Evaluation of toothpastes for treating root carious lesions - a laboratory-based pilot study

BACKGROUND

Root caries is preventable and can be arrested at any stage of disease development. The aim of this study was to investigate the potential mineral exchange and fluorapatite formation within artificial root carious lesions (ARCLs) using different toothpastes containing 5,000 ppm F, 1,450 ppm F or bioactive glass (BG) with 540 ppm F.

MATERIALS AND METHODS

The crowns of each extracted sound tooth were removed. The remaining roots were divided into four parts (n = 12). Each sample was randomly allocated into one of four groups: Group 1 (Deionised water); Group 2 (BG with 540 ppm F); Group 3 (1,450 ppm F) and Group 4 (5,000 ppm F). ARCLs were developed using demineralisation solution (pH 4.8). The samples were then pH-cycled in 13 days using demineralisation solution (6 h) and remineralisation solution (pH 7) (16 h). Standard tooth brushing was carried out twice a day with the assigned toothpaste. X-ray Microtomography (XMT) was performed for each sample at baseline, following ARCL formation and after 13-day pH-cycling. Scanning Electron Microscope (SEM) and 19F Magic angle spinning nuclear magnetic resonance (19F-MAS-NMR) were also performed.

RESULTS

XMT results showed that the highest mineral content increase (mean ± SD) was Group 4 (0.09 ± 0.05), whilst the mineral content decreased in Group 1 (-0.08 ± 0.06) after 13-day pH-cycling, however there was evidence of mineral loss within the subsurface for Groups 1, 3 and 4 (p < 0.05). SEM scans showed that mineral contents within the surface of dentine tubules were high in comparison to the subsurface in all toothpaste groups. There was evidence of dentine tubules being either partially or completely occluded in toothpaste groups. 19F-MAS-NMR showed peaks between - 103 and - 104ppm corresponding to fluorapatite formation in Groups 3 and 4.

CONCLUSION

Within the limitation of this laboratory-based study, all toothpastes were potentially effective to increase the mineral density of artificial root caries on the surface, however there was evidence of mineral loss within the subsurface for Groups 1, 3 and 4.

Are periodontitis and dental caries associated? A systematic review with meta-analyses

AIM

The epidemiological relationship between periodontitis and caries remains controversial, and evidence synthesis is currently lacking. Therefore, this systematic review was designed to answer the following PECO question: 'In human adults (P), do subjects suffering from periodontitis (E) have higher presence/number of untreated carious lesions and caries experience (O) than subjects not suffering from periodontitis (C)?'.

MATERIALS AND METHODS

Observational studies that met specific inclusion criteria established to answer to the PECO question were included. Two review authors independently searched for eligible studies, screened the titles and abstracts, carried out the full text analysis, extracted the data and performed the risk of bias assessment. In case of disagreement, a third review author took the final decision during ad hoc consensus meetings. Data synthesis was carried out through random-effects meta-analyses.

RESULTS

A total of 18 studies on 21 cohorts, involving 135,018 participants, were included. Meta-analyses showed a significant association between periodontitis and the presence of at least one tooth with either untreated carious lesions (odds ratio [OR] = 1.63; 95% confidence interval [CI]: 1.32-2.01; p <.00; I2  = 83.0%) or caries experience (decayed and filled teeth ≥ 1) (OR = 1.27; 95% CI: 1.01-1.59; p = .038; I2  = 90.0%). Moreover, subjects with periodontitis exhibited a higher number of surfaces (difference in means [MD] = 0.86; 95% CI: 0.46-1.27; p <.001; I2  = 0.0%) and teeth (MD = 0.35; 95% CI: 0.28-0.42; p <.001; I2  = 69.6%) with untreated carious lesions, as well as a higher number of teeth with caries experience (standardized difference in means  [SMD] = 1.46; 95% CI: 0.15-2.78; p = .029; I2  = 98.9%) compared with those without periodontitis. Sensitivity analyses focusing on severe periodontitis as exposure mostly showed consistent results. Estimates for caries experience were only slightly attenuated in adjusted models compared with crude models. Subgroup analyses by caries location also indicated that periodontitis was associated only with root caries, while it was not with caries affecting the anatomical crown.

CONCLUSIONS

Periodontitis was found to be associated with the presence and number of treated/untreated root carious lesions. Therefore, caries-specific preventive measures (e.g., fluorides) should be considered for individuals with periodontitis.

Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Adults: A Systematic Review for the US Preventive Services Task Force

Importance

Dental caries and periodontal disease are common adult oral health conditions and potentially amenable to primary care screening and prevention.

Objective

To systematically review the evidence on primary care screening and prevention of dental caries and periodontal disease in adults to inform the US Preventive Services Task Force.

Data Sources

MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (to October 3, 2022); surveillance through July 21, 2023.

Study Selection

Diagnostic accuracy studies of primary care screening instruments and oral examination; randomized and nonrandomized trials of screening and preventive interventions; cohort studies on primary care oral health screening and preventive intervention harms.

Data Extraction and Synthesis

One investigator abstracted data; a second checked accuracy. Two investigators independently rated study quality. Diagnostic accuracy data were pooled using a bivariate mixed-effects binary regression model.

