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Jones JA, Gibson G, Cabral HJ, Wehler CJ, Orner MB, Jurasic MM. Effectiveness of fluorides in root caries prevention, Department of Veterans Affairs (2009-2018). SPECIAL CARE IN DENTISTRY 2024; 44:575-583. [PMID: 37322562 PMCID: PMC10721720 DOI: 10.1111/scd.12894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 05/23/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023]
Abstract
AIMS The aim of this study was to examine the effectiveness of topical fluorides in prevention of root caries-related treatment in high caries risk Veterans. METHODS This retrospective analysis of longitudinal data examined the effectiveness of professionally applied or prescription (Rx) fluoride treatment, in VHA clinics from FY 2009-2018. Professional fluoride treatments included 5% Sodium Fluoride (NaF) varnish (22 600 ppm fluoride), 2% NaF gel/rinse (9050 ppm fluoride), and 1.23% APF gel (12 300 ppm fluoride). The Rx for daily home use was 1.1% NaF paste/gel (5000 ppm fluoride). Outcomes studied were new root caries restorations or extractions and percent of patients with treatment over 1 year. Logistic regressions were adjusted for age, gender, race, ethnicity, chronic medical or psychiatric conditions, number of medication classes, anticholinergic drugs, smoking, baseline root caries treatment, preventive care, and time between first-last restoration in the index year. RESULTS Root caries at baseline was associated with a high risk for new root caries. Veterans without root caries during the index year who received a fluoride gel/rinse intervention were 32-40% less likely to receive caries-related treatment for root caries during the follow-up period. Once Veterans had root caries, fluorides did not exhibit a positive effect. CONCLUSION In older adults with high caries risk, early fluoride prevention is key, before root caries requires treatment.
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Affiliation(s)
- Judith A Jones
- University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
| | - Gretchen Gibson
- Oral Health Quality Group, Veterans Health Administration, Office of Dentistry, Fayetteville, Arkansas, USA
| | - Howard J Cabral
- Boston University School of Public Health, Boston, Massachusetts, USA
| | - Carolyn J Wehler
- Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
- Oral Health Quality Group, Veterans Health Administration, Office of Dentistry, Bedford, Massachusetts, USA
| | - Michelle B Orner
- Oral Health Quality Group, Veterans Health Administration, Office of Dentistry, Bedford, Massachusetts, USA
| | - M Marianne Jurasic
- Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
- Oral Health Quality Group, Veterans Health Administration, Office of Dentistry, Bedford, Massachusetts, USA
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Chen W, Zhu T, Zhang D. The prevalence and common risk indicators of root caries and oral health service utilization pattern among adults, a cross-sectional study. PeerJ 2023; 11:e16458. [PMID: 38025674 PMCID: PMC10676080 DOI: 10.7717/peerj.16458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Root caries is a prevalent oral health concern among adults, yet there remains a need for a comprehensive understanding of its occurrence and associated risk indicators. The present study was aimed to investigate the prevalence of root caries and to determine significantly associated indicators with it among adults. Methods The residents aged 35-74 years old were enrolled in a cross-sectional study in which dental examination were taken and structured questionnaires were collected in Zhejiang Province, China. All data were recorded in an electronic system and analyzed. Results The prevalence of decayed and filled root caries in 1,076 respondents was 31.9%. Elder age, greater attachment loss, and exposed root surface were associated with higher odds of incidence for decayed/filled roots and decayed roots. In the last 12 months, 27.4% of adults with decayed or filled roots and 23.2% of others utilized oral health services. Carious adults who had a very poor/poor oral health status were 2.905 times likely to report dental visits. People with sound roots who were female (OR = 2.103, P < 0.001), perceived their oral health status as moderate (OR = 1.802, P = 0.015), or poor/very poor (OR = 4.103, P < 0.001) were more likely to visit a dentist in the past 12 months. Conclusions Age, attachment loss and root exposure were most significantly associated with the prevalence of root caries. Individuals who recognize their poor or very poor oral health status should feel encouraged to make use of oral health services.
