Temporary Tooth Separation to Improve Assessment of Approximal Caries Lesions: A School-Based Study

2020 ◽  
Vol 45 (6) ◽  
pp. 581-588
Author(s):  
MM Nascimento ◽  
AP Ribeiro ◽  
AJ Delgado ◽  
L Cassiano ◽  
MGD Caraballo ◽  
...  
Keyword(s):  
Caries Risk ◽  
Diagnostic Aid ◽  
Health Records ◽  
Lesion Depth ◽  
Lesion Location ◽  
School Based ◽  
Threshold Criterion ◽  
Oral Biofilms ◽  
Caries Lesions ◽  
Approximal Caries

Clinical Relevance Radiographic lesion depth should not be used as the single determinant of the restorative threshold for clinically inaccessible approximal caries lesions. Temporary tooth separation is a feasible and effective diagnostic aid for assessment and appropriate management of approximal lesions. SUMMARY In the era of tooth-preserving dentistry, the decision to restore approximal caries lesions must be based on the accurate assessment of tooth cavitation, as the accumulation of oral biofilms in these areas encourages lesion progression. However, lesions radiographically into dentin remain the main threshold criterion for restoring approximal lesions even though most of these lesions may not be cavitated. A school-based clinical protocol for temporary tooth separation (TTS) was developed to improve visual-tactile assessment and management of clinically inaccessible approximal lesions. TTS data retrieved from electronic health records were used to correlate radiographic lesion depth and surface cavitation status with lesion location and the patient’s caries risk and to evaluate the effectiveness of TTS as a diagnostic aid for approximal lesions. Of the 206 lesions assessed, 66.5% (n=137) were located in the maxillary arch, 56.6% (n=116) in distal surfaces, 61.3% (n=114) in premolars, and 21.5% (n=40) in molars. After tooth separation, 79.6% (n=164) of the lesions were diagnosed as noncavitated, including 90% (n=66) of the lesions radiographically at the inner half of enamel (E2) and 66% (n=49) of those at the outer-third of dentin (D1). Logistic regression analysis using E2 and D1 lesions showed no significant association between lesion depth or cavitation status with lesion location and caries risk. TTS is a feasible and effective diagnostic aid for the assessment and appropriate management of approximal caries lesions. There is a need to reevaluate the use of radiographic lesion depth as the single determinant of the restorative threshold for clinically inaccessible approximal lesions.

Effect of School-Based Fluoride Varnish Programmes on Approximal Caries in Adolescents from Different Caries Risk Areas

2005 ◽  
Vol 39 (4) ◽  
pp. 273-279 ◽  
Author(s):  
Ulla Moberg Sköld ◽  
Lars G. Petersson ◽  
Agneta Lith ◽  
Dowen Birkhed
Keyword(s):  
Fluoride Varnish ◽  
Caries Risk ◽  
School Based ◽  
Risk Areas ◽  
Approximal Caries

Caries Rates Related to Approximal Caries at Ages 11-13: A 10-year Follow-up Study in Sweden

2002 ◽  
Vol 81 (7) ◽  
pp. 455-458 ◽  
Author(s):  
H. Stenlund ◽  
I. Mejàre ◽  
C. Källestål
Keyword(s):  
Tooth Surface ◽  
Caries Risk ◽  
Caries Lesion ◽  
Follow Up Study ◽  
Two Measures ◽  
The Individual ◽  
The Relationship ◽  
Caries Lesions ◽  
Approximal Caries

Predicting future caries risk is a difficult but important clinical task. The aim of this study was to analyze radiographically the relationship between approximal caries (4d-7m) at ages 11-13 (baseline) and future approximal caries. We followed 534 individuals prospectively through annual bitewing radiographs from 11 to 22 years of age. Two measures were used: individual-based incidence of the first new approximal caries lesion and surface-based incidence of approximal lesions. In the group with no approximal caries lesions at baseline, the individual-based incidence was 19 first new approximal lesions/100 person-years; the corresponding value for those with 3 approximal lesions at baseline was 71. Individuals with no approximal lesions at baseline developed 3.1 new lesions/100 tooth surface-years; the corresponding value for those with 3 lesions at baseline was 7.7. The highest risk for developing new approximal lesions was within the first 2 years after baseline.

