Parameters associated with active caries lesions assessed by two different visual scoring systems on occlusal surfaces of primary molars - a multilevel approach

Association between Sense of Coherence and Caries Activity and Caries Experience among Male Adolescents from Southern Brazil: A Cross-Sectional Study

INTRODUCTION

This cross-sectional study assessed the association between sense of coherence (SoC) and caries activity (number of active caries lesions) and caries experience (DMFT index) among 18-19-year-old male adolescents who joined the Brazilian Army as draftees for mandatory military service (n = 507).

METHODS

Data collection included a questionnaire (level of education, family income, and tooth brushing frequency), the Brazilian short version of the SoC scale (SOC-13), and clinical caries examination (noncavitated/cavitated, inactive/active). The main predictor variable was SoC, categorized as low, moderate, or high. Poisson regression models were used for statistical analysis.

RESULTS

A high SoC was significantly associated with a lower number of active lesions (adjusted rate ratio = 0.85; 95% CI = 0.74-0.98). No association between SoC and DMFT was detected.

CONCLUSION

A high SoC was found to be a protective factor to caries activity in this population.

Comparative evaluation of caries prevalence among group of Egyptian adolescents using DMFS and ICDASII methods: a cross-sectional study

BACKGROUND

Limited data is available regarding the prevalence of dental caries as a chronic disease among adolescents using different caries assessment indices. The aim of this study was to compare and describe the prevalence of dental caries among group of Egyptian students using two caries assessment indices; DMFS and ICDAS II.

METHODS

This descriptive, cross-sectional epidemiological study included 2760 public secondary school students with age range from 15 to 18 years with permanent dentition and good general health. Presence of; retained teeth, congenital or developmental anomalies in the permanent dentition, orthodontic treatments, systematic conditions, smoking and general health problems were considered the exclusion criteria in this study. Participants were selected randomly from 8 public secondary schools in the Great Cairo, Egypt. The examination was achieved by 6 trained and previously calibrated examiners using sets of diagnostic mirrors, compressed air, a WHO probe and cotton rolls. DMFS index and ICDAS II system were used as caries detection methods. In DMFS index; the number of decayed (D), missing (M) and filled (F) surfaces was recorded, while in the ICDAS II index, the assessment of both cavitated and non-cavitated carious, missed and filled teeth with restorations /sealants was recorded. The examiners performed the oral examination using both scoring systems in an alternating manner. The collected data were explored for normality using Kolmogorov-Smirnov and Shapiro-Wilk tests. Chi square test was used to analyze the frequencies.

RESULTS

There was a statistical significant difference between the DMFS and ICDAS II methods results regarding the recorded number of caries affected teeth and cavitated teeth surfaces. The prevalence of dental caries among the investigated secondary school students was (69.56%) and (78.29%) for DMFS and ICDAS II, respectively.

CONCLUSIONS

The prevalence of dental caries among Egyptian adolescent is high. ICDAS scoring system revealed higher caries prevalence values than DMFS method. ICDAS method is the best choice for the preventive goals, while DMFS is sufficient for clinical purposes.

The structure and prevalence of superficial carious and non-carious lesions of permanent and deciduous enamel in children who presented for routine dental care in various districts of St. Petersburg

Relevance. To increase the effectiveness of prevention and treatment protocols, it is above all necessary to consider the activity of caries, especially at the early enamel lesion stage, in the form of a white spot, to make the correct diagnosis based on a clinical examination, which assesses the location, change in surface hardness, symmetry, contour shape, depth, color and opacity of the lesion. Different causes of superficial enamel discoloration, in the form of white spots, are paramount for the restorative treatment as the quality of the enamel preparation affects the marginal fit and the durability of the restoration. However, poor oral hygiene, disturbance in eating behavior affect the course of non-carious hard-tissue diseases, which caries may complicate. Purpose – to optimize the diagnosis of initial dental enamel lesions to improve the caries prevention quality.

Materials and methods. The study examined 460 children living in the Central and Krasnoselsky districts of St. Petersburg. The following indices assessed hard tissue condition: OHI-S, Greene and Vermillion; OHI by O'Leary T., Drake R., Naylor; White spot lesions index, Gorelick L, Geiger A. M, Gwinnett A. J., DMFT and df; caries activity.

