Prevalence of white spot caries lesions in primary teeth in preschool children: systematic review and meta-analysis

Background: The first clinically detectable stage of caries lesion is a non-cavitated white spot lesion (WSL). The detection of early stages of caries lesions allows non-invasive management by fluoride usage, oral hygiene and diet control. There is a lack of information in the literature regarding the prevalence of these caries lesions in preschool children, which is important especially for public health strategies. Objective: The aim of this study was to conduct a systematic review with meta-analysis to verify the WSLs prevalence in primary teeth of preschool children. Methods: A literature search with MEDLINE/PubMed, Scopus, Web of Science, and Open Gray databases was conducted. Included studies fulfilled the eligibility criteria. Meta-analyses were performed using random effects model, for prevalence of pooled WSLs and subgroups analyses. Results: The search strategy identified 4922 potentially relevant articles, with final inclusion of 16 studies. The pooled prevalence of WSLs in primary teeth was 14.0% (95% CI: 8.0-24.0), without publication bias (p=0.2668). For subgroup analyses, an increase in WSLs prevalence for children of low-income economy (24.0%; 95% CI: 20.0-28.0), for age >31 months (22.0%; 95% CI: 12.0-37.0), for validated visual criteria assessment (20.0%; 95% CI: 11.0-33.0), and for tactile assessment with ball-ended probe (26.0%; 95% CI: 11-50.0) were detected. Conclusion: It is suggested that the prevalence of WSLs in primary teeth of preschool children increases in countries with low income economy, with age greater than 31 months as the texture was assessed with visual validated criteria or ball-end probe.

Confocal laser scanning reflection microscopy applied to the remineralization studies in incipient caries lesions

To evaluate through roughness parameters measurement the penetration of calcium phosphate stabilized by casein phosphopeptides (CPP-ACP) in the subsurface zone of the incipient caries lesions known in dentistry as white spot lesion (WSL). To our knowledge, there is no data about roughness parameters to evaluate the demineralization-remineralization process in the body of the lesion. WSL was generated in vitro in 10 dental samples and sectioned in half of them (longitudinal section). CPP-ACP was applied on the WSL (3 minutes daily for 60 days). Roughness parameters (Rp and Ra) were measured on the longitudinal section with a laser scanning confocal microscope in the reflection acquisition mode (CLSRM), either in the WSL or sound enamel, before and after applying CPP-ACP. CLSRM is a non-contact method able to detect small irregularities more precisely due to the small spot of laser illumination (0.5 μm). Mixed linear models were carried out, using the treatment as a fixed factor and the tooth as a random factor (significance level 5%). Rp and Ra values in WSL area before applying the remineralization protocol (WSL pre) were significantly higher than in the sound enamel of the same samples. After applying CPP-ACP, Rp and Ra values decreased significantly with respect to the WSL pre and were similar to the values of these parameters in sound enamel. roughness parameters were used as an indirect way to measure the porosity of WSL at subsurface level. The decrease of these parameters could be interpreted as the remineralization of WSL by the ability of CPP-ACP to penetrate the body of the lesion. Clinical significance: WSL is characterized by the loss of minerals from the enamel and an increase in porosity at the subsurface level. The effectiveness of remineralizing substances would be determined by their ability to penetrate the body of the lesion and reduce porosity.

Antibacterial Effect of Experimental Orthodontic Adhesives Containing Gold Nanoparticles against Streptococcus mutans and Streptococcus sobrinus

Enamel decalcification usually can be found around orthodontic bracket after debonding. Orthodontic adhesives resistant to bacterial colonization were used to prevent white spot lesion and dental caries in orthodontic treatment with fixed appliance. The objectives of this study were to evaluate the antibacterial properties of expeimental orthodontic adhesive containing gold nanoparticles (AuNPs). 108 orthodontic adhesive discs containing 1.0 wt%, 0.5 wt%, 0.25 wt% AuNPs and without AuNPs were prepared from in-house orthodontic adhesive (27 discs per group). The antibcterial properties of adhesive discs were evaluated by direct contact test. Streptococcus mutans and Streptococcus sobrinus suspensions were placed on the discs and incubated at 37 °C for 1 hour. The adhesive discs were transferred to BHI broth and were incubated at 37°C for 16, 20 and 24 h. Bacterial growth was evaluated by optical density (OD) measurement at 590nm. The results showed that experimental orthodontic adhesives with 1.0 wt% and 0.5 wt% AuNPs exhibited higher antibacterial activity compared to the control group (p < 0.05). At 24 h of incubation, the median OD of 1.0 wt%, 0.5 wt%, 0.25 wt% and control in S. mutans were 0.109, 0.006, 0.007 and 0.372, rescpectively. In S. sobrinus, the median OD were 0.173, 0.012 , 0.007 and 0.328. The incorporation of gold nanoparticles into orthodontic adhesives exhibited antibacterial activity against cariogenic microorganism. At a concentration of 0.5 wt% and 1.0 wt% AuNPs, experimental orthodontic adhesive could reduce bacterial growth of both S. mutans and S. sobrinus.

Re Mineralise the Demineralised: How Knowledgeable and Aware are our Dentists in Kashmir Related to this Minimally Invasive Technique

The principles of minimal invasive dentistry clearly dictates the need for developing effective measures to remineralize the early enamel caries lesions. Aim: The aim of the study was to access how knowledgeable and aware the dentist in Kashmir were related to the minimal invasive dentistry. Methodology: A cross sectional study was done on 60 interns and junior residents of Government Dental College Srinagar who were prescribing medicines in the OPD.This survey was to assess how knowledgeable, aware the dentists are while prescribing the re mineralising agents and do they detect the incipient carious lesions early. Results: 80% had observed a white spot lesion as a hypomineralization spot while examining the patient.67% of the dentists said that Fluoride based remineralising agents are the most easily available remineralising agent in the market. Conclusion: Dental caries pathophysiology is not a simple continual cumulative loss of tooth minerals but also a dynamic process characterised by alternating periods of demineralization and re mineralisation and can be reversed by the application of various remineralising agents.

