Comparison of dexmedetomidine and a dexmedetomidine-esketamine combination for reducing dental anxiety in preschool children undergoing dental treatment under general anesthesia: A randomized controlled trial

BACKGROUND

Dental anxiety is a widespread complication occurring in pediatric patients during dental visits and may lead to undesirable complications. Esketamine may be effective in anxiety.

OBJECTIVE

The objective of this study was to investigate the effect of premedication with a dexmedetomidine-esketamine combination compared with dexmedetomidine alone on dental anxiety in preschool children undergoing dental treatment under general anesthesia.

METHODS

This is a prospective, double-blinded, randomized controlled trial. A total of 84 patients were scheduled for elective outpatient dental caries treatment under general anesthesia. Patients were randomly premedicated with intranasal dexmedetomidine (group D) or intranasal dexmedetomidine-esketamine (group DS). The primary outcome was the level of dental anxiety assessed by the Modified Child Dental Anxiety Scale (MCDAS) at 2 h after surgery. Secondary outcomes included level of dental anxiety at 1 day and 7 days after surgery, the incidence of dental anxiety at 2 h, 1 day, and 7 days after surgery, sedation onset time, overall success of sedation, acceptance of mask induction, postoperative pain intensity, incidence of emergence agitation in PACU, adverse reactions, HR, and SpO2 before premedication (baseline) and at 10, 20, and 30 min after the end of study drug delivery.

RESULTS

The dental anxiety in group DS was lower than that in group D at 2 h, 1 day, and 7 days postoperatively (P = 0.04, 0.004, and 0.006, respectively). The incidences of dental anxiety in group DS were lower than those in group D at 2 h (53 % vs 76 %, P = 0.03), 1 day (47 % vs 71 %, P = 0.04), and 7 days (44 % vs 71 %, P = 0.02) after surgery. Group DS had a higher success rate of sedation (P = 0.03) but showed a lower MAS score (P = 0.005) and smoother hemodynamics (P < 0.01) after drug administration than group D. Group DS showed a significantly lower incidence rate of emergence agitation (P = 0.03) and postoperative pain intensity (P = 0.006) than that in group D during the anesthesia recovery time. The occurrence of adverse reactions was similar in both groups (P > 0.05).

LIMITATIONS

We did not analyze and correct for the learning effect caused by repeated applications of the MCDAS and MCDAS scores on the 1 day after surgery were obtained by telephone follow-up.

CONCLUSIONS

Compared to premedication with dexmedetomidine alone, premedication with intranasal dexmedetomidine combined with esketamine could significantly improve dental anxiety in preschool children undergoing dental treatment under general anesthesia.

Medication impact on oral health in schizophrenia

BACKGROUND

Patients with schizophrenia constitute a particularly vulnerable group for oral diseases. Among the different factors involved, we aimed to examine the evidence of how drugs could contribute to the poorer oral health of this population.

MATERIAL AND METHODS

An overview of the potential impact of medication on dental/oral health among people with schizophrenia was proposed focusing on selected literature.

RESULTS

Studies show a higher dental caries and degree of periodontal diseases in this population and point to drug-induced xerostomia as an important risk factor for oral health deterioration. The risk of dry mouth depends on not only antipsychotics, but also drugs with anticholinergic activity. We hypothesize that antipsychotic induced glycaemic alterations might contribute to reduced oral health, and that the antimicrobial activity of certain antipsychotics could have an impact on oral microbiota affecting oral condition. Pharmacovigilance data show that involuntary movements are caused by typical and some atypical antipsychotics. Dry mouth is most frequently reported for quetiapine and olanzapine, while clozapine is more frequently associated with sialorrhea.

CONCLUSIONS

Literature clearly shows higher caries and periodontal disease in schizophrenic patients. However, overall, there is scarce literature about the potential influence of drugs in these disorders. Health professionals should be aware of this issue in order to implement adequate preventive measures in this vulnerable population.

Household smoking impact on the oral health of 5- to 7-years-old children

BACKGROUND

Children's exposure to secondhand smoke, particularly by their parents, could adversely affect their oral health. Thereby, this study aimed to assess the oral health status of children subjected to household smoking and the impact of smoking patterns on the severity of oral health deterioration.

METHODS

A total of 210 healthy children were enrolled in this case-control study and allocated into children subjected to household smoking (HS) and control groups. Participants' guardians were asked to complete a questionnaire regarding sociodemographic characteristics and parental smoking habits. All participants were subjected to clinical dental examination to assess dental caries (ICDAS), hypomineralized primary molars (HSPM), and gingival status (GI). Stimulated saliva samples were collected to assess saliva composition and characteristics. Urine samples were collected and analyzed for cotinine concentration. Data were analyzed using SPSS (v.25) software at a test value of p ≤ 0.05. The t-student test was used to find significant differences between participants' age, gingival index score, saliva pH, flow rate, sIgA, and cotinine level. The Chi-square test was used to test for the significance of parental employment, number of rooms, gender, sweets consumption, brushing frequency, and HMPM. The correspondence analysis was used to test for significance of parents' levels of education, type of house ventilation, ICDAS score, smoking form, frequency, and smoking pattern. The correlation between cotinine level and sIgA was tested for association using Bivariate correlation test.

RESULTS

The HS group showed a significantly increased risk for dental caries (p < 0.000), HSPM lesions (p = 0.007), and GI score (p < 0.000). A significant reduction in salivary flow rate, saliva pH, and sIgA were evident in HS group (p < 0.000). Parental consumption of more than 20 cigarettes/day was accompanied by increased dental caries activity (p < 0.000) and higher risk for increased severity of gingival inflammation (p < 0.000) of children in the HS group. Children of parents who smoke cigarettes and use the hubble/bubble anywhere in the house found to have greater distribution of HSPM (p < 0.000). Reduced sIgA values were found to be significantly associated with increased cotinine concentrations in HS children (p < 0.000).

CONCLUSIONS

Frequent exposure to household smoking could be associated with an increased risk of dental caries progression, enamel hypomineralization, gingival inflammation, and saliva characteristics changes in children.

The effectiveness and safety of botulinum toxin injections for the treatment of sialorrhea with Parkinson's disease: a systematic review and meta-analysis

BACKGROUND

Botulinum toxin (BoNT) injection is an important adjunctive method to treat sialorrhea. The purpose of this systematic review was to analyze the effect and safety of BoNT injections in the intervention of sialorrhea with Parkinson's disease (PD).

