Changing paradigms in concepts on dental caries: consequences for oral health care

The color stability of artificial white spot lesions treated with resin infiltration after exposure to staining beverages

BACKGROUND

To evaluate the effect of staining beverages on the color-changing of resin-infiltrated artificial white spot lesions (WSLs).

METHODS

Thirty-five artificial WSLs were created by pH cycling on flat bovine teeth specimens. The WSLs were treated with resin infiltration and were divided into five groups based on staining beverages: artificial saliva, coffee, wine, green tea, and Coca-Cola. These specimens were subjected to a 28-day exposure to the respective beverages. Color stability was assessed using a spectrophotometer at different time points: baseline, after 7, 14, 21, and 28 days of exposure, and repolishing. The color difference (∆E) between each time point and the baseline was calculated. Statistical analysis was performed using two-way measures ANOVA with a significance level of p = 0.05.

RESULTS

All resin-infiltrated specimens exposed to staining beverages for 7 days exhibited more significant color changes than those exposed to artificial saliva. The color change patterns varied based on the type of beverage. The color alterations intensified with extended immersion in the wine and Coca-Cola groups, while there were no significant differences in the color of specimens after 28 days of immersion in the coffee and green tea groups. However, after cleaning with pumice powder, all specimens showed significantly reduced color changes compared to those observed after 28 days of immersion, except those immersed in coffee.

CONCLUSIONS

Exposure of resin-infiltrated bovine tooth specimens to staining beverages resulted in a significant color alteration as the immersion time increased. However, the staining effect could be minimized by cleaning with pumice powder, except for the coffee group.

CLINICAL RELEVANCE

After resin infiltration treatment, patients should be advised to minimize the consumption of colored beverages to prevent staining that could impact esthetic appearance.

Reduction of microorganisms in carious dentin by photodynamic therapy mediated by potassium iodide added to methylene blue and red laser

OBJECTIVE

To evaluate the effect of the association of potassium iodide to antimicrobial photodynamic therapy on human carious dentin produced with a microcosm biofilm model.

METHODS

A microcosm biofilm model was used to generate a caries lesion on human dentin. Pooled human saliva diluted with glycerol was used as an inoculum on specimens immersed on McBain artificial saliva enriched with 1 % sucrose (24 h at 37 °C in 5 % CO2). After refreshing culture media for 7 days, the dentin specimens were divided in 5 groups (3 specimens per group, in triplicate; n = 9): C (NaCl 0.9 %), CX (2 % chlorhexidine), PKI (0.01 % methylene blue photosensitizer+50 mM KI), L (laser at 15 J, 180 s, 22.7 J/cm2), and PKIL (methylene blue + KI + Laser). After the treatments, dentin was collected, and a 10-fold serial dilution was performed. The number of total microorganisms, total lactobacilli, total streptococci, and Streptococcus mutans was analyzed by microbial counts (CFU/mL). After normality and homoscedasticity analysis, the Welch's ANOVA and Dunnett's tests were used for CFU. All tests used a 5 % significance level.

RESULTS

CX and PKIL groups showed significant bacterial decontamination of dentin, compared to group C (p < 0.05) reaching reductions up to 3.8 log10 for CX for all microorganisms' groups and PKIL showed 0.93, 1.30, 1.45, and 1.22 log10 for total microorganisms, total lactobacilli, total streptococci, and S. mutans, respectively.

CONCLUSION

aPDT mediated by the association of KI and methylene blue with red laser reduced the viability of microorganisms from carious dentin and could be a promising option for cavity decontamination.

Carboxymethyl chitosan stabilized AuNPs/ACP nanohybrids in enamel white spot lesions