Main Outcomes and Measures

Dental caries, periodontal disease, morbidity, quality of life, harms; and diagnostic test accuracy.

Results

Five randomized clinical trials, 5 nonrandomized trials, and 6 observational studies (total 3300 participants) were included. One poor-quality trial (n = 477) found no difference between oral health screening during pregnancy vs no screening in caries, periodontal disease, or birth outcomes. One study (n = 86) found oral health examination by 2 primary care clinicians associated with low sensitivity (0.42 and 0.56) and high specificity (0.84 and 0.87) for periodontal disease and with variable sensitivity (0.33 and 0.83) and high specificity (0.80 and 0.93) for dental caries. Four studies (n = 965) found screening questionnaires associated with a pooled sensitivity of 0.72 (95% CI, 0.57-0.83) and specificity of 0.74 (95% CI, 0.66-0.82) for periodontal disease. For preventive interventions no study evaluated primary care counseling or dental referral, and evidence from 2 poor-quality trials (n = 178) of sealants, and 1 fair-quality and 4 poor-quality trials (n = 971) of topical fluorides, was insufficient. Three fair-quality trials (n = 590) of persons with mean age 72 to 80 years found silver diamine fluoride solution associated with fewer new root caries lesions or fillings vs placebo (mean reduction, -0.33 to -1.3) and decreased likelihood of new root caries lesion (2 trials; adjusted odds ratio, 0.4 [95% CI, 0.3-0.7]). No trial evaluated primary care-administered preventive interventions.

Conclusions and Relevance

Screening questionnaires were associated with moderate diagnostic accuracy for periodontal disease. Research is needed to determine benefits and harms of oral health primary care screening and preventive interventions.

Caries experience and risk indicators of having decayed teeth among 65-year-olds in Oslo, Norway: a cross-sectional study

BACKGROUND

Meeting the oral health needs of the increasing population of older adults presents a major challenge in dental care. Knowledge about the oral health status in the young-elderly age group is essential for the planning of future oral health education and prevention programs. The aims of the present study were therefore to investigate the caries experience among 65-year-olds in Oslo, Norway, and to explore associations between having decayed teeth and sociodemographic, behavioural, and biological factors.

METHODS

A random sample of 65‑year‑olds in Oslo answered a questionnaire and underwent clinical and radiographic examinations (n = 457, 52% men and 48% women) at the Research Clinic, Faculty of Dentistry, University of Oslo, between February and December 2019. Primary- and secondary coronal and root caries lesions, root remnants, and missing and restored teeth were recorded. Decayed teeth (DT) were defined as teeth with coronal- and root caries lesions that had progressed into dentine and root remnants, and the DMFT/S scores were calculated.

RESULTS

The mean number of teeth was 25 (SD: 4) and the mean DMFT was 19.4 (SD: 4.7). Thirty seven percent of the individuals had at least one decayed tooth (DT > 0), and the mean number of filled teeth (FT) was 16.1 (SD: 5.4). Multivariable logistic regression analysis showed that male gender (OR: 1.8, 95% CI: 1.2-2.8), basic level of education (OR: 1.9, 95% CI: 1.2-2.9), irregular dental attendance (OR: 2.2, 95% CI: 1.0-4.8), and hyposalivation (OR: 2.1, 95% CI: 1.0-4.4) were significant risk indicators for having decayed teeth (DT > 0) (p < 0.05).

CONCLUSIONS

In conclusion, 65-year-olds in Oslo had a low average number of decayed and missing teeth, and a high number of restored teeth. Irregular dental attendance and hyposalivation were the strongest risk indicators for having decayed teeth. Based on the present results, it will be important to ensure access to regular dental care and to increase the emphasis on caries preventive measures for individuals with hyposalivation in this age group.

Patient Living with Human Immunodeficiency Virus and Depression with High HIV Viral Load Presenting for Evaluation of Root Caries

A 26-year-old man living with HIV and depression presents with symptoms of tooth sensitivity. His laboratory studies are all within normal limits except for a high viral load. The patient does not require any special dental management protocol and should be treated like other patients, with his laboratory studies reviewed every 6 months to 1 year. HIV is now a chronic medical conditions, with most patients having stable disease if they are compliant with their medications. Universal infection control protocols should be followed for all patients regardless of their HIV status.

Design, development and validation of a questionnaire to assess dentists' knowledge and experience in diagnosing, recording, and managing root caries

OBJECTIVES

The prevalence of root caries is increasing globally, especially in the elderly population, and even though the number of patients with root caries lesions is augmenting, there are still many discrepancies in how dentists manage this condition. The present study aimed to develop and validate a questionnaire to evaluate how dentists diagnose, record and manage root caries lesions, and to verify the validity and reliability of this questionnaire.

MATERIALS AND METHODS

An expert panel developed a self-administered questionnaire survey with three domains: (1) dentists' knowledge on diagnosis, recording, and managing root caries; (2) information about their current general clinical routines; (3) their demographics. The original English [E] version was translated into three different languages (French [F], German [G], Italian [I]), and subsequently back-translated into English by independent dentists. For the validation, 82 dentists (20-22 for each of the translated versions) accepted to answer the questionnaire at two different time-points (with 1-week interval). The data was quality checked. Construct validity, internal reliability, and intra-class correlation (ICC) were assessed.