Cost-Effectiveness through the Dental-Health FRAMM Guideline for Caries Prevention among 12- to 15-Year-Olds in Sweden

2019 ◽  
Vol 53 (3) ◽  
pp. 339-346 ◽  
Author(s):  
Eva-Karin Bergström ◽  
Thomas Davidson ◽  
Ulla Moberg Sköld
Keyword(s):  
Cost Effectiveness ◽  
Dental Health ◽  
Caries Prevention ◽  
Caries Prevalence ◽  
School Based ◽  
Caries Increment ◽  
Dental Records ◽  
Caries Lesions ◽  
Approximal Caries ◽  
Approximal Surfaces

Since 2008, FRAMM has been a guideline for caries prevention for all 3- to 15-year-olds in the Västra Götaland Region in Sweden and a predominant part is school-based fluoride varnish applications for all 12- to 15-year-olds. The aims were to evaluate dental health-economic data among 12- to 15-year-olds, based on the approximal caries prevalence at the age of 12, and to evaluate cost-effectiveness. Caries data for 13,490 adolescents born in 1993 who did not take part and 11,321 adolescents born in 1998 who followed this guideline were extracted from dental records. Those with no dentin and/or enamel caries lesions and/or fillings on the approximal surfaces were pooled into the “low” subgroup, those with 1–3 into the “moderate” subgroup and those with ≥4 into the “high” subgroup. The results revealed that the low subgroup had a low approximal caries increment compared with the moderate and high subgroups during the 4-year study period. In all groups, there were statistically significant differences between those who took part in the guideline and those who did not. The analysis of cost-effectiveness revealed the lowest incremental cost-effectiveness ratio (ICER) for the high subgroup for decayed and/or filled approximal surfaces (DFSa) and approximal enamel lesions together and the highest ICER for the low subgroup for DFSa alone. To conclude, the FRAMM Guideline reduced the caries increment for adolescents with low, moderate and high approximal caries prevalence. The subgroup with the most favourable cost-effectiveness comprised those with a high caries prevalence at the age of 12.

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

Molecules ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 300
Author(s):  
Hani M. Nassar ◽  
Frank Lippert
Keyword(s):  
Mineral Content ◽  
Significance Level ◽  
Lesion Depth ◽  
Caries Lesion ◽  
Mineral Profile ◽  
Bonferroni Test ◽  
Bovine Enamel ◽  
Caries Lesions ◽  
Nail Varnish

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.

scholarly journals CariesCare International adapted for the pandemic in children: Caries OUT multicentre single-group interventional study protocol

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stefania Martignon ◽  
Andrea Cortes ◽  
Gail V. A. Douglas ◽  
J. Timothy Newton ◽  
Nigel B. Pitts ◽  
...  
Keyword(s):  
Oral Health ◽  
Health Behaviour ◽  
Tooth Surface ◽  
Caries Risk ◽  
Single Group ◽  
Surface Level ◽  
Control Effectiveness ◽  
Oral Health Behaviour ◽  
Caries Progression ◽  
Caries Lesions

