Concepts of dental caries and their consequences for understanding the disease

Performance of low shrinkage Bis-EFMA based bulk-fill dental resin composites

OBJECTIVES

The purpose of this study was evaluating the performance of new Bis-EFMA based bulk-fill composites with common methacrylate based composites and commercial dental composites.

METHODS

The Bis-EFMA monomer was synthesized and the novel Bis-EFMA based bulk-fill composites were prepared. The resin composite samples were co-cultured with human gingival epithelial cells and human dental pulp stem cells to test the biocompatibility. The edge adaptation was observed under a combination of stereoscope and scanning electron microscope. The internal hardness was measured using a Vickers microhardness tester after one-time filling of cavities prepared in extracted teeth. After friction and wear test on the surface of the resin composites, the surface morphology and volume wear of each group were measured by the optical profilometer. The color stability was measured by a colorimeter.

RESULTS

Direct contact with human gingival epithelial cells and human dental pulp stem cells did not cause significant changes in their growth density and morphology, indicating good biocompatibility of Bis-EFMA group (p > 0.05). The continuous margin proportion of the Bis-EFMA group was as good as commercial bulk-fill composites (p > 0.05). The sectional microhardness results showed that the Bis-EFMA group had the highest microhardness. After the friction and wear test, the volume wear of the Bis-EFMA group was minimal, indicating its good wear resistance and mechanical strength. Color changes in all resin groups after 28 days of immersion were within the clinically acceptable range.

SIGNIFICANCE

The addition of Bis-EFMA demonstrated excellent biocompatibility, edge adaptation and color stability comparable to commonly used clinical bulk-fill composites, along with preferable mechanical strength, friction and wear resistance. Bis-EFMA based bulk-fill composites have the potential to be employed as a bulk filling material in commercial dental composite applications.

Determining the Failure Rate of Direct Restorations-Chart Review versus Electronic Health Record Reports

Amalgam and composite restorations are used to treat minor dental issues. University of Michigan, School of Dentistry Electronic Health Record (EHR) reports show a 2.31% failure rate for amalgam and 1.14% for composite. Our study aims to determine the true failure rates through manual EHR chart reviews. Patient data from the University of Michigan School of Dentistry were utilized-216 amalgam restorations from 2020 to 2022 and 350 composite restorations in 2021 were searched. We defined failure and retreatment as replacing a restoration with the same material and failure and alternate treatment as replacing restoration with an alternative treatment within one year. The failure rate refers to a combination of replacement with the same and alternative treatment material within one year. For Amalgam: 1.85% failed and were retreated; 7.87% failed and were received an alternate treatment. Composite: 9.71% failed and retreated; 2.86% failed and received alternate treatment. In total anterior composite: 10.5% retreated, 2.6% failed; posterior composite: 9.1% retreated, 3.0% failed. Our study revealed higher restoration failure rates than the reports extracted in the EHR. This highlights the need to foster a culture of precise documentation to align EHR reports with hand-search findings.

Diffusion of Silver Diamine Fluoride Solution in Dentine: An In Vitro Study

OBJECTIVES

The aim of this research was to assess the diffusion dynamics of silver and fluoride ions after 38% silver diamine fluoride (SDF) solution application on dentine of varying thicknesses over 24 weeks.

METHODS

Bovine dentine discs of 5.5 mm in diameter were prepared and separated into 3 groups with thicknesses of 0.5 mm (group 1), 1.0 mm (group 2), and 1.5 mm (group 3). The diameter and number of dentinal tubules of discs were assessed. Each disc received a topical application of 0.05 mL 38% SDF solution. The deionised water in the tube was collected weekly for 24 weeks. The silver and the fluoride ion concentrations in the collected deionised water were determined. Generalised estimating equations was used to explore the potential effects of the key factors on the silver/fluoride diffusion.

RESULTS

The amount of silver and fluoride ion diffusion through dentine almost levelled off after 4 weeks and showed a decline trend over 24 weeks. The mean (SD) 24-week cumulative ion diffusion through dentine in groups 1, 2, and 3 was as follows: 20 (4) μg, 10 (2) μg, and 5 (1) μg for silver (P < .05) and 18 (2) μg, 13 (2) μg, and 7 (1) μg for fluoride (P < .05), respectively.

CONCLUSIONS

Silver and fluoride ion diffusion through dentine showed a decline trend over 24 weeks. The diameter and the number of dentinal tubules on dentine with different thicknesses affects the ion diffusion dynamics. This study provides indications on the pattern of silver/fluoride ions diffusion through dentine to pulp after 38% SDF application. An increased amount of silver/fluoride diffuses through dentine into the pulp with decreased remaining dentine thickness.

Explorations of the chemical constitution and aqueous solution status of caries-arresting silver(I)-diammine fluoride and silver(I)-fluoride products using high-resolution 19F NMR analysis. Spectroscopic and SEM investigations of their interactions with human saliva: evidence for the in vivo salivary-catalysed autoconstruction of Ag/AgCl-based nanoparticles (IV-SCAN)-part I

Introduction

Silver(I)-diammine fluoride (SDF) and silver(I)-fluoride (SF) complexes have been successfully employed for the arrest of dental caries for many years. However, to date there are very few studies available reporting on the molecular structural compositional and solution status of these agents [typically applied as highly-concentrated 38% (w/v) solutions]. Here, we explored the solution status and chemical constitution of commercially-available SDF and SF products, and secondly investigated the multicomponent interplay of these products with biomolecules present in intact human whole-mouth salivary supernatants (WMSSs) in vitro.

Methods

High-resolution 19F NMR analysis was employed to explore SDF and SF product solutions, and to determine WMSS fluoride (F-) concentrations, whereas ammonia (NH3) release form SDF was tracked by 1H NMR spectroscopy. SEM and thin-film FTIR-ATR analyses were employed to explore the atomic and molecular compositions of sequentially-generated AgCl deposits and chromophoric Ag/AgCl nanoparticles (CSNPs); the time-dependent generation of the latter was followed spectrophotometrically.

Results

19F NMR spectra of aqueous SF solutions contained a very broad F- signal (Δv1/2 70 Hz), demonstrating that much of its solvated F- content was rapidly exchanging with Ag(I) on the NMR timescale, but those of SDF had a much sharper resonance, similar to that of "free" F- (4 Hz). Moreover, further NMR results revealed that a popular SDF product contained high molar excesses of both F- and NH3. Treatment of WMSSs with SDF and SF generated an off-white precipitate, which slowly developed into CSNPs at 23°C; SEM demonstrated high contents of both silver and chloride in this material (ca.1:1 atomic content ratio). FTIR-ATR analysis found that the CSNPs formed contained a range of salivary biomolecules, which appear to encapsulate the Ag/AgCl core (significant thiocyanate contents were also found). In conclusion, NMR results acquired demonstrated that SF, but not SDF, product solutions feature rapidly-exchanging F - between its "free" and Ag(I)-bound forms, and that SDF contains large excesses of both F- and its NH3 ligands. Characterised AgCl deposits and CSNPs were sequentially produced from the interactions of these complexes with WMSS biomolecules.

Discussion

In view of their well-known microbicidal and cariostatic properties, the observed autobioconstruction of CSNPs involving salivary catalysis is of much therapeutic significance.

Assessment of Physicochemical Characterization and Mineralization of Nanofibrous Scaffold Incorporated With Aspartic Acid for Dental Mineralization: An In Vitro Study

Aim The aim of this study was to assess the physicochemical characterization and mineralization of nanofibrous scaffold incorporated with nanohydroxyapatite (nHA) and aspartic acid (Asp) for dental mineralization.  Methodology Three nanofibrous scaffolds were prepared, namely polycaprolactone (PCL), PCL with nHA, and PCL with nHA and Asp. Each scaffold was prepared separately by electrospinning. The physicochemical characterization of the surface of the nanofibrous scaffold was imaged using a scanning electron microscope (SEM), energy dispersive X-ray Analysis (EDX), X-ray diffraction (XRD), and Fourier-transform infrared spectroscopy (FTIR). In vitro mineralization studies were performed by immersing the sample in simulated body fluid (SBF) for 7, 14, and 21 days. The surface of the samples was observed under SEM with EDX. Results SEM analysis of PCL/nHA/Asp revealed that the nanofibers were bead-free, smooth, randomly oriented, and loaded with Asp. The EDX spectra of PCL/nHA/Asp composite nanofibrous scaffold revealed broad peaks and corresponded to the amorphous form, while the sharp peaks corresponded to the specific crystalline structure of nHA. FTIR analysis showed specific functional groups corresponding to PCL, nHA, and Asp. The scaffolds incorporated with Asp exhibited higher mineralization potential with an apatite-like crystal formation, which increased with an increase in the duration of immersion in SBF. Conclusion Physiochemical characterization demonstrated the incorporation of PCL/nHA/Asp in the electrospun nanofibrous scaffold. The mineralization analysis revealed that the presence of Asp enhanced the mineralization when compared with the PCL and PCL/nHA. PCL/nHA/Asp incorporated in scaffold can be a promising material for dental mineralization.

Biomimetic Remineralization of Artificial Caries Lesions with a Calcium Coacervate, Its Components and Self-Assembling Peptide P11-4 In Vitro

The application of calcium coacervates (CCs) may hold promise for dental hard tissue remineralization. The aim of this study was to evaluate the effect of the infiltration of artificial enamel lesions with a CC and its single components including polyacrylic acid (PAA) compared to that of the self-assembling peptide P11-4 in a pH-cycling (pHC) model. Enamel specimens were prepared from bovine incisors, partly varnished, and stored in demineralizing solution (DS; pH 4.95; 17 d) to create two enamel lesions per sample. The specimens were randomly allocated to six groups (n = 15). While one lesion per specimen served as the no-treatment control (NTC), another lesion (treatment, T) was etched (H3PO4, 5 s), air-dried and subsequently infiltrated for 10 min with either a CC (10 mg/mL PAA, 50 mM CaCl2 (Ca) and 1 M K2HPO4 (PO4)) (groups CC and CC + DS) or its components PAA, Ca or PO4. As a commercial control, the self-assembling peptide P11-4 (CurodontTM Repair, Credentis, Switzerland) was tested. The specimens were cut perpendicularly to the lesions, with half serving as the baseline (BL) while the other half was exposed to either a demineralization solution for 20 d (pH 4.95; group CC + DS) or pHC for 28 d (pH 4.95, 3 h; pH 7, 21 h; all five of the other groups). The difference in integrated mineral loss between the lesions at BL and after the DS or pHC, respectively, was analyzed using transversal microradiography (ΔΔZ = ΔZpHC - ΔZbaseline). Compared to the NTC, the mineral gain in the T group was significantly higher in the CC + DS, CC and PAA (p < 0.05, Wilcoxon). In all of the other groups, no significant differences between treated and untreated lesions were detected (p > 0.05). Infiltration with the CC and PAA resulted in a consistent mineral gain throughout the lesion body. The CC as well as its component PAA alone promoted the remineralization of artificial caries lesions in the tested pHC model. Infiltration with PAA further resulted in mineral gain in deeper areas of the lesion body.

