated with dental caries and periodontal diseases. Host proteins modulating complement activities in the oral environment and expression profiles of complement proteins in oral tissues were described. In addition, we highlight a sub-set of bacterial proteins involved in complement evasion and/or dysregulation previously characterized in pathogenic species (or strains), but further conserved among prototypical commensal species of the oral microbiome. Potential roles of these proteins in host-microbiome homeostasis and in the emergence of commensal strain lineages with increased virulence were also addressed. Finally, we provide examples of how commensal bacteria might exploit the complement system in competitive or cooperative interactions within the complex microbial communities of oral biofilms. These issues highlight the need for studies investigating the effects of the complement system on bacterial behaviour and competitiveness during their complex interactions within oral and extra-oral host sites.

Efficacy of Glass Ionomer Cement as Pit and Fissure Sealant in Permanent First Molars

Background/Objectives Pit and fissure caries constitute a predominant portion, approximately 90% in permanent posterior teeth and 44% in primary teeth among children and adolescents. Among various preventive modalities, pit and fissure sealants play a pivotal role in safeguarding these vulnerable areas. Categorized by materials such as glass ionomer, composites, and polyacid-modified glass ionomers, these sealants offer effective protection. This study aims to evaluate the efficacy of glass ionomer-based pit and fissure sealants in terms of retention rate at 12-month post-procedure period in permanent first molars. Methodology This study was conducted at the Department of Operative Dentistry, Nishtar Institute of Dentistry, Multan, Pakistan. Fifty-six children, aged 7 to 12 years, presenting with pit and fissure caries in permanent first molar teeth were enrolled. Glass ionomer sealant was meticulously applied to the affected pits and fissures. The efficacy was assessed after 12 months based on predefined criteria. Results The age of participants ranged from 7 to 12 years, with a mean age of 9.24 ± 1.38 years. Among the 56 patients, 23 (41.2%) were male and 33 (58.8%) were female. Sealant retention was noted in 31 (55.35%) patients, while 25 (44.65%) experienced sealant loss. In the 7 to 9-year age group, 19 demonstrated complete sealant retention, whereas in the 10 to 12-year age group, 12 exhibited complete retention. Concerning gender distribution, 17 males and 14 females exhibited complete sealant retention. Conclusion Glass ionomer-based sealants demonstrate excellent properties for pit and fissure sealing owing to their low technique sensitivity, cost-effectiveness, and favorable retention rates. Therefore, they represent an optimal choice for this preventive dental procedure.

Examining the Efficacy of 38% Silver Diamine Fluoride in Halting Active Dental Caries Lesions Among Children: A Descriptive Study

BACKGROUND/OBJECTIVES

Dental caries, a prevalent issue among children, often leads to discomfort and potential complications. Utilizing caries-arresting treatments to slow down its progression offers a practical alternative. Previous research indicates that topical fluorides can deactivate and remineralize enamel caries. This study aims to evaluate the efficacy of 38% silver diamine fluoride (SDF) in halting active dental caries lesions in children.

MATERIALS AND METHODS

This descriptive case series was conducted at the Operative Dentistry Department of the Nishtar Institute of Dentistry in Multan, Pakistan. We enrolled 753 patients aged three to nine years, of both genders, each with at least one cavitated lesion graded 3-6 according to the International Caries Detection and Assessment System (ICDAS). SDF was directly applied to dried and isolated teeth using a micro brush and left to absorb for up to two minutes (adjusted based on the child's cooperation), and parents were instructed to ensure the child refrained from eating or drinking for an hour post-application. Baseline examinations were performed by consultant restorative dentists, and reexaminations were conducted after two to three weeks by a consultant unaware of the study.

RESULTS

The study included children aged three to nine years, with a mean age of 6.02±1.35 years. The majority of patients (61.75%) were aged between three and six years. Among the 753 patients, 619 (82.20%) were male, and 134 (17.80%) were female, with a male-to-female ratio of 4.6:1. The efficacy of 38% SDF in arresting active dental caries lesions in children was observed in 720 (95.62%) patients.

CONCLUSION

This study demonstrates that 38% SDF is highly effective in halting active dental caries lesions in children.

A 16-year-old boy presented with triple-A syndrome associated with neuromuscular disorders: a case report

Introduction and importance

Allgrove syndrome (AS) (AAA syndrome) is a rare autosomal recessive disease caused by mutations in the AAAS gene located on chromosome 12q13. The AAAS gene encodes for the ALADIN protein (alacrima, achalasia, adrenal insufficiency, neurologic disorder). AS can manifest with a plethora of symptoms. Early recognition of the syndrome remains challenging due to its rarity and progressive nature. This report presents an unusual case of triple-A syndrome (TAS) with concurrent neuromuscular manifestations. Understanding the atypical presentation of this syndrome is vital for early diagnosis and appropriate management.