Abstract Background Comprehensive caries care has shown effectiveness in controlling caries progression and improving health outcomes by controlling caries risk, preventing initial-caries lesions progression, and patient satisfaction. To date, the caries-progression control effectiveness of the patient-centred risk-based CariesCare International (CCI) system, derived from ICCMS™ for the practice (2019), remains unproven. With the onset of the COVID-19 pandemic a previously planned multi-centre RCT shifted to this “Caries OUT” study, aiming to assess in a single-intervention group in children, the caries-control effectiveness of CCI adapted for the pandemic with non-aerosols generating procedures (non-AGP) and reducing in-office time. Methods In this 1-year multi-centre single-group interventional trial the adapted-CCI effectiveness will be assessed in one single group in terms of tooth-surface level caries progression control, and secondarily, individual-level caries progression control, children’s oral-health behaviour change, parents’ and dentists’ process acceptability, and costs exploration. A sample size of 258 3–5 and 6–8 years old patients was calculated after removing half from the previous RCT, allowing for a 25% dropout, including generally health children (27 per centre). The single-group intervention will be the adapted-CCI 4D-cycle caries care, with non-AGP and reduced in-office appointments’ time. A trained examiner per centre will conduct examinations at baseline, at 5–5.5 months (3 months after basic management), 8.5 and 12 months, assessing the child’s CCI caries risk and oral-health behaviour, visually staging and assessing caries-lesions severity and activity without air-drying (ICDAS-merged Epi); fillings/sealants; missing/dental-sepsis teeth, and tooth symptoms, synthetizing together with parent and external-trained dental practitioner (DP) the patient- and tooth-surface level diagnoses and personalised care plan. DP will deliver the adapted-CCI caries care. Parents’ and dentists’ process acceptability will be assessed via Treatment-Evaluation-Inventory questionnaires, and costs in terms of number of appointments and activities. Twenty-one centres in 13 countries will participate. Discussion The results of Caries OUT adapted for the pandemic will provide clinical data that could help support shifting the caries care in children towards individualised oral-health behaviour improvement and tooth-preserving care, improving health outcomes, and explore if the caries progression can be controlled during the pandemic by conducting non-AGP and reducing in-office time. Trial registration: Retrospectively-registered-ClinicalTrials.gov-NCT04666597-07/12/2020: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AGM4&selectaction=Edit&uid=U00019IE&ts=2&cx=uwje3h. Protocol-version 2: 27/01/2021.

scholarly journals Infiltration and sealing for managing non-cavitated proximal lesions: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuanyuan Chen ◽  
Dongru Chen ◽  
Huancai Lin
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Meta Analysis ◽  
Low Risk ◽  
Caries Risk ◽  
Moderate Risk ◽  
Risk Levels ◽  
Non Invasive ◽  
Randomised Controlled ◽  
Caries Lesions

Abstract Background Infiltration and sealing are micro-invasive treatments for arresting proximal non-cavitated caries lesions; however, their efficacies under different conditions remain unknown. This systematic review and meta-analysis aimed to evaluate the caries-arresting effectiveness of infiltration and sealing and to further analyse their efficacies across different dentition types and caries risk levels. Methods Six electronic databases were searched for published literature, and references were manually searched. Split-mouth randomised controlled trials (RCTs) to compare the effectiveness between infiltration/sealing and non-invasive treatments in proximal lesions were included. The primary outcome was obtained from radiographical readings. Results In total, 1033 citations were identified, and 17 RCTs (22 articles) were included. Infiltration and sealing reduced the odds of lesion progression (infiltration vs. non-invasive: OR = 0.21, 95% CI 0.15–0.30; sealing vs. placebo: OR = 0.27, 95% CI 0.18–0.42). For both the primary and permanent dentitions, infiltration and sealing were more effective than non-invasive treatments (primary dentition: OR = 0.30, 95% CI 0.20–0.45; permanent dentition: OR = 0.20, 95% CI 0.14–0.28). The overall effects of infiltration and sealing were significantly different from the control effects based on different caries risk levels (OR = 0.20, 95% CI 0.14–0.28). Except for caries risk at moderate levels (moderate risk: OR = 0.32, 95% CI 0.01–8.27), there were significant differences between micro-invasive and non-invasive treatments (low risk: OR = 0.24, 95% CI 0.08–0.72; low to moderate risk: OR = 0.38, 95% CI 0.18–0.81; moderate to high risk: OR = 0.17, 95% CI 0.10–0.29; and high risk: OR = 0.14, 95% CI 0.07–0.28). Except for caries risk at moderate levels (moderate risk: OR = 0.32, 95% CI 0.01–8.27), infiltration was superior (low risk: OR = 0.24, 95% CI 0.08–0.72; low to moderate risk: OR = 0.38, 95% CI 0.18–0.81; moderate to high risk: OR = 0.20, 95% CI 0.10–0.39; and high risk: OR = 0.14, 95% CI 0.05–0.37). Conclusion Infiltration and sealing were more efficacious than non-invasive treatments for halting non-cavitated proximal lesions.