Effect of fluoridated water on invasive NHS dental treatments for adults: the LOTUS retrospective cohort study and economic evaluation

Background

Most water fluoridation studies were conducted on children before the widespread introduction of fluoride toothpastes. There is a lack of evidence that can be applied to contemporary populations, particularly adolescents and adults.

Objective

To pragmatically assess the clinical and cost effectiveness of water fluoridation for preventing dental treatment and improving oral health in a contemporary population of adults, using a natural experiment design.

Design

Retrospective cohort study using routinely collected National Health Service dental claims (FP17) data.

Setting

National Health Service primary dental care: general dental practices, prisons, community dental services, domiciliary settings, urgent/out-of-hours and specialised referral-only services.

Participants

Dental patients aged 12 years and over living in England (n = 6,370,280).

Intervention and comparison

Individuals exposed to drinking water with a fluoride concentration ≥ 0.7 mg F/l between 2010 and 2020 were matched to non-exposed individuals on key characteristics using propensity scores.

Outcome measures

Primary: number of National Health Service invasive dental treatments (restorations/'fillings' and extractions) received per person between 2010 and 2020. Secondary: decayed, missing and filled teeth, missing teeth, inequalities, cost effectiveness and return on investment.

Data sources

National Health Service Business Services Authority dental claims data. Water quality monitoring data.

Primary outcome

Predicted mean number of invasive dental treatments was 3% lower in the optimally fluoridated group than in the sub/non-optimally fluoridated group (incidence rate ratio 0.969, 95% CI 0.967 to 0.971), a difference of -0.173 invasive dental treatments (95% CI -0.185 to -0.161). This magnitude of effect is smaller than what most stakeholders we engaged with (n = 50/54) considered meaningful.

Secondary outcomes

Mean decayed, missing and filled teeth were 2% lower in the optimally fluoridated group, with a difference of -0.212 decayed, missing and filled teeth (95% CI -0.229 to -0.194). There was no statistically significant difference in the mean number of missing teeth per person (0.006, 95% CI -0.008 to 0.021). There was no compelling evidence that water fluoridation reduced social inequalities in treatments received or missing teeth; however, decayed, missing and filled teeth data did not demonstrate a typical inequalities gradient. Optimal water fluoridation in England in 2010-20 was estimated to cost £10.30 per person (excluding original setup costs). Mean National Health Service treatment costs for fluoridated patients 2010-20 were 5.5% lower per person, by £22.26 (95% CI -£23.09 to -£21.43), and patients paid £7.64 less in National Health Service dental charges per person (2020 prices).

Limitations

Pragmatic, observational study with potential for non-differential errors of misclassification in fluoridation assignment and outcome measurement and residual and/or unmeasured confounding. Decayed, missing and filled teeth data have not been validated. Water fluoridation cost estimates are based on existing programmes between 2010 and 2020, and therefore do not include the potentially significant capital investment required for new programmes.

Conclusions

Receipt of optimal water fluoridation between 2010 and 2020 resulted in very small health effects, which may not be meaningful for individuals, and we could find no evidence of a reduction in social inequalities. Existing water fluoridation programmes in England produced a positive return on investment between 2010 and 2020 due to slightly lower National Health Service treatment costs. These relatively small savings should be evaluated against the projected costs and lifespan of any proposed capital investment in water fluoridation, including new programmes.

Future work

National Health Service dental data are a valuable resource for research. Further validation and measures to improve quality and completeness are warranted.

Trial registrations

This trial is registered as ISRCTN96479279, CAG: 20/CAG/0072, IRAS: 20/NE/0144.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR128533) and is published in full in Public Health Research; Vol. 12, No. 5. See the NIHR Funding and Awards website for further award information.

Amount of Dentifrice and Fluoride Concentration Affect the pH and Inorganic Composition of Dual-Species Biofilms of Streptococcus mutans and Candida albicans

This work assessed the influence of the amount of dentifrice and fluoride (F) concentration in the product on the pH and inorganic components of Streptococcus mutans and Candida albicans dual-species biofilms. The biofilms were treated with suspensions of fluoride dentifrices containing 550 or 1100 ppm of F (550 F or 1100 F, respectively) administered at comparable intensities: (i-1) 550 F/0.08 g or 1100 F/0.04 g; (i-2) 550 F/0.16 g or 1100 F/0.08 g; and (i-3) 550 F/0.32 g or 1100 F/0.16 g. A placebo dentifrice (without NaF, 0.32 g) was used as a negative control. After the last treatment, the biofilm pH was measured and the F, calcium (Ca), and phosphorus (P) concentrations were determined. Data were subjected to an ANOVA/Kruskal-Wallis test, and a Student-Newman-Keuls test. The highest biofilm pH and F concentrations (biomass and fluid) were observed for 1100 F at i-3. Overall, 1100 F resulted in F levels similar to 550 F for i-1 and i-2. In addition, 550 F applied at i-2 and i-3 led to higher F in the biomass/fluid compared to 1100 F applied at i-1 and i-2, respectively. In biomass, the lowest Ca concentrations were observed for 1100 F at i-3. The conclusion drawn is that the treatment intensity holds greater significance as a parameter compared to the concentration of F or the amount of dentifrice when considered individually.

A comparative evaluation of fluoride release and rechargeability in conventional GIC (type II), pediatric GIC (type IX), and Cention-N: an in vitro study

PURPOSE

A comparative evaluation of fluoride release and re-chargeability in conventional glass ionomer cement (GIC) (type II), Pediatric GIC (type IX), and Cention-N-an in vitro study at an interval of first, fourteenth, and twenty first days.

METHODS

Three groups of test materials, each with twenty samples, were prepared. Measurements of the cumulative fluoride release [parts per million (ppm)] and re-release measured on the first, fourteenth, and twenty first days. Analysis of variance (ANOVA) was used to compare the means for different readings, and Tukey's post hoc analysis was used to compare each group with each other.

RESULTS

Initial and subsequent fluoride release of Cention-N at days one, fourteen, and twenty-one were all noticeably higher than those of conventional and pediatric GIC.

CONCLUSION

Compared to the Conventional and Pediatric GIC restorative materials, Cention-N was more effective in the initial and fluoride re-release.

Effect of calcium-coacervate infiltration of artificial enamel caries lesions in de- and remineralizing conditions

OBJECTIVES

Calcium-coacervate emulsions (CC) might be considered as mineral precursors to foster remineralization of carious dental hard tissues. This study analyzed the instant effect of repeated infiltration of artificial caries lesions with a CC emulsion as well as the effects of subsequent exposure of CC-infiltrated lesions to demineralizing and remineralizing environments.

METHODS

Bovine enamel specimens were partly covered with varnish to leave three exposed windows. Artificial enamel caries lesions were created (pH 4.95, 17d). Baseline controls (BL) were obtained by preparing a thin section of each specimen. Specimens were allocated to five groups. In three groups lesions were etched with 37 % phosphoric acid gel, infiltrated with dipotassium hydrogen phosphate and subsequently with a calcium coacervate emulsion, prepared by mixing CaCl2 ⋅ 2H2O with polyacrylic acid sodium salt (PAA-Na). Subsequently, the infiltration effect was either analyzed immediately (Inf.) or after exposition to either de- (Inf.+DS) or remineralizing solution (Inf.+RS) for 10 or 20 days, respectively. In two control groups specimens were exposed to either DS or RS, respectively without prior CC infiltration. Integrated mineral loss [ΔZ(vol%×µm)] was analyzed using transverse microradiography (TMR).

RESULTS

Infiltration of enamel caries lesions with coacervate solution resulted in only subtle immediate mineral gain even if repeated. When exposed to demineralizing conditions, infiltrated lesions showed significantly less mineral loss compared to untreated controls (p < 0.05; Kruskal Wallis) and exhibited characteristic mineral depositions within the lesion body.

CONCLUSIONS

While immediate mineral gain by infiltration was only modest, the CC-emulsion might be able to prevent demineralization in acidic conditions.

CLINICAL SIGNIFICANCE

Calcium coacervates might act protective against further demineralization when infiltrated into enamel caries lesions.

Biofilm volume and acidification within initial biofilms formed in situ on buccally and palatally exposed bracket material

PURPOSE

Acidification by bacterial biofilms at the bracket/tooth interface is one of the most common problems in fixed orthodontic treatments, which can lead to white spot lesions (WSL) and caries. As lingual brackets were shown to exhibit reduced WSL formation clinically, the aim of this in situ study was to compare initial intraoral biofilm formation and acidification on bracket-like specimens placed buccally and palatally in the upper jaw as a possible cause for this observation.

METHODS

Intraoral biofilm was collected from splints equipped with buccally and palatally exposed test specimens, which were worn by 12 volunteers for a total of 48 h. The test specimens consisted of standard bracket material cylinders on top of a hydroxyapatite disc to represent the bracket/tooth interface. They were analyzed for three-dimensional biofilm volume and live/dead distribution by fluorescence staining and confocal laser scanning microscopy as well as for acidification by fluorescence-based pH ratiometry.