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Affiliation(s)
- Weixing Chen
- Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, Zhejiang University, Hangzhou, China
| | - Tianer Zhu
- Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, Zhejiang University, Hangzhou, China
| | - Denghui Zhang
- Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, Zhejiang University, Hangzhou, China
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Zamperini CA, Bedran-Russo AK. Immediate and Sustained Root Caries Prevention of Fluoride Varnish Combined with Toothpastes. Caries Res 2023; 57:592-601. [PMID: 37549651 DOI: 10.1159/000533279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 07/16/2023] [Indexed: 08/09/2023] Open
Abstract
The aim of this study was to determine the immediate and sustained effect of a fluoride varnish and its combinations with toothpastes in preventing root caries development using a salivary microcosm in vitro model. Human root dentin specimens (n = 150) were randomly divided into 5 experimental protocols (n = 30): (1) Fluoride Varnish (V); (2) V followed by Paste One (V + PO); (3) V followed by Paste Plus (V + PP); (4) V followed by PO and PP (V + PO + PP); and (5) No treatment (control). One varnish layer was applied on the specimens (except for the control group) and kept for 18 h. Then, the varnish was removed and toothpaste treatments were initiated according to experimental groups. For the short-term incubation model (n = 15), the specimens were also immediately subjected to 7-day cariogenic challenge. For that, human saliva was used as bacterial inoculum and McBain artificial saliva containing 2% sucrose as growth medium. The other half of the specimens (n = 15) were used to study the varnish's sustained effect by long-term incubation (8 weeks) before cariogenic challenge. The protocols' anti-caries properties were evaluated by dentin porosity (rhodamine intensity; RI) and mineral density, while their anti-biofilm effects were evaluated using biofilm's biomass and viability assays. For short- and long-term incubation models, all experimental regimens resulted in statistically significant decreases (p < 0.05) in the RI (up to 180 μm and 120 μm, respectively) as well as higher mineral density compared to No treatment (p < 0.001). V + PO + PP and/or V + PO resulted in statistically lower RI compared to V for some depths (p < 0.05) in both models. There were changes in RI and mineral density within groups over time. All experimental treatments exhibited anti-biofilm effects. All prevention protocols exhibited immediate and sustained anti-caries effect against root caries development. The combination of a fluoride varnish with PO resulted in superior additional anti-caries effects.
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Affiliation(s)
- Camila A Zamperini
- Department of Restorative Dentistry, College of Dentistry, University of Illinois Chicago, Chicago, Illinois, USA
| | - Ana K Bedran-Russo
- Department of Oral Biology, College of Dentistry, University of Illinois Chicago, Chicago, Illinois, USA
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Göstemeyer G, Preus M, Elhennawy K, Schwendicke F, Paris S, Askar H. Accuracy of different approaches for detecting proximal root caries lesions in vitro. Clin Oral Investig 2023; 27:1143-1151. [PMID: 36112228 PMCID: PMC9985551 DOI: 10.1007/s00784-022-04709-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/05/2022] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Gerd Göstemeyer
- Department of Operative, Preventive and Pediatric Dentistry, Charité - Universitätsmedizin Berlin, Assmannshauser Straße 4-6, 14197, Berlin, Germany.
