Visual scoring of non cavitated caries lesions and clinical trial efficiency, testing xylitol in caries-active adults

Effect of xylitol tablets with and without red propolis on salivary parameters, dental biofilm and sensory acceptability of adolescents: a randomized crossover clinical trial

The effect of xylitol tablets with (XPT) and without (XT) red propolis on salivary parameters, dental biofilm and acceptability of adolescents was evaluated through a blinded randomized crossover clinical trial. Healthy volunteers were allocated in the XPT and XT groups with a 30-day washout period for consumption of two tablets/dayfor seven days. An increase in salivary parameters was only observed immediately after tablet consumption, without differences between XPT and XT. The results for total microorganisms were similar, but XT was better in controlling Streptococcus spp. Rothia dentocariosa and Streptococcus salivarius were the most frequent in the biofilm and saliva, respectively. XPT and XT showed similar acceptability, with the highest purchase intention for XT. Although propolis did not enhance the properties of XT, further studies testing different protocols and follow-up are necessary; XT controlled Streptococcus spp. in biofilms, which demonstrate its potential for clinical application.

Recent Advances in Dental Hard Tissue Remineralization: A Review of Literature

The dental caries is not simply a continuous and unidirectional process of the demineralization of the mineral phase, but a cyclic event with periods of demineralizations and remineralisation. The remineralization process is a natural repair mechanism to restore the minerals again, in ionic forms, to the hydroxyapatite (HAP) crystal lattice. It occurs under near-neutral physiological pH conditions whereby calcium and phosphate mineral ions are redeposited within the caries lesion from saliva and plaque fluid resulting in the formation of newer HAP crystals, which are larger and more resistant to acid dissolution. Numerous types of remineralizing agents and remineralizing techniques have been researched and many of them are being used clinically, with significantly predictable positive results. The recent researches on remineralization are based on biomimetic remineralization materials, having the capability to create apatite crystals within the completely demineralized collagen fibers.

How to cite this article

Arifa MK, Ephraim R, et al. Recent Advances in Dental Hard Tissue Remineralization: A Review of Literature. Int J Clin Pediatr Dent 2019;12(2):139-144.

The effect of base material composition on demineralization assessment in CPOCT dental imaging

Cross-polarization optical coherence tomography (CP-OCT) is a promising imaging modality to detect demineralization under the margins of composite restorations. The aim of this study was to assess how base materials applied under composite resin may affect CP-OCT image assessment. Base materials are commonly used for managing deep dentinal decay but once applied residual amounts of the base materials can be inadvertently left on the inner enamel walls. This study determined that base materials have significantly different scattering properties. The order grouping in the mean backscattered reflectivity (mR) of the base material was Dycal>caries phantom>Fuji IX, Vitrebond, Fuji II (p<0.05). The calcium hydroxide base (Dycal) had a higher mR than demineralized dentin and Vitrebond before and after the resin restoration was placed (p<0.05). While calcium hydroxide maybe a confounder in CPOCT imaging, several protective base materials are compatible with this type of imaging modality.

The dynamic behavior of the early dental caries lesion in caries-active adults and implications

OBJECTIVE

To describe the full range of behavior of the visible, noncavitated, early caries lesion in caries-active adults with substantial fluoride exposure, and to consider implications.

METHODS

The data were from the Xylitol for Adult Caries Trial (X-ACT) collected annually for 33 months using condensed ICDAS caries threshold criteria. Individual tooth surfaces having a noncavitated caries lesion were included, and the patterns of transition to each subsequent annual clinical examination to sound, noncavitated or cavitated, filled or crowned were determined. The resulting sets of patterns for an individual tooth surface, looking forward from its first appearance as a noncavitated lesion, were combined into one of four behavior profiles classified as reversing, stable, oscillating, or continuously progressing, or were excluded if not part of the caries continuum. The distributions of profile types were assessed using the Rao-Scott chi-square test, which adjusts for clustering of tooth surfaces within teeth.

RESULTS

Inter- and intra-examiner kappa scores demonstrated acceptable calibration at baseline and annually. 8084 tooth surfaces from 543 subjects were included. The distribution of profile types differed significantly between coronal and root surfaces. Overall, two-thirds of all coronal noncavitated lesions were first seen at baseline, half reversed, over a fifth were stable, 15% oscillated, and only 8.3% progressed to cavitation, filled, or crowned in 33 months or less (6.3% consistently Progressed plus 2.0% inconsistently, a subset of oscillating, which oscillated before progressing to cavitation). Approximal, smooth, and occlusal coronal surfaces each were significantly different in their individual distributions of profile types. Xylitol showed no significant and consistent effect on this distribution by tooth surface type. This was in keeping with the X-ACT's lack of effect of xylitol at the noncavitated plus cavitated lesion thresholds combined.

CONCLUSIONS

This study demonstrated the full dynamic range of early caries lesion behavior. The great majority were not progressive, and few (8.3%) became cavitated over 33 months in caries-active adults using fluorides. Important caries management implications favoring recorded longitudinal monitoring, prevention of active risks, and minimal restoration only after direct visual determination of cavitation are discussed.