Evaluation of Quantitative Light-induced Fluorescence to assess lesion depth in cavitated and non-cavitated root caries lesions – an in vitro study

2021 ◽  
pp. 102675
Author(s):  
Deborah Kreher ◽  
Kyung-Jin Park ◽  
Gerhard Schmalz ◽  
Ellen Schulz-Kornas ◽  
Rainer Haak ◽  
...  
Keyword(s):  
In Vitro Study ◽  
Vitro Study ◽  
Root Caries ◽  
Lesion Depth ◽  
Caries Lesions

scholarly journals Dentists’ Decision to Conduct CRA in Adult Patients in Turkey: A Questionnaire-based Survey

2020 ◽  
Vol 11 (1) ◽  
pp. 77-82
Author(s):  
Sinem Akgül ◽  
İhsan Yıkılgan ◽  
Hüma Ömürlü
Keyword(s):  
Logistic Regression ◽  
Multiple Logistic Regression Analysis ◽  
Daily Practice ◽  
Preventive Dentistry ◽  
Regression Analyses ◽  
Caries Risk ◽  
Minimal Intervention ◽  
Number Of Patients ◽  
E Mail ◽  
Caries Lesions

Aim: The concept of minimal intervention in dentistry is one of the most important stages of the preventive dentistry, and caries risk assessment (CRA) is an application that needs to be primarily evaluated in order to perform minimal intervention approaches. This study was aimed to evaluate the awareness of CRA and whether CRA is included in daily practice by dentists in Turkey. Materials and Methods: This study used a questionnaire survey. A survey was prepared and sent to the dentists who were registered with the Turkish Dental Association via e-mail. A total of 790 dentists returned and 95 respondents were excluded. All the registered dentists filled and returned their survey. Descriptive and logistic regression analyses were performed (n = 695). Results: A total of 86.9 percent dentists who took the survey said that they performed CRA in daily practice. “Lack of time” was specified as the most important factor by the respondents who did not perform CRA in daily practice (61.5%). Current oral hygiene status (96.4%) and the presence of one or more active caries lesions (74.5%) were considered the most important risk factors for not performing CRA. Results of multiple logistic regression analysis showed that clinical experience, number of patients treated per day, and type of practice were mostly associated with whether or not performing CRA ( P = .012, .018, and .035, respectively). Conclusions: It can be concluded that most of the dentists are aware of the importance of conducting CRA and, with differences in the factors considered, CRA is required in their daily practice in Turkey. The concept of minimal intervention in dentistry is one of the most important stages of preventive dentistry, and CRA is an application that needs to be primarily evaluated in order to perform minimal intervention approaches.

scholarly journals Metabolic Profile of Supragingival Plaque Exposed to Arginine and Fluoride

2019 ◽  
Vol 98 (11) ◽  
pp. 1245-1252 ◽  
Author(s):  
M.M. Nascimento ◽  
A.J. Alvarez ◽  
X. Huang ◽  
C. Browngardt ◽  
R. Jenkins ◽  
...  
Keyword(s):  
Acid Production ◽  
Metabolic Profile ◽  
Assessment System ◽  
Caries Detection ◽  
Metabolic Profiles ◽  
Ph Homeostasis ◽  
Supragingival Plaque ◽  
Plaque Ph ◽  
Oral Biofilms ◽  
Caries Lesions

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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