Results. The total prevalence of superficial (initial) lesions of hard tissues was 37.82%, i.e. 174 people out of 460 examined patients had superficial enamel lesions according to the criteria of I and II categories. The study found enamel changes in the age groups: 5-6 years (130) – 36 people (27.69%); 12 years old (175) – 62 people (35.42%); 15 years old (155) – 76 people (49.03%).

Conclusions. Focusing on the caries activity signs rather than a precise differential diagnosis of the lesion nature is necessary to provide well-timed treatment and prevention upon detecting initial enamel lesion at a dental check-up.

Radiographic modalities for diagnosis of caries in a historical perspective: from film to machine-intelligence supported systems

Radiographic imaging for the diagnosis of caries lesions has been a supplement to clinical examination for approximately a century. Various methods, and particularly X-ray receptors, have been developed over the years, and computer systems have focused on aiding the dentist in the detection of lesions and in estimating lesion depth. The present historical review has sampled accuracy ex vivo studies and clinical studies on radiographic caries diagnosis that have compared two or more receptors for capturing the image. The epochs of film radiography, xeroradiography, digital intraoral radiography, panoramic radiography and other extraoral methods, TACT analysis, cone-beam CT and artificial intelligence systems aiding in decision-making are reviewed. The author of this review (43 years in academia) has been involved in caries research and contributed to the literature in all the mentioned epochs.

How combining different caries lesions characteristics may be helpful in short-term caries progression prediction: model development on occlusal surfaces of primary teeth

Background

Few studies have addressed the clinical parameters' predictive power related to caries lesion associated with their progression. This study assessed the predictive validity and proposed simplified models to predict short-term caries progression using clinical parameters related to caries lesion activity status.

Methods

The occlusal surfaces of primary molars, presenting no frank cavitation, were examined according to the following clinical predictors: colour, luster, cavitation, texture, and clinical depth. After one year, children were re-evaluated using the International Caries Detection and Assessment System to assess caries lesion progression. Progression was set as the outcome to be predicted. Univariate multilevel Poisson models were fitted to test each of the independent variables (clinical features) as predictors of short-term caries progression. The multimodel inference was made based on the Akaike Information Criteria and C statistic. Afterwards, plausible interactions among some of the variables were tested in the models to evaluate the benefit of combining these variables when assessing caries lesions.

Results

205 children (750 surfaces) presented no frank cavitations at the baseline. After one year, 147 children were reassessed (70%). Finally, 128 children (733 surfaces) presented complete baseline data and had included primary teeth to be reassessed. Approximately 9% of the reassessed surfaces showed caries progression. Among the univariate models created with each one of these variables, the model containing the surface integrity as a predictor had the lowest AIC (364.5). Univariate predictive models tended to present better goodness-of-fit (AICs < 388) and discrimination (C:0.959–0.966) than those combining parameters (AIC:365–393, C:0.958–0.961). When only non-cavitated surfaces were considered, roughness compounded the model that better predicted the lesions' progression (AIC = 217.7, C:0.91).

Conclusions

Univariate model fitted considering the presence of cavitation show the best predictive goodness-of-fit and discrimination. For non-cavitated lesions, the simplest way to predict those lesions that tend to progress is by assessing enamel roughness. In general, the evaluation of other conjoint parameters seems unnecessary for all non-frankly cavitated lesions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01568-2.