Case presentation

We report a 16-year-old boy with severe malnutrition presented with painful swallowing, fatigue, and bilateral congenital ptosis. Barium swallow, upper gastrointestinal endoscopy, and Shimmer test were performed, which led to the diagnosis of TAS. Treatment included laparoscopic Heller's procedure, artificial tears, hydrocortisone.

Clinical discussion

TAS, also known as AS, is a rare multisystem disorder characterized by achalasia, Addison's disease, and alacrima. This syndrome is occasionally referred to as 4A syndrome due to the inclusion of autonomic dysfunction. There is no treatment for AS. Management includes artificial tears for alacrima, glucocorticoid replacement therapy to treat adrenal insufficiency, and treatment of achalasia.

Conclusion

This case emphasizes the importance of considering atypical presentations of TAS. Early diagnosis and treatment are paramount in addressing the varied components of this rare disorder. Understanding the clinical complexities of this syndrome aids in improved patient care and underscores the necessity for comprehensive evaluation and management in similar cases.

Dental divisions: exploring racial inequities of dental caries amongst children

DATA SOURCES

The search strategy involved three sequential stages. Initially, MEDLINE/PubMed was explored for relevant articles, identifying pertinent terms for formal searching. Using the terms ethnic, race, minoritised and dental caries, a strategy was formed and nine databases searched. Finally, hand-searching of reference lists of included articles and sourcing grey literature from relevant government reports, national oral health surveys, and registries which had comparative data for dental caries between racial groups, completed the search.

STUDY SELECTION

Studies included were original primary research which reported dental caries and compared racially minoritised children, aged 5-11 years, to similarly aged from national, majority, or privileged populations. Dental caries had to be recorded from a clinical examination which assessed decayed, missing, and filled teeth (dmft) in primary dentitions. Studies were excluded if they used immigration status as a basis of racial status, or they were a case report, case series, in vitro study, or literature review.

DATA EXTRACTION AND SYNTHESIS

After removing duplicates, two independent researchers screened abstracts, prior to extracting critical data following full-text reviews of included articles. Information collected included study and participant characteristics, definitions of race, and dental caries measurement. The authors of studies which had missing data were contacted, whilst those not written in the English language were translated. Methodological quality of each study was independently assessed by two reviewers using a modified version of the Newcastle-Ottawa scale. All studies were included in the review regardless of quality. A narrative overview of all included studies was conducted. Meta-analyses were completed using studies that reported the mean and standard deviation of the caries outcomes in both groups. Caries outcomes included severity (defined as mean dmft) or prevalence (percentage of teeth with untreated dental caries > 0%). Due to anticipated heterogeneity, statistical analyses approaches such as I2 statistics were used to estimate between-study variability. Additional sub-group analyses were conducted based on country of study and world income index. Contour-enhanced funnel plots and trim-and-fill analysis were completed to explore potential publication bias. Sensitivity analyses were performed to ensure robustness of the findings.

RESULTS

Seventy-five studies were included from a variety of countries. A higher mean dmft score of 2.30 (0.45, 4.15) and prevalence of decayed teeth (d > 0) was 23% (95% CI: 16, 31) was noted amongst racially minoritised children compared to privileged children's populations. Notable disparities were reported in high-income countries, with minoritised children burdening the greatest distribution of caries incidence. The study faced challenges in consistent racial classification and encountered high heterogeneity in its findings, leading to varied GRADE assessment scores.

CONCLUSIONS

The study calls for global, social, and political changes to tackle the substantial disparities in dental caries among minoritised children to achieve oral health equity.

