Metabolic Profile of Supragingival Plaque Exposed to Arginine and Fluoride

Caries lesions develop when acid production from bacterial metabolism of dietary carbohydrates outweighs the various mechanisms that promote pH homeostasis, including bacterial alkali production. Therapies that provide arginine as a substrate for alkali production in supragingival oral biofilms have strong anticaries potential. The objective of this study was to investigate the metabolic profile of site-specific supragingival plaque in response to the use of arginine (Arg: 1.5% arginine, fluoride-free) or fluoride (F: 1,100 ppm F/NaF) toothpastes. Eighty-three adults of different caries status were recruited and assigned to treatment with Arg or F for 12 wk. Caries lesions were diagnosed using International Caries Detection and Assessment System II, and plaque samples were collected from caries-free and carious tooth surfaces. Taxonomic profiles were obtained by HOMINGS (Human Oral Microbe Identification using Next Generation Sequencing), and plaque metabolism was assessed by the levels of arginine catabolism via the arginine deiminase pathway (ADS), acidogenicity, and global metabolomics. Principal component analysis (PCA), partial least squares–discriminant analysis, analysis of variance, and random forest tests were used to distinguish metabolic profiles. Of the 509 active lesions diagnosed at baseline, 70 (14%) were inactive after 12 wk. Generalized linear model showed that enamel lesions were significantly more likely to become inactive compared to dentin lesions ( P < 0.0001), but no difference was found when treatment with Arg was compared to F ( P = 0.46). Arg significantly increased plaque ADS activity ( P = 0.031) and plaque pH values after incubation with glucose ( P = 0.001). F reduced plaque lactate production from endogenous sources ( P = 0.02). PCA revealed differences between the metabolic profiles of plaque treated with Arg or F. Arg significantly affected the concentrations of 16 metabolites, including phenethylamine, agmatine, and glucosamine-6-phosphate ( P < 0.05), while F affected the concentrations of 9 metabolites, including phenethylamine, N-methyl-glutamate, and agmatine ( P < 0.05). The anticaries mechanisms of action of arginine and fluoride are distinct. Arginine metabolism promotes biofilm pH homeostasis, whereas fluoride is thought to enhance resistance of tooth minerals to low pH and reduce acid production by supragingival oral biofilms.

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Monitoring of Sound and Carious Surfaces under Sealants over 44 Months

Journal of Dental Research ◽

10.1177/0022034514551753 ◽

2014 ◽

Vol 93 (11) ◽

pp. 1070-1075 ◽

Cited By ~ 42

Author(s):

M. Fontana ◽

J.A. Platt ◽

G.J. Eckert ◽

C. González-Cabezas ◽

K. Yoder ◽

...

Keyword(s):

Assessment System ◽

Retention Rates ◽

Caries Detection ◽

Major Barrier ◽

Occlusal Surfaces ◽

Before And After ◽

Permanent Molars ◽

Caries Lesions ◽

Sealant Retention ◽

Lesion Severity

Although there is strong evidence for the effectiveness of sealants, one major barrier in sealant utilization is the concern of sealing over active caries lesions. This study evaluated detection and monitoring of caries lesions through a clear sealant over 44 mo. Sixty-four 7- to 10-year-old children with at least 2 permanent molars with International Caries Detection and Assessment System (ICDAS) scores 0-4 (and caries less than halfway through the dentin, radiographically) were examined with ICDAS, DIAGNOdent, and quantitative light-induced fluorescence (QLF) before sealant placement and 1, 12, 24, and 44 mo (except QLF) after. Bitewing radiographs were taken yearly. DIAGNOdent and QLF were able to distinguish between baseline ICDAS before and after sealant placement. There was no significant evidence of ICDAS progression at 12 mo, but there was small evidence of minor increases at 24 and 44 mo (14% and 14%, respectively) with only 2% ICDAS ≥ 5. Additionally, there was little evidence of radiographic progression (at 12 mo = 1%, 24 mo = 3%, and 44 mo = 9%). Sealant retention rates were excellent at 12 mo = 89%, 24 mo = 78%, and 44 mo = 70%. The small risk of sealant repair increased significantly as baseline ICDAS, DIAGNOdent, and QLF values increased. However, regardless of lesion severity, sealants were 100% effective at 12 mo and 98% effective over 44 mo in managing occlusal surfaces at ICDAS 0-4 ( i.e., only 4 of 228 teeth progressed to ICDAS ≥ 5 associated with sealants in need of repair and none to halfway or more through the dentin, radiographically). This study suggests that occlusal surfaces without frank cavitation (ICDAS 0-4) that are sealed with a clear sealant can be monitored with ICDAS, QLF, or DIAGNOdent, which may aid in predicting the need for sealant repair.