| | - Mareike Preus
- Department of Operative, Preventive and Pediatric Dentistry, Charité - Universitätsmedizin Berlin, Assmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Karim Elhennawy
- Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité - Universitätsmedizin Berlin, Assmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Assmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Sebastian Paris
- Department of Operative, Preventive and Pediatric Dentistry, Charité - Universitätsmedizin Berlin, Assmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Haitham Askar
- Department of Operative, Preventive and Pediatric Dentistry, Charité - Universitätsmedizin Berlin, Assmannshauser Straße 4-6, 14197, Berlin, Germany
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Kreher D, Schmalz G, Haak R, Ziebolz D. Laser fluorescence is a predictor of lesion depth in non-cavitated root carious lesions - an in vitro study. Photodiagnosis Photodyn Ther 2022; 41:103243. [PMID: 36565731 DOI: 10.1016/j.pdpdt.2022.103243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/17/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND This in vitro study was designed to compare the assessment of carious root surfaces using laser fluorescence or visual assessment and µCT. METHODS A total of 107 extracted human teeth were included in the study. For the subsequent assessment, a clinical evaluation according to Ekstrand and Nyvad criteria, laser fluorescence measurements (DIAGNOdent-Pen©), and µCT imaging (Bruker Skyscan 1172) of the included root surfaces were performed. For cavitated lesions, the surface was reconstructed on µCT. Target parameters were: clinical appearance, laser fluorescence reading (0-99), and lesion depth in µm (µCT). The statistical analysis included chi² and Spearman-Rho tests. RESULTS Laser fluorescence values were significantly higher (p < 0.01) in leathery non-cavitated (median [IQR]: 73.50 [48.00]) and cavitated (88.50 [29.00]) surfaces than in hard intact surfaces (7.00 [35.00]). In addition, laser fluorescence values showed a significant correlation with lesion depth for non-cavitated surfaces (0.750; p < 0.01). Further statistically significant correlations were not detectable. Regression analysis showed that the laser fluorescence values increased with increasing demineralization depth (β: 0.648, CI95: 0.631-1.053; p < 0.01). CONCLUSION Laser fluorescence measured by DIAGNOdent© is a predictor for the depth of demineralization in carious root caries lesions with intact surfaces. Considering the limitations of this in vitro study, laser fluorescence is suitable for assessing the depth extent of (non-cavitated) root caries lesions and is a tool for clinical diagnosing and assessing the course of lesion development.
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Affiliation(s)
- Deborah Kreher
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, Leipzig 04103, Germany
| | - Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, Leipzig 04103, Germany
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, Leipzig 04103, Germany
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, Leipzig 04103, Germany.
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Kreher D, Korn V, Meißner T, Haak R, Schmalz G, Ziebolz D. How do carious root lesions develop after the end of professional preventive measures?—Preliminary findings of a randomized clinical trial. Odontology 2022; 110:805-813. [PMID: 35410411 PMCID: PMC9463297 DOI: 10.1007/s10266-022-00706-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/21/2022] [Indexed: 12/04/2022]
Abstract
Aim of this randomized clinical trial was to assess the development of root caries lesions with and without (adjuvant) professional prevention treatment over 24 months. 20 participants with two or three non-cavitated root carious lesions were included (n = 52), whereby lesions were randomly assigned to one out of three groups depending on varnish application (CF: Cervitec F [n = 20], P: placebo [n = 20], DP: Duraphate [n = 12]). All lesions were assessed by quantitative light-induced fluorescence (QLF; QRayCam); following outcome parameters were analyzed: fluorescence loss (ΔF %), lesion volume (ΔQ %µm2) and bacterial activity (ΔR %). Professional tooth cleaning and adjuvant varnish application were performed at baseline, after 3, 6, and 9 months. A follow-up examination was performed 1 year after preventive care with varnish application 24 months after baseline. ∆F showed a significant time effect in CF (p = 0.03), which was not confirmed in post hoc analysis (p > 0.05). For P and DP, no time effect was detected (p > 0.05). ∆Q was significantly higher 12 months after baseline in CF (p = 0.02). In P, a significant time effect occurred (p = 0.01), without significant results in post hoc testing. ∆R showed higher values at baseline vs. 12 months in CF (p = 0.03) and 24 months compared to 12 months in DP (p = 0.02). Professional preventive treatment inhibited the progression of root caries lesions beyond their termination for 12 months, irrespective of an adjunctive varnish application. Preventive measures have a long-term effect on root carious lesions, even 1 year after their termination.