Polyelectrolyte-Cation Complexes Using PAsp-Sr Complexes Induce Biomimetic Mineralization with Antibacterial Ability

Remineralized dentin with an antibacterial ability is still a significant challenge in dentistry. Previously, a polyelectrolyte-calcium complexes pre-precursor (PCCP) process is proposed for rapid collagen mineralization. In the present study, the expansion concept of the PCCP process is explored by replacing the calcium with other cations, such as strontium. The results of transmission electron microscopy (TEM), 3D stochastic optical reconstruction microscopy, energy-dispersive X-ray analysis, Fourier transform infrared spectroscopy, and high-resolution TEM with selected area electron diffraction demonstrate that biomimetic mineralization of collagen fibrils and demineralized dentin could be fulfilled with Sr&F-codoped hydroxyapatite (HAp) after they are treated with poly-aspartic acid-strontium (PAsp-Sr) suspension followed by a phosphate&fluoride solution. Moreover, dentin remineralized with Sr&F-codoped HAp exhibits in vitro and in vivo antibacterial ability against Streptococcus mutans. The cytotoxicity and oral mucosa irritation tests reveal excellent biocompatibility of mineralization mediums (PAsp-Sr suspension and phosphate&fluoride solution). The demineralized dentin's mechanical properties (elastic modulus and microhardness) could be restored almost to that of the intact dentin. Hence, the expansion concept of the PCCP process that replaces calcium ions with some cationic ions along with fluorine opens up new horizons for generating antibacterial remineralized dentin containing ions-doped HAp with excellent biocompatibility via biomimetic mineralization technology.

Investigating the causal relationship between human blood/urine metabolites and periodontal disease using two-sample Mendelian randomization

Background and Aims

The aim is to investigate the cause-and-effect connection between metabolites found in blood/urine and the likelihood of developing periodontal disease (PD) through the utilization of a two-sample Mendelian randomization (MR) method.

Methods

Using an inverse variance weighted (IVW) method and two additional two-sample MR models, we examined the relationship between blood/urine metabolites and PD by analyzing data from a comprehensive metabolome-based genome-wide association study and the Genome-Wide Association Studies (GWAS) of PD. To assess the consistency and dependability of the findings, diversity, cross-effects, and sensitivity analyses were conducted.

Results

Out of the 35 metabolites found in blood and urine, a total of eight metabolites (C-reactive protein, Potassium in urine, Urea, Cystatin C, Non-albumin protein, Creatinine, estimated Glomerular Filtration Rate, and Phosphate) displayed a possible causal connection with the risk of dental caries/PD using the inverse variance weighted (IVW) method (p < 0.05). This includes five metabolites in the blood and three in the urine. No metabolites were statistically significant in IVW MR models (p < 3.68 × 10- 4). Even after conducting sensitivity analysis with the leave-one-out method and removing the confounding instrumental variables, the impact of these factors on dental caries/PD remained significant.

Conclusion

Based on the available evidence, it is not possible to establish a significant causal link between the 35 blood metabolites and the likelihood of developing dental caries and PD.

Is food insecurity associated with dental caries?

DATA SOURCES

Eight electronic databases including APA PsycINFO, CINAHL, Embase, LILACS, PubMed, Ovid, Scopus and Web of Science were searched from date of inception to November 2021. An updated search was conducted in August 2022. Google Scholar was accessed including Open Grey and ProQuest. Reference lists of the included studies were analysed for potentially eligible studies.

STUDY SELECTION

Observational studies (cross-sectional, case-control and cohort) that evaluated the association between dental caries and food insecurity were eligible for analysis. Qualitative studies, reviews and meeting abstracts were excluded. There were no restrictions on language or publication date.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently screened titles and abstracts. A third experienced researcher was consulted if there was disagreement. Food insecurity status was the exposure with dental caries the outcome. The authors retrieved effect measures, 95% CI's and P values where available. Heterogeneity was assessed via I2 and R2. A total of 514 records were initially identified. Once duplicates were removed, 19 references were assessed in full. The association between food insecurity and dental caries were presented as odds-ratios, relative risks and prevalence ratios with 95% CIs. A random-effects model was fitted to all meta-analyses.

RESULTS

Evaluation identified 14 studies for the qualitative synthesis and 7 studies for the quantitative synthesis. The total sample size for the 14 studies was 150,546 individuals. Quantitative data merged from two studies found food-insecure individuals more prone to dental caries than food-secure individuals (OR = 1.62; 95% CI, 1.01-2.60; P = 0.045). In two studies that used binary data to compare food security or insecurity, food insecure individuals were more likely to exhibit dental caries (OR = 1.66; 95% CI, 1.36-2.02; P < 0.0001).

CONCLUSIONS

People experiencing food insecurity are more likely to exhibit dental caries than those who have food security.