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The International Caries Detection and Assessment System – ICDAS: A Systematic Review

Caries Research ◽

10.1159/000486429 ◽

2018 ◽

Vol 52 (5) ◽

pp. 406-419 ◽

Cited By ~ 19

Author(s):

Kim Rud Ekstrand ◽

Thais Gimenez ◽

Fernanda R. Ferreira ◽

Fausto M. Mendes ◽

Mariana M. Braga

Keyword(s):

Roc Curves ◽

Diagnostic Odds Ratio ◽

Assessment System ◽

Caries Detection ◽

Activity Assessment ◽

Caries Progression ◽

Overall Performance ◽

Meta Analyses ◽

Caries Lesions ◽

Specific Search

The aims of this study were: (1) to evaluate the overall reproducibility and accuracy of the International Caries Detection and Assessment System (ICDAS) for assessing coronal caries lesions, and (2) to investigate the use of systems associated with the ICDAS for activity assessment of coronal caries lesions. Specific search strategies were adopted to identify studies published up to 2016. For the first objective, we selected studies that assessed primary coronal caries lesions using the ICDAS as a reference standard. A total of 54 studies were included. Meta-analyses summarized the results concerning reproducibility and accuracy (correlation with histology, summary ROC curves [SROC], and diagnostic odds ratio [DOR]). The latter 2 were expressed at D1/D3 levels. The heterogeneity of the studies was also assessed. Reproducibility values (pooled) were > 0.65. The ICDAS mostly presented a good overall performance as most areas under SROC were > 0.75 at D1 and > 0.90 at D3; DOR ≥6. For the second objective, we selected studies investigating activity assessment associated with the ICDAS. The meta-analyses pooled results based on the same methodology and parameters as above. Longitudinal findings regarding caries progression were described to estimate the validity of these systems. On average, the systems for activity assessment of caries lesions showed moderate values concerning reproducibility and overall performance. Active caries lesions were more prone to progress than inactive ones after 2 years. In conclusion, the ICDAS presented a substantial level of reproducibility and accuracy for assessing primary coronal caries lesions. Additional systems associated with the ICDAS that classify caries lesion activity can be useful as they are moderately reproducible and accurate.

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Influence of Examiner Experience on Clinical Performance of Visual Inspection in Detecting and Assessing the Activity Status of Caries Lesions

Operative Dentistry ◽

10.2341/12-067-c ◽

2013 ◽

Vol 38 (6) ◽

pp. 583-590 ◽

Cited By ~ 14

Author(s):

T Gimenez ◽

DG Bittar ◽

C Piovesan ◽

CAB Guglielmi ◽

KY Fujimoto ◽

...

Keyword(s):