RESULTS

Similar general biofilm morphology with regard to volume and viability could be detected for buccally and palatally exposed specimens. For pH values, biofilms from both positions showed increased acidification at the bottom layer. Interestingly, the pH value at the top layers of the biofilms was slightly lower on palatally than on buccally exposed specimens, which may likely be due to anatomic conditions.

CONCLUSION

Based on the results of this study, initial intraoral biofilm formation and acidification is almost similar on the bracket material/biomimetic tooth interface when placed buccally or palatally in the upper jaw. As lingual brackets were shown to exhibit reduced WSL formation clinically, future studies should investigate further factors like bracket geometry.

The fluorosis conundrum: bridging the gap between science and public health

Fluorosis, a chronic condition brought on by excessive fluoride ingestion which, has drawn much scientific attention and public health concern. It is a complex and multifaceted issue that affects millions of people worldwide. Despite decades of scientific research elucidating the causes, mechanisms, and prevention strategies for fluorosis, there remains a significant gap between scientific understanding and public health implementation. While the scientific community has made significant strides in understanding the etiology and prevention of fluorosis, effectively translating this knowledge into public health policies and practices remains challenging. This review explores the gap between scientific research on fluorosis and its practical implementation in public health initiatives. It suggests developing evidence-based guidelines for fluoride exposure and recommends comprehensive educational campaigns targeting the public and healthcare providers. Furthermore, it emphasizes the need for further research to fill the existing knowledge gaps and promote evidence-based decision-making. By fostering collaboration, communication, and evidence-based practices, policymakers, healthcare professionals, and the public can work together to implement preventive measures and mitigate the burden of fluorosis on affected communities. This review highlighted several vital strategies to bridge the gap between science and public health in the context of fluorosis. It emphasizes the importance of translating scientific evidence into actionable guidelines, raising public awareness about fluoride consumption, and promoting preventive measures at individual and community levels.

A Cross-Sectional Study of Oral Health Status and Behavioral Risk Indicators among Non-Smoking and Currently Smoking Lithuanian Adolescents

The purpose of this study was to evaluate oral health status, behavioral risk indicators, and the impact of smoking on oral health among Lithuanian adolescents. This representative cross-sectional study was conducted among 15-year-old Lithuanian adolescents. The method of multistage cluster sampling was used. A total of 1127 adolescents met the inclusion criteria. Two originally created self-reported questionnaires were used in this study. Dental caries, periodontal status, and oral hygiene status were evaluated by four trained researchers. A p-value ≤ 0.05 was set to indicate statistically significant differences. Statistical analysis included Mann-Whitney, Kruskal-Wallis, and Spearman correlation tests. Out of all the participants, 9.6% self-reported being a current tobacco smoker. The mean PI value was 1.14 ± 0.69 among all the participants. Currently smoking adolescents had more active caries lesions (D-S) than those who did not smoke (13.2 ± 16.4 vs. 9.8 ± 10.7, p = 0.023). Considering periodontal status, non-smoking adolescents had significantly lower mean PSR index scores than current smokers (0.52 ± 0.51 vs. 0.61 ± 0.50, p = 0.0298). Tobacco smoking and the consumption of energy drinks were significantly associated (OR = 3.74, 95% CI 2.66-5.26, p < 0.001) among participants. Currently smoking adolescents tended to have improper dietary habits, especially a higher consumption of energy drinks; thus, they were more likely to have active dental caries lesions, as well as poorer periodontal status, than their non-smoking peers.

Oral Health Interventions in Natural Disasters: A Scoping Review

OBJECTIVES

This work aimed to identify, appraise, and summarize existing knowledge about oral health interventions in the context of natural disasters and verify the main research gaps.

METHODS

We searched in PubMed (National Library of Medicine, Maryland, USA), EMBASE (Elsevier, Amsterdam, Netherlands) and Epistemonikos (Epistemonikos Foundation, Santiago, Chile) until 2021 for primary studies and systematic reviews, assessing any oral health intervention in the context of natural disasters. The interventions were classified according to Cochrane Effective Practice and Organization of Care (EPOC) categories, and the type of natural disaster was defined according to the classification by the Centre for Research on the Epidemiology of Disasters (CRED).

RESULTS

We assessed a total of 19 studies (majorly in Japan, n = 8), all performed in the context of an earthquake or mixed natural disasters (earthquake and tsunami). Regarding interventions, 12 studies reported a promotional/ preventive intervention, with oral examination being the most frequent. 7 studies reported therapeutic interventions, mainly related to emergency management of fractures and injuries.

CONCLUSIONS

The evidence accessed in our study was limited, highlighting the need for further research to focus on different oral health care interventions and outcomes in the context of different natural disasters, thus enhancing the formulation and implementation of recommendations and protocols worldwide.

Clinical Evaluation of Reasons for Replacement of Amalgam vs Composite Posterior Restorations

Background

The aim of the present study is to evaluate the most common reasons for replacing posterior amalgam and resin composite restorations in patients attending the university dental restorative clinics.

Methods

A total of 318 restorations which needed to be replaced were clinically and radiographically evaluated in a period of nine months. The frequencies of reasons for replacing posterior amalgam and resin composite restorations were calculated; secondary caries, restoration/tooth fracture, marginal discoloration/ditching, proximal overhang/open margin, loss of anatomy, pain/sensitivity, and esthetics.

Results

The sample population comprised of 191 females and 106 males. The majority of the sample population fell in the age group of 40-50 years (n = 110). 318 restorations (n = 318) were examined in this study. 82% of examined teeth were restored with amalgam (n = 261), while posterior composite restorations comprised 18% of the examined teeth (n = 57). Among all restorations demanded to be replaced by the patients (n = 318), aesthetic need was the most common reason (n = 98), followed by Ditching or discoloration (n = 64), secondary caries (n = 57), and fracture (n = 44). Loss of anatomy was the least common cause to replace both amalgam and resin composite restorations (n = 5). The different reasons of failure were all significant between amalgam and resin composite restorations as shown in (Fig. 1) (p < 0.005). The most common reason for amalgam replacement was aesthetic. The most common reason for composite replacement was secondary caries and marginal ditching.

Conclusion

Both amalgam and composite had different reasons for replacement. Amalgam had lesser risk of developing secondary caries and higher longevity than composite.

Association between asthma and oral conditions in children and adolescents: a systematic review with meta-analysis

OBJECTIVE

To investigate the association between asthma and oral conditions in children and adolescents.

MATERIAL AND METHODS

Observational studies that evaluated the association between asthma and oral conditions in children and/or adolescents were retrieved from five databases, grey literature and reference lists up to April 7^th, 2022. Meta-analyses were performed, and I² statistics were calculated. The mean difference was used as a measure of effect for continuous variables. Event frequencies were evaluated to determine odds ratios for dichotomous variables. Publication bias was investigated using Egger's test. The methodological quality (JBI) and certainty of the evidence (GRADE) were assessed.

RESULTS

Forty-two studies were eligible, and sixteen were included in the meta-analysis. Mean dmft (MD: 1.11, 95%CI: 0.48-1.73), DMFT (MD: 1.01, 95% CI: 0.45-1.56), dmfs (MD: 3.62, 95%CI: 2.60-4.63) and DMFS (MD: 4.47, 95%CI: 0.98-7.96) indices were significantly higher in asthmatic children and adolescents compared to those without asthma. In the analysis of biofilm, asthmatic children and adolescents had a higher Plaque Index compared to those without asthma (MD: 0.18, 95%CI: 0.03-0.33).

CONCLUSION

Asthmatic children and adolescents may be more likely to develop tooth decay and build up biofilm compared to those without asthma. It is suggested that there are no differences between asthmatic and non-asthmatic children and adolescents regarding gingivitis, developmental defects of enamel or erosive tooth wear. The certainty of the evidence was classified as 'very low'.

CLINICAL RELEVANCE

Knowledge of the risks that asthma and asthma medications for oral health can assist in counselling families of children and adolescents with this condition in terms of control and prevention measures for oral problems.

Comparison of Cariostatic and Remineralizing Potential of Two Commercial Silver Diamine Fluoride Preparations using Confocal Laser Microscopy and EDX-SEM Spectroscopy: An In Vitro study

Aim

To investigate the cariostatic and remineralizing effect of two commercial silver diamine fluoride (SDF) preparations on enamel and dentinal caries using a bacterial plaque model.

Materials and methods

A total of 32 extracted primary molars were divided into two groups (n = 16), group I (FAgamin), and group II (SDF). Plaque bacterial model was used to induce caries on enamel and dentin. Preoperative evaluation of samples was done using confocal laser microscopy (CLSM) and energy-dispersive X-ray spectroscopy-scanning electron microscope (EDX-SEM). All samples were treated with test materials and evaluated for postoperative remineralization quantification.

Results

Energy-dispersive X-ray spectroscopy (EDX) revealed that mean preoperative levels (in weight %) of silver (Ag) and fluoride (F2) in carious enamel lesions were 0.0 and 0.0, which increased postoperatively to 11.40 and 31.05 for FAgamin and 13.61 and 31.87 for SDF, respectively. For dentinal caries, EDX revealed mean preoperative levels (in weight %) of Ag and F2 were 0.0 and 0.0, which increased to 11.47 and 48.71 for FAgamin and 10.16 and 47.82 for SDF, respectively postoperatively. Both the groups showed evident demineralization with exposed collagen under SEM. The mean value of enamel lesion depth for the group I and II were 38.64 and 39.30 µm, that reduced to 28.02 and 28.70 µm while for dentinal caries, the mean depth from 38.05 and 38.29 µm that reduced significantly to 28.96 and 30.10 µm, respectively (p < 0.001). Caries depth declined significantly after the application of both FAgamin and SDF (p < 0.001).

Conclusion

FAgamin and SDF show similar cariostatic and remineralization potential for dental caries. The bacterial plaque model used in this study is an efficient method to induce artificial carious lesions in teeth.

Clinical significance

A comparative evaluation of these two cariostatic and remineralizing agents will aid in identifying the efficacy of both commercial products in treating initial caries lesions in an effective noninvasive and child-friendly manner.