Oral Healthcare Utilization Factors Shaping the Perceived Oral Health Outcome Among Gond Tribes of Chhattisgarh: A Cross-Sectional Study Based on Andersen's Behavioral Model

INTRODUCTION

The Gonds are a highly ancient and expansive tribal community, ranking among the largest in the world. A review of the literature has suggested that they are more vulnerable to oral diseases and are less inclined to utilize oral health services due to the comprehensive approach that considers the socioeconomic, cultural, and structural factors affecting the Gond community's access to oral health services. Tribal health requires action in the health sector. Utilization is an essential marker of the health status of any population and is necessary to bridge the gap between tribes and the wider portion of the community. Hence, this study was conducted among the Gond tribes of Chhattisgarh to evaluate the oral healthcare utilization factors shaping the perceived oral health outcome using Andersen's behavior model.

MATERIALS AND METHODS

This cross-sectional study was carried out among 400 Gond tribes residing in villages of Chhattisgarh. Data was collected through a standardized questionnaire, adapted from Andersen's behavioral model of healthcare utilization during house-to-house survey. The questionnaire included predisposing, enabling, perceived, and evaluated need factors. Oral health status for evaluated need was assessed using the World Health Organization (WHO) Oral Health Assessment form (1997), and the perceived oral health outcome was measured using Oral Health Impact Profile-14 (OHIP-14). Results were computed using descriptive statistics, chi-square test, and one-way analysis of variance (ANOVA). Multivariate analysis was done using binomial logistic regression.

RESULTS

The dental visit in the past one year was only 14%. The findings of logistic regression revealed that the perceived oral health outcome was significantly associated with age, occupation, and positive belief in the efficacy of dentist, perceived need, and presence of dental caries.

CONCLUSION

The findings of the present study support Andersen's behavioral model and suggest that there is an interrelationship of predisposing characters, predisposing health beliefs, and enabling need factors that determine the likelihood of use of services, which in turn determines the good or bad oral health outcome.

Barriers to routine dental care for children with special health care needs

PURPOSE

The aim of this mixed method study was to identify barriers for children with special health care needs (SHCN) to receiving routine preventive dental care following restorative dental care with general anesthesia (GA).

METHODS

Electronic health records were reviewed for inclusion criteria and demographic data. Caregivers of children with SHCN were contacted to participate in qualitative interviews. Interview topics explored child, family, and community level influences to accessing routine dental care. Qualitative analysis identified key themes of barriers and enablers to care.

RESULTS

A total of 1708 children received dental care with GA during the 2-year study period, of which 498 (29.16%) had a diagnosis of a SHCN. The most common type of SHCN was neurodevelopmental disorders (28.51%). The mean age at time of GA was 8.6 years. Fifty caregivers completed interviews. Identified barriers to obtaining routine dental care included child stress/anxiety, finding an accepting provider, dismissive providers, and proximity of provider/transportation to dental care. Enablers to obtaining care included effective behavior management, continuity of provider/care, positive provider attitude, and referral to an accepting provider.

CONCLUSION

Adequately trained and local providers with an accepting attitude are essential to enabling children with SHCN to obtain equitable access to routine dental care.

Exploring Recent Decreases in First Molar Sealants among US Children

Analyses of National Health and Nutrition Examination Survey (NHANES) data suggested a significant decrease in sealant prevalence among children between 2011 to 2014 and 2015 to 2018. We explore whether this decrease could be associated with possible changes in 1) clinical sealant delivery, 2) dental materials (i.e., increased use of glass ionomer [GI] sealants resulting in an inability to detect sealant fragments that still provide preventive benefits or increased use of composite restorations leading to misclassifying sealants as restorations), and 3) examination sensitivity and specificity. We used NHANES data to estimate the prevalences of sealants, untreated caries, and restorations in ≥1 first permanent molar among children aged 7 to 10 y and used Medical Expenditure Panel Survey data to estimate the annual clinical delivery of sealants and fluoride treatments. We examined changes in outcomes between 2 periods (P < 0.05) controlling for selected sociodemographic characteristics. NHANES sealant examination quality was based on the reference examiner's replicate examinations. The adjusted prevalence of sealants decreased relatively by 27.5% (46.6% vs. 33.8%). Overall, untreated caries decreased. Untreated caries and restoration decreased among children without sealants. Annual clinical sealant delivery did not change, whereas fluoride treatment delivery increased. The decrease in sealant prevalence held when assessed for various age ranges and NHANES cycle combinations. While sealant examination specificity remained similar between the periods, sensitivity (weighted by the proportion of exams by each examiner) decreased relatively by 17.4% (0.92 vs. 0.76). These findings suggest that decreased sealant prevalence was not supported by decreased clinical sealant delivery nor increased use of composite restorations. Decreased examination sensitivity, which could be due to an increased use of GI sealants, could contribute to the decrease in sealant prevalence. The decrease in caries among children without sealants could suggest the increased use of GI sealants. However, we could not rule out that the decrease in caries could be attributable to increased fluoride treatment delivery.