When to intervene in the caries process? A Delphi consensus statement

Objectives To define an expert Delphi consensus on when to intervene in the caries process and existing carious lesions.Methods Non-systematic literature synthesis, expert Delphi consensus process and expert panel conference.Results Lesion activity, cavitation and cleansability determine intervention thresholds. Inactive lesions do not require treatment (in some cases, restorations may be placed for form, function, aesthetics); active lesions do. Non-cavitated carious lesions should be managed non- or micro-invasively, as should most cavitated lesions which are cleansable. Cavitated lesions which are not cleansable usually require minimally invasive management. In specific circumstances, mixed interventions may be applicable. Occlusally, cavitated lesions confined to enamel/non-cavitated lesions extending radiographically into deep dentine may be exceptions. Proximally, cavitation is hard to assess tactile-visually. Most lesions extending radiographically into the middle/inner third of dentine are assumed to be cavitated. Those restricted to the enamel are not cavitated. For lesions extending radiographically into the outer third of dentine, cavitation is unlikely. These lesions should be managed as if they were non-cavitated unless otherwise indicated. Individual decisions should consider factors modifying these thresholds.Conclusions Comprehensive diagnosis is the basis for systematic decision-making on when to intervene in the caries process and existing lesions.

Assessment of caries on the first permanent molars in a group of seven- to thirteen-year-old schoolchildren: Comparison of DMF and ICDAS systems

OBJECTIVES

The objective of this study was to compare ICDAS and DMFT/S in the evaluation of caries status of the first permanent molar in 200 children aged 7 to 13 years.

METHODS

This was a cross-sectional design study. Participants were selected from two private schools in Lebanon. The examinations were performed by two trained and calibrated examiners using a dental mirror and a WHO probe. The number of decayed (D), missing (M) and filled (F) teeth was recorded in DMFT/S form, and the numbers related to D, M and F were then added to record the DMFT/S value (D1MFT/S, D2MFT/S and D3MFT/S). In the ICDAS, the assessment of caries associated with restorations and sealant was recorded. Student t tests/and Mann-Whitney tests were used to compare the continuous variables. Chi-square tests and Fisher exact tests were used to compare the categorical variables.

RESULTS

The average age of the participants was 9.21 ± 1.927 (7-13 years old). No significant difference was found between the mean time to score DMFT, DMFS and ICDAS indices (-p-value > 0.05). The prevalence of caries with D1MFS, D2MFS and D3MFS was 80.5%, 54% and 30.5%, respectively. However, the prevalence of caries with ICDAS II was 77.5%.

CONCLUSION

The DMF index is an international user-friendly system that shows the carious history of teeth. However, the ICDAS assesses the different stages of caries and describes the restorative status of the tooth, promoting new preventive approaches and curative needs. More studies should be done to confirm these findings.

A randomized clinical trial to arrest dentin caries in young children using silver diamine fluoride

OBJECTIVES

The study aimed to compare the effectiveness of 38% silver diamine fluoride (SDF) solution, and 5% sodium fluoride (NaF) varnish applied semiannually in arresting dentin caries in young children with high caries risk.

METHODS

Children aged 1-3 years who had at least one active dentin carious lesion were randomly allocated into 2 groups as follows: Group 1 = 38% SDF (Topamine), and Group 2 = 5% NaF varnish (Duraphat). Both agents were applied every 6 months onto the carious surface. Lesion activity was assessed by the visual-tactile examination. Baseline and follow-up examinations were conducted by the same examiner. The children's demographic background, oral health-related habits, and oral hygiene practices, as well as parental satisfaction with children's dental appearance were collected at baseline and the 12-month follow-up.

RESULTS

At baseline, 153 and 149 children were recruited in Group 1 and Group 2, respectively. The mean dmfs scores in Groups 1 and 2 were 8.89 and 9.79, respectively. After 12 months, 87.1% remained in the study. The caries arrest rate of Group 1 (35.7%) was significantly higher than that of Group 2 (20.9%) (p < 0.001). The results of the multilevel logistic regression analysis confirmed that the treatment in Group 1 was more effective in arresting dentin carious lesions than that of Group 2 (OR = 2.04; 95% CI, 1.41-2.96). The presence of plaque on caries lesions, tooth type, tooth surface type, frequency of milk feeding, snack taking, and family income influenced on caries activity. Regardless of the intervention groups, there were no differences in parental satisfaction with on the child's dental appearance before and after receiving the intervention.

CONCLUSION

Based on the 12-month results, 38% SDF is more effective than 5% NaF varnish in arresting dentin carious lesions in young children. SDF has no negative impact on parental satisfaction with the child's dental appearance.