How to cite this article

Kale YJ, Misal S, Dadpe MV, et al. Comparison of Cariostatic and Remineralizing Potential of Two Commercial Silver Diamine Fluoride Preparations using Confocal Laser Microscopy and EDX-SEM Spectroscopy: An In Vitro study. Int J Clin Pediatr Dent 2022;15(6):643-651.

Emissivity evaluation of human enamel and dentin

Background: Human enamel and dentin temperatures have been assessed with non-contact infrared imaging devices for safety and diagnostic capacity and require an emissivity parameter to enable absolute temperature measurements. Emissivity is a ratio of thermal energy emitted from an object of interest, compared to a perfect emitter at a given temperature and wavelength, being dependent on tissue composition, structure, and surface texture. Evaluating the emissivity of human enamel and dentin is varied in the literature and warrants review. The primary aim of this study was to evaluate the emissivity of the external and internal surface of human enamel and dentin, free from acquired or developmental defects, against a known reference point. The secondary aim was to assess the emissivity value of natural caries in enamel and dentin.

Method: Fourteen whole human molar teeth were paired within a thermally stable chamber at 30°C. Two additional teeth (one sound and one with natural occlusal caries–ICDAS caries score 4 and radiographic score RB4) were sliced and prepared as 1-mm-thick slices and placed on a hot plate at 30°C within the chamber. A 3M Scotch Super 33 + Black Vinyl Electrical Tape was used for the known emissivity reference-point of 0.96. All samples were allowed to reach thermal equilibrium, and a FLIR SC305 infrared camera recorded the warming sequence. Emissivity values were calculated using the Tape reference point and thermal camera software.

Results: The external enamel surface mean emissivity value was 0.96 (SD 0.01, 95% CI 0.96–0.97), whereas the internal enamel surface value was 0.97 (SD 0.01, 95% CI 0.96–0.98). The internal crown-dentin mean emissivity value was 0.94 (SD 0.02, 95% CI 0.92–0.95), whereas the internal root-dentin value was 0.93 (SD 0.02, 95% CI 0.91–0.94) and the surface root-dentin had a value of 0.84 (SD 0.04, 95% CI 0.77–0.91). The mean emissivity value of the internal enamel surface with caries was 0.82 (SD 0.05, 95% CI 0.38–1.25), and the value of the internal crown-dentin with caries was 0.73 (SD 0.08, 95% CI 0.54–0.92).

Conclusion: The emissivity values of sound enamel, both internal and external, were similar and higher than those of all sound dentin types in this study. Sound dentin emissivity values diminished from the crown to the root and root surface. The lowest emissivity values were recorded in caries lesions of both tissues. This methodology can improve emissivity acquisition for comparison of absolute temperatures between studies which evaluate thermal safety concerns during dental procedures and may offer a caries diagnostic aid.

Sustainable development goals and ending ECC as a public health crisis

Early Childhood Caries (ECC) remains a global issue despite numerous advancements in research and interventional approaches. Nearly, 530 million children suffer from untreated dental caries of primary teeth. The consequences of such untreated dental caries not only limit the child's chewing and eating abilities but also, significantly impact the child's overall growth. Research has demonstrated that ECC is associated with nearly 123 risk factors. ECC has also been associated with local pain, infections, abscesses, and sleep pattern. Furthermore, it can affect the child's emotional status and decrease their ability to learn or perform their usual activities. In high-income countries, dental care continues to endorse a "current treatment-based approach" that involves high-technology, interventionist, and specialized approaches. While such approaches provide immediate benefit at an individual level, it fails to intercept the underlying causes of the disease at large. In low-income and middle-income countries (LMICs), the "current treatment approach" often remains limited, unaffordable, and unsuitable for the majority of the population. Rather, dentistry needs to focus on "sustainable goals" and integrate dental care with the mainstream healthcare system and primary care services. Dental care systems should promote "early first dental visits," when the child is 1 year of age or when the first tooth arrives. The serious shortages of appropriately trained oral healthcare personnel in certain regions of the world, lack of appropriate technologies and isolation of oral health services from the health system, and limited adoption of prevention and oral health promotion can pose as critical barriers. The oral health care systems must focus on three major keystones to combat the burden of ECC-1. Essential oral health services are integrated into healthcare in every country ensuring the availability of appropriate healthcare accessible and available globally, 2. Integrating oral and general healthcare to effectively prevent and manage oral disease and improve oral health, 3. Collaborating with a wide range of health workers to deliver sustainable oral health care tailored to cater to the oral health care needs of local communities.

Comparative Evaluation of Cariostatic and Remineralizing Potential of Two Commercial Silver Diamine Fluoride Preparations Using Confocal Laser Microscopy and EDX-SEM Spectroscopy: An In Vitro Study

Aim

To investigate the cariostatic and remineralizing effect of two commercial silver diamine fluoride (SDF) preparations on enamel and dentinal caries using a plaque bacterial model.

Materials and methods

Thirty-two extracted primary molars were divided into two groups (n = 16) as group I (Advantage Arrest) and group II (e-SDF). Plaque bacterial model was used to induce caries on enamel and dentin. Preoperative evaluation of samples was done using confocal laser scanning microscopy (CLSM) and energy-dispersive X-ray spectroscopy-scanning electron microscope (EDX-SEM). All samples were treated with test materials and evaluated for postoperative remineralization quantification.

Results

EDX revealed that mean preoperative levels (in weight%) of silver (Ag) and fluoride (F) in enamel carious lesions were 0.0 and 0.0, which increased postoperatively to 11.40 and 31.05 for Advantage Arrest and 13.61 and 31.87 for e-SDF, respectively. For dentinal caries, EDX revealed mean preoperative levels (in weight%) of Ag and F were 0.0 and 0.0, which increased to 11.47 and 48.71 for Advantage Arrest and 10.16 and 47.82 for e-SDF, respectively postoperatively. Both groups showed evident demineralization with exposed collagen under SEM. The mean values of enamel lesion depth for the group I and II were 38.64 and 39.30 µm, that reduced to 28.02 and 28.70 µm, while for dentinal caries, the mean depth from 38.05 to 38.29 µm that reduced significantly to 28.96 and 30.10 µm, respectively (p < 0.001). Caries depth declined significantly after the application of both Advantage Arrest and e-SDF (p < 0.001).

Conclusion

Advantage arrest and e-SDF show similar cariostatic and remineralization potential for dental caries. The plaque bacterial model used in this study is an efficient method to induce artificial carious lesions in teeth.

How to cite this article

Kale YJ, Misal S, Dadpe M, et al. Comparative Evaluation of Cariostatic and Remineralizing Potential of Two Commercial Silver Diamine Fluoride Preparations Using Confocal Laser Microscopy and EDX-SEM Spectroscopy: An In Vitro Study. Int J Clin Pediatr Dent 2022;15(4):442-449.

Diagnostic accuracy, available treatment, and diagnostic methods of dental caries in practice: a meta-analysis

Background

Diagnosis of dental caries and identification of patients with dental caries is the biggest challenge in dentistry. For this diagnostic accuracy, several methods are studied. The present study attempts to re-study the published data in the last 50 years, between 1960 and 2020.

Main body

Based on designed keywords, we made a thorough search of 4 different databases and found 3887 articles after removing the duplicate. The included database was PubMed, Ovid, Web of Science, and Cochrane library. On keen screening of the articles, we included 19 articles in the review. All the articles were analyzed based on the Cochrane risk assessment method. Maximum studies of up to 80% of caries management are based on children from 1 to 10 years of age. About 47% of articles were found based on reported use of drugs against dental caries, whereas 52.6% of articles were based on the behavioral and socio-demographic study of the mother and caretakers. We found that attentive parents and caretakers of the children can help in reducing the prevention of caries. Frese et al. (Sci Rep. 8(1):16991, 2018. 10.1038/s41598-018-34777-x), Liu et al. (PLoS ONE 8(11):e78723, 2013. 10.1371/journal.pone.0078723), and Innes et al. J Dent Res 99(1):36–43, 2020. 10.1177/0022034519888882) were the studied articles with high quality and low bias risk. These methods were based on the use of stannous fluoride for dental caries, the study of the effect of smoking on older adults, by checking the anxiety level of the participants.

Short conclusions

Tooth decay is a common condition in the general population and affects mostly children. The method with high accuracy and low risk can be recommended for routine treatment.

Non-communicable Diseases and Oral Health: An Overview

Non-communicable diseases (NCDs) such as cardiovascular and metabolic diseases, diabetes, cancer and diseases of the oral cavity such as caries or periodontitis represent a global and highly relevant problem due to demographic and epidemiological changes. NCDs are not only responsible for millions of deaths worldwide, but they cause relevant costs for national economies arise for the health care of societies. Assuming that oral health and general health are directly linked, emerging interactions between systemic and oral diseases are increasingly being researched. Common important risk factors have implications for economic, social, and moral determinants of health. Interdisciplinarity trained oral health professionals are needed to address the excessively high rates of inequities in oral health. The main reason that oral diseases are still a global health problem is related to mainly individual subjective high-risk approaches, which resulting in high costs and low effectiveness. A paradigm shift for a public health approach is needed at population level that integrates different health professionals who deal with NCDs. Oral care, like physical activity, is one of the most important lifestyle-related determinants of health. Widespread recognition of this kind of approach is critical to both reducing the impact of oral and non-oral NCDs. A multi-sectoral, comprehensive and integrated strategy is therefore necessary. The focus should be on social, environmental and population strategies, but should also support individual strategies.

In vitro evaluation of EDTA combined with photodynamic therapy to reduce Streptococcus mutans in carious dentin

BACKGROUND

This in vitro study aimed to evaluate the use of EDTA combined with photodynamic therapy to reduce Streptococcus mutans in carious dentin.