METHODS

We searched PubMed, Web Of Science (WOS), Scopus, Cochrane CENTRAL, and Embase from inception until April 2022. Randomized controlled trials or randomized crossover trials comparing BoNT with placebo in sialorrhea with PD were eligible. PRISMA guidelines were used to carry out the meta-analysis. The Drooling Severity Frequency Scale (DSFS) score and the number of adverse events (AEs) were the primary and secondary outcomes, respectively. Standardized mean differences (SMDs) and risk differences (RDs) are used to express continuous and categorical outcomes, respectively. Heterogeneity among these studies was evaluated using I2 tests. We used the GRADE tool to assess the certainty of evidence (COE).

RESULTS

Eight articles involving 259 patients compared BoNT injections with a placebo for PD with sialorrhea. This meta-analysis showed a significant reduction in DSFS scores between BoNT injections and placebo (SMD=-0.98; 95% CI, -1.27 to 0.70, p<0.001; COE: high). This meta-analysis showed a significant difference in AEs between BoNT injections and placebo (RD=0.15; 95% CI, 0.05 to 0.24, p=0.002; COE: low).

CONCLUSIONS

The pooled results suggest that BoNT injections have some effect on DSFS scores with sialorrhea caused by PD. There are also mild adverse events, which generally recover within a week or so. The results indicate that BoNT injection is one of the treatments for sialorrhea caused by PD, but we need to pay attention to adverse events. In addition, the follow-up time was extended to observe oral hygiene, ulceration or dental caries, and digestive function.

TRIAL REGISTRATION

Our review protocol was registered on PROSPERO (42021288334).

Artificial Caries Lesion Characteristics after Secondary Demineralization with Theobromine-Containing Protocol

Developing artificial caries lesions with varying characteristics is needed to adequately study caries process in vitro. The objective of this study was to investigate artificial caries lesion characteristics after secondary demineralization protocol containing theobromine and fluoride. Sixty bovine enamel slabs (4 × 3 mm) were demineralized using a Carbopol-containing protocol for 6 days. A baseline area (2 × 3 mm) was protected with acid-resistant nail varnish, after which specimens were exposed for 24 h to a secondary demineralization protocol containing acetic acid plus one of four fluoride/theobromine combinations (n = 15): theobromine (50 or 200 ppm) and fluoride (0 or 1 ppm). Specimens were sectioned and analyzed using transverse microradiography for changes in mineral content, lesion depth, and surface layer mineralization. Data was analyzed using paired t-test and analysis of variance followed by Bonferroni test at 0.05 significance level. After secondary demineralization, fluoride-containing groups had significantly deeper lesions (p = 0.002 and 0.014) compared to the group with 0 ppm fluoride and 50 ppm theobromine. Mineral content and lesion depth were significantly different compared to baseline for all groups. Theobromine did not show an added effect on mineral uptake. Theobromine-containing groups exhibited particularly deep lesions with a more uniform mineral profile in the presence of fluoride.

Association of sugar-sweetened drinks with caries in 10- and 15-year-olds

BACKGROUND

Sugar-sweetened drinks (SSDs) are known to be cariogenic, but this association has not been well investigated in population-based repeated cross-sectional studies in recent years. Therefore, this study examined whether SSD intake is associated with higher caries experience in 10- and 15-year-olds.

METHODS

The study sample included participants from the Munich study centre of two birth cohorts with data on non-cavitated caries lesions (NCCL/S), caries experience (DMF/S index), overall caries burden (DMF + NCCL/S) and SSD intake. In total, 915 and 996 children were included from the 10- and 15-year follow-ups, respectively. Intake (g/day) of SSDs, comprising cola, lemonade, ice-tea, sport/energy drinks, fruit squashes and nectars, was calculated from food frequency questionnaires. For analyses, the SSD intake was converted into portions (250 ml/day). Multiple logistic regression and prospective analysis models were performed to test associations between SSD intake and various definitions of caries, adjusting for sex, parental education, body mass index (BMI) categories, study cohort, plaque-affected sextants, mode of SSD consumption, energy content of SSDs, and total energy intake.

RESULTS

The mean overall caries burden at 10 and 15 years of age was 1.81 (SD: 2.71) and 6.04 (SD: 8.13), respectively. The average consumption of SSDs at the 10- and 15-year follow-ups was 0.48 (SD: 0.85) and 0.83 (SD 1.40) portions/day, respectively. After adjusting for confounders, in 10-year-olds, SSD intake was significantly associated with higher caries experience based on the indices DMF/S (adjusted odds ratio: 1.29; 95% CI: 1.06-1.57), NCCL/S (1.24; 1.03-1.49) and DMF + NCCL/S (1.27; 1.05-1.55). At the 15-year follow-up, SSD consumption was significantly associated with increased DMF/S index (1.12; 1.01-1.25) only. Prospective model associating 10-year SSD intake with 15-year caries experience was not significant.

CONCLUSIONS

SSD intake significantly increases the caries burden in 10-year-olds, with attenuated effects in 15-year-olds. To prevent caries, SSD consumption should be reduced, especially in children and adolescents.

Added Sugar and Dental Caries in Children: A Scientific Update and Future Steps

Excess added sugars, particularly in the form of sugar-sweetened beverages, is a leading cause of tooth decay in US children. Although added sugar intake is rooted in behavioral and social factors, few evidence-based, theory-driven socio-behavioral strategies are currently available to address added sugar intake. Dental health professionals are in a position to help identify and address problematic sugar-related behaviors in pediatric patients and advocate for broader upstream approaches, including taxes, warning labels, and policy changes, that can help reduce added sugar intake, prevent tooth decay, and improve health outcomes in vulnerable child populations.

Cariogenic potential of sweet flavors in electronic-cigarette liquids

Background

Most electronic-cigarette liquids contain propylene glycol, glycerin, nicotine and a wide variety of flavors of which many are sweet. Sweet flavors are classified as saccharides, esters, acids or aldehydes. This study investigates changes in cariogenic potential when tooth surfaces are exposed to e-cigarette aerosols generated from well-characterized reference e-liquids with sweet flavors.

Methods

Reference e-liquids were prepared by combining 20/80 propylene glycol/glycerin (by volume fraction), 10 mg/mL nicotine, and flavors. Aerosols were generated by a Universal Electronic-Cigarette Testing Device (49.2 W, 0.2 Ω). Streptococcus mutans (UA159) were exposed to aerosols on tooth enamel and the biological and physiochemical parameters were measured.