Clinical Features ◽

Visual Inspection ◽

Dental Treatment ◽

Pediatric Dentistry ◽

Dental Students ◽

Assessment System ◽

Caries Detection ◽

Caries Activity ◽

Caries Lesions ◽

Different Levels

SUMMARYOur hypothesis was that a method of caries activity evaluation based on the clinical features of the lesions would be less time consuming but more influenced by the examiner's experience than the scoring system used in association with the International Caries Detection and Assessment System (ICDAS). Thus, the aim of this study was to evaluate the performance of three groups of examiners with different levels of experience using two different methods to assess the activity status of caries lesions by visual inspection. A cross-sectional study in a dental office setting was performed selecting 18 children, aged three to eight years, who had sought dental treatment at a dental school. Examinations to detect caries lesions were performed using visual inspection by six examiners with different levels of experience: two undergraduate dental students, two specialists in pediatric dentistry, and two graduate students. The examiners used ICDAS and two different methods to assess caries activity: using an additional score system or considering the examination of clinical features. Two benchmark examiners examined the children in a joint session, and their consensus was considered to be the reference standard. The sensitivity, specificity, and reproducibility were calculated for different thresholds: all, cavitated, and active caries lesions. Multilevel analyses were performed to compare the different methods and examiners. No differences were observed among the examiners, either in detecting all lesions and cavitated lesions or regarding the activity assessment. The methods of assessing activity status performed similarly, but the time spent on examinations was shorter for the method evaluating clinical features. In conclusion, the experience of examiners does not significantly influence the performance of visual inspection, and both methods of assessing activity status result in similar diagnostic accuracy.

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Clinical Trial of the Canary System for Proximal Caries Detection: A Comparative Study

Current Journal of Applied Science and Technology ◽

10.9734/cjast/2021/v40i3531572 ◽

2021 ◽

pp. 38-50

Author(s):

Janja Jan ◽

Wan Zaripah Wan Bakar ◽

Sapna M. Mathews ◽

E. Uzamere ◽

Linda O. Okoye ◽

...

Keyword(s):

Assessment System ◽

Receiver Operating Curve ◽

Caries Detection ◽

Proximal Caries ◽

Bitewing Radiography ◽

Initial Caries ◽

High Caries Risk ◽

Icdas Ii ◽

Risk Patients ◽

Caries Lesions

Background: Detecting initial caries on the proximal surfaces of teeth in an intact dentition is a problem in dental practice since radiograph has been shown to have poor sensitivity with this stage of caries lesions. Hence there is need for an alternative technology. Objectives: The aim of this study was to investigate the efficacy of the Canary System (CS) to detect proximal caries in a clinical setting, comparing it with bitewing radiography (BWR). Methodology: 33 subjects, age 18 years and above, were recruited from a mixed population of low, moderate, and high caries risk patients. BWR and the CS were used to detect proximal caries lesions in these subjects. Teeth were separated by 48 hours insertion of rubber rings, and the proximal surfaces were examined by direct visual examination using the International Caries Detection and Assessment System II (ICDAS-II) scoring system. The Sensitivity (se), specificity (sp), positive (ppv) and negative predictive (npv) values of the CS and BWR in detecting caries on proximal surfaces were calculated by evaluating each method alone against ICDAS-II system (used as bronze standard). The two methods were compared statistically using their Area Under the Receiver Operating Curve (AUC). The sensitivities and specificities were compared using a test of proportions and AUC values were compared using DeLong’s method of nonparametric testing of AUC values. Results: The se, sp, ppv and npv for the CS are 0.92, 0.78, 0.89, 0.84 respectively, and for BWR are 0.67, 0.54, 0.78, and 0.40 respectively. The AUC of the Canary System (0.77) was statistically significantly higher than the AUC of the radiography (0.53, P < .001). Conclusions: This study demonstrated the efficacy of the Canary System in detecting proximal caries lesions to be greater than that of bitewing radiography. Clinical Significance: The Canary System can be a valuable clinical device for detecting and monitoring proximal caries lesions in clinical practice.

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A Hands-On Exercise on Caries Diagnostics among Dental Students—A Qualitative Study

Dentistry Journal ◽

10.3390/dj9100113 ◽

2021 ◽

Vol 9 (10) ◽

pp. 113

Author(s):

Heidi Kangas ◽

Saujanya Karki ◽

Tarja Tanner ◽

Anne Laajala ◽

Helvi Kyngäs ◽

...