Acidic bacterial biofilms-associated enamel white spot lesions (WSLs) are one of the hallmarks of early caries, causing demineralization and decomposition of dental hard tissues. Therefore, to effectively prevent and treat WSLs, it is important to inhibit the activity of cariogenic bacteria while promoting the remineralization of demineralized enamel. Amorphous calcium phosphate (ACP) favors hard tissue remineralization due to its biological activity and ability to release large amounts of Ca2+ and PO4 3-. However, ACP-based biomineralization technology is not effective due to its lack of antimicrobial properties. Here, carboxymethyl chitosan (CMCS) was employed as a reducing agent and stabilizer, and dual-functional nanohybrids CMCS/AuNPs/ACP with biofilm resistance and mineralization properties were successfully synthesized. The addition of AuNPs enhances the antimicrobial activity and participates in regulating the formation of hydroxyapatite (HAp). The nanohybrids exhibited significant destructive effects against cariogenic bacteria and their biofilms and showed bactericidal activity under bacteria-induced acidic conditions. More importantly, this nanohybrids showed superior results in promoting the remineralization of demineralized enamel, compared to fluoride and CMCS/ACP in vitro. The CMCS/AuNPs/ACP nanohybrids not only reverse the cariogenic microenvironment at the microbial level, but also promote self-repairing of enamel WSLs regarding the microstructure. The present work offers a theoretical and experimental basis for using the CMCS/AuNPs/ACP nanohybrids as a potential dual-functional agent for the clinical treatment of enamel WSLs.

Plant-Derived Compounds: A Promising Tool for Dental Caries Prevention

There is a growing shift from the use of conventional pharmaceutical oral care products to the use of herbal extracts and traditional remedies in dental caries prevention. This is attributed to the potential environmental and health implications of contemporary oral products. This comprehensive review aims at the analysis of plant-derived compounds as preventive modalities in dental caries research. It focuses on data collected from 2019 until recently, trying to emphasize current trends in this topic. The research findings suggest that several plant-derived compounds, either aqueous or ethanolic, exhibit notable antibacterial effects against Streptococcus mutans and other bacteria related to dental caries, with some extracts demonstrating an efficacy comparable to that of chlorhexidine. Furthermore, in vivo studies using plant-derived compounds incorporated in food derivatives, such as lollipops, have shown promising results by significantly reducing Streptococcus mutans in high-risk caries children. In vitro studies on plant-derived compounds have revealed bactericidal and bacteriostatic activity against S. mutans, suggesting their potential use as dental caries preventive agents. Medicinal plants, plant-derived phytochemicals, essential oils, and other food compounds have exhibited promising antimicrobial activity against oral pathogens, either by their anti-adhesion activity, the inhibition of extracellular microbial enzymes, or their direct action on microbial species and acid production. However, further research is needed to assess their antimicrobial activity and to evaluate the cytotoxicity and safety profiles of these plant-derived compounds before their widespread clinical use can be recommended.

Association between periodontitis and dental caries: a systematic review and meta-analysis

OBJECTIVES

Recent evidence suggested a link between periodontitis (PD) and dental caries, but the trends and nature of this association remained unclear. The overall aim of this study was to critically assess the correlation of two disorders.

METHODS

A comprehensive search was conducted within the PUBMED and EMBASE databases including grey literatures up to July 5th, 2023. The Newcastle-Ottawa scale was used to qualitatively evaluate the risk of bias.

RESULTS

Overall, 18 studies were included. In terms of caries risk in PD patients, the prevalence of caries was increased by PD (OR = 1.57, 95%CI:1.20-2.07), both in crown (OR = 1.03, 95%CI:1.01-1.05) and root caries (OR = 2.10, 95%CI:1.03-4.29). Odds of caries were also raised by PD severity (OR moderate = 1.38, 95%CI:1.15-1.66; OR severe = 2.14, 95%CI:1.74-2.64). Besides, patients with PD exhibited a higher mean number of decayed, missing and filled teeth (DMFT) and decayed and filled root teeth (DFR) [weighted mean difference (WMD)DMFT = 0.87, 95%CI: -0.03-1.76; WMDDFR = 1.13, 95%CI: 0.48-1.78]. Likewise, patients with caries had an elevated risk of PD (OR = 1.79, 95%CI:1.36-2.35). However, Streptococcus mutans, one of the main pathogens of caries, was negatively correlated with several main pathogens of periodontitis.

CONCLUSIONS

This study indicated a positive correlation between dental caries and periodontitis clinically, while the two disease-associated pathogens were antagonistic.

CLINICAL RELEVANCE

Further research, including clinical cohort studies and mechanisms of pathogens interaction is needed on this link for better prevention and treatment of PD and caries. In addition, innovative prevention strategies need to be developed and incorporated in dental practices to prevent these two highly prevalent oral diseases.

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.