Results

E-cigarette aerosols produced four-fold increase in microbial adhesion to enamel. Exposure to flavored aerosols led to two-fold increase in biofilm formation and up to a 27% decrease in enamel hardness compared to unflavored controls. Esters (ethyl butyrate, hexyl acetate, and triacetin) in e-liquids were associated with consistent bacteria-initiated enamel demineralization, whereas sugar alcohol (ethyl maltol) inhibited S. mutans growth and adhesion. The viscosity of the e-liquid allowed S. mutans to adhere to pits and fissures. Aerosols contained five metals (mean ± standard deviation): calcium (0.409 ± 0.002) mg/L, copper (0.011 ± 0.001) mg/L, iron (0.0051 ± 0.0003) mg/L, magnesium (0.017 ± 0.002) mg/L, and silicon (0.166 ± 0.005) mg/L.

Conclusions

This study systematically evaluated e-cigarette aerosols and found that the aerosols have similar physio-chemical properties as high-sucrose, gelatinous candies and acidic drinks. Our data suggest that the combination of the viscosity of e-liquids and some classes of chemicals in sweet flavors may increase the risk of cariogenic potential. Clinical investigation is warranted to confirm the data shown here.

The association between diabetes mellitus, sugar-sweetened beverages, and tooth loss in adults: Evidence from 18 states

BACKGROUND

Sugar-sweetened beverages (SSBs) are dietary sources of sugar that are factors in caries development and tooth loss. Dietary sugar also is linked to diabetes mellitus (DM). There is limited research related to SSBs and tooth loss in people with DM. The authors investigated the association between SSBs and tooth loss as it related to the presence or absence of DM.

METHODS

The authors used a cross-sectional design with data reported by adults (18 years and older) who responded to the 2012 Behavior Risk Factor Surveillance System questionnaire, which was used in 18 states (N = 95,897; 14,043 who had DM and 81,854 who did not have DM). The authors conducted χ² and logistic regression analyses to determine associations related to DM status.

RESULTS

Overall, 12.3% of the survey respondents had DM, 15.5% had 6 or more teeth extracted, and 22.6% reported that they consumed 1 or more SSB daily. In the adjusted analyses, among adults who had DM, those who consumed at least 2 SSBs daily were more likely to have had 6 or more teeth extracted than those who reported that they did not consume SSBs (adjusted odds ratio, 2.35; 95% confidence interval, 1.37 to 4.01; P = .0018). Among adults who did not have DM, those who consumed more than 1 but fewer than 2 SSBs per day were more likely to have had at least 6 teeth extracted (adjusted odds ratio, 1.46; 95% confidence interval, 1.21 to 1.77; P < .0001).

CONCLUSIONS

The authors found that, among adults with DM, consuming 2 or more SSBs per day was associated with having had 6 or more teeth extracted.

PRACTICAL IMPLICATIONS

Dietary sugar is a concern for oral and systemic health; however, a strong, independent relationship between the number of teeth extracted and a single source of dietary sugar is not adequate to explain the complexity of tooth loss. Clinicians should use broadly worded dietary messages when discussing caries assessment with patients.

Mechanisms underlying methamphetamine-related dental disease

BACKGROUND

The authors clarified the causal mechanisms underlying the high prevalence of dental disease encountered in people who habitually use methamphetamine (meth).

METHODS

Using a stratified sampling approach, the authors conducted comprehensive oral examinations and psychosocial assessments for 571 study participants who used meth. Three calibrated dentists, who used National Health and Nutrition Examination Survey (NHANES) protocols, characterized the study participants' dental disease. The authors also collected data related to study participants' history of meth use and other attributes linked to dental disease.

RESULTS

Study participants who used meth manifested higher rates of xerostomia and caries experience compared with NHANES control participants. Participants who used meth had a higher level of daily consumption of sugary beverages compared with NHANES control participants. Smoking meth did not increase caries experience over other modes of intake. Dental hygiene was a significant determinant of dental health outcomes.

CONCLUSIONS

Mode of intake and frequency of meth use have a minimal impact on dental health outcomes. Behaviors, such as sugary beverage consumption and poor oral hygiene, better explain dental health outcomes.

PRACTICAL IMPLICATIONS

Having a better understanding of the causal mechanisms of "meth mouth" sets the stage for clinicians to provide more personalized interventions and management of dental disease in people who use meth.

[Drugs and dosage forms as risk factors for dental caries]

Dental caries is a multifactorial disease which, despite a series of preventive measures, remains the most common infectious disease worldwide. Susceptibility or resistance to caries may be a result of the presence of risk or protective factors, genetic predisposition, inappropriate lifestyle associated with education, behavioural and socioeconomic factors. The aim of this review is to highlight the risks associated with the use of some drugs and dosage forms in relation to the formation and development of dental caries. Drugs are classified by the mechanism of their action in this process, into those that 1. influence the tooth development, especially enamel, 2. directly or indirectly damage the tooth structure and/or 3. disrupt the protective function of saliva, causing oral microflora dysbiosis. The review article assesses the current possibilities in the treatment and prevention of dental caries using drugs, dietary supplements and supporting measures. The conclusion of the study deals with recommendations for prevention of adverse effects of drug therapy in the oral cavity, through preventive measures and/or by considering the duration of the treatment to achieve an optimal balance between benefits and risks. Since the topic of the study is of an interdisciplinary character, information on prevention within the oral health improvement in the population can be used not only by pharmacists, who should primarily warn patients about the risks associated with pharmacotherapy, but also dentists, paediatricians/general practitioners and the public.Key words: dental caries prevention drug dosage form adverse effect.

Effect of Biodentine on secondary caries formation: An in vitro study

PURPOSE

To compare the effects of two materials, Biodentine and conventional glass-ionomer cement (CGIC), on secondary caries formation around restorations when used as a dentin replacement material.

METHODS

30 approximal cavities were prepared on mesial and distal surfaces of 15 caries-free human premolar teeth extracted for orthodontic or periodontal reasons. Cavities were filled with A: Biodentine as a base + Filtek Z250 composite (n = 15) or B: CGIC as a base + Filtek Z250 composite (n = 15). The materials were applied according to the manufacturers' instructions. Teeth were thermocycled, and placed in a demineralizing solution for 5 weeks. Secondary caries formation was assessed using the International Caries Detection and Assessment System (ICDAS) II and quantitative computer- aided image measurement of caries depth.

RESULTS

The computer-aided measurements showed that the Biodentine group had significantly lower lesion depth measurements than the CGIC group (P = 0.004). However, there was no significant difference among the groups based on the ICDAS II scores (P > 0.05).

