Effectiveness of Visual-Tactile Examination and DIAGNOdent Pen in Detecting Early Enamel Caries and Its Remineralisation: An In Vitro Study

Background. The caries preventive effect of Colgate Duraphat® and GC Tooth Mousse Plus® has been widely studied, but the remineralisation potential of initial occlusal caries using these two remineralisation materials remains unclear. Aim. This study is aimed at evaluating and comparing the remineralisation of early enamel caries on the occlusal surface of permanent posterior teeth using ICDAS II caries scoring system and DIAGNOdent Pen (DDPen) after remineralisation with Colgate Duraphat® and GC Tooth Mousse Plus®. Materials and Methods. Extracted posterior teeth ( N = 120 ) with incipient occlusal caries were included in this study. The occlusal surface of each tooth was scored using DDPen and ICDAS II scoring before remineralisation. Then, remineralisation of the teeth of the experimental group was carried out using either CPP-ACP-F or fluoride varnish. After the remineralisation procedures, the occlusal surface of each tooth was again scored using DDPen and ICDAS II scoring. The teeth were then fixed in dental stone blocks and sectioned longitudinally for histological examination using a stereomicroscope. Statistical analysis was performed to calculate the sensitivity and specificity of DDPen and ICDAS II to detect remineralisation and compare with the gold standard histological examination. Results. According to ICDAS-II scores, a significant difference was noted in GC Tooth Mousse Plus® and Duraphat® study samples, whereas the difference between the pre-and post-remineralisation of the control group was not significant. According to the DDPen score criteria, a statistically significant difference was noted among all study groups; however, a greater significance level was noted in the GC Tooth Mousse Plus® and Duraphat® study samples compared with the control group. The Spearman’s rank correlation of ICDAS-II and DDPen with Downer’s histological score (gold standard) revealed a higher association of DDPen score (.738) as compared to ICDAS-II scores (.430). Conclusion. The study concluded that both ICDAS II and DDPen could detect remineralisation of early enamel occlusal caries. DDPen was more sensitive than ICDAS-II to detect remineralisation compared with the Downers histological scores.

Effects of Homemade Nano-Hydroxyapatite and Olive Oil Paste on Remineralization of Early Caries Lesions

Nano-hydroxyapatite (nHAP) particles are a new generation of materials reported to remineralize enamel lesions. The purpose we aimed was to compare the in vitro effects of fluoride gel, sodium fluoride toothpaste, and homemade nHAP paste on remineralizing artificial early enamel caries. Methods: Incipient caries were induced in 21 extracted, sound premolar teeth by storing each specimen in a demineralization solution for 72 hours, followed by pH cycling. The samples (n= 7, each) were then treated with 2% neutral fluoride gel, 0.25% sodium fluoride toothpaste, or homemade nHAP paste, comprising a mixture of nHAP powder and olive oil. After demineralization and remineralization, the results were compared using the DIAGNOdent pen (KaVo, Germany). The data were statistically analyzed using paired t-tests and a one-way ANOVA test. Outcomes: The degree of demineralization in each of the three groups (fluoride gel group, 15.71; sodium fluoride dentifrice group, 15.28; nHAP paste group, 16.71) was significantly elevated compared to baseline (3, 2.5, 2.28, respectively); however, no significant difference was observed between the remineralization readings in each of the three groups (6, 7, 5.5, respectively) (p > 0.05). In conclusion, we concluded that the homemade nHAP paste had a beneficial effect on the remineralization of initial enamel caries lesions.

The Application of Zirconia in Tooth Defects

Dental caries is among the most prevalent chronic diseases of childhood, affecting larger part of children and adults. Non-treated enamel caries can lead to destruction and then spreads into the underlying softer and sensitive dentine layer. Dental restorative materials are applied to treat and reconstruct damaged teeth clinically and recover their functions. Currently, there are various dental restorative materials available, and many appropriate materials are used to restore dental carious teeth. The applicability of biomimetic principles can elicit innovations in restorative dentistry for tooth conservation and preservation. There are three types of materials commonly used in dental restorations: resin, alloys, and ceramic. During the past decade, zirconia-based ceramics have been successfully introduced into the clinic due to acceptable biocompatibility, lower price compared with gold restorations, and better appearance than traditional metal-ceramic restorations. Recently, zirconia restoration is an acceptable treatment option in restorative dentistry and a developing trend in esthetic dentistry.