Keyword(s):

Content Analysis ◽

Qualitative Study ◽

Learning Experience ◽

Dental Students ◽

Assessment System ◽

Diagnostic Methods ◽

Caries Detection ◽

Caries Diagnostics ◽

Hands On ◽

Caries Lesions

According to current care practices, the aim is to prevent the onset of caries lesions and to stop the progression of incipient lesions. A visual lesion assessment system, International Caries Detection and Assessment System (ICDAS), has been developed to promote reliability and repeatability of assessment of different stage caries lesions. The aims of this study were to evaluate the experiences of a hands-on exercise with authentic teeth as an adjunct to lecturing among third-year dental students and to evaluate the learning process during the hands-on exercise measured by qualitative (inductive content) analysis of the given feedback. In 2018, 51 third-year dental students at the University of Oulu, Finland, participated in a hands-on exercise on caries detection, where they assessed the depth and activity of lesions in extracted teeth using the ICDAS classification. After the lecture, students evaluated the exercise, giving feedback according to five given topics, three of which were analyzed using inductive content analysis. The exercise was considered useful and necessary but, overall, also challenging. The diverse activities and materials, as well as observational methods, promoted learning. The classification of lesions, the diagnostic methods, and the fact that there was not enough time to adopt things during the exercise were found to be challenging. For developing the exercise, the students suggested that more time should be scheduled for it and there should be more individual teaching. This qualitative study showed that, despite the challenge in caries diagnostics, dental students perceive the hands-on exercise as both a communal and individual learning experience.

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Identifying a Potential Summary Measure for Overall Caries Level in Children Examined with the International Caries Detection and Assessment System

Caries Research ◽

10.1159/000479389 ◽

2017 ◽

Vol 51 (6) ◽

pp. 568-575 ◽

Cited By ~ 1

Author(s):

Mohamed ElSalhy ◽

Aishah Alsumait ◽

Hollis Lai ◽

José Manuel Almerich-Silla ◽

Chaiana Piovesan ◽

...

Keyword(s):

Permanent Dentition ◽

Primary Dentition ◽

Assessment System ◽

Mixed Dentition ◽

Caries Detection ◽

Strong Correlations ◽

Summary Measure ◽

Severity Levels ◽

The Relationship ◽

Caries Lesions

Objective: To identify a potential summative summary measure that reflects a patient's overall caries level in children examined with the International Caries Detection and Assessment System (ICDAS). Subjects and Methods: Participants were 1- to 15-year-old children from Kuwait, Brazil, and Spain. Children's teeth were examined using the ICDAS. Multiple measures of central tendency and dentition-specific indices were considered as potential summative measures. The relationship between the summative measures and number of caries lesions was evaluated considering degrees of caries severity using Spearman's correlation analysis. The results were generated using the Kuwaiti sample and were cross-validated using the Brazilian and Spanish samples. Results: A total of 2,808 children participated in the present study. Total ICDAS score and mean ICDAS score showed a strong correlation with the number of caries lesions at different caries severity levels in primary, mixed, and permanent dentitions. The total ICDAS score of 51 buccal (B), 61B, 54 occlusal (O), 55O, 64O, 65O, 74O, 75O, 84O, and 85O surfaces in primary dentition and the total ICDAS score of 14O, 16 lingual (L), 16O, 24O, 26L, 26O, 36B, 36O, 37O, 46O, 46B, and 47O surfaces in permanent dentition or mixed dentition (if present) showed strong correlations with the number of caries lesions at different caries severity levels. Conclusions: Total ICDAS and mean ICDAS scores were the best summary measures of overall caries level at different dental stages. Total ICDAS scores of selectively examined 10 surfaces in primary dentition and 12 surfaces in permanent dentition can give an excellent summary measure for a patient's overall caries level with high diagnostic accuracy.