METHODS

Sixty third molars were sectioned to obtain flat dentin surfaces. All specimens were waterproofed, except for the coronal dentin, and subjected to cariogenic challenge in brain-heart infusion (BHI) broth supplemented with 0.5% yeast extract, 1% glucose, 1% sucrose, and standard strain of S. mutans (ATCC 25175). The specimens were divided into 6 groups (n = 10 each): (1) control - caries collection; (2) EDTA - 17% EDTA was actively applied with a microbrush for 1 min; (3) aPDT - antimicrobial photodynamic therapy with 0.01% methylene blue photosensitizer (wavelength of 660 nm, energy of 4 J, power of 100 mW, spot size of 0.028 cm², energy density of 142 J/cm² for 40 s); (4) EDTA+aPDT - 17% EDTA actively applied for 1 min plus aPDT; (5) (EDTA+PT) + L - application of EDTA compounded with photosensitizer plus laser irradiation; and (6) PT - photosensitizer alone. Collection of caries was performed after the different cavity disinfection protocols. Aliquots from each dilution were seeded for colony-forming unit (CFU) counts. The results were log₁₀-transformed and analyzed by the Kruskal-Wallis test (Student-Newman-Keuls).

RESULTS

There was a significant reduction in S. mutans after aPDT (p<0.05), EDTA+aPDT (p<0.001), and (EDTA+PT) + L (p<0.001). The percentage of microbial reduction in ascending order was as follows: EDTA: 1.65%; PT: 15.51%; aPDT: 38.28%; EDTA+aPDT: 75.24%; and (EDTA+PT) + L: 97.35%.

CONCLUSION

Application of 17% EDTA prior to photosensitization or compounded with a photosensitizer increased the antimicrobial effect of aPDT on S. mutans in carious dentin.

Nitinol Type Alloys General Characteristics and Applications in Endodontics

A very extensive literature review presents the possibilities and needs of using, in endodontics, the alloys commonly known as nitinol. Nitinol, as the most modern group of engineering materials used to develop root canals, is equilibrium nickel and titanium alloys in terms of the elements’ atomic concentration, or very similar. The main audience of this paper is engineers, tool designers and manufacturers, PhD students, and students of materials and manufacturing engineering but this article can also certainly be used by dentists. The paper aims to present a full material science characterization of the structure and properties of nitinol alloys and to discuss all structural phenomena that determine the performance properties of these alloys, including those applied to manufacture the endodontic tools. The paper presents the selection of these alloys’ chemical composition and processing conditions and their importance in the endodontic treatment of teeth. The results of laboratory studies on the analysis of changes during the sterilization of endodontic instruments made of nitinol alloys are also included. The summary of all the literature analyses is an SWOT analysis of strengths, weaknesses, opportunities, and threats, and is a forecast of the development strategy of this material in a specific application such as endodontics.

Mesenchymal Stromal/Stem Cells-Derived Exosomes as an Antimicrobial Weapon for Orodental Infections

The oral cavity as the second most various microbial community in the body contains a broad spectrum of microorganisms which are known as the oral microbiome. The oral microbiome includes different types of microbes such as bacteria, fungi, viruses, and protozoa. Numerous factors can affect the equilibrium of the oral microbiome community which can eventually lead to orodental infectious diseases. Periodontitis, dental caries, oral leukoplakia, oral squamous cell carcinoma are some multifactorial infectious diseases in the oral cavity. In defending against infection, the immune system has an essential role. Depending on the speed and specificity of the reaction, immunity is divided into two different types which are named the innate and the adaptive responses but also there is much interaction between them. In these responses, different types of immune cells are present and recent evidence demonstrates that these cell types both within the innate and adaptive immune systems are capable of secreting some extracellular vesicles named exosomes which are involved in the response to infection. Exosomes are 30-150 nm lipid bilayer vesicles that consist of variant molecules, including proteins, lipids, and genetic materials and they have been associated with cell-to-cell communications. However, some kinds of exosomes can be effective on the pathogenicity of various microorganisms and promoting infections, and some other ones have antimicrobial and anti-infective functions in microbial diseases. These discrepancies in performance are due to the origin of the exosome. Exosomes can modulate the innate and specific immune responses of host cells by participating in antigen presentation for activation of immune cells and stimulating the release of inflammatory factors and the expression of immune molecules. Also, mesenchymal stromal/stem cells (MSCs)-derived exosomes participate in immunomodulation by different mechanisms. Ease of expansion and immunotherapeutic capabilities of MSCs, develop their applications in hundreds of clinical trials. Recently, it has been shown that cell-free therapies, like exosome therapies, by having more advantages than previous treatment methods are emerging as a promising strategy for the treatment of several diseases, in particular inflammatory conditions. In orodental infectious disease, exosomes can also play an important role by modulating immunoinflammatory responses. Therefore, MSCs-derived exosomes may have potential therapeutic effects to be a choice for controlling and treatment of orodental infectious diseases.

Antimicrobial agents in dental restorative materials: a on polymerization, short-term drug release and biological impact

With the aim to design bioactive dental restorative material, the present study investigated the influence of the antimicrobial agents chlorhexidine diacetate (CHX) and octinidine (di)hydrochloride (ODH) when incorporated in two different materials. Selected parameters were polymerization enthalpy, short-term drug release, and the effect on Streptococcus mutans as well as human gingival fibroblasts. Samples were made by mixing a nano-hybrid ormocer (O) and a methacrylate-based nano-hybrid composite (C), each with a mass fraction of 2% CHX or ODH. Release profiles and concentrations of active agents from the resins were assessed, and the cell proliferation of human gingival fibroblasts as well as Streptococcus mutans cultured with the eluates were evaluated. The influence on polymerization was assessed by means of differential scanning calorimetry. Both drugs, especially ODH, showed a decreasing effect on polymerization enthalpies associated with a lowered crosslinking degree. At the same time ODH appeared to be released more persistently than CHX. Moreover, ODH was more efficient with regard to bacteria growth inhibition but also more cytotoxic in terms of reduction of cell viability. ODH is deemed more appropriate for application in a dental resin-based drug delivery system, because of the more persistent drug release than seen for CHX.

From 'ICDAS' to 'CariesCare International': the 20-year journey building international consensus to take caries evidence into clinical practice

This paper charts the 20-year collaborative journey made by international teams of dental researchers, educators and practitioners. Following the initial development of the International Caries Detection and Assessment System (ICDAS) in 2002, the International Caries Classification and Management System (ICCMS) was collaboratively developed between 2010-2017 with several dental research and practice organisations, and influenced by best evidence judged via SIGN methodology, the UNEP Minamata Treaty (and linked phasing down of dental amalgam), three Dental Policy Labs and an international movement in operative dentistry to move towards minimally invasive dentistry. The FDI World Dental Federation publicised and advocated the ICCMS in 2019, when the 'CariesCare International' Consensus Guide and 4D caries management system was published to aid the delivery of ICCMS into practice. This system, which is designed to help practitioners deliver optimal caries care for patients, is now being adapted internationally for post-pandemic use in the 'Caries OUT' study. It is also being used as a vehicle for implementing the updated Delivering better oral health guidance on caries, as part of the minimum intervention oral healthcare delivery framework in the UK.

Development Strategy of Endodontic Filling Materials Based on Engineering and Medical Approaches

This article is a literature review aimed at presenting the general state of knowledge in manufacturing engineering and materials engineering to develop engineering materials applied for endodontic treatment as filling materials. Particular attention was paid to theoretical analyses concerning the selection of methods for developing and obturating root canals and discussing the results of experimental studies available in the literature. These activities aimed to compare the importance of the most commonly used endodontic filling materials based on gutta-percha or polymeric polyester materials, commonly known as resilon, respectively. The motivation to take up this complex, multi-faceted topic in this paper is the extent of caries, periodontal disease, and other oral diseases in 3 to 5 billion people, often affecting toothlessness and contributing to an increase in the index of disability-adjusted life years (number). Endodontics is an important element of the authors’ concept of Dentistry Sustainable Development (DSD) > 2020. The principles of qualifying patients for endodontic treatment are discussed. The introduction of rotary tools, especially manufactured from Nitinol alloy, to develop root canals and the latest thermohydraulic and condensation techniques for obturation guarantee progress in endodontics. The “Digital Twins” methodology was used, rooted in the idea of Industry 4.0 and the resulting idea of Dentistry 4.0, as well as knowledge management methods, to perform experimental research in virtual space, concerning methods of developing and obturating the root canal and assessing the tightness of fillings. Microscopic visualization methods were also used. Significant factors determining the effectiveness of endodontic obturation are the selection of the filling material and the appropriate obturation method. The generalized dendrological matrix of endodontic filling materials considers the criteria of mechanical strength influencing the potential root fracture and the quality of root canal filling. The results of the SWOT point analysis (strengths and weaknesses, opportunities, threats) were also compared. For both filling materials, the weaknesses are much less than the strengths, while the threats are slightly less than the opportunities for the gutta-percha-based material, while for resilon the opportunities are much smaller than the threats. It requires the application of an appropriate development strategy, i.e., MAXI-MAXI in the case of a filling material based on gutta-percha and MAXI-MINI in the case of resilon. Therefore, the analysis of these experimental data does not indicate the real competitiveness of resilon for the gutta-percha-based material. This material deservedly maintains its strong position as the “Gold Standard of Endodontics”.

What Are the Chances of Resilon to Dominate the Market Filling Materials for Endodontics?

This paper is a literature review with additional virtual analyses of the authors’ own experimental research results. Knowledge from various areas was synergistically combined, appropriately for concurrent engineering, presenting several possible methodological approaches used in research, optimizing the selection of engineering materials and the conditions of their application with particular application in endodontics. Particular attention was paid to the theoretical aspects of filling material strengths, weaknesses, opportunities, and threats SWOT analysis. Attention was paid to the original concepts of Sustainable Dentistry Development in conjunction with Dentistry 4.0, which includes endodontics as an important element. The dentists’ actions, among others, in conservative dentistry, along with endodontics, requires close cooperation with engineers and the enginering sciences. Methods of root canal preparation were described, together with selected tools, including those made of nitinol. Principles concerning the process of cleaning and shaping the pulp complex are presented. The importance of obturation methods, including the Thermo-Hydraulic-Condensation THC technique, and the selection of filling materials with the necessary sealants for the success of endodontic treatment are discussed. The experimental studies were carried out in vitro on human teeth removed for medical reasons, except for caries, for which two groups of 16 teeth were separated. After the root canal was prepared, it was filled with studs and pellets of a filling material based on polyester materials, which has gained the common trade name of resilon or, less frequently, RealSeal (SybronEndo) with an epiphany sealant. The teeth for the first group were obturated by cold lateral condensation. In the second case the obturation was performed using the Thermo-Hydraulic-Condensation technique using System B and Obtura III. The experimental leakage testing was done using a scanning electron microscope SEM and a light stereoscopic microscope LSM, as typical research tools used in materialography. The research results, in a confrontation with the data taken from the literature studies, do not indicate the domination of resilon in endodontics.