CLINICAL SIGNIFICANCE

To control dentin carious lesions in young children with high caries risk, 38% SDF is more effective than 5% NaF varnish.

Effects of Cariogenic Bacteria and Sealant Evaluated by International Caries Detection Assessment System

Aim:

Evaluation of tooth surface level effect of cariogenic bacteria and sealant.

Background:

International Caries Detection Assessment System (ICADS) is a clinical scoring system that can assess the non-cavitated early stage of dental caries by surface level. Scores used in ICDAS are ordinary and each tooth within one individual is not statistically independent.

Objective:

In this study, by applying mixed effect modeling, the effect of cariogenic bacteria and fissure sealant for tooth surface-level caries progression was analyzed.

Methods:

Ninety-eight patients who had been regularly visited the dental hospital for the regular check-ups were enrolled in this study. Among them, patients who visited at baseline, after one and two years, were included for the analysis. Fifty-two patients were dropped out. The study population consisted of 25 boys and 21girls and their mean ages were 9.3 +/- 2.1. Salivary levels of cariogenic bacteria were measured by qPCR. Mixed effect modeling with repeated measures was applied for the analysis.

Results:

Salivary levels ofS. mutansandLactobacilliwere affected by the progression of the ICDAS score. Maxillary teeth, molars and buccal and occlusal surfaces were tended to progress. Maxillary tooth, molar tooth and buccal, approximal, and occlusal surface were tended to be affected by both cariogenic bacteria.

Conclusion:

By applying mixed effect modeling, highly-detailed surface-level analysis can be available.

When to intervene in the caries process? An expert Delphi consensus statement

OBJECTIVES

To define an expert Delphi consensus on when to intervene in the caries process and on existing carious lesions using non- or micro-invasive, invasive/restorative or mixed interventions.

METHODS

Non-systematic literature synthesis, expert Delphi consensus process and expert panel conference.

RESULTS

Carious lesion activity, cavitation and cleansability determine intervention thresholds. Inactive lesions do not require treatment (in some cases, restorations will be placed for reasons of form, function and aesthetics); active lesions do. Non-cavitated carious lesions should be managed non- or micro-invasively, as should most cavitated carious lesions which are cleansable. Cavitated lesions which are not cleansable usually require invasive/restorative management, to restore form, function and aesthetics. In specific circumstances, mixed interventions may be applicable. On occlusal surfaces, cavitated lesions confined to enamel and non-cavitated lesions radiographically extending deep into dentine (middle or inner dentine third, D2/3) may be exceptions to that rule. On proximal surfaces, cavitation is hard to assess visually or by using tactile methods. Hence, radiographic lesion depth is used to determine the likelihood of cavitation. Most lesions radiographically extending into the middle or inner third of the dentine (D2/3) can be assumed to be cavitated, while those restricted to the enamel (E1/2) are not cavitated. For lesions radiographically extending into the outer third of the dentine (D1), cavitation is unlikely, and these lesions should be managed as if they were non-cavitated unless otherwise indicated. Individual decisions should consider factors modifying these thresholds.

CONCLUSIONS

Comprehensive diagnostics are the basis for systematic decision-making on when to intervene in the caries process and on existing carious lesions.

CLINICAL RELEVANCE

Carious lesion activity, cavitation and cleansability determine intervention thresholds. Invasive treatments should be applied restrictively and with these factors in mind.

Risk of Dental Caries in Primary Teeth with Developmental Defects of Enamel: A Longitudinal Study with a Multilevel Approach