Impact of perinatal HIV exposure and infection on salivary properties among Nigerian children

BACKGROUND

There is growing evidence that perinatal HIV infection and exposure affect salivary pH and flow rate in children in most parts of the world, but not against the background of caries and the African demographic. This study aimed to evaluate the impact of HIV infection as well as exposure on salivary properties and their influence upon the dental caries experience among school-aged children in Nigeria.

METHOD

This cross-sectional study assessed the salivary flow rates and salivary pH of HIV infected and exposed school-aged (4-11) children receiving care at a Nigerian tertiary hospital. A total of 266 consenting participants which comprised of three groups as follows: (1) HIV Infected (HI) (n = 87), (2) HIV Exposed and Uninfected (HEU) (n = 82) and (3) HIV Unexposed and Uninfected (HUU) (n = 97) were recruited for the study. Questionnaires completed by parents/guardians were used for data collection. Three calibrated dentists performed oral examinations for dental caries. International Caries Detection and Assessment Scores (ICDAS) was used and presented as dmft/DMFT. Salivary pH was measured using MColourpHast™ pH indicator strips, while salivary flow rate was determined by collecting unstimulated whole saliva using the suction method. Data analysis relied on comparative statistics to determine the correlation between HIV exposure and infection on salivary pH and flow rates.

RESULT

Across the groups, (HI, HEU, and HUU) mean pH of the HI was significantly less than that of HEU and HUU. Similarly, there was a statistically significant difference in the SFR across the three groups (p = 0.004). Other variables such as gender, age and oral hygiene status expressed by the gingival inflammatory scores had no significant influence on the pH and SFR of study participants. There was a rather unexpected positive correlation of DMFT of HI and HEU groups with increasing salivary flow rate; though, the relationship was weak and not significant.

CONCLUSION

Perinatal HIV exposure and infection significantly impact salivary pH and flow rate among school-aged children in Nigeria. The findings of this study imply that HIV infection influenced the salivary pH, while HIV maternal exposure (without infection) impacted salivary flow rates when compared to the controls.

Comparative Evaluation of the Antimicrobial Efficacy of Elettaria cardamomum (0.5%) Mouthwash, Camellia sinensis (0.5%) Mouthwash, and 0.12% Chlorhexidine Gluconate Mouthwash against Streptococcus mutans: An In Vitro Study

Aim

The in vitro study aimed to evaluate and compare the antimicrobial efficacy of Elettaria cardamomum (0.5%) mouthwash, Camellia sinensis (0.5%) mouthwash, and 0.12% chlorhexidine gluconate mouthwash against Streptococcus mutans.

Materials and methods

A total of 60 samples of the five mouthwash preparations were prepared to check for their antimicrobial efficacy. The zone of inhibition (ZOI) against S. mutans was measured as a diameter in mm, and the minimum inhibitory concentration (MIC) of mouthwash preparations was measured as μg/mL. All the groups were compared statistically using the Mann-Whitney U test and the Kruskal-Wallis test.

Results

The highest ZOI was observed in group V chlorhexidine gluconate [mean: 20.8, standard deviation (SD): 0.58], followed by group III C. sinensis (alcohol-free) (mean: 15.5, SD: 0.67), group IV C. sinensis (alcohol-based) (mean: 14.08, SD: 0.66), and group II E. cardamomum (alcohol-based) (mean: 13.2, SD: 0.45). The least ZOI was observed in group I E. cardamomum (alcohol-free) (mean: 10.7, SD: 0.45). This difference was statistically significant (p < 0.01). The MIC was similar in all the groups (p = 0.13).

Conclusion

Chlorhexidine gluconate 0.12% mouthwash showed the best antimicrobial action; however, C. sinensis mouthwash showed potential against S. mutans. E. cardamomum mouthwash exhibited limited antimicrobial activity.

How to cite this article

Deolikar S, Jawdekar A, Saraf T, et al. Comparative Evaluation of the Antimicrobial Efficacy of Elettaria cardamomum (0.5%) Mouthwash, Camellia sinensis (0.5%) Mouthwash, and 0.12% Chlorhexidine Gluconate Mouthwash against Streptococcus mutans: An In Vitro Study. Int J Clin Pediatr Dent 2024;17(4):461-466.