Is Gutta-Percha Still the “Gold Standard” among Filling Materials in Endodontic Treatment?

The paper is an extensive monographic review of the literature, and also uses the results of the authors’ own experimental research illustrating the noticed developmental tendencies of the filling material based on gutta-percha. The whole body of literature proves the correctness of the research thesis that this material is the best currently that can be used in endodontics. Caries is one of the most common global infectious diseases. Since the dawn of humankind, the consequence of the disease has been the loss of dentition over time through dental extractions. Both tooth caries and tooth loss cause numerous complications and systemic diseases, which have a serious impact on insurance systems and on the well-being, quality, and length of human life. Endodontic treatment, which has been developing since 1836, is an alternative to tooth extraction. Based on an extensive literature review, the methodology of qualifying patients for endodontic treatment was analyzed. The importance of selecting filling material and techniques for the development and obturation of the root canal during endodontic treatment was described. Particular attention was paid to the materials science aspects and the sequence of phase transformations and precipitation processes, as well as the need to ensure the stoichiometric chemical composition of Ni–Ti alloys, and the vacuum metallurgical processes and material processing technologies for the effects of shape memory and superelasticity, which determine the suitability of tools made of this alloy for endodontic purposes. The phenomena accompanying the sterilization of such tools, limiting the relatively small number of times of their use, play an important role. The methods of root canal preparation and obturation methods through cold side condensation and thermoplastic methods, including the most modern of them, the thermo-hydraulic condensation (THC) technique, were analyzed. An important element of the research hypothesis was to prove the assumption that to optimize the technology of development and obturation of root canals, tests of filling effectiveness are identified by the density and size of the gaps between the root canal wall, and the filling methods used and devices appropriate for material research, using mainly microscopy such as light stereoscopic (LSM) and scanning electron (SEM). The most beneficial preparations were obtained by making a longitudinal breakthrough of 48 natural human teeth, extracted for medical reasons, different from caries, with compliance with all ethical principles in this field. The teeth were prepared using various methods and filled with multiple obturation techniques, using a virtual selection of experimental variants. The breakthroughs were made in liquid nitrogen after a one-sided incision with a narrow gap created by a diamond disc using a materialographic cutter. The best effectiveness of the root canal filling was ensured by the technology of preparing the root canals with K3 rotary nitinol tools and filling the teeth with the THC thermoplastic method using the System B and Obtura III devices with studs and pellets of filling material based on gutta-percha after covering the root canal walls with a thin layer of AH Plus sealant. In this way, the research thesis was confirmed.

Effect of interdental cleaning devices on proximal caries

OBJECTIVES

To estimate the association between the use of interdental cleaning devices and proximal caries experience.

METHODS

This study used a cross-sectional data from the Sixth Korea National Health and Nutrition Examination Survey (2013-2015). A total of 13 525 adults aged 19-64 years who participated in both the nutrition survey and the health examination survey were included. Data on sociodemographic factors (age and sex), socioeconomic factors (level of education and household income) and personal health practices (frequency of toothbrushing, visits to dental clinic, frequency of snacking and self-rated oral health status), and number of proximal caries were collected. Prevalence ratios (PRs) and 95% confidence intervals (95% CI) were calculated using the multivariable Poisson generalized linear model according to use of dental floss or an interdental brush. The risk of proximal caries for dental floss following the stratification of participants into various subgroups related to oral health was assessed.

RESULTS

While nonflossers had 1.46 times (PR 1.46, 95% CI: 1.16-1.84) higher risk for proximal caries than flossers, the use of an interdental brush was not associated with proximal caries. In the nonflossers, the association for proximal caries was the strongest in those in their 40s (PR 2.28, 95% CI: 1.29-4.03), followed by those in their 30s (PR 1.85, 95% CI: 1.18-2.90). Although nonflossers with middle-low household income had a 59% higher risk (PR 1.59, 95% CI: 1.24-2.03) for proximal caries than those with high household income, there were no significant differences in household income in flossers.

CONCLUSIONS

The findings of the study suggest that flossing at home along with toothbrushing is one of the easiest ways to prevent proximal caries. Therefore, dental floss should not be excluded from oral healthcare products.

Caries lesion transition patterns of schoolchildren in a fluoridated community in Brazil

OBJECTIVE

To describe the caries lesion transition pattern in permanent tooth surfaces over 2 years among a convenience sample of children in a fluoridated (0.8 ppm F) low-socioeconomic community of Brazil.

MATERIAL AND METHODS

One hundred forty-nine schoolchildren (7-12 years) were examined for caries using Nyvad criteria at baseline and after 2 years. Descriptive analysis was used to evaluate caries lesion transition patterns.

RESULTS

Less than 1% of sound surfaces and non-cavitated caries lesions at baseline progressed to cavitation stage within 2 years. 12.7% of the active non-cavitated (ANC) lesions became inactive, 34.7% regressed to sound, 48.0% remained active, and 4.6% progressed to cavitated/filled stages at follow-up. Similarly, 55.2% of the inactive non-cavitated (INC) lesions at baseline remained inactive, 33.3% regressed to sound, 8.0% progressed to cavitated/filled lesions, while only 3.5% progressed to ANC lesions.

CONCLUSION

The caries lesion transition pattern in this child population exposed to water fluoride and fluoride toothpaste showed that a low proportion of sound surfaces and non-cavitated lesions progressed to cavitation within the 2-year follow-up. Caries arrest was mainly ascribed to a high proportion of active non-cavitated lesions regressing to sound or inactive lesions.

CLINICAL RELEVANCE

Caries activity can be controlled by regular exposure to fluoridated water and fluoridated toothpaste.

Detection Methods for Early Caries Diagnosis: A Systematic Review and Meta-Analysis

The aim was to appraise the evidence on the performance of various means for the detection of incipient caries in vivo. Five databases of published and unpublished research were searched for studies from January 2000 to October 2019. Search terms included "early caries" and "caries detection." Inclusion criteria involved diagnostic test accuracy studies for early caries detection in permanent and primary teeth. A risk-of-bias assessment was performed using the QUADAS-2 tool. We performed the study selection, data extraction, and risk-of-bias assessment in duplicate. The review protocol was a priori registered in the Open Science Framework. Of the initially 22,964 search results, 51 articles were included. For permanent teeth, when histologic examination was considered as the reference for occlusal surfaces, the sensitivity (Se) range appeared high for the DIAGNOdent Pen (DD Pen) at 0.81-0.89, followed by ICDAS-II at 0.62-1, DIAGNOdent (DD) at 0.48-1, and bitewing radiography (BW) at 0-0.29. The corresponding specificity (Sp) range was: DD Pen 0.71-0.8, ICDAS-II 0.5-0.84, DD 0.54-1, and BW 0.96-1. When operative intervention served as the reference for occlusal surfaces, again, the DD means valued the most promising results on Se: DD 0.7-0.96 and DD Pen 0.55-0.90, followed by ICDAS-II 0.25-0.93, and BW 0-0.83. The Sp range was: DD 0.54-1, DD Pen 0.71-1, ICDAS-II 0.44-1, and BW 0.6-1. For approximal surfaces, the Se was: BW 0.75-0.83, DD Pen 0.6, and ICDAS-II 0.54; the Sp was: BW 0.6-0.9, DD Pen 0.2, and ICDAS-II 1. For primary teeth, under the reference of histologic assessment, the Se range for occlusal surfaces was: DD 0.55-1, DD Pen 0.63-1, ICDAS-II 0.42-1, and BW 0.31-0.96; the respective Sp was: DD 0.5-1, DD Pen 0.44-1, ICDAS-II 0.61-1, and BW 0.79-0.98. For approximal surfaces, the Se range was: DD Pen 0.58-0.63, ICDAS-II 0.42-0.55, and BW 0.14-0.71. The corresponding Sp range was: DD Pen 0.85-0.87, ICDAS-II 0.73-0.93, and BW 0.79-0.98. Se and Sp values varied, due to the heterogeneity regarding the setting of individual studies. Evidently, robust conclusions cannot be drawn, and different diagnostic means should be used as adjuncts to clinical examination. In permanent teeth, visual examination may be enhanced by DD on occlusal surfaces and BW on approximal surfaces. In primary teeth, DD Pen may serve as a supplementary tool across all surfaces.

Virtual Approach to the Comparative Analysis of Biomaterials Used in Endodontic Treatment

The importance of endodontics is presented within our own concept of Dentistry Sustainable Development (DSD) consisting of three inseparable elements; i.e., Advanced Interventionist Dentistry 4.0 (AID 4.0), Global Dental Prevention (GDP), and the Dentistry Safety System (DSS) as a polemic, with the hypothesis of the need to abandon interventionist dentistry in favour of the domination of dental prevention. In view of the numerous systemic complications of caries that affect 3−5 billion people globally, endodontic treatment effectively counteracts them. Regardless of this, the prevention of oral diseases should be developed very widely, and in many countries dental care should reach the poorest sections of society. The materials and methods of clinical management in endodontic procedures are characterized. The progress in the field of filling materials and techniques for the development and obturation of root canals is presented. The endodontics market is forecast to reach USD 2.1 billion in 2026, with a CAGR of 4.1%. The most widely used and recognized material for filling root canals is gutta-percha, recognized as the “gold standard”. An alternative is a synthetic thermoplastic filler material based on polyester materials, known mainly under the trade name Resilon. There are still sceptical opinions about the need to replace gutta-percha with this synthetic material, and many dentists still believe that this material cannot compete with gutta-percha. The results of studies carried out so far do not allow for the formulation of a substantively and ethically unambiguous view that gutta-percha should be replaced with another material. There is still insufficient clinical evidence to formulate firm opinions in this regard. In essence, materials and technologies used in endodontics do not differ from other groups of materials, which justifies using material engineering methodology for their research. Therefore, a detailed methodological approach is presented to objectify the assessment of endodontic treatment. Theoretical analysis was carried out using the methods of procedural benchmarking and comparative analysis with the use of contextual matrices to virtually optimize the selection of materials, techniques for the development and obturation of root canals, and methods for assessing the effectiveness of filling, which methods are usually used, e.g., in management science, and especially in foresight research as part of knowledge management. The results of these analyses are presented in the form of appropriate context matrices. The full usefulness of the research on the effectiveness and tightness of root canal filling using scanning electron microscopy is indicated. The analysis results are a practical application of the so-called “digital twins” approach concerning the virtual comparative analysis of biomaterials used in endodontic treatment.