Dental disease patterns in methamphetamine users: Findings in a large urban sample

BACKGROUND

The authors used a large community sample of methamphetamine (MA) users to verify the patterns and severity of dental disease and establish a hierarchy of caries susceptibility by tooth type and tooth surface.

METHODS

Using a stratified sampling approach, 571 MA users received comprehensive oral examinations and psychosocial assessments. Three calibrated dentists characterized dental and periodontal disease by using National Health and Nutrition Examination Survey protocols. The authors also collected data on substance use history and other attributes linked to dental disease.

RESULTS

On all dental outcome measures, MA users evidenced high dental and periodontal disease, with older (≥ 30 years) and moderate or heavy MA users disproportionately affected. Women had higher rates of tooth loss and caries, as well as a greater prevalence of anterior caries. Current cigarette smokers were more likely to manifest 5 or more anterior surfaces with untreated caries and 3 or more teeth with root caries. Nearly 3% were edentulous, and a significant percentage (40%) indicated embarrassment with their dental appearance.

CONCLUSIONS

MA users have high rates of dental and periodontal disease and manifest a dose-response relationship, with greater levels of MA use associated with higher rates of dental disease. Women and current cigarette smokers are affected disproportionately. The intraoral patterns and hierarchy of caries susceptibility in MA users are distinctive.

PRACTICAL IMPLICATIONS

The prevalence and patterns of dental and periodontal disease could be used to alert dentists to possible covert MA use and to plan treatment. Concerns about dental appearance have potential as triggers for behavioral interventions.

Dental demineralization and caries in patients with head and neck cancer

Concurrent chemoradiation (CCR) therapy is a standard treatment for patients with locally advanced head and neck cancer (HNC). It is well documented that CCR causes profound acute and late toxicities. Xerostomia (the symptom of dry mouth) and hyposalivation (decreased salivary flow) are among the most common treatment side effects in this cohort of patients during and following treatment. They are the result of radiation-induced damage to the salivary glands. Patients with chronic hyposalivation are at risk for demineralization and dental cavitation (dental caries), often presenting as a severe form of rapidly developing decay that results in loss of dentition. Usual post-radiation oral care which includes the use of fluoride, may decrease, but does not eliminate dental caries associated with radiation-induced hyposalivation. The authors conducted a narrative literature review regarding dental caries in HNC population based on MEDLINE, PubMed, CLNAHL, Cochrane database, EMBASE, and PsycINFO from 1985 to 2014. Primary search terms included head and/or neck cancer, dental caries, dental decay, risk factor, physical symptom, physical sequellea, body image, quality of life, measurement, assessment, cost, prevention, and treatment. The authors also reviewed information from National Institute of Dental and Craniofacial Research (NIDCR), American Dental Association (ADA), and other related healthcare professional association web sites. This literature review focuses on critical issues related to dental caries in patients with HNC: potential mechanisms and contributing factors, clinical assessment, physical sequellea, negative impact on body image and quality of life, potential preventative strategies, and recommendations for practice and research in this area.

The impact of the new scene drug "crystal meth" on oral health: a case-control study

OBJECTIVE

The use of methamphetamine (MA), a highly addictive stimulant, is rapidly increasing, with MA being widely abused as the scene drug "Crystal Meth" (CM). CM has been associated with severe oral health effects, resulting in so-called "Meth mouth". This term appeared for the first time in 2005 in the literature and describes the final complex of symptoms including rampant caries, periodontal diseases and excessive tooth wear. The aim of this study was to investigate the effects of chronic CM abuse on teeth and intraoral tissue with respect to potential symptoms of Meth mouth.

MATERIALS AND METHODS

In cooperation with two centres for addiction medicine, we performed clinical intraoral investigations in 100 chronic CM users and 100 matched-pair controls. We undertook a caries and periodontal examination by using the clinical parameters DMF-T/DMF-S, bleeding on probing index (BOP) and periodontal screening index (PSI) and tested individual oral hygiene by using approximal space plaque index (API). All clinical data were analysed by the t test for independent samples.

RESULTS

We found significantly larger numbers of caries (p < 0.001) and higher levels of gingival bleeding (p < 0.001) and periodontal disease (p < 0.001) among CM users. Oral hygiene was significantly lower in CM users (p < 0.024).

CONCLUSION

Chronic CM use can lead to extensive potential damage within the intraoral cavity. When CM is used over a long period of time and in the absence of treatment, clinical symptoms in terms of Meth mouth syndrome cannot be excluded.

CLINICAL RELEVANCE

Based on our results, we recommend a specific prevention and therapeutic concept including educational campaigns for MA users and specialized dental care for CM patients.

Drugs that promote dental caries

Dental caries result from erosion of tooth enamel or cementum by acidic substances produced by bacteria found in dental plaque. Caries can lead to pulp necrosis and tooth loss. Risk factors include certain dietary habits, poor oral hygiene, and dry mouth. Diabetes and Sjogren's syndrome can also promote dental caries. Psychotropic substances such as cocaine, methamphetamine, heroin and cannabis can promote dental caries. Many medicinal drugs facilitate the formation of dental caries, through various mechanisms; they include formulations with a high sugar content; drugs that cause dry mouth (especially antimuscarinics); drugs that lower the buccal pH (inhaled powders, etc.); and drugs that cause demineralisation (tetracyclines, etc.). In practice, patients (and parents) should be informed that some drugs can increase the risk of dental caries. They should be encouraged to adapt and reinforce dental hygiene, and advised to visit a dentist regularly.

Isolation of dentin tissue by usinga new liner biodentine at management of simulated experimental caries

The aim of our study was the use of different types of isolation systems in the treatment of experimentally simulated dental caries that will allow to present additional comparative characteristic for morphological responses of the pulp.For realization of this purpose, 3 systems have been selected: UltraBlend (Ultradent), Biodentine (Septodont) and adhesive system Prime&Bond NT (Dentsply). The study was conducted at the laboratory of Alexander Natishvili Institute of Morphology. For this experiment, 12 male, 6 months of age rabbits were selected. There were created 3 experimental groups, each of which included 4 rabbits. Restoration of the teeth in experimental rabbits with Biodentine revealed sufficient physical properties enabling the operator most comfortably conduct his/her clinical activities: kneading, bringing into caries cavity, condensing and filling dental defect. Isolation of dentin by Biodentine doesn't contradict and/or reduce application of adhesive systems, which is also important for teeth restorations. Biodentine has optimal working time (final curing 10-12 minutes) enabling the operator to conduct maximal formation of material at the bottom of caries cavity.