Community and individual socioeconomic inequalities and dental caries from childhood to adolescence: A 10-year cohort study

PURPOSE

To evaluate the effect of individual and contextual socioeconomic inequalities in the occurrence of untreated dental caries during the transition from childhood to adolescence.

METHODS

This 10-year prospective cohort study followed up an initial sample of 639 1-5 years old schoolchildren from southern Brazil. After 7 and 10 years from the baseline (T1), two other reassessments were conducted (T2 and T3), respectively. Untreated dental caries was measured through the International Caries Detection and Assessment System (ICDAS- scores 3, 5 and 6) at T1 and T3. Socioeconomic status (SES) at the contextual and individual level was assessed at T1. At T2, socioeconomic, behavioural and psychosocial characteristics were evaluated as possible pathways of explanation. Structural equation modelling was used to estimate the direct and indirect effects among the variables over 10 years.

RESULTS

A total of 429 adolescents were reevaluated at 10-year follow-up (cohort retention rate of 67.1%). About 30.6% presented untreated dental caries at T3. Low individual SES at T1 directly impacted a higher occurrence of dental caries at T3. Non-white skin colour at T1 also indirectly impacted a higher occurrence of dental caries at T3 through low individual SES at T1 and lower household income at T2. Contextual SES did not predict, directly or indirectly, dental caries at T3.

CONCLUSION

There is strong evidence that socioeconomic inequalities at the individual level play an important role on the occurrence of dental caries from childhood to adolescence. On the other hand, there was no evidence that contextual SES influences the occurrence of dental caries over time.

Caries indicators in relation to healthcare access and hygienic-dietary habits in Spanish preschoolers

INTRODUCTION

Dental caries continues to be a public healthcare problem due to its high prevalence and morbidity. It was proposed to evaluate caries indicators in relation to healthcare access and hygienic-dietary habits in Spanish preschoolers.

MATERIALS AND METHODS

A cross-sectional study was carried out on a random sample consisting of 343 patients ranging from 3 to 5 years of age in the primary care setting, the main measurements were: dental care access, hygienic-dietary habits, and caries registration according to WHO criteria.

RESULTS

The prevalence of caries was 35.3% and mean ± standard deviation (SD) dft was 1.51 ± 2.93. Preschoolers who had ever visited the dentist had a higher dft occurrence than those who had never attended the dentist. The lower prevalence of caries was significantly associated with the frequency of two daily brushings versus non-daily brushing (p = 0.007; 25.3% vs. 47.1%) and was 10.7% lower in patients who had the habit of night brushing (p = 0.041). The consumption of sugary liquids between meals implied a higher dft index.

CONCLUSIONS

The high prevalence of early childhood caries and the dental care access associated with poor oral health suggest the need to implement a multidisciplinary oral healthcare program that involves both healthcare and dental healthcare professionals in Primary Health Care Units without forgetting the participation of the community and local administrations.

Early Childhood Caries and Dental Care Utilization in Mangalore, India: Parents' Perceptions

BACKGROUND

Parents often underuse dental care services for their children with early childhood caries (ECC), resulting in a high burden of untreated dental caries.

AIM

To describe parental perceptions and challenges in dental care utilization for their children with ECC.

DESIGN

A descriptive qualitative study was conducted with parents of children with ECC seeking dental care in Mangalore, India. Data were collected through focus group discussions using an interview guide. Manual line-by-line coding and content analysis methods were used for data analysis.

RESULTS

Three categories were generated from data obtained through 5 focus groups of 27 participants: dental care visiting patterns, the significance of dental visits, and challenges to dental care utilization. Parents would only visit the dentist when they perceived their children's tooth problems. The challenges faced include time constraints, misinformation, lack of awareness and motivation, costs, fear, and anxiety of the children and the parents themselves. Parents perceived improvements in the awareness of their children's oral health and quality of life after dental visits.

CONCLUSION

Attending dental services to treat their children's tooth problems was the primary way of attaining awareness about prevention among the parents of children with ECC. Increased oral health awareness and improved quality of life can motivate parents to seek further dental care for their children. Collaboration with multidisciplinary stakeholders is required to improve oral health awareness among parents of children with ECC.