Using an Optical Reflectometer to Measure Caries Lesion Activity on Enamel

Background: Specular reflection can be used to quantify dental erosion, and might also provide similar results for caries. This study assessed the possibility of using specular reflection intensity (SRI; quantitative lesion activity assessment) to measure the progression of initial enamel caries lesions. Methods: Two hundred native enamel specimens and flat ground enamel specimens (n=100 each) were subjected to a 4-species biofilm caries model during 2, 4, 6, 8, and 10 weeks (n=20 each), to induce ‘active’ enamel caries lesions. Afterwards, to induce ‘inactive’ lesions, all specimens were continuously remineralized and brushed twice daily for 2, 4, 6, 8, and 10 weeks. Change in specular reflection intensity (%SRI), visual caries detection (ICDAS) and visual caries severity assessment were performed for all active lesions and during the remineralization phase. Scanning electron microscopy (SEM) images were taken for qualitative analysis. Results: For active lesions, %SRI dropped from 100% to about 80% in native enamel, and to about 15% in polished enamel. Remineralization/brushing increased %SRI in native enamel, but not in polished enamel. The comparison with visual caries scores yielded a better linear relationship of %SRI with early enamel lesion where caries was induced for up to 6 weeks. Conclusion: The use of the optical reflectometer for the assessment of caries lesion activity seemed to work better for early caries lesions and for polished specimens.

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.

Dental caries in children and adolescents with juvenile idiopathic arthritis and controls: a multilevel analysis

Background Optimal utilization of dental caries data is crucial in epidemiological research of individuals with juvenile idiopathic arthritis (JIA). The aims were to: explore whether caries is more prevalent among children and adolescents with JIA compared to controls; examine presence of caries according to JIA group, socio-behavioral and intraoral characteristics, and the extent to which surface-specific caries varies between and within individuals; assess whether surface-specific caries varies according to JIA group and dentition; and investigate whether disease-specific clinical features of JIA are associated with presence of caries. Methods In this comparative cross-sectional study, calibrated dentists examined index teeth (primary 2. molars, 1. permanent molars) of 4–16-year-olds with JIA (n = 219) and matched controls (n = 224), using a detailed caries diagnosis system (including enamel caries). JIA-specific characteristics were assessed by pediatric rheumatologists and socio-behavioral information collected by questionnaires. Multilevel mixed-effect logistic regressions reporting odds ratios (OR) with 95% confidence interval (CI) were applied (caries at surface level as outcome variable). Potential confounders were adjusted for, and the effect of dependency of surface-specific caries data was estimated by calculating intra-class correlation coefficients (ICC). Results At individual level, no significant difference in caries prevalence was found between individuals with JIA and controls, regardless of inclusion of enamel caries. Proportion of enamel lesions exceeded dentine lesions. JIA was not associated with presence of caries, but in both groups, low maternal educational level was associated with presence of caries (OR: 2.07, 95% CI: 1.24–3.46). Occlusal and mesial surfaces, compared to buccal surfaces, had generally higher OR according to presence of caries than distal and lingual surfaces (ICC = 0.56). Surface-specific caries in the permanent dentition differed significantly according to group affiliation. Some JIA disease-specific variables were suggested to associate with presence of caries. Conclusions No overall difference in caries prevalence between individuals with JIA and controls was observed, but for both groups, low maternal educational level and tooth surface associated with presence of caries. Associations between JIA disease-specific variables and presence of caries cannot be excluded. Due to predominance of enamel lesions, the potential of preventative dental strategies is considerable.