Anti-cariogenic Properties of a Water-soluble Extract from Cacao

The addition of a water-soluble extract from cacao-extracted powder (CEPWS) to a cariogenic model food, a white chocolate-like diet that contains 35% sucrose, significantly reduced caries scores in SPF rats infected with Streptococcus sobrinus 6715, compared to control rats fed a white chocolate-like diet. CEPWS markedly inhibited water-insoluble glucan (WIG) synthesis through crude glucosyltransferases (GTFs) from Streptococcus sobrinus B13N in vitro. GTF-inhibitor(s) in CEPWS was prepared through three-step fractionation, and was termed CEPWS-BT, which is a high molecular weight (>10 kDa) heat-stable matrix of sugar, protein, and polyphenol. When the inhibitory effect of CEPWS-BT on glucan synthesis was examined using the purified GTF-I, GTF-T, and GTF-U enzymes from S. sobrinus B13N, significant reduction in GTF-I and GTF-T activity as a result of adding CEPWS-BT at low concentrations was observed. These results suggest that the addition of CEPWS to cariogenic food could be useful in controlling dental caries.

Caries prevalence in heroin addicts

The aim of the study was to determine the prevalence of caries in patients who are heroin addicts and the effects of salivary flow and saliva pH on its prevalence. The study included 200 subjects (100 subjects diagnosed with heroin addiction as the test group and 100 subjects taking no addictive substances as the control group). In both groups, saliva status was established by determining flow rates and pH of stimulated and unstimulated saliva. The total number of dental caries cases was determined using the DMFT index and their more specific detection in the context of localization on the tooth using the DMFS index. The DMFT index was higher in the test group (mean 18.78) than in the control group (mean 5.32), with a statistically significant difference (P < 0.000). The highest caries prevalence in both groups was recorded on occlusal dental surfaces (44.70% in the test group and 16.20% in the control group). The prevalence of caries of vestibular dental surfaces was higher in the test group (9.40%) than in the control group (2.34%), and the difference was statistically significant (P < 0.000). A statistically significant correlation was established between heroin addiction and reduced production of unstimulated saliva (P < 0.001) and stimulated saliva (P < 0.002), as well as pH values of stimulated saliva (P < 0.001) and unstimulated saliva (P < 0.001). In conclusion, a higher prevalence of caries of hard dental tissue was found in the test group. The flow of stimulated and unstimulated saliva as was as saliva pH was lower in the test group.

[The influence of the element status on mineralization of dental hard tissues in young children]

Child's organism is a kind of marker of increased sensitivity to environmental conditions. Lack of vital (essential) elements may lead to disease occurrence, caused by deficiency, excess or imbalance of micro- and macro elements in the organism. To assess the level of trace elements content in the human body, the hair is a good informative material as it concentrates trace elements and most fully reflects the level of both toxic and essential elements content. In order to conduct a comparative analysis of the elemental composition of hair in children and assess the relationship between the elemental composition of hair and the state of oral health status, we have examined 28 patients who underwent simultaneous determination of 28 chemical elements in the hair. According to the obtained data, in elemental composition of hair in children of group I, living in the regions with moderate environmental contamination, there was a minimal decrease of essential elements (except Ca), a slight increase of toxic chemical elements - Pb and Cd and decompensated form of dental caries have been observed. Investigation of the second group of children living in environmentally unfavorable regions showed that children with decompensated form of caries prevalence are characterized by the significant reduction of hair essential chemical elements in average of 28- to 56% and by a high content of toxic elements such as Pb, Hg, and Zr. The fact indicates enhanced excretion of essential elements under the influence of heavy metals, which in its turn affects the whole body and dental health.

Local study of fissure caries by Fourier transform infrared microscopy and X-ray diffraction using synchrotron radiation

Investigations of intact dental enamel as well as carious-affected human dental enamel were performed using infrared spectromicroscopy and X-ray diffraction applying synchrotron radiation. Caries of enamel was shown to be characterized by an increase in the number of deformation and valence vibrations for N-C-O, N-H and C=O bonds, a decrease of the crystallinity index, and by the absence of the preferable orientation of hydroxyapatite crystals within the affected enamel. This indicates the presence of destructive processes in the organic matrix of hard tooth tissues.

Cariogenic potential of commercial sweeteners in an experimental biofilm caries model on enamel

OBJECTIVE

Scarce evidence is available on the cariogenic potential of the widely used commercial sweeteners. The aim of this study was to evaluate the effect of several sweeteners on enamel demineralisation and on the cariogenic properties of Streptococcus mutans biofilms in an artificial caries model.

METHODS

S. mutans-UA159 biofilms were cultured on bovine enamel slabs and exposed to one of the following commercial sweeteners in tablet or powder form: stevia, sucralose, saccharin, aspartame or fructose. Ten percent sucrose and 0.9% NaCl were used as caries-positive and caries-negative controls, respectively. Slabs/biofilms were exposed to the sweeteners three times per day for 5min each time. After 5 days, biofilms were recovered to determine: biomass, bacterial counts and intra- and extracellular polysaccharides. Surface microhardness was measured before and after the experiment to assess enamel demineralisation, expressed as percentage of surface hardness loss (%SHL). Data were analysed using analysis of variance (ANOVA) and Bonferroni (p<0.05).

RESULTS

All tested commercial sweeteners, except fructose, showed less enamel demineralisation than sucrose (p<0.05). Only saccharine showed less biomass and intracellular polysaccharides than the rest of the groups (p<0.05). Stevia, sucralose and saccharine reduced the number of viable cells when compared with sucrose (p<0.05). All sugar alternatives reduced extracellular polysaccharide formation when compared with sucrose (p<0.05).

CONCLUSIONS

Most commercial sweeteners appear to be less cariogenic than sucrose, but still retaining some enamel demineralisation potential. Products containing stevia, sucralose and saccharine showed antibacterial properties and seem to interfere with bacterial metabolism. Further studies are necessary to deepen these findings.