RESULTS

Seventy-seven dentists completed the questionnaire twice [E: 17; F: 19; G: 19; I: 22]. The mean ICC (standard deviation) was 0.98(0.03) for E, 0.90(0.12) for F, 0.98 (0.04) for G, and 0.98 (0.01) for I. Overall, the test-retest reliability was excellent (mean ICC (SD): 0.96 (0.08)). Furthermore, the questionnaire demonstrated good internal reliability (inter-observer reliability; Fleiss kappa: overall:0.27(fair); E:0.30 (fair); F: 0.33(fair); G: 0.33(fair); I: 0.89 (almost perfect)).

CONCLUSION

The questionnaire was validated and is suitable to be used in the four languages to assess the knowledge of dentists on diagnosing, recording and managing root caries.

CLINICAL SIGNIFICANCE

The present questionnaire was validated and seems to be a good tool to evaluate how dentists diagnose, record, and manage root caries lesions both in its original (English) and its translated (French, German, and Italian) versions.

Accuracy of different approaches for detecting proximal root caries lesions in vitro

OBJECTIVES

The objective was to evaluate the diagnostic accuracy of radiographic evaluation (XR), visual-tactile assessment (VT), laser-fluorescence (LF) (DIAGNOdent Pen/KaVo), and near-infrared-light transillumination (NILT) (DIAGNOcam/KaVo) on proximal root caries lesions in vitro.

METHODS

Two-hundred extracted permanent premolars and molars with and without proximal root caries lesions were allocated to 50 diagnostic models simulating the proximal contacts between teeth and mounted in a phantom dummy head. Two independent examiners used the diagnostic approaches to detect any or advanced root caries lesions, with histologic evaluation of the lesions serving as reference. Receiver operating characteristic (ROC) curves were employed, and sensitivity, specificity, and the area under the ROC curve (AUC) are calculated. Significant differences in mean AUCs between approaches were assumed if p < 0.05 (two-sample t-test).

RESULTS

NILT was not applicable for proximal root caries detection. The sensitivity/specificity to detect any lesions was 0.81/0.63 for XR, 0.76/0.88 for VT and 0.81/0.95 for LF, and the sensitivity/specificity to detect advanced lesions was 0.43/0.94 for XR, 0.66/0.99 for VT, and 0.83/0.78 for LF, respectively. For both, any and advanced root caries lesions, mean AUCs for LF and VT were significantly higher compared to XR (p < 0.05). For any root caries lesions, LF was significantly more accurate than VT (p = 0.01), but not for advanced root caries lesions (p = 0.59).

CONCLUSIONS

Under the in vitro conditions chosen, LF and VT were more accurate than XR to detect proximal root caries lesions, with LF being particularly useful for initial lesion stages.

CLINICAL RELEVANCE

LF might be a useful diagnostic aid for proximal root caries diagnosis. Clinical studies are necessary to corroborate the findings.

A bibliometric analysis of studies on root caries

This study aimed to review the current state of the root caries field, explore the current hot topic, and anticipate future research frontiers. The Web of Science Core Collections (WoSCC) was searched to acquire publications that were relevant to root caries from 1992 to 2021. After retrieval and manual screening, the co-occurrence and co-operation analysis of keywords and countries/institutions/authors were performed through Citespace and VOSviewer based on two periods (1992-2006 and 2007-2021). From 1992 to 2021, 451 unique publications were selected. The USA, which has been the center of international cooperation, has produced the most publications in the research area in 1992-2021. Journal of Dental Research and Caries Research are the main counterpart journals in the field of root caries. The University of London is the institution with the highest number of publications in the analyzed 30 years. "Demineralization," "remineralization," "aged," "dentin," and "fluoride" have been commonly used as keywords throughout the past 30 years. More studies from different aspects have been published in the field of root caries in recent years (2007-2021). The findings of this study provide a full picture of the last 30 years in this research area; hopefully, they also provide essential information for researchers and policymakers to make decisions.

Demonstration of an optical dentin hardness measuring device using bovine dentin with different demineralization times

SIGNIFICANCE

The increase in root caries is a serious problem as society ages. Root caries is diagnosed by inspection and palpation, which are qualitative. A method to objectively and quantitatively evaluate the progress of root caries in a clinical setting is strongly desired. The root caries could be diagnosed by measuring hardness because dentin becomes softer as the caries progresses. Vickers hardness has been customarily used as an indicator of tooth hardness. However, this method cannot be used to in vivo teeth because the teeth must be dried prior to measurement to make the indentation. A hardness meter using an indenter with light for tooth monitoring (HAMILTOM) is proposed as an optical device. HAMILTOM could measure hardness of teeth in wet condition as a dark area while applying a load to dentins without drying. Therefore, HAMILTOM may realize hardness measurements of in vivo teeth in a clinical setting quantitatively.

AIM

The aim of our study is to demonstrate the optical dentin hardness measuring device HAMILTOM using bovine dentin with different demineralization times and to evaluate the correlation between the dark areas measured by HAMILTOM and the Vickers hardness measured by the Vickers hardness tester.