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Affiliation(s)
- Deborah Kreher
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Viktoria Korn
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Thomas Meißner
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany.
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Schiffner U. [Use of fluorides for caries prevention]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:830-837. [PMID: 34115151 PMCID: PMC8241667 DOI: 10.1007/s00103-021-03347-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/30/2021] [Indexed: 11/18/2022]
Abstract
Seit wenigen Jahrzehnten ist in Deutschland ein Rückgang der Karieslast in allen Altersgruppen feststellbar. Hierfür wird die regelmäßige Anwendung von Fluoridpräparaten als wesentliche Ursache beschrieben. Es gilt als gesichert, dass für den Rückgang der Kariesprävalenz und Karieserfahrung die lokale Fluoridapplikation, insbesondere durch fluoridhaltige Zahnpasten und Fluoridlacke, auf die Zahnoberflächen in der Mundhöhle verantwortlich ist. Für die klinische Gesamtwirkung wurden einzelne Wirkungsmechanismen wie die Bildung einer Fluoridspeicherschicht, die Remineralisation sowie Effekte auf die bakterielle Plaque bestimmt. Diese Einzeleffekte können an Schmelz und Wurzeldentin bei Patienten jeden Alters wirksam werden. Dabei besteht eine Dosis-Wirkungs-Beziehung zwischen der Fluoridkonzentration in den angewendeten Präparaten und der durchschnittlich erzielten Kariesreduktion. Es bestehen keine allgemeintoxikologischen Bedenken gegenüber der lokalen Fluoridanwendung. Fluoridzahnpasten sollen ab Durchbruch des ersten Milchzahns verwendet werden. Die Menge der verwendeten Zahnpasta ist auf die empfohlenen Volumina zu begrenzen, um die Entstehung von Schmelzfluorosen zu vermeiden. Die professionell durchgeführte Applikation von hochkonzentrierten Fluoridlacken weist neben einer hohen karieshemmenden Effektivität auch bei erhöhtem Kariesrisiko und bei bereits vorhandenen Demineralisationen besondere Vorteile auf. Dies trifft auch für die Anwendung am Wurzeldentin zu, wo durch Verwendung hochkonzentrierter Fluoridpräparate signifikante primär- und sekundärpräventive Effekte nachgewiesen wurden.
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Affiliation(s)
- Ulrich Schiffner
- Zentrum für Zahn‑, Mund- und Kieferheilkunde, Poliklinik für Parodontologie, Präventive Zahnmedizin und Zahnerhaltung, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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Schwendicke F, Müller A, Seifert T, Jeggle-Engbert LM, Paris S, Göstemeyer G. Glass hybrid versus composite for non-carious cervical lesions: Survival, restoration quality and costs in randomized controlled trial after 3 years. J Dent 2021; 110:103689. [PMID: 33979577 DOI: 10.1016/j.jdent.2021.103689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/02/2021] [Accepted: 05/05/2021] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE This study compared survival, restoration quality and costs of glass hybrid (GH; EQUIA Forte Fil/EQUIA Forte Coat) and resin composite restorations (RC; OptiBond FL/Filtek Supreme XTE) of sclerotic non-carious cervical lesions. METHODS This is a cluster-randomized trial (ClinicalTrials.gov: NCT02631161). 88 patients (50-70 years) with 175 sNCCLs were randomized to receive GH or RC. Restorations were placed without mechanical cavity preparation and followed for a mean 36 (min/max: 31/55) months (variable follow-up due to COVID-19 lockdown). Restoration quality was re-evaluated at 1-, 18- and 36-months using FDI-criteria. Survival was assessed using multi-level Cox-regression analysis. Costs were estimated from a payer's perspective in Germany. Initial costs were determined based on micro-costing using time recordings and hourly costs, and follow-up costs based on statutory insurance fee-item-catalogues. RESULTS 88 patients (175 restorations) were treated; 43 received GH (83 restorations), 45 RC (92 restorations). 17 GH and 19 RC showed total retention loss, 5 GH were partially lost (p = 0.396/Cox). FDI ratings were not sufficiently different for any domain except surface luster, where RC showed higher score (p < 0.001). Costs were initially lower for GH (32.57; SD 16.36 €) than RC (44.25; SD 21.40 €), while re-treatment costs were similar (GH: 9.15; SD 15.70 €; RC: 7.35; SD 14.51 €), resulting in significantly lower costs for GH (GH: 41.72; SD 25.08 €) than RC (51.60; 26.17 €) (p < 0.001/GLM). CONCLUSIONS While survival was not significantly different, GH was significantly less costly both initially and long-term than RC for restoring non-carious cervical lesions. CLINICAL SIGNIFICANCE Within this trial, survival was not significantly different between GH and RC to restore sclerotic NCCLs. As GH was significantly less costly both initially and long-term than RC, using RC was only cost-effective for payers willing to invest high additional expenses per minimal survival gains.