Groundwater fluoride and dental fluorosis in southwestern Nigeria

This study was carried out to assess the fluoride levels of groundwater from open wells, consumed by the residents of three communities located in two distinct geological terrains of southwestern Nigeria. Fluoride concentration was determined using spectrophotometric technique, while analysis of other parameters like temperature, pH and total dissolve solids followed standard methods. Results of the analysis indicated that groundwater samples from Abeokuta Metropolis (i.e., basement complex terrain) had fluoride content in the range of 0.65 ± 0.21 and 1.20 ± 0.14. These values were found to be lower than the fluoride contents in the groundwater samples from Ewekoro peri-urban and Lagos metropolis where the values ranged between 1.10 ± 0.14-1.45 ± 0.07 and 0.15 ± 0.07-2.20 ± 1.41 mg/l, respectively. The fluoride contents in almost all locations were generally higher than the WHO recommended 0.6 mg/l. Analysis of Duncan multiple range test indicated that there is similarity in the level of significance of fluoride contents between different locations of same geological terrain at p ≤ 0.05. It was also observed that fluoride distribution of groundwater samples from the different geological terrain was more dependent on factors like pH and TDS than on temperature. The result of the analyzed social demographic characteristics of the residents indicated that the adults (between the age of 20 and >40 years) showed dental decay than the adolescent (<20 years). This signifies incidence of dental fluorosis by the high fluoride content in the drinking water of the populace. Further investigation on all sources of drinking water and other causes of tooth decay in the area is suggested.

Treatment of white spot lesions with ACP paste and microabrasion

OBJECTIVE

To examine the effects of application of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) paste and microabrasion treatment on the regression of white spot lesions (WSLs).

MATERIALS AND METHODS

Artificially-induced WSLs in bovine enamel were randomly assigned to one of four treatment groups: CPP-ACP paste only, microabrasion only, microabrasion and CPP-ACP, and a control. Samples were treated with each regimen twice daily for 2 weeks and stored in remineralizing solution between the treatments. Quantitative light-induced fluorescence was used to measure changes in fluorescence, which indicate changes in mineral content of WSLs immediately before (T1) and 2 weeks after treatment (T2). A two-within-subject factor analysis of variance was used to analyze the significance of any changes in mineral content of the lesions from T1 to T2.

RESULTS

There was a statistically significant (P < .05) gain in fluorescence associated with the microabrasion only, as well as the microabrasion and CPP-ACP treatments. The changes in fluorescence for the CPP-ACP treatment alone were not statistically significant (P  =  .40).

CONCLUSIONS

CPP-ACP paste alone does not significantly improve the fluorescence value (ie, the mineral content) of WSLs. Within the limitations of this in vitro study, microabrasion treatment with or without CPP-ACP improved the fluorescence and thus reduced WSLs.

In vitro analysis of the cariogenic and erosive potential of paediatric antitussive liquid oral medications

We evaluated in vitro the cariogenic and erosive potential of antitussive liquid oral medications for paediatric use. Fifteen paediatric liquid antitussives were sampled. The endogenous pH was evaluated by potentiometry, titratable acidity was measured according to the method adopted by the Association of Official Analytical Chemists, total soluble solids content (TSSC) readings were performed by Brix refractometry using the Abbé refractometer, and the total sugar content was determined according to the Fehling methodology. The experiments were performed in triplicate and the obtained data were entered in the Excel software, analyzed and presented by descriptive statistics (means and standard deviations). Endogenous pH values ranged from 2.49 ± 0.09 (Iodetox®) to 6.75 ± 0.005 (Carbocysteine®) and twelve medications showed pHs below the critical value of 5.5 for enamel demineralization. Iodetox® (0.021 ± 0.01) presented the lowest titratable acidity and Aerofrin® (1.171 ± 0.01) presented the highest titratable acidity. Celergin® presented the highest TSSC (62.26 ± 0.40) and Acetyleysteine® (100 mg granules bags) presented the lowest TSSC (3.25 ± 0.43). Only 5 medications contained sugar, with total sugar content ranging from 35.93% ± 6.65 (Iodetox®) to 59.60% DP ± 6.66 (Celergin®). The paediatric antitussive medications showed low endogenous pH, some of them even below the critical value for enamel dissolution (pH<5.5). These antitussives are potentially cariogenic and erosive to dental structures if used frequently because of the high titratable acidity and high sugar concentration, especially when adequate oral clearance is not performed after administration of each dose.

Effect of bamboo salt-NaF dentifrice on enamel remineralization

PURPOSE

To evaluate the laboratory remineralization effects of a dentifrice with bamboo salt and NaF on artificial caries-like enamel lesions, at both the surface and deep areas.

METHODS

Early dental caries lesions were formed by treating bovine enamel samples for 48 hours at 37 degrees C with a demineralization solution (pH 5.0) containing 0.1 M lactic acid, 0.2% Carbopol 907, and 50% saturated calcium phosphate tribasic. pH cycling was then performed by immersing the samples in dentifrice slurry for 2 minutes every 8 hours per day, and in demineralization solution for 4 hours and mixed saliva for the remaining time period. The mixed saliva consisted of 50% human saliva and 50% artificial saliva. The surface hardness and the level of mineral surface alterations were analyzed using a hardness tester and transversal microradiography, among negative control (fluoride free), positive control (sodium fluoride 1100 ppm, Crest Cavity Protection), and test dentifrice (3.0% bamboo salt with sodium fluoride 1,000 ppm) groups.

RESULTS

Test and positive control groups significantly increased the level of the surface hardness and decreased mineral loss of the artificial caries-like enamel lesions compared to the negative control (P<0.05). The test dentifrice also significantly decreased the lesion depth compared to the other two groups (P<0.05).

[Sugar substitute products impact on oral fluid biochemical properties]

Sugar substitute products impact on oral fluid protein and carbohydrate content, as well as oxidative balance were studied in 60 medical school students in compare with conventional sugar. Sugar intake proved to cause cariesogenic carbohydrate metabolism disorders in oral fluid, intensification of lipoperoxidation and decrease in antioxidation activity. Sugar substitute products help to prevent dental decay.

Cariogenic and erosive potential of the medication used by HIV-infected children: pH and sugar concentration

OBJECTIVE

The aim of this work was to analyze pH and sugar concentration in seven antiretroviral and three antibacterial medications frequently prescribed to HIV infected paediatric patients.

METHOD

Sugars (sucrose, glucose, lactose and fructose) and pH were measured from every one of ten medications with different serial numbers in two samples. The pH was determined by a previously calibrated digital pHmeter (Beckman). Analysis of free sugars was performed using thin-layer chromatography (TLC). The pH results and the amount of sugar originated from the two samples in each lot were added. The arithmetic mean of these results were computed.