APPROACH

The samples were 20 bovine dentins. They were demineralized by a lactic acid solution with different times and divided into groups 1 and 2 of 10 samples each. In both groups, the dark areas and Vickers hardness were measured for each sample. Group 1 was used to obtain a calibration curve to calculate Vickers hardness from the dark area. Group 2 was used to validate the calibration curve obtained from the dentin samples of group 1.

RESULTS

The areas appearing black without a total internal reflection of the indenter measured by HAMILTOM increased as the demineralization time increased. Additionally, the Vickers hardness of group 2 calculated by the dark areas of group 2 and the calibration curve obtained in group 1 and the Vickers hardness of group 2 measured by the Vickers hardness tester were strongly correlated with a determination coefficient of 0.99.

CONCLUSIONS

The results demonstrate that HAMILTOM may be a suitable alternative to the conventional method. Unlike the conventional method, which cannot be used for in vivo teeth, HAMILTOM holds potential to quantitatively evaluate the progress of caries in in vivo teeth.

The Opinions and Practices of Saudi Arabian Dentists about Cervical Margin Relocation

AIM

The aim of this study was to assess the opinions and practices of different dentists about the cervical margin relocation (CMR) concept.

MATERIALS AND METHODS

A total of 432 general dentists, advanced general dentists (AGDs), periodontists, restorative dentists, and prosthodontists practicing in Saudi Arabia were approached in person or asked to complete an electronic survey (Google Forms) assessing demographic data and their opinions and practice of CMR. Differences between groups were assessed using the Chi-squared test, and binary regression models were constructed to identify predictors of opinions and practice of CMR.

RESULTS

About half of the surveyed dentists practiced CMR when indicated, but many felt that it represents an invasion of the biological width and might affect crown survival. Participants had several, often concurrent concerns about CMR. The opinions and practices of CMR were influenced by several factors including educational degree, work setting, country of clinical training, years of experience, and specialty.

CONCLUSION

The relatively conservative attitude of dentists towards CMR is justifiable, as it is a relatively new concept with little long-term clinical data. Clinical trials with sufficient follow-up periods are now needed to evaluate outcomes from CMR to provide further confidence to dentists to implement the procedure.

CLINICAL SIGNIFICANCE

Deep proximal carious lesions extending subgingivally is a common clinical scenario. Assessing the opinion and practice of dentists towards conservative treatment with CMR provides the basis for encouraging practitioners to use the procedure both clinically and in clinical trials.

Knowledge, Practices and Attitudes towards Silver Diamine Fluoride Therapy among Dentists in Japan: A Mixed Methods Study

In 2021, the World Health Organization included silver diamine fluoride (SDF) as an essential medicine to manage caries in adults and children. SDF was developed in the 1960s, but its use for children became unpopular in Japan because of the decline and low prevalence of early childhood caries. This mixed methods study explored the knowledge, practices and attitudes towards SDF therapy among dentists promoting fluoride use in Japan. It also investigated senior dentists’ perceptions of SDF therapy in Japan. The quantitative study invited all 173 members of the largest organisation promoting fluoride use in Japan to complete a web-based questionnaire survey. Sixty (60/173; 35%) dentists promoting fluoride use in Japan completed the questionnaire survey. All dentists knew of SDF treatment, and 50 (50/60; 83%) used SDF for dental care. Fifty-nine dentists (59/60; 98%) agreed that SDF therapy was simple and quick. All 60 dentists agreed that SDF was effective to arrest caries; 51 dentists (51/60; 85%) agreed that SDF was effective to prevent caries. Most dentists (51/60; 85%) were concerned about SDF’s unaesthetic staining. Fifty-seven dentists (57/60; 95%) used SDF to arrest primary posterior teeth, and 52 dentists (52/60; 87%) used SDF to arrest root caries. However, 25 dentists (25/60; 42%) did not use SDF to prevent caries in permanent teeth. The qualitative study interviewed 12 senior dentists using snowball sampling and achieved data saturation. The dentists opined that SDF therapy was effective, simple, painless, non-invasive and inexpensive. SDF is seldom used in Japan at present because of the unaesthetic black staining and the low prevalence of early childhood caries; however, it can regain popularity by arresting root caries in the aging population.

Diabetes mellitus and its association with dental caries, missing teeth and dental services utilization in the US adult population: Results from the 2015-2018 National Health and Nutrition Examination Survey

AIMS

This study aimed to evaluate the associations of self-reported diabetic status with clinically assessed dental end points, including teeth with untreated coronal and root caries, missing teeth, complete tooth retention, edentulism and routine dental services utilization among adults aged ≥20 years in the United States.

METHODS

We pooled data from the 2015-2016 and 2017-2018 cycles of the National Health and Nutrition Examination Survey (NHANES), a nationally representative, cross-sectional, continuous survey of noninstitutionalized US population. The analysed data included all adult participants aged ≥20 years who completed the dental examination and reported their diabetic status. We estimated the prevalence and average outcomes of dental end points by diabetic status. Regression analyses were employed to evaluate the associations between diabetic status and dental outcomes.