The predictive power of saliva electrolytes exceeds that of saliva microbiomes in diagnosing early childhood caries

Early childhood caries (ECC) is one of the most prevalent chronic diseases affecting children worldwide, and thus its etiology, diagnosis, and prognosis are of particular clinical significance. This study aims to test the ability of salivary microbiome and electrolytes in diagnosing ECC, and their interplays within the same population. We here simultaneously profiled salivary microbiome and biochemical components of 331 children (166 caries-free (H group) and 165 caries-active children (C group)) aged 4-6 years. We identified both salivary microbial and biochemical dysbiosis associated with ECC. Remarkably, K⁺, Cl^-, NH₄⁺, Na⁺, SO₄^2-, Ca²⁺, Mg²⁺, and Br^- were enriched while pH and NO₃^- were depleted in ECC. Moreover, the dmft index (ECC severity) positively correlated with Cl^-, NH₄⁺, Ca²⁺, Mg²⁺, Br^-, while negatively with pH and NO₃^-. Furthermore, machine-learning classification models were constructed based on these biomarkers from saliva microbiota, or electrolytes (and pH). Unexpectedly, the electrolyte-based classifier (AUROC = 0.94) outperformed microbiome-based (AUROC = 0.70) one and the composite-based one (with both microbial and biochemical data; AUC = 0.89) in predicting ECC. Collectively, these findings indicate ECC-associated alterations and interplays in the oral microbiota, electrolytes and pH, underscoring the necessity of developing diagnostic models with predictors from salivary electrolytes.

The Concept of Sustainable Development of Modern Dentistry

This paper concerns the assessment of the current state of dentistry in the world and the prospects of its sustainable development. A traditional Chinese censer was adopted as the pattern, with a strong and stable support on three legs. The dominant diseases of the oral cavity are caries and periodontal diseases, with the inevitable consequence of toothlessness. From the caries 3.5–5 billion people suffer. Moreover, each of these diseases has a wide influence on the development of systemic complications. The territorial range of these diseases and their significant differentiation in severity in different countries and their impact on disability-adjusted life years index are presented (DALY). Edentulousness has a significant impact on the oral health-related quality of life (OHRQoL). The etiology of these diseases is presented, as well as the preventive and therapeutic strategies undertaken as a result of modifying the Deming circle through the fives’ rules idea. The state of development of Dentistry 4.0 is an element of the current stage of the industrial revolution Industry 4.0 and the great achievements of modern dental engineering. Dental treatment examples from the authors’ own clinical practice are given. The systemic safety of a huge number of dentists in the world is discussed, in place of the passive strategy of using more and more advanced personal protective equipment (PPE), introducing our own strategy for the active prevention of the spread of pathogenic microorganisms, including SARS-CoV-2. The ethical aspects of dentists’ activity towards their own patients and the ethical obligations of the dentist community towards society are discussed in detail. This paper is a polemic arguing against the view presented by a group of eminent specialists in the middle of last year in The Lancet. It is impossible to disagree with these views when it comes to waiting for egalitarianism in dental care, increasing the scope of prevention and eliminating discrimination in this area on the basis of scarcity and poverty. The views on the discrimination of dentistry in relation to other branches of medicine are far more debatable. Therefore, relevant world statistics for other branches of medicine are presented. The authors of this paper do not agree with the thesis that interventional dental treatment can be replaced with properly implemented prophylaxis. The final remarks, therefore, present a discussion of the prospects for the development of dentistry based on three pillars, analogous to the traditional Chinese censer obtaining a stable balance thanks to its three legs. The Dentistry Sustainable Development (DSD) > 2020 model, consisting of Global Dental Prevention (GDP), Advanced Interventionist Dentistry 4.0 (AID 4.0), and Dentistry Safety System (DSS), is presented.

Bacterial levels and amount of endotoxins in carious dentin within reversible pulpitis scenarios

OBJECTIVES

the objective of the present exploratory study was to determine bacterial diversity and endotoxin levels in deep carious lesions of teeth presenting symptoms of reversible pulpitis.

MATERIALS AND METHODS

Twenty patients with deep carious lesions, reporting clinical symptomatology compatible with reversible pulpitis (n = 10) or not reporting clinical symptomatology (n = 10), were selected. Carious dentin samples were obtained with the aid of sterile and pyrogen-free spoon excavators and harvested in two steps: before and after infected dentin removal. Samples were collected for checkerboard and for kinetic chromogenic LAL assay for determination of microbial profile and quantitation of endotoxin, respectively. Data were analyzed by Mann Whitney for bacteria and two-way ANOVA for endotoxins (5%).

RESULTS

No difference on the studied bacteria was detected between the superficial and deep dentin layers. Symptomatic teeth showed greater presence of Lactobacillus species, Capnocytophaga sputigena, and Leptotrichia buccalis. For the endotoxins, symptomatic teeth resulted in greater quantity of endotoxins (p = 0.047), being 4.13 log₁₀ EU/mL/μg dentin and 3.45 log10 EU/mL/μg dentin, for symptomatic and asymptomatic teeth, respectively. Dentin collected in different areas presented similar number of endotoxins (p = 0.139).

CONCLUSION

The amount of the studied bacteria does not seem to be related to reported symptomatology of deep carious lesions, while endotoxins quantity is greater in symptomatic scenarios, regardless of the harvesting area.

CLINICAL RELEVANCE

The understanding of bacterial amount in reversible pulpitis is important to establish a clinical protocol of treatment.

Oral health in older adults

The UK population is rapidly ageing, and this is set to continue for many more years. Consequently, this projects a number of health problems and challenges that need to be addressed. Functional impairment and age-related diseases have a significant impact on oral health, leading to a poor quality of life. Dental diseases become more prevalent in older adults, partly as a result of their poor general health, medication side effects and, in some instances, due to limited access to good dental care. Healthcare staff should be aware of these problems and ensure that individuals are given the correct advice, care and treatment. This article outlines what is known about oral health among older adults and highlights some of the common health conditions that affect oral health status in this population. Community nurses are well placed to educate and empower older adults in maintaining good oral health.

Effect of arginine on microorganisms involved in dental caries: a systematic literature review of in vitro studies

This systematic review aimed to discuss the effects of arginine on caries-related microorganisms in different in vitro biofilm models. The eligibility criteria were in vitro studies that evaluated the effect of arginine at different concentrations on caries-related microorganisms using biofilm models. Eighteen studies published between 2012 and 2019 were included. Different bacterial species were studied. Seventeen studies (94.4%) achieved a low risk of bias and only one showed a medium risk of bias. The studies showed that arginine is a promising approach for the ecological management of dental caries. The focus of this review was to evaluate the effects of arginine on microorganisms involved in the mechanism of dental caries.

Does pre-irradiation time influence the efficacy of antimicrobial photodynamic therapy?

Antimicrobial photodynamic therapy (aPDT) has emerged as a promising antimicrobial treatment to control microorganisms including those involved in oral diseases, especially dental caries. Hence, the aim of this study was to evaluate the influence of aPDT - pre-irradiation time (PIT), at different periods, on antimicrobial rate of Streptococcus mutans (S. mutans). A standard suspension of S. mutans UA159 was prepared and submitted at sensitization of 0.005 % methylene blue (MB) for 0, 1, 3 and 5 min (G1 - G4 groups, respectively) and irradiated with a red laser (660 nm; 321 J/cm²; 9 J; 90 s) afterward. A control group using PBS instead of MB was performed as well (G5). The number of colony-forming units (CFU)/mL was recorded, transformed into log₁₀ and analyzed by ANOVA and Tukey's test at a cutoff value at 0.05. Overall, the aPDT groups tested achieved a bacterial reduction > 1-log₁₀ when compared to G5 (p < 0.05) with no statistical difference among the different PIT tested. The need of PIT before aPDT application deserves attention, since its time reduction implies on shorter clinical approaches without compromising the photodynamic antibacterial efficacy in the in vitro parameters employed.

General dental practitioners' approach to caries prevention in high-caries-risk children

AIMS

To evaluate the advice and preventive care provided by General Dental Practitioners (GDPs) to high-caries-risk children in Jordan.

METHODS

A cross-sectional study using an open-ended questionnaire. GDPs were presented with a high-caries-risk child scenario and asked regarding: (1) oral hygiene and dietary advice they would give; (2) preventive-care they would offer; (3) barriers they face in prevention delivery. Answers were compared to an evidence-based guideline. Data were input into SPSS-20 and analysed using descriptive statistics and frequencies. Chi-square test was used to compare results by age, gender, practice location and type.

RESULTS

One-hundred and sixty GDPs were approached and 128 agreed to participate (80%), of whom 87 (69%) were female. The average age was 31 years [range 22-50]. Sixty-nine percent practiced in the capital, Amman. Sixty-five percent gave advice on tooth-brushing frequency, but only 23% suggested brushing at bed-time and 24% recommended parental supervision. None provided advice on toothpaste fluoride content. Seventy-one percent advised reducing sugary-food amounts, but only 21% focused on frequency and 2% suggested using diet diaries. Most knew about fissure-sealants (77%) and fluoride-varnish (80%). Forty-two percent reported barriers to delivering preventive-care, including parental attitudes (36%), child cooperation (30%), financial reward (19%), and training (6%). Participants practicing outside of the capital were less likely to use fluoride-varnish [P = 0.002] and more likely to report barriers [P = 0.001].