The risk of dental caries seems to be greater in the presence of developmental defects of enamel (DDE). The aim was to determine whether the presence of DDE in the primary teeth of preschool children increases the risk of dental caries in the primary dentition after a period of approximately 2 years. This study was conducted in two stages: baseline (T0) and follow-up (T1). At T0, examinations were conducted for the diagnosis of enamel defects using the DDE index (FDI, 1992), dental caries, and oral hygiene. The participants were allocated to two groups according to the presence (affected) or absence (unaffected) of DDE. At the second evaluation (T1), examinations were performed for the diagnosis of dental caries. Poisson regression analysis with a multilevel approach was used to determine the association between DDE and dental caries. The two levels of the analysis were tooth and child. Among the 339 children (113 affected and 226 unaffected) examined at baseline (T0), 325 were re-examined at follow-up (T1). According to the multilevel analysis, teeth with enamel hypoplasia had a greater risk of having dental caries (RR: 1.99; 95% CI: 1.19-3.33). The risk of caries was greater on posterior teeth (RR: 2.59; 95% CI: 2.18-3.07) and maxillary teeth (RR: 1.48; 95% CI: 1.26-1.75) that had DDE at T0. On the child level, dental caries at T1 was associated with having dental caries at T0 (RR: 1.38; 95% CI: 1.32-1.46). In conclusion, enamel hypoplasia and previous dental caries are risk factors for carious lesions in the primary dentition.

Caries treatment decisions among undergraduate and postgraduate students supported by visual detection systems

BACKGROUND

The difficulties of caries diagnosis and the level of examiner's experience may influence the treatment decision, resulting excessive and inefficient intervention.

AIM

This randomized experimental study evaluated caries treatment decisions made by undergraduate (UG) and postgraduate (PG) students when examination was performed through conventional visual clinical examination (CVCE) and when supported by ICDAS (IC) or Nyvad's (NY) criteria.

DESIGN

Four UG and four PG initially analyzed, by CVCE, 300 primary incisors and molars surfaces of 25 children aged 5-12 years, and choose between no treatment, non-operative, and operative treatment. Students were randomized between IC (2UG; 2PG) and NY (2UG; 2PG) and, after one week of receiving training, repeated evaluations and treatment suggestions. Reference standard was established by two researchers' consensus. Sensitivity, specificity, ROC analysis, and kappa were calculated. Treatment decisions were analyzed by means of contingency tables.

RESULTS

Only sensitivity showed statistical difference (P < 0.05). Operative treatment had high percentage for initial lesions at first evaluation for both criteria; second evaluation showed higher percentage of non-operative treatments for the same lesions.

CONCLUSIONS

IC and NY present satisfactory performance in primary teeth by UG and PG, and their use may assistance UG to adopt a less interventionist approach for initial enamel lesions.

Association between quantitative measures obtained using fluorescence-based methods and activity status of occlusal caries lesions in primary molars

BACKGROUND

Fluorescence-based methods (FBM) can add objectiveness to diagnosis strategy for caries. Few studies, however, have focused on the evaluation of caries activity.

AIM

To evaluate the association between quantitative measures obtained with FBM, clinical parameters acquired from the patients, caries detection, and assessment of activity status in occlusal surfaces of primary molars.

DESIGN

Six hundred and six teeth from 113 children (4-14 years) were evaluated. The presence of a biofilm, caries experience, and the number of active lesions were recorded. The teeth were assessed using FBM: DIAGNOdent pen (Lfpen) and Quantitative light-induced fluorescence (QLF). As reference standard, all teeth were evaluated using the ICDAS (International Caries Detection and Assessment System) associated with clinical activity assessments. Multilevel regressions compared the FBM values and evaluated the association between the FBM measures and clinical variables related to the caries activity.

RESULTS

The measures from the FBM were higher in cavitated lesions. Only, ∆F values distinguished active and inactive lesions. The LFpen measures were higher in active lesions, at the cavitated threshold (56.95 ± 29.60). Following regression analyses, only the presence of visible biofilm on occlusal surfaces (adjusted prevalence ratio = 1.43) and ∆R values of the teeth (adjusted prevalence ratio = 1.02) were associated with caries activity.

CONCLUSION

Some quantitative measures from FBM parameters are associated with caries activity evaluation, which is similar to the clinical evaluation of the presence of visible biofilm.

Do the ball-ended probe cause less damage than sharp explorers?-An ultrastructural analysis

BACKGROUND

No evidence about damage caused by ball-ended probes on tooth is available. No study compared probing defects caused by ball-ended probes with sharp explorers during tactile examinations of primary teeth. This exploratory study aimed to compare ultrastructural defects caused by ball-ended probes with sharp explorers during tactile examinations of primary teeth.