RESULTS

Of 10,249 participants, 1,562 reported having diabetes mellitus, which translates to 11.3% of US adults aged ≥20 years (25.7 million). Compared to non-diabetic individuals, adults with diabetes had 1.49 (95%CI = 1.1-2.0) and 1.46 (95%CI = 1.2-1.8) times higher odds of developing coronal and root caries respectively. Adults with diabetes were 32% less likely to be fully dentate (OR = 0.68; 95%CI = 0.55-0.83) and had a higher average number of missing teeth (mean ratio = 1.35; 95%CI = 1.18-1.55). There was no association between diabetic status and routine dental services utilization.

CONCLUSIONS

Adults with diabetes exhibited worse dental health; nonetheless, there was no difference in dental services utilization. Multidisciplinary efforts from both medical and dental service providers are required to proactively address the well-being of adults with diabetes in terms of oral health.

[Research on microflora and the qualitative composition of periodontal pathogens by PCR method in patients with root caries and external cervical resorption]

OBJECTIVE

The aim of the study was to study the microflora of periodontal pockets and gingival fluid; determine the qualitative composition of periodontal pathogens by PCR; to determine the main associations of microorganisms, to determine the periodontal index in patients with cement caries, external pathological resorption and in patients from the comparison group.

MATERIAL AND METHODS

The examination included 80 patients, including 28 patients with a diagnosis of cement caries, 25 patients with a diagnosis of external cervical root resorption, 27 patients in the comparison group without tooth root damage. Based on the results of microbiological studies in various clinical conditions of the oral cavity, in particular, in different forms of lesions of the periodontium and hard tissues of teeth, the predominant microbial representatives and their combinations were identified.

RESULTS

According to the study, it was revealed that all patients with cement caries and external pathological resorption have pathological processes arising in the periodontium. The study of the qualitative composition of the microflora showed that in patients with cement caries, the following associations of microorganisms are most often found: Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Tannerella forsythia, Porphyromonas gingivalis, Candida albicans, Treponema denticola. Patients with external pathological resorption of microorganisms were found in patients with external pathological resorption of microorganisms: Prevotella intermedia, Treponema denticola, Candida albicans, Tannerella forsythia, Porphyromonas gingivalis, Epstein-Barr virus. These periodontal pathogenic microorganisms have a wide range of pathogenicity factors, which allows them to induce a prolonged inflammatory process.

CONCLUSION

The study of the microflora of periodontal pockets and gingival sulcus in case of caries of cement and external pathological resorption is an important link in preventing the development and aggravation of pathological conditions of hard tissues of the tooth root and periodontal tissues.

Suppression of root caries progression by application of Nanoseal®: A single-blind randomized clinical trial

The aim of this single-blind, parallel and randomized controlled trial was to evaluate the effect of Nanoseal® application on root caries progression. Adult patients (n=129, mean age: 66.4±10.1 years) with root caries were randomly allocated into three groups: high-frequency (HF, n=43; intervention: Nanoseal application at baseline and 1-5 months), low-frequency (LF, n=43; intervention: Nanoseal application at baseline and 3 months), and control (n=43; intervention: no application of Nanoseal) groups. Measurements of fluorescence laser values of carious lesions using a DIAGNOdent™ Pen (D-value) were performed for each subject before intervention (baseline) and at 3 and 6 months. Significantly lower D-values for the HF (p=0.017) and LF (p=0.034) groups were observed compared with the control group at 6 months. Nanoseal application would be an effective procedure to suppress root caries progression.

[Effect of dental varnish containing fluoride either with CPP-ACP or bioglass on root caries]

PURPOSE

To investigate the effect of dental varnish containing fluoride either with casein phosphopeptide-amorphous calcium phosphate(CPP-ACP) or bioglass on root caries.

METHODS

The active roots collected in Peking University People's Hospital from April 2017 to October 2018 were randomly divided into group A, group B, group C, and group D, each with 18 teeth. All groups received toothbrushing containing fluoride, in addition, group B received another 5% sodium fluoride, group C added 5% sodium fluoride + CPP-ACP, and group D added 5% sodium fluoride + bioglass. The severity, surface roughness and mineral concentration of root caries before and after brushing were observed. SPSS 23.0 software package was used to determine the correlation between root severity and surface roughness.

RESULTS

After 50 days of brushing, the hardness of group B, C and D was significantly improved (P<0.05), and was significantly better than that of group A (P<0.05). The hardness was the highest in group D after 50 days of brushing, followed by group C and B, with significant difference(P<0.05). The surface roughness scores of group B and C were significantly higher than those of group A and D after 7 days of brushing(P<0.05). The surface roughness scores of group B were significantly higher than those of group A, C and D after 14 days of brushing(P<0.05). The surface roughness scores of group D were significantly higher than those of group B and C after 50 days of brushing(P<0.05). The severity score of root caries in group A was negatively correlated with surface roughness (P<0.05). The mineral concentration of each group was increased 50 days after brushing (P<0.05).

CONCLUSIONS

Application of dental varnish containing fluoride either with CPP-ACP or bioglass can effectively prevent root caries. Compared with CPP-ACP, bioglass is more stable, and can effectively improve the mineral concentration on tooth surface.