Assessment of Mineral Gain in White Spot Lesions Using CPP-ACP and CPP-ACFP in Different Clinical Protocols: A Proof of Concept Study

Subsurface remineralization can be promoted by the topical application of nanoparticles of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP). To assess changes in enamel white spot lesions, an in situ proof-of-concept investigation was performed using 5 subjects (all of whom were healthy young adults) with a cross-over study design. Custom orthodontic brackets were attached to the buccal surfaces of the maxillary second premolar and first molar teeth. Each bracket had a recess that held a slab of enamel with a standardized 100 μm deep white spot lesion (WSL). Changes in mineral were evaluated in lesion cross sections using backscatter electron imaging (BSE) and electron probe microanalysis (EPMA). The following products were applied twice daily for 2 weeks: GC Tooth Mousse™ (CPP-ACP), Tooth Mousse Plus™ (CPP-ACFP), CPP-ACFP Mineral Enhanced (CPP-ACFP Enh), or the vehicle paste of CPP-ACFP containing 900 ppm fluoride. To ensure blinding, all products had identical flavours and packaging. For each subject, the products were used in a random sequence, with washout periods between products. Compared to the baseline situation, favourable changes in white spot lesions occurred with all products. Analysis of enamel samples in cross section showed improvements in mineral levels, as seen in BSE grey scale levels from the enamel surface through the lesion. These were accompanied by enhanced calcium and phosphorus levels as seen using EPMA. The ranking of products for subsurface mineral gain, from best to worst, was: CPP-ACFP = CPP-ACFP Enh > CPP-ACP > vehicle with fluoride. Rapid remineralization occurred in this clinical model, which is due to a combination of factors: the enamel slabs were located on tooth surfaces exposed to parotid saliva, the surfaces were brushed regularly to remove dental plaque biofilm, and compliance with twice daily topical use of products was high. Such model systems may be useful for screening new product formulations for their effect on enamel WSL.

Biofilm formation following chitosan-based varnish or chlorhexidine-fluoride varnish application in patients undergoing fixed orthodontic treatment: a double blinded randomised controlled trial

Background Orthodontic treatment poses an increased risk of plaque accumulation and demineralisation of enamel leading to white spot lesion around the brackets. This parallel arm trial aims to assess the degree of bacterial plaque formation adjacent to orthodontic brackets, following the application of a chitosan-based varnish or chlorhexidene-fluoride varnish. Methods A total of 200 teeth from 20 patients undergoing fixed orthodontic therapy were assessed and biofilm formation around the brackets were recorded using the Bonded Bracket Index (Plaque index) at baseline and weekly for 6 weeks. The bacterial count and plaque pH at corresponding weekly intervals were also recorded. Following bracket bonding, the patients were cluster randomised to receive chitosan-based varnish-CHS (UNO Gel Bioschell, Germiphene corp., Brantford, Canada) or chlorhexidine-fluoride varnish-CFV (Cervitec F, Ivoclar Vivadent, Schaan, Liechtenstein) every week on the representative teeth respectively. BBI proportions were compared between groups at all time intervals using Chi square test. Mean plaque bacterial count and plaque pH were compared using Mann Whitney U test and Tukey’s HSD test respectively. Results Baseline characteristics were similar between the groups: Mean age was CHS = 23 and CFV = 21; male to female ratio was CHS = 5/5, CFV = 7/3. At the end of 6 weeks, chitosan-based varnish performed equal to chlorhexidine-fluoride varnish (P > 0.05) with 98% and 95% of teeth with acceptable scores respectively. The plaque bacterial count significantly reduced at 6 weeks for both varnish compared to the baseline; The value for CHS was 0.43 ± 0.4 × 104 and CFV was 0.77 ± 0.64 × 104 CFU (P < 0.05), with no difference between both the varnishes. Both varnishes had no effect on the plaque pH that remained neutral. Conclusion This trial showed that both chitosan-based varnish and chlorhexidine-fluoride varnish reduced bacterial count, while the plaque pH remained neutral over a period of six weeks in patients undergoing fixed orthodontic therapy. The anti-plaque effects of the natural biopolymeric chitosan-based varnish was similar to that of chlorhexidine-fluoride varnish, a known chemotherapeutic agent. Registration: This trial protocol was registered with https://www.ctri.nic.in (CTRI/2019/05/018896). (Date of registration 02/05/2019). Protocol: The protocol was not published before trial commencement.

Systematic Review on White Spot Lesions Treatments

The difference in refractive index between the healthy enamel and the demineralized area generates a lesion with a milky white opaque appearance, clearly distinguishable from the surrounding healthy enamel. The aim of this systematic review is to evaluate if the infiltration technique is the most efficient treatment to resolve a white spot lesion when compared with remineralization and microabrasion techniques. The Population/Intervention/Comparison/Outcome question investigated: “in enamel WS lesion, the infiltration treatment compared to remineralization or microabrasion treatments is more or less effective in the camouflage effect?” The research was performed on electronic databases, including Ovid MEDLINE, PubMed, and web of science. The search was conducted up to April 1, 2020. The scientific search engines produced 324 results. Only 14 were screened after screening. Based on the articles analyzed in this systematic review, the resin infiltration technique seems to be the most effective and predictable treatment for the aesthetic resolution of WSLs.