Efficiency of casein phosphopeptide amorphous calcium phosphate versus topical fluorides on remineralizing early enamel carious lesions - A systematic review and meta analysis

Objective

To assess the remineralizing efficiency of caesin phosphopepdide amorphous calcium phosphate (CPP-ACP) versus topical fluorides on early enamel lesions in vivo.

Data sources

PubMed, Web of Science, Scopus, EBSCO were searched based on the PICOS criteria up to December 2022 with English language restriction. All relevant studies were subjected to two separate reviews before being included at the title, abstract, and full text levels.

Study selection

41 studies were reviewed and 11 selected for inclusion in the final sample for the review. All were randomized clinical trials with the follow-up period of the studies ranging from 3 to 12 months. Out of the 11 studies, only two are with low risk of bias on assessment with Cochrane risk of bias assessment tool, while the other nine articles were with the moderate and high risk of bias.

Conclusions

Conflicting evidence exists on the clinical efficacy of CPP-ACP compared to the various fluoride forms tested, and no adverse effect associated with CPP-ACP use was discovered in comparison to fluorides that had certain detrimental health impacts. Although, the review results in favor of both fluorides and CPP-ACP with similar clinical efficiency, when ill effects are considered the CPP-ACP can be a choice of remineralizing early enamel lesions. However, before concrete suggestions can be given, high-quality, well-designed clinical research in this area are still necessary.

Clinical significance

A considerable remineralizing impact has been shown in both in vitro and in vivo experiments, making CPP-ACP/CPP-ACPF a more promising remineralizing agent than fluorides. Therefore, this can be applied clinically to early enamel carious lesion.

Exploring the Effect of Cetylpyridinium Chloride Addition on the Antibacterial Activity and Surface Hardness of Resin-Based Dental Composites

The aim of this study was to evaluate the effect of cetylpyridinium chloride (CPC) addition on the antibacterial and surface hardness characteristics of two commercial resin-based dental composites (RBDCs). A total of two hundred and seventy (n = 270) specimens from Filtek Z250 Universal and Filtek Z350 XT flowable RBDCs were fabricated with the addition of CPC at 2 %wt and 4 %wt concentrations to assess their antibacterial activity using the agar diffusion test and direct contact inhibition test, and their surface hardness using the Vickers microhardness test after 1 day, 30 days, and 90 days of aging. A surface morphology analysis of the specimens was performed using a scanning electron microscope (SEM). The RBDCs that contained 2 %wt and 4 %wt CPC demonstrated significant antibacterial activity against Streptococcus mutans up to 90 days, with the highest activity observed for the 4 %wt concentration. Nevertheless, there was a reduction in antibacterial effectiveness over time. Moreover, compared to the control (0 %wt) and 2 %wt CPC groups, the universal RBDCs containing 4 %wt CPC exhibited a notable decrease in surface hardness, while all groups showed a decline in hardness over time. In conclusion, the satisfactory combination of the antibacterial effect and surface hardness property of RBDCs was revealed with the addition of a 2 %wt CPC concentration.

Quantifying the potential of morphological parameters for human dental identification: part 1-proof of concept

In forensic identification, lack of eccentric characteristics of intact dentitions hinders correct ante-mortem/post-mortem (AM/PM) matching. It remains unclear which morphological dental parameters hold strong potential as identifiers. This study aimed to establish a method to quantify and rank the identifying potential of one (or a combination of) continuous morphological parameter(s), and to provide a proof of concept. First, a statistic was defined that quantifies the identifying potential: the mean potential set (MPS). The MPS is derived from inter-observer agreement data and it indicates the percentage of subjects in the AM reference dataset who at least need to be considered to detect the correct PM subject. This was calculated in a univariate and a multivariate setting. Second, the method was validated on maxillary first molar crowns of 82 3D-digitally scanned cast models. Standardized measurements were registered using 3D modeling software (3-Matic Medical 12.0, Materialise N.V., Leuven, Belgium): tooth depth, angles between cusps, distances between cusps, distances between the cusps, and the mesial pit. A random sample of 40 first molars was measured by a second examiner. Quantifying and ranking the parameters allowed selecting those with the strongest identifying potential. This was found for the tooth depth (1 measurement, MPS = 17.1%, ICC = 0.879) in the univariate setting, and the angles between cusps (4 measurements, MPS = 3.9%) in the multivariate setting. As expected, the multivariate approach held significantly stronger identifying potential, but more measurements were needed (i.e., more time-consuming). Our method allows quantifying and ranking the potential of dental morphological parameters as identifiers using a clear-cut statistic.