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Affiliation(s)
- Falk Schwendicke
- Department of Oral Diagnostics, Digital Health, Health Services Research, Charité - Universitätsmedizin Berlin, Germany.
| | - Anne Müller
- Department of Oral Diagnostics, Digital Health, Health Services Research, Charité - Universitätsmedizin Berlin, Germany
| | - Tilmann Seifert
- Department of Periodontology, Oral Medicine and Oral Surgery, Charité - Universitätsmedizin Berlin, Germany
| | | | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany
| | - Gerd Göstemeyer
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany
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Göstemeyer G, Woike H, Paris S, Schwendicke F, Schlafer S. Root Caries Preventive Effect of Varnishes Containing Fluoride or Fluoride + Chlorhexidine/Cetylpyridinium Chloride In Vitro. Microorganisms 2021; 9:microorganisms9040737. [PMID: 33916105 PMCID: PMC8065905 DOI: 10.3390/microorganisms9040737] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/08/2021] [Accepted: 03/31/2021] [Indexed: 11/23/2022] Open
Abstract
Caries preventive varnishes containing only fluoride might differ from those containing a combination of fluoride and antimicrobial components in terms of mineralization properties and their impact on the cariogenic biofilm. We compared a fluoride and a fluoride + chlorhexidine (CHX)/cetylpyridinium chloride (CPC) varnish on root caries formation in vitro. One hundred bovine root dentin samples were allocated to five groups (n = 20/group): (1) 7700 ppm fluoride varnish (Fluorprotector S (F)), (2) experimental placebo varnish for F (F-P), (3) 1400 ppm fluoride + 0.3% CHX/0.5% CPC varnish (Cervitec F (CF)), (4) experimental placebo varnish for CF (CF-P), (5) untreated control. Cariogenic challenge was provided using a multi-station, continuous-culture 3-species (Streptococcus mutans (SM), Lactobacillus rhamnosus (LR), Actinomyces naeslundii (AN)) biofilm model for 10 days. Mineral loss (ΔZ) was evaluated using transversal microradiography and bacterial counts in the biofilm assessed as colony-forming units. Fluorescence in situ hybridization (FISH) and confocal microscopy were performed to assess the three-dimensional biofilm architecture. Mean ± SD (vol% × μm) ΔZ was significantly lower for F (9133 ± 758) and CF (9835 ± 1677) compared to control (11362 ± 919) (p < 0.05), without significant differences between F and CF. SM counts were significantly lower and LR counts significantly higher in F- and CF-biofilms compared to control. AN counts were significantly higher in the F-biofilms than in all other groups. According to FISH, SM and LR invaded dentinal tubules only in the control-group. In the CF-group, the basal biofilm layer did not contain SM and AN. Both F and CF varnishes had similar caries-preventive effects and a considerable impact on biofilm structure and composition.