Silver Diamine Fluoride May Prevent and Arrest Root Caries in Older Adults

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Controlling caries in exposed root surfaces with silver diamine fluoride: A systematic review with meta-analysis. Oliveira BH, Cunha-Cruz J, Rajendra A, Niederman R. J Am Dent Assoc 2018;149(8):671-9.e1.

SOURCE OF FUNDING

Government funding, partially supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health, and partially funded through a Patient-Centered Outcomes Research Institute (PCORI) award. The Teacher Training Program of the University of the State of Rio de Janeiro also supported the work.

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis on randomized clinical trials.

New Preventive Approaches Part II: Role of Dentin Biomodifiers in Caries Progression

Dental caries is the most prevalent infectious chronic disease in children and adults. With a globally aging population, new demands in the management of dental caries are awakened by the rampant increase in the incidence of dental root caries. Like crown caries, root caries requires bacterial driven tissue demineralization followed by the degradation of the extracellular dentin matrix. Due to the complex composition and ultrastructure, preventive strategies targeting the mineral phase of dentin are insufficient for managing the prevention and progression of root caries. However, the composition and ultrastructure of dentin has inspired novel strategies for the effective management of highly susceptible root surfaces. Specifically, the complex and dynamic dentin extracellular matrix (ECM). The ECM of mature dentin contains a robust type I collagen fibrils scaffold, and carefully distributed non-collagenous components, such as proteoglycans, phosphoproteins, and proteases. In this chapter, we will review the experimental strategies of potential clinical impact to prevent root caries progression by site modifications of the mature extracellular dentin matrix. This approach, termed dentin biomodification, encompasses bioinspired strategies to locally enhance the biological and biomechanical characteristics of the tissue by mimicking natural processes. Here, synthetic and biosynthetic compounds can decrease the biodegradability of the dentin ECM and provide mechanical enhancement of dentin. The resulting effect is the maintenance of the dentin ECM to halt root caries progression and possibly mediate effective remineralization of the caries affected root dentin.

Etiology, Risk Factors and Groups of Risk

Population aging and the concomitant reduction in tooth loss will have a profound effect on dentistry. In particular, an increase in the prevalence of root caries can be expected. Root caries is not evenly distributed across the population and identification of high-risk groups or individuals would facilitate targeted prevention strategies. Unfortunately, the lack of consensus in the literature on the diagnosis and measurement of root caries makes comparison of studies extremely challenging. At present, we do not have an adequately validated risk assessment tool for root caries. Future research should focus resources on investigating risk indicators, which have been found to be significant in past studies and on externally validating previously described risk models.

Assessment of Root Caries Lesion Activity and Its Histopathological Features

Despite certain similarities in the etiology of root caries (RC) and coronal caries, there are notable differences in their histology, namely with regard to the demineralization process, which should be taken into consideration when assessing lesion activity. In this chapter, we present the histological changes to the dentin and pulp, occurring physiologically or in response to caries lesions. We focus on the histological features specific to RC lesions, discussing the assessment of lesion activity. The physiological changes occurring to the dentin and pulp are the formation of secondary dentin and the sclerosis of dentin tubules, while tertiary dentin is formed during pathologic stimuli from caries lesions. Already in the early stages of active RC, the lesions seem softer, and bacteria are easily found within the dentin tubules. Inactive lesions, on the contrary, are characterized by fully remineralized tissue, with irregular mineral precipitation and containing ghost cells of microorganisms. Lesion activity is determined by observing their tactile sensation and their position with respect to the gingival margin.

Endogenous Enzymes in Root Caries

Similar to coronal caries, root caries results from a disequilibrium of the de-remineralization balance in favor of the demineralization process. It mainly involves a bacterial shift in favor of an increase in the proportion of acidogenic and aciduric bacteria. This process permanently damages the dental mineralized tissues, namely the dental cementum and dentin. In addition to the demineralization and exposure of the dentin or the cementum organic matrix, acid production by cariogenic bacteria induces the activation of endogenous (host-derived) enzymes within the dentin and saliva. These enzymes include matrix metalloproteinases and cathepsins. Once activated, these potent proteolytic enzymes collectively have the capacity to degrade all the components of the exposed organic dentin and cementum matrices. In this chapter, the description of the healthy cement and dentin organic matrices and their endogenous proteases will be followed by the role of these proteases in the root caries process.

Nano Silver Fluoride for preventing caries

DESIGN

Randomised controlled trial, double blind, in a community setting.

INTERVENTION

School children with active caries in primary teeth and no pulpal exposure, fistula or decay in permanent teeth were chosen. Caries and unsupported enamel were left as found and cotton wool rolls were used for isolation. Two drops of NSF or one drop of water were applied to the tooth with a microbrush for two minutes, once in a 12-month period.

OUTCOME MEASURE

At one week, five months and 12 months the presence of active caries, as classified using International Caries Detection and Assessment System (ICDAS II) criteria, was measured. If a blunt probe easily penetrated dentine with light force, active caries was recorded and taken to be a failure.