RESULTS

Two antiretrovirals (Zidovudin and Abacavir Sulphate) had pH below critical level (3.55 and 3.93, respectively). All three antibacterials analyzed had pH above 5.5, and one of them (Azithromycin) had the highest pH level of the ten medications examined (9.28). Sugar was present in seven out of 10 of the medications analyzed. The antibacterials contained the highest concentration of sucrose, ranging from 40% to 54%. Glucose was found in one of the ten, sucrose was present in seven of them and none showed lactose. Fructose was not observed with the technique used.

CONCLUSIONS

A number of medications frequently used by HIV-infected children may cause a significant risk of both caries and dental erosion.

Meth mouth

Methamphetamine (meth) is a drug traditionally sought by groups living on the fringes of society. But now, it has entered the mainstream. Over the last five years, meth has seen a surge in abuse, media coverage and attention from law-enforcement officers. Meth mouth is characterized by rampant caries, typically on the smooth surfaces of dentition. This article gives a history of meth use and abuse. It describes the condition of meth mouth and its etiology. Treatment options and other dental considerations are discussed.

Long-term effects of chemotherapy on caries formation, dental development, and salivary factors in childhood cancer survivors

OBJECTIVE

The aim of this study was to investigate the long-term effects of chemotherapy on oral health and dental development in childhood cancer survivors (CCS).

STUDY DESIGN

Ninety-six CCS patients with a mean age of 10.8 years and 96 healthy children of the same age and sex and social background composed the study group. The caries experience of the children was recorded according to the criteria of the World Health Organization, and plaque-gingival status was evaluated according to the Silness-Loe Index. The children were also investigated for stimulated salivary flow rate, buffer capacity, salivary mutans streptococci, and lactobacilli. Disturbances of enamel mineralization were recorded according to the index of developmental defects in dental enamel. Dental development disturbances were diagnosed on panoramic radiographs.

RESULTS

The caries experience, mutans streptococci, and lactobacilli colonization in CCS children were found significantly higher than in the healthy subjects (P < .05). White/cream colored opacities were the most frequent enamel mineralization disturbances (69.8 %). The occurrence of arrested root development with short V-shaped root malformation was significantly higher in CCS children than in the healthy subjects (P < .05). No statistically significant difference was found between group <or=5 years and >5 years.

CONCLUSION

This current investigation has shown that CCS children are at an increased risk of caries and developmental dental disturbances.

Influence of tobacco use in dental caries development

This review article describes different forms of tobacco usage and its direct relationship with the prevalence of dental caries. Smoking along with co-existing factors like old age, bad oral hygiene habits, food habits, limited preventive dental visits and over all health standards, can be associated with high caries incidence. However, a direct etiological relationship is lacking. Environmental tobacco smoke (ETS) causes dental caries in children but no studies have been reported in adults. Existing findings are not sufficient and conclusive enough to confirm that ETS causes dental caries. Oral use of smokeless tobacco (ST), predominantly tobacco chewing, is presumably a positive contributing factor to higher incidence of dental caries. Unfortunately, published studies are not converging towards one single factor through which tobacco usage can have direct relationship to dental caries.

Susceptibility of bleached enamel and root dentin to artificially formed caries-like lesions

PURPOSE

To evaluate in vitro the susceptibility of caries-like lesion formation on enamel and root dentin that had been bleached with carbamide peroxide agents.

METHODS

150 slabs of bovine enamel and root dentin were ground flat and polished. According to a randomized complete block design, the specimens were then allocated to be bleached with agents (Rembrandt) containing 12% [CP12], 16% [CP16], 22% [CP22] or 30% [CP30] of carbamide peroxide over 21 days. The control group remained unbleached. Afterwards, all specimens were randomly distributed between two subgroups (n= 15): one was subjected to alternating demineralizing and remineralizing solutions to induce caries-like lesions and the other was not. Enamel specimens were cycled four times in demineralizing (pH 5.0) and remineralizing solutions (pH 7.0), while root dentin specimens were cycled twice. Microhardness measurements were carried out at the post-bleaching and at the post-caries lesion formation phases.

RESULTS

In the post-bleaching condition, microhardness values for both enamel and root dentin were dependent on the bleaching agent used. At the post-caries formation stage, there was a significant interaction between the bleaching treatment and substrate condition (carious or noncarious) for enamel and root dentin. Regardless of the bleaching agent, carious enamel and root dentin presented significantly lower microhardness values as compared to the noncarious counterparts. For carious enamel, those specimens exposed to CP16 exhibited higher microhardness values than the subset group formed by CP22, CP30 and unbleached samples. Both subsets did not differ from CP12. For carious root dentin, no difference was observed among the microhardness values attained as a result of the different bleaching treatments.

Cough mixture abuse as a novel cause of folate deficiency: a prospective, community-based, controlled study

Cough mixture abuse has been reported to cause severe folate deficiency and neurological defects. We carried out a prospective case-controlled survey to confirm this association and define the incidence and severity of the problem. A total of 57 cough mixture abusers and 47 other substance abusers (controls) were studied. When compared with controls, cough mixture abusers had a high incidence of low folate levels that could only be detected by screening.

Developmental dental defects in children exposed to PCBs in eastern Slovakia

The effects of long-term exposure to polychlorinated biphenyls (PCBs) on developmental dental defects of deciduous and permanent teeth in children in eastern Slovakia, where PCBs from a chemical plant manufacturing Delors contaminated the surrounding district were evaluated. Four hundred and thirtytwo children, lifelong residents, aged 8-9 years were examined. Children's caries susceptibility and gingival health was assessed by standard dental indices, and developmental enamel defects by the FDI index. Data from the PCBRISK project data set and questionnaires completed by the parents provided information on exposure and various confounding factors. The proportion of teeth with different types and extensions of developmental enamel defects correlated with serum PCB concentration. The proportion of deciduous teeth affected with enamel defects was significantly higher in higher exposed children (chi(2)=8.35; p=0.03) according to their serum PCB concentration (group 0: <200; group 1: 200-600; group 2: >600 ng PCBs g(-1) serum lipids). The proportion of permanent teeth affected with any enamel defect was significantly higher in higher exposed children (chi2=7.237; p=0.027). Furthermore, the extent of the enamel defects was also greater (chi2=10.714; p=0.005). In multivariate linear regression analysis PCB exposure was significantly related to developmental enamel defects of permanent teeth only. No associations between PCB exposure and caries susceptibility, gingival health or number of teeth were observed. This study demonstrated a dose-response relationship between PCB exposure and developmental enamel defects of permanent teeth in children, the evidence for deciduous teeth was not conclusive.