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Affiliation(s)
- Gerd Göstemeyer
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany; (H.W.); (S.P.)
- Correspondence: ; Tel.: +49-30-450-562-328
| | - Helen Woike
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany; (H.W.); (S.P.)
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany; (H.W.); (S.P.)
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany;
| | - Sebastian Schlafer
- Section for Oral Ecology and Caries Control, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark;
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Abstract
BACKGROUND Root caries is a well-recognised disease, with increasing prevalence as populations age and retain more of their natural teeth into later life. Like coronal caries, root caries can be associated with pain, discomfort, tooth loss, and contribute significantly to poorer oral health-related quality of life in the elderly. Supplementing the visual-tactile examination could prove beneficial in improving the accuracy of early detection and diagnosis. The detection of root caries lesions at an early stage in the disease continuum can inform diagnosis and lead to targeted preventive therapies and lesion arrest. OBJECTIVES To assess the diagnostic test accuracy of index tests for the detection and diagnosis of root caries in adults, used alone or in combination with other tests. SEARCH METHODS Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 31 December 2018); Embase Ovid (1980 to 31 December 2018); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 31 December 2018); and the World Health Organization International Clinical Trials Registry Platform (to 31 December 2018). We studied reference lists as well as published systematic review articles. SELECTION CRITERIA We included diagnostic accuracy study designs that compared one or more index tests (laser fluorescence, radiographs, visual examination, electronic caries monitor (ECM), transillumination), either independently or in combination, with a reference standard. This included prospective studies that evaluated the diagnostic accuracy of single index tests and studies that directly compared two or more index tests. In vitro and in vivo studies were eligible for inclusion but studies that artificially created carious lesions were excluded. DATA COLLECTION AND ANALYSIS Two review authors extracted data independently and in duplicate using a standardised data extraction and quality assessment form based on the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) specific to the review context. Estimates of diagnostic test accuracy were expressed as sensitivity and specificity with 95% confidence intervals (CI) for each dataset. We planned to use hierarchical models for data synthesis and explore potential sources of heterogeneity through meta-regression. MAIN RESULTS Four cross-sectional diagnostic test accuracy studies providing eight datasets with data from 4997 root surfaces were analysed. Two in vitro studies evaluated secondary root caries lesions on extracted teeth and two in vivo studies evaluated primary root caries lesions within the oral cavity. Four studies evaluated laser fluorescence and reported estimates of sensitivity ranging from 0.50 to 0.81 and specificity ranging from 0.40 to 0.80. Two studies evaluated radiographs and reported estimates of sensitivity ranging from 0.40 to 0.63 and specificity ranging from 0.31 to 0.80. One study evaluated visual examination and reported sensitivity of 0.75 (95% CI 0.48 to 0.93) and specificity of 0.38 (95% CI 0.14 to 0.68). One study evaluated the accuracy of radiograph and visual examination in combination and reported sensitivity of 0.81 (95% CI 0.54 to 0.96) and specificity of 0.54 (95% CI 0.25 to 0.81). Given the small number of studies and important differences in the clinical and methodological characteristics of the studies we were unable to pool the results. Consequently, we were unable to formally evaluate the comparative accuracy of the different tests considered in this review. Using QUADAS-2 we judged all four studies to be at overall high risk of bias, but only two to have applicability concerns (patient selection domain). Reasons included bias in the selection process, use of post hoc (data driven) positivity thresholds, use of an imperfect reference standard, and use of extracted teeth. We downgraded the certainty of the evidence due to study limitations and serious imprecision of the results (downgraded two levels), and judged the certainty of the evidence to be very low. AUTHORS' CONCLUSIONS Visual-tactile examination is the mainstay of root caries detection and diagnosis; however, due to the paucity of the evidence base and the very low certainty of the evidence we were unable to determine the additional benefit of adjunctive diagnostic tests for the detection and diagnosis of root caries.