METHODS

Forty-nine primary extracted teeth were tactile examined as performed for caries activity assessment. Surfaces were randomly divided into groups based on probe type (ball-ended probe or sharp explorer). Two examiners probed different surfaces using the sharp explorer and the ball-ended probe. The order for examination was randomly determined. Images were captured using environmental scanning electron microscopy (ESEM) before and after probing. Two external examiners evaluated independently the ESEM images and scored them as: 0) no damage, 1) slight marks, 2) distinct marks, 3) marks with discontinuity, 4) enamel break-offs. Multilevel Poisson regression models were used to analyze associations between probing ultrastructural damage and surface type, baseline condition and probe type. Prevalence ratios (PR) were calculated with 95 % confidence interval (CI).

RESULTS

The most common defects observed on the dental surfaces were probing marks without discontinuity (scores 1 and 2). Ball-ended probes caused significantly less severe damage than sharp explorers (PR: 0.28; CI: 0.11-0.76, p = 0.01).

CONCLUSION

Ball-ended probes cause less damage than sharp explorers when probing gently dental surfaces of primary teeth.

Monitoring of caries disease by risk assessments and activity

ABSTRACT Dental caries is a non-communicable disease and is considered a public health problem. For diagnosis and correct treatment, the study of risk assessment and caries activity is necessary. The caries risk assessment is a way to formalize the balance and imbalance of predictably disease to diagnose dental caries. Therefore, the caries risk assessment is performed through different evaluation systems. Another parameter of great importance to be studied is the activity of caries, because through it is done the correct treatment decision for the patient. The objective of this article is to inform the reader about: the concepts and caries risk factors; the different caries risk assessment systems described in the literature; and which systems are validated. In addition, this literature review provides for identification and evaluation of risk factors and activity of caries lesions in order to enable greater objectivity in the diagnosis and facilitate the decisions of a successful treatment.

Determinant Factors of Untreated Dental Caries and Lesion Activity in Preschool Children Using ICDAS

The aim of the present study was to investigate determinant factors associated with the presence of dental caries and lesion activity in preschool children. A population-based, cross-sectional study was carried out with 843 children of aged three to five years enrolled at public and private preschools in the city of Campina Grande, Brazil. A questionnaire addressing socio-demographic data and oral health care was self-administered by parents/caregivers. Three dentists previously calibrated examined the children for the diagnosis of dental caries and lesion activity using the International Caries Detection and Assessment System (ICDAS). Nutritional status was evaluated based on the body mass index. Logistic regression analysis for complex samples was performed (α = 5%). The prevalence of dental caries was 66.3%. Among the children with caries, 88.0% had active lesions. Dental caries was more prevalent in girls (OR = 1.53, 95%CI: 1.05–2.23), in children from families with a monthly household income ≤US$312.50 (OR = 2.38, 95%CI: 1.65–3.43) and those whose mothers had up to eight years of schooling (OR = 1.55, 95%CI: 1.07–2.23). Lesion activity was significantly associated with mother’s schooling ≤ 8 years (OR = 2.15, 95%CI: 1.15–4.00). The prevalence rates of dental caries and lesion activity were high and mainly associated with a lower socioeconomic status and mother’s schooling.

Detecting Short-Term Changes in the Activity of Caries Lesions with the Aid of New Technologies

This paper discusses the use of new technologies for the assessment of caries and more in particular changes in caries activity. Over the past decades, we have seen a shift from restorative treatment caries to a prevention-driven approach. Also there is a need for shorter and less expensive caries clinical trials. These demand earlier detection of lesions and the monitoring of lesion changes longitudinally in time, which has led to the development of new technologies to aid clinical visual examination. Also clinical visual inspection indices have been refined to fit this purpose. There is a constant flow of technologies emerging and disappearing. This review discusses the merits of recent developments regarding their respective uses for research purposes in testing new caries prevention strategies as well as in clinical caries management in dental private practice. Which technique to choose highly depends on the needed resolution of information.

Effectiveness of a preventive program based on caries risk assessment and recall intervals on the incidence and regression of initial caries lesions in children

BACKGROUND

Evidence on caries risk assessment (CRA) and recall intervals are limited in terms of caries prevention.