KNOWLEDGE TRANSFER STATEMENT

The study's results will help plan targeted preventive programs for children with ECC. The study suggests dental care utilization by children with ECC is based on parental perceptions of their children's tooth problems. It outlines the challenges that affect dental visits of children with ECC and the role of multidisciplinary stakeholders. Improved oral health awareness and quality of life following dental treatment can facilitate further dental visits.

Host-Guest Mechanism via Induced Fit Fullerene Complexation in Porphin Receptor to Probe Salivary Alpha-Amylase in Dental Caries for Clinical Applications

Salivary α-amylase is the most abundant protein of human saliva that potentially binds to streptococcus and other bacteria via specific surface-exposed α-amylase-binding proteins and plays a significant role in caries development. The detection of α-amylase in saliva can be used as a bioindicator of caries development. Herein, a facile strategy has been applied, tailoring the photochemical properties of 5,10,15,20-tetrakis(4-hydroxyphenyl)-21H,23H-porphine (TPPOH) and the fullerene C60 complex. The fluorescence emission of TPPOH is quenched by starch-coated fullerene C60 via charge-transfer effects, as determined by UV absorption and fluorescence spectroscopic studies. The starch-coated C60 has been thoroughly characterized via Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD), field emission scanning electron microscopy (FE-SEM), optical microscopy, thermal gravimetric analysis (TGA), static water contact angle measurements, and zeta potential measurements. The analytical response of the assay showed a linear fluorescent response in α-amylase concentrations ranging from 0.001-0.1 Units/mL, with an LOD of 0.001 Units/mL. The applicability of the method was tested using artificial saliva with quantitative recoveries in the range 95-100%. The practicability of the procedure was verified by inspecting saliva samples of real clinical samples covering all age groups. We believe that the proposed method can serve as an alternative analytical method for caries detection and risk assessment that would also minimize the cost of professional preventive measures and treatments.

Caries Experience before and after COVID-19 Restrictions: An Observational Study

Background: The declaration of COVID-19 as a pandemic by the World Health Organization in 2020 led to the suspension of several clinical practices globally, including dentistry. This study investigates the impact of these restrictions on dental caries experience. Methods: A retrospective cross-sectional study was conducted at Egas Moniz University's dental hospital in the Lisbon Metropolitan Area from June 2019 to June 2021. The study involved 3380 participants who were divided into two cohorts: after and before COVID-19 restrictions. Data collection included a questionnaire, full-mouth clinical examinations, and radiographs (panoramic X-rays, bitewings). Results: Before the COVID-19 restrictions, the prevalence of dental caries was 91.8%, with an average DMFT (decayed, missing, and filled teeth) index of 12.13. Post-restrictions, the prevalence decreased to 84.5%, with a DMFT index of 10.99. There was an increase in missing teeth and a decrease in decayed and filled teeth. Additionally, the frequency of toothbrushing declined among participants. Conclusions: The COVID-19 pandemic restrictions have significantly impacted dental caries experiences and oral health, highlighting a decrease in dental caries, but also a concerning reduction in oral hygiene practices. These results emphasize the importance of customized dental healthcare during public health emergencies to reduce impacts and maintain oral health.

Antibacterial Activity of Plant Polyphenols Belonging to the Tannins against Streptococcus mutans-Potential against Dental Caries

Dental caries (DC) is the most common oral pathology. The main bacteria responsible for DC is Streptococcus mutans. One of the strategies that can decrease or eliminate the risk of DC development is using compounds that will inhibit both the growth and virulence factors of S. mutans. Tannins are plant polyphenols that have strong antibacterial activity. The purpose of this study was to assess the antibacterial activity of three tannins against S. mutans. In this investigation, microbiological tests (MIC and MBC) and physicochemical techniques like the fluorescence measurements of tannins' interaction with S. mutans cell membrane and membrane proteins, zeta potential, and thermodynamic analyses were used to obtain knowledge about the antibacterial potential of the investigated compounds against S. mutans as well as about the mechanisms associated with antibacterial activity. The obtained results demonstrate that the used compounds exhibit high antibacterial activity against S. mutans. The mechanisms of their antibacterial activity are linked to the strong change in the S. mutans membrane fluidity and potential, and to their interaction with membrane proteins that can result in great disturbance of bacterial physiology and ultimately the inhibition of bacterial growth, triggering their death. Therefore, it can be concluded that the investigated compounds can be potentially used as natural factors in the prevention of dental caries.