Factors affecting tooth loss among rural Khon Kaen adults: analysis of two data sets

BACKGROUND

Tooth loss is an oral health problem affecting Thai people and people of other nations as well. Not much of epidemiologic evidence concerning factors affecting tooth loss among Thai people has been reported although severity of tooth loss among Thai people has never been decreased.

METHODS

This study employed two existing data sets to evaluate the role of health behaviors such as tobacco smoking and betel quid chewing (a common habit prevalent among rural Thai females), together with other factors in relation to tooth loss among rural Thai people. The study population in the first (phase I) and second (phase II) data sets included 1484 and 3471 male and female adults residing in rural areas of Khon Kaen province, Thailand during 1990-1991 and 1992-1994, respectively. The data were obtained through oral examination and interview. Employing descriptive, bivariate, and multivariable Poisson regression, key risk indicators of tooth loss were identified for both data sets.

RESULTS

The findings from final multivariable Poisson regression models were consistent in that tobacco smoking, betel quid chewing, age, dental caries (defined as decayed plus filled teeth) and periodontitis were significantly related to tooth loss among these rural populations.

CONCLUSION

Therefore, preventive programs aiming at discouraging Thai people from smoking tobacco and/or chewing betel quid should be established so that healthy natural teeth can be maintained.

Penetration ability and microleakage of a fissure sealant applied on artificial and natural enamel fissure caries

OBJECTIVES AND METHODS

This study investigated the sealing ability of a current available unfilled fissure sealant applied over sound (n=80), artificially created (n=80) and naturally carious fissures (n=80) under different humidity conditions (90+/-2 and 45+/-2% relative humidity) and etching times (40 and 60s). All samples were submitted to 5000 thermal cycles and examined by light microscopy after sectioning. Microleakage, penetration ability, fissure type, fissure entrance angle, sealant occlusal length, caries location and caries depth were assessed.

RESULTS

The significantly longer sealant occlusal length and larger entrance angle exhibited by shallow fissures, contributed to their higher microleakage and smaller amounts of unfilled areas compared to deep fissures. Sealant microleakage was significantly influenced by the condition of the enamel (sound, artificial and natural caries) and the caries location in the fissures, but not by enamel caries depth (D1 and D2), etching time, or humidity condition. Natural caries exhibited significantly higher microleakage than sound or artificially created carious fissures.

CONCLUSIONS

Based on the results of this study, it can be concluded that location of caries in the fissure rather than its depth should be taken into account when applying a fissure sealant. When the borders of the fissure sealant are on carious enamel, a significantly higher microleakage must be expected. The artificial caries model was not a suitable method to assess the behavior of natural fissure caries.

Dental caries and periodontitis associated with betel quid chewing: analysis of two data sets

BACKGROUND

Not much research evidence concerning the relationship between betel quid chewing and oral health has been established although betel quid chewing is a common practice among people in many Asian countries including rural areas of Thailand.

OBJECTIVE

The present study employed two existing data sets to evaluate the association between betel quid chewing and oral diseases.

MATERIAL AND METHOD

The study populations for phase I comprised a total of 796 females, aged 30-89 years, residing in five districts of Khon Kaen province, Thailand during 1990-91. In phase II, there were 2,253 females, aged 31-86 years, residing in Chonnabot district, Khon Kaen province, Thailand during 1992-94, respectively. The data were obtained through oral examination and interview. The analyses employed descriptive, bivariate, and multivariable logistic regression.

RESULTS

Findings from final multivariable logistic regression models revealed the inverse relationship between betel quid chewing and dental caries adjusting for other variables. In addition, results from the final multivariable logistic regression models predicting periodontitis showed that betel quid chewing was directly associated with periodontitis in the presence of several confounding factors. The consistent findings from both data sets suggest that although betel quid chewing may reduce dental caries, it was directly related to periodontitis and enhanced the possibility of increasing tooth loss.

CONCLUSION

Therefore, preventive programs aiming at discouraging Thai people from chewing betel quid should be established to preserve favorable oral health.

"Meth mouth": rampant caries in methamphetamine abusers

Rampant dental caries is a characteristic finding in methamphetamine abusers. The popularity of methamphetamine, particularly among the gay community where it is linked to the spread of HIV, its ready availability, and rapid spread across the nation have placed methamphetamine use in an epidemic status in many communities unaccustomed to dealing with drug abuse. We present a case of a 25-year-old male "meth" abuser of unknown HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) status to promote recognition by the health care team of the association of rampant dental caries with methamphetamine abuse for appropriate intervention to ensure successful treatment and prevention of disease progression.

Soft drinks and dental health: a review of the current literature

In recent years there has been increased interest in the role of commercial soft drinks in dental diseases namely as dental caries and erosion. The objective of this paper has been to review the past and current literature to determine the present knowledge on this subject. The literature related to dental caries, erosion, drinks, soft drinks and fruit juices was reviewed. The literature shows efforts have been taken to modify soft drinks by either adding or deleting certain components so as to reduce their harmful effects on teeth. A rational protocol to encourage the sensible use of drinks and the modification of drinks to render them less harmful would be advisable.

A Novel in vitro Microbial-Based Model for Studying Caries Formation – Development and Initial Testing

We report on the development and the initial testing of a new microbial-based caries model. Specimens were fixed on a rotating mount within a reaction chamber hermetically surrounded by a sterilised glove box. A cariogenic environment was obtained by inoculation with Streptococcus mutans (ATCC 25175) combined with a continuously repeating supply of sucrose solution, trypticase soy broth and artificial saliva applied by dripping. Twenty-five caries-free upper premolars were used. The mesial parts of the occlusal fissures had been sealed with a resin-based fissure sealant (test group 1). To produce marginal gaps, the distal parts had been moistened with saliva before resin application (test group 2). Five teeth served as control and were exposed to all fluids under sterile conditions before being removed from the system after 7 days. Test specimens were infected with S. mutans and were incubated for another 14 days. No unintentional contamination occurred during the 3-week period of operation. Demineralizations were evaluated by using confocal laser scanning microscopy. Only the test specimens showed clearly visible signs of biofilm formation and caries-like lesions. The mean primary lesion depth did not differ significantly between test groups. Wall lesion depths and surface areas of demineralizations underneath the fissure sealants were significantly higher in test group 2. Thus, our model allows the simultaneous production of primary and secondary caries-like enamel lesions in a considerable number of specimens and facilitates the possibility to manipulate and transfer them without necessarily terminating the experiment, opening new possibilities for in vitro caries research.