Antibacterial properties and abrasion-stability: Development of a novel silver-compound material for orthodontic bracket application

PURPOSE

Bacteria-induced white spot lesions are a common side effect of modern orthodontic treatment. Therefore, there is a need for novel orthodontic bracket materials with antibacterial properties that also resist long-term abrasion. The aim of this study was to investigate the abrasion-stable antibacterial properties of a newly developed, thoroughly silver-infiltrated material for orthodontic bracket application in an in situ experiment.

METHODS

To generate the novel material, silver was vacuum-infiltrated into a sintered porous tungsten matrix. A tooth brushing simulation machine was used to perform abrasion equal to 2 years of tooth brushing. The material was characterized by energy dispersive X‑ray (EDX) analysis and roughness measurement. To test for antibacterial properties in situ, individual occlusal splints equipped with specimens were worn intraorally by 12 periodontal healthy patients for 48 h. After fluorescence staining, the quantitative biofilm volume and live/dead distribution of the initial biofilm formation were analyzed by confocal laser scanning microscopy (CLSM).

RESULTS

Silver was infiltrated homogeneously throughout the tungsten matrix. Toothbrush abrasion only slightly reduced the material's thickness similar to conventional stainless steel bracket material and did not alter surface roughness. The new silver-modified material showed significantly reduced biofilm accumulation in situ. The effect was maintained even after abrasion.

CONCLUSION

A promising, novel silver-infiltrated abrasion-stable material for use as orthodontic brackets, which also exhibit strong antibacterial properties on in situ grown oral biofilms, was developed. The strong antibacterial properties were maintained even after surface abrasion simulated with long-term toothbrushing.

Core Cariology Curriculum Framework in Spanish for Latin American dental schools: development and consensus

The aim of this study was to develop and achieve consensus on a cariology teaching framework for dental schools in Latin American Spanish-speaking countries. The Delphi process, with a ≥8 0% pre-defined participants' agreement, included three phases and a Coordinating Group. During the Preparation phase three panels of experts were selected and invited to participate: a) Regional academic/professional Dental Associations (Associations-Panel): n = 12; b) Regional Dental Schools (Dental-Schools-Panel): existing dental schools (n = 263) from the 19 Spanish-speaking regional countries; c) International academic/professional associations Peer Experts (Peer-Panel): n = 4. Based on consensus documents from Europe, Colombia, the Caribbean, USA, Chile and Spain, and updated scientific evidence, the Coordinating Group developed a baseline framework proposal of domains, main competencies (MC) and specific competencies (SC). The Consultation-Agreement and Consensus phases included three rounds of questionnaires with a step-wise sharing of the MC updated version of the consensus framework with the Dental-Schools-Panel and including SC with the Associations-Panel. Diverse communication strategies were used ( e.g ., independent google-form questionnaires and workshops). Consensus was reached after an on-site Associations-Panel workshop and secret voting, followed by an online meeting with the Peers-Panel. A total of 127 academic/professional institutions participated (Associations-Panel: 11, 91.6%; Dental-Schools-Panel: 112, 42.6%, all countries; Peers-Panel: 4, 100%). The baseline Cariology teaching framework of 5 domains, 10 MC and 92 SC underwent modifications after agreements for a final consensus framework consisting of 5 domains, 10 MC and 85 SC. A Core Cariology curriculum framework in Spanish for Latin American Dental Schools was successfully developed and agreed upon with regional dental academic and professional institutions.

Evaluation of the marginal integrity of various pit and fissure sealants

PURPOSE

To evaluate the marginal integrity of various pit and fissure sealants subjected to different application methods.

METHODS

A total of 253 non-carious human third molars extracted and randomly divided into two groups according to the preparation method employed: invasive or non-invasive. Eight fissure sealant materials were tested: nano-filled flowable composite (Filtek Ultimate Flow), nanohybrid flowable composite (GrandioSo Flow), micro-hybrid flowable composite (Majesty Flow), resin-based unfilled fissure sealant (ClinPro Sealant), resin-based filled fissure sealant (Fissurit FX), resin-based highly filled fissure sealant (GrandioSeal), giomer-based fissure sealant (BeautiSealant), and glass ionomer-based fissure sealant (Fuji Triage). Samples were subjected to two-year cyclic thermo-mechanical and brushing simulations. Two observers quantitatively evaluated the restoration margins and classified them as either "permanent restoration edge", or if a gap larger than 250 μm was evident, "gapping at the restoration edge". The extent of the gap was recorded as a percentage relative to the total length of the restoration edge.