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Affiliation(s)
- Patrick A Fee
- Dundee Dental School, University of Dundee, Dundee, UK
| | - Richard Macey
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Janet E Clarkson
- Division of Oral Health Sciences, Dundee Dental School, University of Dundee, Dundee, UK
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11
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Schwendicke F, Krois J, Jordan R. Can We Predict Usage of Dental Services? An Analysis from Germany 2000 to 2015. JDR Clin Trans Res 2020; 5:349-357. [PMID: 32023133 PMCID: PMC7495688 DOI: 10.1177/2380084420904928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES We aimed to predict the usage of dental services in Germany from 2000 to 2015 based on epidemiologic and demographic data, and to compare these predictions against claims within the statutory health insurance. METHODS Indicators for operative (number of coronally decayed or filled teeth, root surface caries lesions, and fillings), prosthetic (number of missing teeth), and periodontal treatment needs (number of teeth with probing pocket depths (PPDs) ≥ 4 mm) from nationally representative German Oral Health Studies (1997, 2005, 2014) were cross-sectionally interpolated across age and time, and combined with year- and age-specific population estimates. These, as well as the number of children eligible for individual preventive services (aged 6 to 17 y), were adjusted for age- and time-specific insurance status and services' utilization to yield predicted usage of operative, prosthetic, periodontal, and preventive services. Cumulative annual usage in these 4 services groups were compared against aggregations of a total of 24 claims positions from the statutory German health insurance. RESULTS Morbidity, utilization, and demography were highly dynamic across age groups and over time. Despite improvements of individual oral health, predicted usage of dental services did not decrease over time, but increased mainly due to usage shifts from younger (shrinking) to older (growing) age groups. Predicted usage of operative services increased between 2000 and 2015 (from 52 million to 56 million, +7.8%); predictions largely agreed with claimed services (root mean square error [RMSE] 1.9 million services, error range -4.6/+3.8%). Prosthetic services increased (from 2.4 million to 2.6 million, +11.9%), with near perfect agreement to claimed data [RMSE 0.1 million services, error range -8.3/+3.9%]). Periodontal services also increased (from 21 million to 27 million, +25.9%; RMSE 5.2 million services, error range +21.9/+36.5%), as did preventive services (from 22 million to 27 million, +20.4%; RMSE 3 million, error range -13.7/-4.7%). CONCLUSION Predicting dental services seems viable when accounting for the joint dynamics of morbidity, utilization, and demographics. KNOWLEDGE TRANSFER STATEMENT Based on epidemiologic and demographic data, predicting usage of certain dental services is viable when accounting for the dynamics of morbidity, utilization, and demographics.
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Affiliation(s)
- F Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany
| | - J Krois
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany
| | - R Jordan
- Institute of German Dentists (IDZ), Cologne
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12
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Mulic A, Tveit AB, Stenhagen KR, Oscarson N, Staxrud F, Jönsson B. The frequency of enamel and dentin caries lesions among elderly Norwegians. Acta Odontol Scand 2020; 78:6-12. [PMID: 31267814 DOI: 10.1080/00016357.2019.1634283] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aim: To describe the distribution of enamel-, dentin-, root- and secondary caries within an elderly population in Northern-Norway.Material and methods: A study population (n = 1 173) was divided into age groups: 65-69 (seniors), 70-74 (young elderly), 75-79 (elderly) and 80-94 (old elderly). Seven examiners registered presence, location and severity of caries lesions on x-rays and intra-oral photos. Severity of approximal, occlusal, secondary and root caries was graded (D1-2: into enamel; D3-5: into dentin, root caries), and decayed missing filled surfaces/teeth (DMFS/DMFT) were calculated. T-test, ANOVA and a Bonferroni correction were used.Results: The seniors had more primary caries (DS1-5) compared to the oldest age groups, while the old elderly had significantly more secondary caries than the other groups (p < .05). Of those ≥65 years 13.8% were affected with root caries, 21% among the oldest. About 48% of the old elderly had one or more surfaces with untreated caries lesions into dentin, while for the other groups the number was 35% (p < 0.05).Conclusion: Individuals seem to maintain good oral health up to at least 80 years of age. Those older than 80 years have more root caries needing more intensified caries-controlling measures and a higher prevalence of untreated dentin lesions often in need of operative treatment.