AIM

To assess the effectiveness of a program on the incidence and regression of initial caries lesions.

DESIGN

A total of 296 children aged 1-12 years old were assessed by calibrated examiners for Gingival Bleeding Index, Dental Plaque Index, dmf-t/DMF-T Index, initial caries lesions, and caries lesion activity. Children were classified as low, moderate, and high caries risk with different recall interval visits. Statistical analysis included Cox regression and Kaplan-Meier curves.

RESULTS

The mean (SD) time of total follow-up for the sample was 11.5(5.5). Higher dmft index at baseline showed a higher risk of new initial lesions (HR = 1.93; P < 0.0001). Higher number of active initial lesions, at baseline and during follow-up visits, is a higher risk predictor for new initial lesions (HR = 9.49; P < 0.0001), as well as for no arrestment of active lesions during follow-up (HR = 1.32; P < 0.0001). Each follow-up visit attended presented a 77% lower risk of initial lesions. The majority (94.8%) of patients did not show new initial lesions.

CONCLUSIONS

The Program is effective on reducing the incidence and promoting regression of initial caries lesions in children.

Bacteriological analysis of necrotic pulp and fistulae in primary teeth

Objectives

Primary teeth work as guides for the eruption of permanent dentition, contribute for the development of the jaws, chewing process, preparing food for digestion, and nutrient assimilation. Treatment of pulp necrosis in primary teeth is complex due to anatomical and physiological characteristics and high number of bacterial species present in endodontic infections. The bacterial presence alone or in association in necrotic pulp and fistula samples from primary teeth of boys and girls was evaluated.

Material and Methods

Necrotic pulp (103) and fistula (7) samples from deciduous teeth with deep caries of 110 children were evaluated. Bacterial morphotypes and species from all clinical samples were determined.

Results

A predominance of gram-positive cocci (81.8%) and gram-negative coccobacilli (49.1%) was observed. In 88 out of 103 pulp samples, a high prevalence of Enterococcus spp. (50%), Porphyromonas gingivalis (49%), Fusobacterium nucleatum (25%) and Prevotella nigrescens (11.4%) was observed. Porphyromonas gingivalis was detected in three out of seven fistula samples, Enterococcus spp. in two out of seven samples, and F. nucleatum, P. nigrescens and D. pneumosintes in one out of seven samples.

Conclusions

Our results show that Enterococcus spp. and P. gingivalis were prevalent in necrotic pulp from deciduous teeth in boys from 2 to 5 years old, and that care of the oral cavity of children up to five years of age is important.

How different do visuo-tactile criteria assess caries lesions activity status on occlusal surfaces?

OBJECTIVES

We tested the association between active caries lesions assessed by two different criteria and clinical features of these caries lesions.

MATERIALS AND METHODS

Three examiners examined forty-nine 3- to 12-year-old children: one examiner used the Nyvad criteria, another examiner used the International Caries Detection and Assessment System with an additional criteria--Lesion Activity Assessment (ICDAS + LAA), and a reference examiner classified lesions regarding plaque stagnation, colour, lustre, cavities, depth and texture. Logistic regressions were used to test associations. For analyses, we grouped sound sites and inactive lesions vs active caries lesions, but also considering only inactive vs active lesions.

RESULTS

Active lesions scored by both criteria were similarly associated with different clinical parameters tested, except when the sound sites were excluded from the analysis. In these cases, active lesions according to ICDAS + LAA were associated only with cavitation and texture. Texture was associated with divergences between criteria when differentiating sound or inactive lesions from active ones. Fewer divergences in differentiating active from inactive lesions were observed when lesions present lustre.

CONCLUSION

Most clinical signs associated with active caries lesions were similar, but texture and severity tend to have a greater importance when using ICDAS + LAA for distinguishing caries activity status. Attention should be given to differences due to texture and lustre when using different indices.