RESULTS

The baseline marginal adaptation had no significant effect on the marginal adaptation (P > 0.05). However, the preparation method and type of fissure sealant material had a significant impact on the marginal adaptation (P < 0.05).

CONCLUSION

On the basis of quantitative analysis, the highest marginal integrity was observed for flowable composites, whereas the lowest was observed for glass ionomer-based fissure sealant.

Effectiveness of MI Varnish™ and PreviDent® Varnish in Noncavitated Interproximal Lesions: A Randomized Clinical Trial

Aim

Evaluating the remineralization efficacy of noncavitated proximal incipient lesions with Colgate® PreviDent® and MI™ varnishes in comparison to the industry standard (1.23%) acidulated phosphate fluoride (APF) gel.

Study design

Parallel randomized controlled, multicenter, single-blinded trial.

Materials and methods

By flipping a coin, 18 patients with 91 lesions were divided into three groups. The Colgate® PreviDent (n = 33), MI varnish (n = 30), and control (APF gel) groups (n = 28) were identified as the three arms. We conducted an initial assessment and therapy as well as follow-ups at 3 and 6 months to evaluate the course of the caries lesion.

Results and statistics

Caries progression was significantly reduced on treated surfaces across both groups. Nine surfaces in the Colgate® PreviDent® group with white spots and dryness did not change, one surface turned into a white patch without dryness, and another surface changed to a sound surface; only two surfaces were discontinued from treatment (restored) due to a misdiagnosis by the operator (n = 2). Nine of the surfaces in the MI™ group maintained their white patches with dryness, whereas one developed a new white patch that was not dry. Only MI varnish™-treated teeth exhibited dramatic radiographic improvement. Caries on the outside enamel were either unchanged or restored to healthy levels. Caries on the inner surface of the enamel also did not change.

Conclusion

Remineralizing noncavitated early-stage lesions may be done with both MI™ and Colgate® PreviDent® varnishes. Despite this, radiographic results did not vary significantly across the three groups. In situations of rather advanced incipient caries seen on radiographs, the MI varnish™ might be recommended.

How to cite this article

Helal N, Azzahrani GS, Azzouz LZ. Effectiveness of MI VarnishTM and PreviDent® Varnish in Noncavitated Interproximal Lesions: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2023;16(5):751-757.

In vitro remineralization assessment of enamel subsurface lesions using different percentages of surface reaction-type pre-reacted glass-ionomer containing gum-based material

OBJECTIVE

To identify the remineralization activity of enamel subsurface lesions using different percentages of surface pre-reacted glass-ionomer (S-PRG) filler containing gum-base material.

METHODS

Gum extracts from gum-base materials containing 0wt%, 5wt%, and 10wt% S-PRG filler were prepared as GE0, GE5, and GE10, respectively. A total of 50 bovine enamel specimens were used, and the polished enamel surface of a 3 × 3 mm2 window area was exposed. The specimens were then subjected to a demineralization solution for seven days to create a subsurface enamel lesion. Remineralization was then conducted for seven days using a protocol whereby the specimens were immersed three times a day in prepared gum extracts (0wt%, 5wt%, and 10wt%) and artificial saliva of pH 7 (Control) for 20 min at 37 °C. Thereafter, remineralization assessment was performed by using Swept Source Optical Coherence Tomography (SS-OCT) and micro-computed tomography (μCT). Surface morphology and elemental analysis were conducted by scanning electron microscopy (SEM) and energy-dispersive X-ray spectrometry (EDS).

RESULTS

The depths of the demineralized lesions in the GE5 and GE10 groups were significantly lower than those of the Control and the GE0 groups. SEM observations of the enamel surface morphology of the GE5 and GE10 groups indicated remineralization with S-PRG filler-related elements present.

CONCLUSION

The GE5 and GE10 S-PRG filler containing gum-base materials showed significantly improved surface remineralization and reduced demineralization of the enamel lesions. EDS analysis suggested that the released ions from the S-PRG filler might be responsible for surface remineralization.