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Affiliation(s)
- Aida Mulic
- Nordic Institute of Dental Materials, NIOM, Oslo, Norway
| | - Anne B. Tveit
- Public Dental Service Competence Centre of Northern Norway, TkNN, Tromsø, Norway
| | | | - Nils Oscarson
- Public Dental Service Competence Centre of Northern Norway, TkNN, Tromsø, Norway
| | - Frode Staxrud
- Nordic Institute of Dental Materials, NIOM, Oslo, Norway
| | - Birgitta Jönsson
- Public Dental Service Competence Centre of Northern Norway, TkNN, Tromsø, Norway
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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13
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Meyer-Lueckel H, Opdam NJM, Breschi L, Buchalla W, Ceballos L, Doméjean S, Federlin M, Field J, Gurgan S, Hayashi M, Laegreid T, Loomans BAC, Lussi A, Lynch CD, Pallesen U, Peumans M, Toth Z, Wilson NHF. EFCD Curriculum for undergraduate students in Integrated Conservative Oral Healthcare (ConsCare). Clin Oral Investig 2019; 23:3661-3670. [PMID: 31270666 DOI: 10.1007/s00784-019-02978-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- H Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
| | - N J M Opdam
- Radboud Institute for Health Sciences, Department of Dentistry, Radboud University Medical Center, P.O. Box 9101, 6500HB, Nijmegen, The Netherlands
| | - L Breschi
- Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna-Alma Mater Studiorum, Bologna, Italy
| | - W Buchalla
- Department for Conservative Dentistry and Periodontology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - L Ceballos
- Departamento de Medicina y Cirugía, Psicología, Medicina Preventiva y Salud Pública e Inmunología y Microbiología Médica y Enfermería y Estomatología, Universidad Rey Juan Carlos, Madrid, Spain
| | - S Doméjean
- Département Odontologie Conservatrice. CHU Estaing Clermont-Ferrand, Service d'Odontologie, 63001 Clermont-Ferrand, UFR d'Odontologie, Centre de Recherche en Odontologie Clinique EA 4847, University Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - M Federlin
- Department for Conservative Dentistry and Periodontology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - J Field
- School of Clinical Dentistry, The University of Sheffield, Sheffield, UK
| | - S Gurgan
- Faculty of Dentistry, Department of Restorative Dentistry, Hacettepe University, 06100, Ankara, Turkey
| | - M Hayashi
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadoka, Suita, Osaka, 565-0871, Japan
| | - T Laegreid
- Section of Cariology, Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Postboks 7804, 5020, Bergen, Norway
| | - B A C Loomans
- Radboud Institute for Health Sciences, Department of Dentistry, Radboud University Medical Center, P.O. Box 9101, 6500HB, Nijmegen, The Netherlands
| | - A Lussi
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - C D Lynch
- University Dental School & Hospital, University College, Cork, Ireland
| | - U Pallesen
- Section for Cariology and Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Nörre Alle 20, DK-2200, Copenhagen N, Denmark
| | - M Peumans
- Department of Oral Health Sciences, BIOMAT & UZ Leuven (University Hospitals Leuven), Dentistry, KU Leuven (University of Leuven), Kapucijnenvoer 7, B-3000, Leuven, Belgium
| | - Z Toth
- Department of Conservative Dentistry, Semmelweis University, Üllői út 26, Budapest, H-1085, Hungary
| | - N H F Wilson
- Emeritus Professor of Dentistry, King's College London, London, UK
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