RESULTS

One hundred and thirty primary teeth in 60 children with a mean age of 6.31 (± 0.60) were randomised. Sixty-three teeth were in the NSF group and 67 in the control group. After one week there were no losses, at the five-month follow up eight teeth were lost from the NSF group due to exfoliation or extraction and five from the control group. At twelve months a further five teeth were lost from the NSF group and 13 from the control group.At the one week follow up there was a 19% failure rate in the NSF group compared to 100% in the control group. At the five month recall this was 27.3% NSF compared to 72.6% water and at the final recall there was a 33.3% NSF failure rate and 65.3% control failure rate. The preventative fraction at this point was 50% and the NNT 3.12. All were statistically significant results (p= <0.05).

CONCLUSIONS

The annual application of NSF solution was more effective in hardening and arresting dentine caries in primary teeth than the placebo. The effectiveness of NSF was found to be similar to silver diamine fluoride when applied once a year, but did not stain the dental tissue black and had no metallic taste. The application is simple, does not require a clinical setting and is inexpensive. NSF was demonstrated to be effective in arresting caries in children in poor communities, but further studies are required to investigate alternative protocols and for use in tooth sensitivity and root caries.

[Observation of genetic diversity in dental plaque of elder people with root caries]

PURPOSE

Bacterial community in dental plaque of elder people was analyzed to learn about the microhabitat composition and diversity.

METHODS

Dental plaque samples were collected from 25 elders. PCR-based denaturing gradient gel electrophoresis (PCR-DGGE) was used to evaluate the microbial diversity by displaying PCR-generated 16SrDNA fragments that migrate at different distances, reflecting the different sequence of fragment. SPSS12.0 software was used to analyze the variance of genotypes between different groups of bacteria.

RESULTS

Genotypes of bacteria in dental plaques in the root caries group was significantly more than the other two groups. Crown caries group and caries-free group had no significant difference.

CONCLUSIONS

The genetic diversity of the dental plaque microflora in the root caries group is significantly higher than coronal caries group and caries-free group.

[Remineralization of artificial root caries by fluoride dentifrice of different fluoride concentration in vitro]

PURPOSE

Although the effectiveness of fluoride dentifrice in remineralizing enamel caries has been established, the optimum fluoride concentration for remineralization root caries has not been defined. The aim of this study was to assess and compare the effect of 1.1g/L, 1.45g/L and 5g/L fluoride dentifrices in remineralization of artificial root caries.

METHODS

Sound human tooth fragments obtained from the cervical portion of root were stored in a demineralization solution for 96h at 37 degrees centigrade to induce artificial root caries lesions. The fragments were then randomly divided into four treatment groups including 1.1g/L, 1.45g/L, 5g/L fluoride dentifrice group and non-fluoride dentifrice control group. The demineralized samples were pH-cycled through treatment solutions, acidic buffer and neutral buffer for 8 days at 6 cycles per day. The samples were evaluated using electrical caries monitor(ECM), polarized light microscopy (PLM) and confocal laser scanning microscopy (CLSM). The data was analyzed using ANOVA with SPSS13.0 software package.

RESULTS

Variations of LgECM, total fluorescence and average fluorescence from CLSM after remineralization in fluoride dentifrice groups were significantly higher than those in the control group(P<0.05) Variations of LgECM, total fluorescence and average fluorescence from CLSM after remineralization in the 5g/L fluoride dentifrice group were significantly higher than those in the 1.1g/L and 1.45g/L fluoride dentifrice groups(P<0.05). PLM observation showed that a banding or deposit of mineral appeared within the lesions of specimens in the fluoride dentifrice groups. A wider mineral band was seen in the 5g/L fluoride dentifrice group than in the 1.1g/L and 1.45g/L fluoride dentifrice groups.

CONCLUSIONS

Fluoride dentifrice is effective in remineralizing artificial root caries and 5g/L fluoride dentifrice has better effect than 1.1g/L and 1.45g/L fluoride dentifrices.

[The genotypic diversity of oral Actinomyces naeslundii of root caries in aged people]

OBJECTIVE

To investigate the genotypic diversity of Actinomyces naeslundii in aged people and the relationship between the genotypes of Actinomyces naeslundii and root caries.

METHODS

According to the inclusion criteria, 20 aged people with root caries and 20 without root caries were chosen into two groups for this study. Two sites were chosen in subjects with root caries: One site was the exposed sound root surface, and the other site was the root caries. In subjects without root caries the sampling site of root surface was exposed. Bacteria were cultured and then identified. Repetitive extragenic palindromic sequence-based polymerase chain reaction (REP-PCR) was used to analyze the genotypic diversity of the Actinomyces naeslundii clinic isolates.

RESULTS

299 strains were isolated from the groups, 156 strains were chosen to analyze, belonged to 61 different genotypes. At the site of sound root surface in the subjects with root caries, there were 57 strains with 25 different patterns. At the site of root caries and of sound root surface in subjects without caries, there were 34 strains with 25 different patterns and 65 strains with 26 different patterns respectively. There was the genotypic diversity within Actinomyces naeslundii. There was significant difference in the genotypes in every individual site.

CONCLUSION

Many different genotypes of Actinomyces naeslundii concerned with occurrence of root caries.