CLINICAL SIGNIFICANCE

The S-PRG filler containing gum-base material may have a significant remineralization effect and improve the surface morphology of enamel subsurface lesions.

Is there an association between dental caries and genetics? Systematic review and meta-analysis of studies with twins

OBJECTIVE

This review aimed to assess the agreement of dental caries experience between monozygotic (MZ) and dizygotic (DZ) twins.

DATA RESOURCES

This systematic review was performed by reviewers in the databases Embase, MEDLINE-PubMed, Scopus, Web of Science and manual searches and gray literature Google Scholar® and Opengray. Observational studies that evaluated dental caries in twins were included. The risk of bias was analyzed using the Joanna Briggs checklist. Meta-analyses were performed to assess the pooled Odds Ratio to estimate the agreement values of dental caries experience and DMF index between pairs of twins (p < 0.05). To assess the certainty of evidence, the GRADE scale was used.

STUDY SELECTION

2533 studies were identified, of which 19 were included in the qualitative analysis, six in the quantitative synthesis, with two meta-analyses being carried out. Association between genetics and the development of the disease was observed in most studies. In the risk of bias analysis, 47.4% had moderate risk. Higher agreement of dental caries experience was observed in MZ twins than DZ in both dentitions (OR: 5.94; 95% CI: 2.00-17.57). However, there was no difference between the MZ and DZ twin groups in the analysis comparing DMF index agreement (OR: 2.86; 95%CI: 0.25-32.79). The certainty of evidence was considered low and very low for all studies included in meta-analyses.

CONCLUSION

With very low certainty of the evidence, the genetic factor seems to influence the agreement of the caries experience.

CLINICAL RELEVANCE

Understanding the genetic influence on the disease has the potential to contribute to the development of studies that may use biotechnologies for prevention and treatment as well as guide future research involving gene therapies aiming to prevent the occurrence of dental caries.

Short-term Clinical and Microbiological Performance of Resin-modified Glass Ionomer Cement Containing Chlorhexidine for Atraumatic Restorative Treatment

Aim

This study evaluated the short-term clinical and microbiological performance of resin-modified glass ionomer cement (RM-GIC) cement containing chlorhexidine (CHX) for atraumatic restorative treatment (ART) in primary teeth.

Materials and methods

The clinical trial was conducted in 36 children that received ART in primary molars either with GIC (group I, n = 18) or GIC containing 1.25% CHX (group II, n = 18). The survival rate of restorations was checked 7 days, 3, and 6 months after their application when saliva and biofilm were collected for microbiological assessment of mutans streptococci (MS) counts. Data were analyzed using the Kruskal-Wallis/Mann-Whitney U tests for clinical analysis and microbiological evaluations (p < 0.05).

Results

The survival rate of restorations was similar comparing groups I with II. Microbiological analysis showed a significant reduction in MS levels 7 days after the treatment in both saliva and biofilm of children treated with RM-GIC containing CHX (group II); however, MS counts at 3 and 6 months did not differ from the initial counts.

Conclusion

A total of 1.25% CHX improved the microbiological properties of GIC in the short term without impairing the clinical performance of ART restorations.

Clinical significance

Glass ionomer cement (GIC) containing CHX could be an alternative in ART procedures with the objective of promoting an additional antimicrobial effect, which is interesting for children with high counts of MS during the initial phase of adaptation to dental treatment.

How to cite this article

da Silva ME, de Sena MD, Colombo NH, et al. Short-term Clinical and Microbiological Performance of Resin-modified Glass Ionomer Cement Containing Chlorhexidine for Atraumatic Restorative Treatment. Int J Clin Pediatr Dent 2023;16(S-1):S27-S32.