Effect of bottled fluoridated water to prevent dental caries in primary teeth: study protocol for a phase 2 parallel group 3.5-year randomized controlled clinical trial (waterBEST)

Background

Fluoridation of public water systems is known as a safe and effective strategy for preventing dental caries based on evidence from non-randomized studies. Yet 110 million Americans do not have access to a fluoridated public water system and many others do not drink tap water. This article describes the study protocol for the first randomized controlled trial (RCT) of fluoridated water that assesses its potential dental caries preventive efficacy when delivered in bottles.

Methods

waterBEST is a phase 2b proof-of-concept, randomized, quadruple-masked, placebo controlled, parallel group, trial designed to estimate the potential efficacy of fluoridated versus non-fluoridated bottled water to prevent dental caries incidence in the first four years of life. Two hundred children living in eastern North Carolina, USA, and aged 2-6 months at screening are being allocated at random in a 1:1 ratio to receive fluoridated (0.7 mg/L F) or non-fluoridated bottled water sourced from two local public water systems. Throughout the 3.5-year intervention, study water is delivered monthly in 5-gallon bottles to each child's home with instructions to use it whenever the child consumes water as a beverage or in food preparation. Parents are interviewed quarterly to monitor children's water consumption and health. At annual visits, the presence of dental caries is evaluated with a dental screening examination. Clippings from fingernails and toenails are collected to quantify fluoride content as a biomarker of total fluoride intake. The primary endpoint is the number of primary tooth surfaces decayed, missing, or filled due to dental caries measured by the study dentist near the time of the child's fourth birthday. Tooth decay is assessed at the threshold of macroscopic enamel loss. For the primary aim, a least-squares, generalized linear model will estimate efficacy and its one-tailed, upper 80% confidence limit.

Discussion

waterBEST is the first evaluation of a randomized intervention of fluoridated drinking water in bottles to prevent dental caries in the primary dentition. This innovative method of delivering fluoridated water has potential to prevent early childhood caries in a large segment of the U.S. population that currently does not benefit from fluoridated public water.

Polarization-Sensitive Optical Coherence Tomography for Monitoring De- and Remineralization of Bovine Enamel In Vitro

Early caries diagnosis still challenges dentistry. Polarization-sensitive optical coherence tomography (PS-OCT) is promising to detect initial lesions non-invasively in depth-resolved cross-sectional visualization. PS-OCT with determined degree of polarization (DOP) imaging provides an intuitive demineralization contrast. The aim of this study is to evaluate the suitability of DOP-based PS-OCT imaging to monitor controlled de- and remineralization progression for the first time and to introduce it as a valid, non-destructive in vitro detection method. Twelve standardized bovine enamel specimens were divided in different groups and demineralized with hydrochloric acid (HCl) as well as partly remineralized with fluoride over a 14-day pH-cycling experiment. The specimens were stored in artificial saliva and sodium chloride (NaCl), respectively. Progress measurements with PS-OCT were made with polarization-sensitive en faceand B-scan mode for qualitative evaluation. The specimens demineralized in HCl showed the most pronounced surface change (lowest DOP) and the most significant increase in depolarization. Additional fluoride treatment and the storage in artificial saliva resulted in the opposite (highest DOP). Therefore, DOP-based PS-OCT imaging appears to be a valuable technique for visualization and monitoring of enamel demineralization and remineralization processes in vitro. However, these findings need to be confirmed in human teeth ex vivo or in situ.

Occlusal Caries Detection with Intraoral Scanners in Pediatric Dentistry: A Comparative Clinical Study

Background: The aim of this clinical study was to compare the occlusal caries detection (OCD) performance of the intraoral scanners (IOSs) Trios 4 (TIO, 3Shape) and Emerald S (EME, Planmeca) and the Diagnocam (DIA, KaVo) with the established visual (WHO) examination (VIS, reference method). Methods: Between 08/2022 and 02/2023, 60 children (mean age 9.6 ± 2.5 years) were examined as part of their regular dental checkups. OCD was performed at the tooth level, separately for primary and permanent unrestored teeth. Furthermore, two thresholds were analyzed: sound versus overall caries (pooled data of enamel and dentin caries, TH1) and pooled data of sound and enamel caries versus dentin caries (TH2). Results: The best agreement with the reference method (reliability) in both dentitions was obtained for DIA (ĸ = 0.829/ĸ = 0.846; primary/permanent teeth), followed by EME (ĸ = 0.827/ĸ = 0.837) and TIO (ĸ = 0.714/ĸ = 0.680). Similar results were shown for the diagnostic quality (sensitivity, specificity and area under the curve of the receiver operating characteristic curve), with higher values for TH1 than for TH2. Both IOSs and the DIA showed worse results than the reference method VIS. Conclusions: Currently, IOS should be used as an additional caries detection tool, especially for visualization, and cannot be recommended as a basic tool for diagnosis or invasive/noninvasive therapy decisions in OCD.