Radiographic display of carious lesions and cavitation in approximal surfaces: Advantages and drawbacks of conventional and advanced modalities

BACKGROUND

Treatment strategies have changed with efforts on arresting carious lesions suspected to have an intact surface sparing operative treatment for cavitated lesions. Radiography is still the most recommended adjunct method in the diagnosis of clinically inaccessible approximal surfaces. BITEWING RADIOGRAPHY: The major drawback of bitewing radiography for caries diagnosis is that the clinical state of the surface cannot be determined; i.e. if cavitation has developed or the demineralized surface is still intact. Based on studies of the relationship between radiographic lesion depth and clinical cavitation in approximal surfaces, a threshold for operative treatment decision has been suggested when a lesion is observed radiographically more than one-third into dentine. However, the results from previous studies are contradictory and the majority of studies are ~25 years old. In addition, there are few longitudinal observational studies on the behaviour of dentinal carious lesions, particularly in adults. CONE BEAM COMPUTED TOMOGRAPHY: Cone beam CT is an advanced 3-dimensional radiographic modality, which seems much more accurate than intra-oral modalities for displaying cavitation in approximal surfaces. Nonetheless, there are several drawbacks with CBCT, such as radiation dose, costs and imaging artefacts. Therefore, CBCT cannot be advocated at current as a primary radiographic examination with the aim of diagnosing cavitated carious lesions.

CONCLUSIONS

Bitewing radiography is, thus, still state-of-the-art as an adjunct in diagnosing carious lesions in clinically inaccessible approximal surfaces. The risk for cavitation is related to lesion depth, but new studies are needed in both child and adult populations to validate current thresholds for the operative treatment decision based on the radiographic lesion depth.

Evaluation of different types of enamel conditioning before application of a fissure sealant

The aim of the study was to compare fissure sealant quality after mechanical conditioning of erbium-doped yttrium aluminium garnet (Er:YAG) laser or air abrasion prior to chemical conditioning of phosphoric acid etching or of a self-etch adhesive. Twenty-five permanent molars were initially divided into three groups: control group (n = 5), phosphoric acid etching; test group 1 (n = 10), air abrasion; and test group 2, (n = 10) Er:YAG laser. After mechanical conditioning, the test group teeth were sectioned buccolingually and the occlusal surface of one half tooth (equal to one sample) was acid etched, while a self-etch adhesive was applied on the other half. The fissure system of each sample was sealed, thermo-cycled and immersed in 5% methylene dye for 24 h. Each sample was sectioned buccolingually, and one slice was analysed microscopically. Using specialized software microleakage, unfilled margin, sealant failure and unfilled area proportions were calculated. A nonparametric ANOVA model was applied to compare the Er:YAG treatment with that of air abrasion and the self-etch adhesive with phosphoric acid (α = 0.05). Test groups were compared to the control group using Wilcoxon rank sum tests (α = 0.05). The control group displayed significantly lower microleakage but higher unfilled area proportions than the Er:YAG laser + self-etch adhesive group and displayed significantly higher unfilled margin and unfilled area proportions than the air-abrasion + self-etch adhesive group. There was no statistically significant difference in the quality of sealants applied in fissures treated with either Er:YAG laser or air abrasion prior to phosphoric acid etching, nor in the quality of sealants applied in fissures treated with either self-etch adhesive or phosphoric acid following Er:YAG or air-abrasion treatment.

Measuring Dental Caries in the Mixed Dentition by ICDAS

Caries has traditionally been assessed with WHO criteria including only obvious caries lesions. ICDAS has been developed to detect also the enamel caries lesions. This study aims to study caries and the associations of the number of caries lesions between the permanent and primary molars with ICDAS in the mixed dentition of the first and second grade primary school children. The clinical examinations of 485 children were conducted by four examiners with high reproducibility (inter- and intraexaminer kappas >0.9). The mean number of caries lesions—especially dentine caries—seemed to be higher in the second primary molars than in the first permanent molars. There were significant correlations between the number of lesions on occlusal and lingual surfaces between the primary and permanent molars. Enamel caries lesions, restorations, and caries experience did not increase according to age. Therefore, caries might be increasing in this population. As a conclusion, ICDAS recording seems to give appropriate information from the occurrence of caries lesions and its correlations between the primary and permanent teeth and surfaces.