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Characterization of the Arginolytic Microflora Provides Insights into pH Homeostasis in Human Oral Biofilms

Caries Research ◽

10.1159/000365296 ◽

2015 ◽

Vol 49 (2) ◽

pp. 165-176 ◽

Cited By ~ 36

Author(s):

Xuelian Huang ◽

Renee M. Schulte ◽

Robert A. Burne ◽

Marcelle M. Nascimento

Keyword(s):

Dental Caries ◽

Dental Health ◽

Oral Bacteria ◽

Arginine Deiminase ◽

Rrna Gene ◽

Bacterial Strains ◽

Ph Homeostasis ◽

Increased Risk ◽

Plaque Ph ◽

Oral Biofilms

A selected group of oral bacteria commonly associated with dental health is capable of producing alkali via the arginine deiminase system (ADS), which has a profound impact on the pH of human oral biofilms. An increased risk for dental caries has been associated with reduced ADS activity of the bacteria in oral biofilms. Arginolytic bacterial strains from dental plaque samples of caries-free and caries-active adults were isolated and characterized to investigate the basis for differences in plaque ADS activity between individuals. Fifty-six ADS-positive bacterial strains were identified by 16S rRNA gene sequencing, and their ADS activity levels were compared under standard growth conditions. The spectrum of bacterial ADS activity ranged from 45.2 to 688.0 units (mg protein)-1. Although Streptococcus sanguinis was the most prevalent species, other Streptococcus sp. were also represented. Biochemical assays carried out using 27 ADS-positive strains under conditions known to induce or repress ADS gene expression showed substantial variation in arginolytic activity in response to pH, oxygen and the availability of carbohydrate or arginine. This study reveals that the basis for the wide spectrum of arginolytic expression observed among clinical strains is, at least in part, attributable to differences in the regulation of the ADS within and between species. The results provide insights into the microbiological basis for intersubject differences in ADS activity in oral biofilms and enhance our understanding of dental caries as an ecologically driven disease in which arginine metabolism moderates plaque pH and promotes dental health.

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Clinical effectiveness of fluorescence, digital images and ICDAS for detecting occlusal caries

Revista de Odontologia da UNESP ◽

10.1590/1807-2577.12416 ◽

2017 ◽

Vol 46 (2) ◽

pp. 109-115 ◽

Cited By ~ 2

Author(s):

Cristina Dupim PRESOTO ◽

Tamara Carolina TREVISAN ◽

Maria Costa de ANDRADE ◽

Andrea Abi-Rached DANTAS ◽

Juliana Alvares Duarte Bonini CAMPOS ◽

...

Keyword(s):

Likelihood Ratio ◽

Roc Curve ◽

Digital Images ◽

Assessment System ◽

Caries Detection ◽

Occlusal Caries ◽

Posterior Teeth ◽

Occlusal Surfaces ◽

Discrimination Capacity ◽

Caries Lesions

Abstract Introduction The detection of small caries lesions is still a challenge for dental professionals who in their clinical practice have a wide variety of methods to detect caries on occlusal surfaces. Objective To clinically assess the effectiveness of the Vista Proof fluorescence camera, the Vista Cam digital intraoral micro camera and the International Caries Detection and Assessment System (ICDAS) visual criterion for detecting caries lesions on occlusal surfaces of permanent teeth. Material and method One hundred and seven posterior teeth from adult patients were examined visually and by means of digital radiographs by an examiner who rated them according to the presence or absence of occlusal caries. The teeth were then assessed by the other examiner using ICDAS, fluorescence and magnified digital images. The effectiveness of the methods was measured based on sensitivity, specificity, positive and negative likelihood ratio. For each method, the Receiver Operating Characteristic (ROC) curve and the Area Under the ROC curve (AUROC) were estimated. Result There was exceptional discrimination capacity for the intraoral images (AUROC=.93) and the ICDAS (AUROC=.91), with no significant statistical difference between them (z=.35, p=.73). The fluorescence exhibited an acceptable discrimination capacity (AUROC=0.78), although it was lower than the others. The positive likelihood ratio for the fluorescence was only 2.32, compared to 20.58 for the intraoral image and 58.11 for the ICDAS. Conclusion Both methods and the ICDAS exhibited an adequate clinical performance, although the ICDAS and intraoral image were more effective than the fluorescence.