Oral Health Status and Oral Health-Related Behaviours of Hong Kong Students with Vision Impairment

This cross-sectional epidemiological study aimed to describe dental caries and oral hygiene conditions among visually impaired students in Hong Kong. Students aged 6-21 years from two specialised schools for those with vision impairment were invited. Information on sociodemographic background and oral health-related behaviours was collected through an online parent-reported questionnaire. Dental caries and oral hygiene were assessed using the Decayed, Missing and Filled Teeth (DMFT) index and the Visible Plaque Index (VPI), respectively. Chi-square, Mann-Whitney U and Kruskal-Wallis H tests were conducted to analyse the association between students' background and oral health status. A total of 73 participants were recruited, of whom 57.5% were male. Their mean (SD) age was 12.9 (4.7) years. Their mean DMFT score (SD) was 1.0 (1.8), and 43.8% had caries experience. The mean VPI (SD) was 0.76 (0.30). Their caries experience was significantly associated with their snacking habits (p = 0.013). Male participants had poorer oral hygiene than females (p = 0.048). In summary, dental caries is prevalent among visually impaired students in Hong Kong and their oral hygiene condition is unsatisfactory. Caries experience is significantly associated with snacking frequency, whereas oral hygiene is associated with gender. More specially designed preventive oral health measures should be provided for visually impaired students and their caretakers.

Analysis of Spatial and Biochemical Characteristics of In Vitro Cariogenic Biofilms

Background Dental caries is the most common bacterial disease of calcified tissues of teeth. Cariogenic biofilms formed on the tooth surface secrete organic acids and thus result in demineralization. Delving into the depth of biofilms is crucial to understand the pathogenic mechanisms and design improved therapeutic approaches. The aim of the study is to analyze the spatial and biochemical characteristics of cariogenic biofilms. Materials and methods Pulp tissue samples sourced from freshly extracted third molars were incubated with oral cariogenic bacteria namely Streptococcus mutans, Staphylococcus aureus, Escherichia coli, Entamoeba faecalis, and Candida albicans to form the biofilm. Spatial assessment of biofilms was done under FESEM (field emission scanning electron microscope, JSM-IT800, JEOL, Tokyo, Japan). FTIR (Fourier transform infrared spectroscopy, Alpha II, Bruker, Germany) spectra were assessed for chemical molecular interactions in 24- and 48-hour time periods.  Results Morphological assessment with FESEM revealed rapid growth and aggregation within a short time period. FTIR spectra to analyze chemical constituents of biofilm presented with varied peaks of water, amide A, amide I, water, lipids, and phospholipids. Conclusion Further validation with more advanced imaging for an extended time period is vital to derive better conclusive evidence.

Evaluating the Accuracy of AI-Based Software vs Human Interpretation in the Diagnosis of Dental Caries Using Intraoral Radiographs: An RCT

Background

Dental caries is a prevalent oral health issue, often diagnosed through intraoral radiographs. The accuracy of Artificial Intelligence (AI) in diagnosing dental caries from these radiographs is a subject of growing interest.

Materials and Methods

In this RCT, 200 intraoral radiographs were collected from patients seeking dental care. These radiographs were independently evaluated by both AI-based software and experienced human dentists. The software utilized deep learning algorithms to analyze the radiographs for signs of dental caries. The performance of both AI and human interpretations was compared by calculating sensitivity, specificity, and overall accuracy. Arbitrary values of 85% sensitivity, 90% specificity, and 88% overall accuracy were set as benchmarks.

Results

The AI-based software demonstrated a sensitivity of 88%, a specificity of 91%, and an overall accuracy of 89% in diagnosing dental caries from intraoral radiographs. Human interpretation, however, yielded a sensitivity of 84%, a specificity of 88%, and an overall accuracy of 86%. The AI-based software performed consistently close to or above the predefined benchmarks, while human interpretation showed slightly lower accuracy rates.

Conclusion

This RCT suggests that AI-based software is a valuable tool for diagnosing dental caries from intraoral radiographs, with performance comparable to or exceeding that of experienced human dentists. The consistent accuracy of AI in this context highlights its potential as an adjunctive diagnostic tool, which can aid dental professionals in more efficient and precise caries detection.