CONCLUSIONS

Advice delivered by GDPs to high-caries-risk children in Jordan does not meet the standards of an evidence-based guideline. Future initiatives for oral-health-promotion should aim to address the barriers reported, especially outside the capital.

Characterization of a Type II-A CRISPR-Cas System in Streptococcus mutans

CRISPR-Cas is one of the mechanisms used by bacteria to defend against viral predation. Increasing our knowledge of the biology and diversity of CRISPR-Cas systems will also improve our understanding of virus-bacterium interactions. As CRISPR-Cas systems acquiring novel immunities under laboratory conditions are rare, Streptococcus mutans strain P42S provides an alternative model to study the adaptation step, which is still the least understood step in CRISPR-Cas biology. Furthermore, the availability of a natural Cas9 protein recognizing an AT-rich PAM opens up new avenues for genome editing purposes.

Streptococcus mutans and its virulent phages are important members of the human oral microbiota. S. mutans is also the primary causal agent of dental caries. To survive in this ecological niche, S. mutans must encode phage defense mechanisms, which include CRISPR-Cas systems. Here, we describe the CRISPR-Cas type II-A system of S. mutans strain P42S, which was found to display natural adaptation and interference activity in response to phage infection and plasmid transformation. Newly acquired spacers were integrated both at the 5′ end of the CRISPR locus and ectopically. In comparisons of the cas genes of P42S to those of other strains of S. mutans, cas1, cas2, and csn2 appear to be highly conserved within the species. However, more diversity was observed with cas9. While the nuclease domains of S. mutans Cas9 (SmCas9) are conserved, the C terminus of the protein, including the protospacer adjacent motif (PAM) recognition domain, is less conserved. In support of these findings, we experimentally demonstrated that the PAMs associated with SmCas9 of strain P42S are NAA and NGAA. These PAMs are different from those previously reported for the CRISPR-Cas system of the model strain S. mutans UA159. This study illustrates the diversity of CRISPR-Cas type II-A systems that can be found within the same bacterial species.

IMPORTANCE CRISPR-Cas is one of the mechanisms used by bacteria to defend against viral predation. Increasing our knowledge of the biology and diversity of CRISPR-Cas systems will also improve our understanding of virus-bacterium interactions. As CRISPR-Cas systems acquiring novel immunities under laboratory conditions are rare, Streptococcus mutans strain P42S provides an alternative model to study the adaptation step, which is still the least understood step in CRISPR-Cas biology. Furthermore, the availability of a natural Cas9 protein recognizing an AT-rich PAM opens up new avenues for genome editing purposes.

Comparison of the Antimicrobial Activity of Hibiscus sabdariffa Calyx Extracts, Six Commercial Types of Mouthwashes, and Chlorhexidine on Oral Pathogenic Bacteria, and the Effect of Hibiscus sabdariffa Extracts and Chlorhexidine on Permeability of the Bacterial Membrane

To determine and compare the antimicrobial effect of Hibiscus sabdariffa calyx extracts, six types of commercial mouthwashes, and chlorhexidine on Streptococcus mutans, Streptococcus sanguinis, Capnocytophaga gingivalis, and Staphylococcus aureus. Two varieties of H. sabdariffa cultivated in Mexico were used. Aqueous, methanolic, ethanolic, acetonic, and ethyl acetate extracts were obtained from H. sabdariffa calyces. Six different types of mouthwash (Astringosol^®, Colgate plax-ice-infinity^®, Crest pro-health^®, Dental max^®, Equate^®, and Listerine zero^®) and chlorhexidine (0.12%) were purchased at a pharmacy. The antimicrobial activity of the H. sabdariffa calyx extracts, mouthwashes, and chlorhexidine was determined by the agar disc diffusion technique. The minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) of all solutions were determined by the broth dilution method and the pour plate technique, respectively. Also, the effect of H. sabdariffa extracts and chlorhexidine on permeability of the bacterial membrane was determined by the violet crystal assay. All H. sabdariffa calyx extracts and chlorhexidine showed antibacterial activity against all oral pathogenic bacteria. The mouthwashes showed lower antibacterial effect than H. sabdariffa extracts and chlorhexidine. Dental max showed no antibacterial effect. The MICs and MBCs, respectively, for H. sabdariffa extracts were between 5-20 and 10-20 mg/mL; and for chlorhexidine, between 3-4 and 3-5 mg/mL. For the Listerine^®, the MIC and MBC values were between 20-25 and 25-33 mg/mL, respectively. The results of the crystal violet test indicate that H. sabdariffa calyx extracts and chlorhexidine alter the permeability of the bacterial membrane. All H. sabdariffa extracts and chlorhexidine showed significantly greater antimicrobial effect than mouthwashes. This is the first report in which the antimicrobial effect of the H. sabdariffa calyx extracts, mouthwashes, and chlorhexidine is compared.

Estimation of Caries Treatment Needs in First Permanent Molars of Lithuanian 5-6-Year-Old Children, Based on Caries Lesion Activity Assessment

Background and Objectives: Early detection of dental caries lesions at active stages of development can facilitate their monitoring and reduce needs for restorative dental care. This study aimed to describe the prevalence and caries treatment needs in first permanent molars of pre-school children, based on a caries lesion activity assessment, and in relation to participants’ ages, dental plaque levels and toothbrushing habits. Materials and Methods: Large cross-sectional dental caries survey using multistage cluster sampling was conducted among Lithuanian 4–6-year-old children attending kindergartens. For the present study purpose, all individuals presenting erupted permanent molars were selected. Thus, only 5–6-year-olds (n = 453) took part in this study. They were examined for caries by one calibrated examiner using Nyvad clinical diagnostic criteria that differentiate between active and inactive caries lesions. Dental plaque was assessed by the Silness-Löe index, and parents’ reports about toothbrushing frequency were collected. Results: Overall, 41% of permanent molars were affected by caries; 6-year-olds had more caries lesions than 5-year-olds (p < 0.05). Mean number of decayed and filled surfaces (DF-S) of all participants was 1.79 (SD 2.93), half of lesions were noncavitated, more than one-third were cavitated and fillings comprised less than one surface per child. Majority of lesions were active; prevalence of inactive lesions (all noncavitated) was 1% and 6% in 5- and 6-year-olds, respectively. Prevalence of active lesions increased with age; it correlated with plaque levels and with toothbrushing frequency (<0.001). Likelihood to detect active lesions was up to nine times higher in teeth with abundant plaque (odds ratio (OR) 8.73; confidence interval (CI) 5.35–14.25), and up to seven times higher in individuals brushing teeth irregularly (OR 6.88; CI 2.21–21.41). Conclusions: The obtained data indicate high treatment needs in the erupted permanent molars of the Lithuanian pre-school population and imply that caries management should primarily focus on improved biofilm removal, accompanied with regular use of fluoridated toothpaste.

Integrated hypothesis of dental caries and periodontal diseases

This review considers an integrated hypothesis of dental caries and periodontal diseases that builds on theoretical ecological principles. The backbone of the hypothesis is based on the dynamic stability stage of the oral microbiota, at which intrinsic (mainly saliva and gingival crevicular fluid) and bacterial (mainly metabolic) resilience factors maintain ecological dynamic stability, compatible with clinical health. However, loss of intrinsic resilience factors and/or prolonged changes in the availability of microbial metabolic substrates may shift the ecological balance of the microbiota into either saccharolytic (acidogenic) or amino acid-degrading/proteolytic (alkalinogenic) stages, depending on the nature of the predominant substrates, leading to clinical diseases. Therefore, to maintain and restore the dynamic stability of the oral microbiota, it is necessary to control the drivers of disease, such as salivary flow and influx of bacterial nutrients into the oral cavity. Contrary to conventional wisdom, excessive intake of fermentable carbohydrates may contribute to inflammation in periodontal tissues resulting from hyperglycaemia. An integrated hypothesis emphasizes that both dental caries and periodontal diseases originate in the dynamic stability stage and emerge in response to nutritional imbalances in the microbiota. Periodontal diseases may belong to the sugar driven inflammatory diseases, similar to diabetes, obesity, and cardiovascular diseases.

Comparative Evaluation of Microhardness and Enamel Solubility of Treated Surface Enamel with Resin Infiltrant, Fluoride Varnish, and Casein Phosphopeptide-amorphous Calcium Phosphate: An In Vitro Study

Aim and objective

The aim and objective of this study was to do a comparative evaluation of microhardness and enamel solubility (ES) of the treated surface enamel with resin infiltrant, fluoride varnish, and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP).

Materials and methods

An in vitro study was conducted on freshly extracted 85 sound permanent teeth of which 5 teeth were subjected to check for microhardness by the Vickers microhardness tester and the remaining teeth were exposed to demineralizing solution to create initial enamel lesions. These 80 teeth were assigned to four groups: group I—negative control (n = 20), group II—resin infiltrant (n = 20), group III—fluoride varnish (n = 20), and group IV—CPP-ACP (n = 20), and microhardness was checked after application. These teeth were exposed to caries attack three times a day for three consecutive days. The ES of these four groups was checked by calcium ion loss in the artificial cariogenic solution and whole saliva by an atomic absorption spectrophotometer.

Results

It was found that none of the experimental groups reached the microhardness values of sound intact teeth. At 3rd day, the values of microhardness were: group II = group III > group IV > group I. Maximum ES was found for group I (control) followed with group IV.

Conclusion

All agents used in study remineralized initial carious lesion. Fluoride varnish has the highest microhardness and showed least ES compared to other remineralizing agents.

Clinical significance

Fluoride varnish can be regarded as the choice of material to be used for the treatment of incipient carious lesions because of the low application frequency (once every 3–6 months), requires minimal patient compliance as it is a noninvasive procedure and less time consuming.

How to cite this article

Dhillon SN, Deshpande AN, Macwan C, et al. Comparative Evaluation of Microhardness and Enamel Solubility of Treated Surface Enamel with Resin Infiltrant, Fluoride Varnish, and Casein Phosphopeptide-amorphous Calcium Phosphate: An In Vitro Study. Int J Clin Pediatr Dent 2020;13(S-1):S14–S25.