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Laser fluorescence as an alternative for digital radiography in detecting caries lesions

Clinical and Laboratorial Research in Dentistry ◽

10.11606/issn.2357-8041.clrd.2020.169239 ◽

2020 ◽

Author(s):

Lucila Massu Yoshizaki Akinaga Moreira ◽

Bruna Cordeiro Amarante ◽

Bruno Munhoz Marotta ◽

Christyan Hiroshi Iida ◽

Danielle Ayumi Nishimura ◽

...

Keyword(s):

Diagnostic Method ◽

Near Infrared ◽

New Technologies ◽

Assessment System ◽

Laser Fluorescence ◽

Infrared Light ◽

Caries Detection ◽

Complementary Method ◽

Diagnodent Pen ◽

Caries Lesions

Diagnosis of caries lesions consists of visual/tactile methods following the International Caries Detection and Assessment System (ICDAS) and radiographic methods (BW), however these methods have limitations for detecting caries at different depths and locations and is usually influenced by the examiner’s experience. New technologies have emerged to improve caries diagnosis methods, among these are methods that use optical principles to quantify differences between healthy and demineralized tissues, for example: quantitative light- -induced fluorescence (QLF), the “DIAGNOdent” caries detection pen, and VistaProof (fluorescence camera). This literature review aims to provide up-to-date information on the applicability of fluorescence-based methods in the diagnosis of caries. The results show that DIAGNOdent pen was the most effective method for diagnosing caries, wherein some authors indicate that it can be used as the only diagnostic method, but most recommend using it as a complementary method to ICDAS and BW. LFpen must be used in association with ICDAS and 2 articles indicate near-infrared light transillumination (NILT) as a substitute for BW, however there is still a need for further studies to reach a concrete decision. In conclusion, digital methods for the diagnosis of caries are efficient, but they do not replace visual/tactile methods and bitewing radiographs. Therefore, they should be used as a complementary diagnostic method to those already known and widely used and studied.

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Sealant versus Fluoride in Primary Molars of Kindergarten Children Regularly Receiving Fluoride Varnish: One-Year Randomized Clinical Trial Follow-Up

Caries Research ◽

10.1159/000431038 ◽

2015 ◽

Vol 49 (4) ◽

pp. 458-466 ◽

Cited By ~ 7

Author(s):

Sisko Honkala ◽

Mohamed ElSalhy ◽

Maddi Shyama ◽

Sabiha A. Al-Mutawa ◽

Hanan Boodai ◽

...

Keyword(s):

Retention Rate ◽

First Grade ◽

Assessment System ◽

Fluoride Varnish ◽

Caries Detection ◽

Primary Molars ◽

Occlusal Caries ◽

Occlusal Surfaces ◽

Caries Lesions

Objectives: The objectives of this study were to measure the caries preventive effect of sealants applied to occlusal surfaces of primary molars compared to fluoride varnish applications, and to assess the retention rate of sealants after 1 year. Methods: 147 first-grade pupils from two kindergarten schools in Kuwait, whose parents gave their written consent, were included. The children were examined by one dentist using the International Caries Detection and Assessment System. After the examination, sealants and fluoride varnish were applied on the selected occlusal surfaces of primary molars by another dentist. The jaw quadrant for intervention was selected randomly; molars on the contralateral side of the mouth received the contralateral intervention. Examinations and intervention were provided on the school premises in the mobile dental unit with a portable spotlight. Moisture was controlled by cotton rolls, suction and air drying. The follow-up examinations were conducted after 1 year. All children received fluoride varnish before and 6 months after the intervention. Results: From 267 matched pairs of occlusal surfaces of primary molars, varnished surfaces were significantly more likely to develop new caries lesions than the sealed ones (odds ratio = 2.92; 95% confidence interval = 1.82-4.71) during the 1-year follow-up. The majority (73.0%) of the sealants were completely retained and 15.1% partially. Conclusions: Sealing fissures seems to be better in preventing occlusal caries lesions in primary molars than applying only fluoride varnish. After 1 year, the majority of sealants were retained sound.

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