[The investigation of dental caries among elderly people in northeast of China]

OBJECTIVE

To study the dental caries status of the 65-74 years old people in northeast of China, analyze the distribution of caries in the group of people, and provide scientific basis for establishing the oral health care policies.

METHODS

The representative samples were selected by multi-stage, stratified and random sampling from the three province of northeast of China. Dental caries of 2 364 people aged 65-74 were recorded according to WHO criteria. SPSS 12.0 software was used to analyze the data.

RESULTS

1) Among 2,364 elderly people in northeast of China, the prevalence of dental caries was 67.5% and DFT was 2.68, the composition of filling was 10.82%. 2) The prevalence of coronal caries was 66.4% and DFT was 2.55. The composition of filling was 11.37%. 3) The prevalence of root surface caries was 48.4% and DFT was 1.64. The composition of filling was only 1.8%.

CONCLUSION

The prevalence of dental caries among elderly people in northeast of China is still very high, and the filling rate is low. The community based oral health promotion should be strengthened and preventive-oriented oral health care systems are needed in northeast of China.

[Analysis of the first permanent molar caries epidemiological investigation in area of northeast China]

OBJECTIVE

To survey the tooth decay of the first molars among the people in area of northeast China in order to provide the foundation for prevention and treatment strategies of caries.

METHODS

According to the third national oral health investigation of epidemiology, the dental caries of first permanent molars were examined among 9394 people aged 5, 12, 35-44 and 65-74 in northeast China. The data were analyzed by SPSS 13.0 statistical software. Dental caries prevalence rate and DMFT (dmft) of first permanent molar were calculated.

RESULTS

The prevalence of crown and root dental caries in northeast China were 26.86% and 3.81% respectively, mean DMFT (dmft) of crown and root dental caries were 0.41 and 0.04 respectively. There were significant differences of dental caries among provinces in northeast China. Mandibular first molar suffered from dental caries easily. The prevalence of caries of female was higher than that of male (P<0.01), but there was not significant difference of prevalence of root caries between two sexes (P>0.05). Except Jilin province, there were significant differences of prevalence of crown caries between city and rural area in Liaoning and Heilongjiang provinces (P<0.01). It was no significant difference of prevalence and mean DMFT (dmft) of root caries between city and rural area in each province (P>0.05).

CONCLUSION

The prevalence of dental caries of the first molar among the people in northeast China is high. The dental caries prevention and cure of first permanent molar should be emphasized in oral health field.

[Study of the relationship between oral Actinomyces and childhood caries]

OBJECTIVE

Actinomyces are members of the indigenous oral microbiota which have been implicated in root caries, but their role in childhood caries initiation and progression is not well-understood. The distribution of Actinomyces in supragingival plaque on the primary teeth and the relationship between oral Actinomyces spp. and childhood caries primarily were investigated.

METHODS

Forty children aged from three to five years old were divided into two groups. Twenty children were caries-free and twenty were caries-susceptible. Dental plaque samples from different places of the teeth were collected with sterile toothpick and polymerase chain reaction was performed with specific primers which were designed for this research.

RESULTS

Actinomyces spp. were detected 100% in the caries-free group, while 95% in the caries-susceptible group. There was no significant differences between the two groups (P > 0.05). Actinomyces naeslundii, Actinomyces odontolyticus, Actinomyces gerencseriae, Actinomyces israelii and Actinomyces viscosus all could be detected in both groups. The prevalence of Actinomyces naeslundii, Actinomyces gerencseriae and Actinomyces odontolyticus were higher in caries-free group than those in caries-susceptible group (P < 0.05), while the prevalence of Actinomyces israelii and Actinomyces viscosus had no significant difference between the two groups (P > 0.05).

CONCLUSION

Actinomyces is the main colonized bacteria in the supragingival plaque of children. The prevalence of the Actinomyces spp. may have a negative relationship with the childhood caries, and has nothing to do with different places of the teeth.

Resin-modified glass ionomer cement and self-cured resin composite luted ceramic inlays. A 5-year clinical evaluation

OBJECTIVE

This study evaluated IPS Empress ceramic inlays luted with two chemical-cured luting agents, a resin-modified glass ionomer cement (Fuji Plus (F)) and a resin composite (RC) (Panavia 21 (P)).

METHODS

Seventy-nine ceramic inlays were placed in Class II cavities in 29 patients. At least two inlays were placed in each patient to compare the luting techniques intra-individually. In each patient half of the inlays were luted with F and the other half with P. The inlays were evaluated clinically, according to modified USPHS criteria (van Dijken, 1986), at baseline, after 6 months, and yearly during 5 years.

RESULTS

At 5 years, 71 inlays were evaluated. Two small partial fractures were observed at 3 years (1P, 1F). One inlay showed recurrent root caries at 4 years (P). Four inlays, two in each group showed non-acceptable color match (2P, 2F). Small defects were observed in 4 inlays (2P, 2F). A slight ditching of the cement margins was observed in both luting groups but did not seem to increase during the second half of the evaluation. No significant difference in durability was observed between the two luting agents.

SIGNIFICANCE

IPS Empress inlays luted with the chemical-cured RC and the resin-modified glass ionomer cement functioned satisfactory during the 5 years follow-up.