Lactiplantibacillus Plantarum CCFM8724 Reduces the Amounts of Oral Pathogens and Alters the Oral Microbiota in Children With Dental Caries: a Randomized, Double-Blind, Placebo-Controlled Trial

Objective Early childhood caries (ECC) is closely related to the disorders of oral microbiota. Probiotics antagonize pathogenic bacteria and regulate the composition of the microbiota. We aimed to investigate the effects of Lactiplantibacillus plantarum CCFM8724 on Streptococcus mutans, Candida albicans, and oral microbiota of patients.Methods Children with ECC aged 3‒6 years were randomly divided into probiotic and placebo groups in the double-blind controlled trial. The intervention and washout periods were 28 days and 14 days, respectively. On days 1 and 28, dental plaques were collected. The effects of L. plantarum CCFM8724 on the oral microbiota of patients were investigated by sequencing the V3-V4 region of 16S rDNA. On days 1, 14, 28 and 42, qPCR was used to investigate the effect of L. plantarum CCFM8724 on the amounts of S. mutans and C. albicans in the saliva of children with ECC.Results L. plantarum CCFM8724 significantly reduced the amounts of S. mutans and C. albicans in saliva of children with ECC (p < 0.01). After consumption of L. plantarum CCFM8724, the abundance of Firmicutes, Granulicatella and Gemella increased, whereas the abundance of Proteobacteria, Neisseria, Bifidobacterium and Catonella decreased. Conclusion: Our results emphasize that probiotics could play a beneficial role in the prevention and treatment of ECC in children from an oral microecological perspective.

The revolutionary evolution in carious lesion management

Contemporary paradigms of dental caries management focus on the biological approaches to treating the disease and its principal symptom, the carious lesion. This narrative review traces the evolution of carious lesion management from the operative and invasive approaches of G. V. Black's era to the current period of minimally invasive biological approaches. The paper explains the rationale for adopting biological approaches to dental caries management and lists the five core principles of this management approach. The paper also details the aims, features, and the most recent evidence base for the different biological carious lesion management approaches. Based on current practice guidelines, collated clinical pathways for lesion management are also presented in the paper to aid clinicians in their decision-making. It is hoped that the biological rationale and evidence summarized in this paper will bolster the shift to modern biological carious lesion management approaches among dental practitioners.

Socio-economic status, psychosocial factors, health behaviours and incidence of dental caries in 12-year-old children living in deprived communities in Manaus, Brazil

OBJECTIVES

This study examines the relationships between socio-economic status, psychosocial factors, health-related behaviours and the incidence of dental caries among 12-year-old schoolchildren living in deprived communities in Manaus, Brazil.

METHODS

A longitudinal study involving 312 children aged 12 years was conducted in the city of Manaus, Brazil. Baseline data including socio-economic status (number of goods, household overcrowding, parents' schooling, family income), psychosocial factors (sense of coherence [SOC-13], social support [Social Support Appraisals questionnaire]) and health-related behaviours (frequency of toothbrushing, sugar consumption, sedentary behaviour) were collected through structured questionnaires. The number of decayed teeth was clinically assessed at baseline and one-year follow-up. A hypothesised model evaluating the direct and indirect pathways between the variables was tested using confirmatory factor analysis and structural equation modelling.

RESULTS

The incidence of dental caries at the one-year follow-up was 25.6%. Sugar consumption (β = 0.103) and sedentary behaviour (β = 0.102) directly predicted the incidence of dental caries. A higher socio-economic status was directly linked with lower sugar consumption (β = -0.243) and higher sedentary behaviour (β = 0.227). Higher social support directly predicted lower sugar consumption (β = -0.114). Lower socio-economic status (β = -0.046) and lower social support (β = -0.026) indirectly predicted the incidence of dental caries via sugar consumption and sedentary behaviour.

CONCLUSIONS

In the population studied, sugar consumption and sedentary behaviour are meaningful predictors of the incidence of dental caries among schoolchildren living in deprived communities. Indirect pathways of lower socio-economic status and low social support with dental caries incidence via sugar consumption and sedentary behaviour were detected. These findings should be considered in oral interventions and oral health care policies to prevent dental caries among children living in deprivation.

CLINICAL SIGNIFICANCE

Social conditions, social support, sedentary behaviour and sugar consumption directly influence dental caries in children.

Microbiome and Human Health: Current Understanding, Engineering, and Enabling Technologies

The human microbiome is composed of a collection of dynamic microbial communities that inhabit various anatomical locations in the body. Accordingly, the coevolution of the microbiome with the host has resulted in these communities playing a profound role in promoting human health. Consequently, perturbations in the human microbiome can cause or exacerbate several diseases. In this Review, we present our current understanding of the relationship between human health and disease development, focusing on the microbiomes found across the digestive, respiratory, urinary, and reproductive systems as well as the skin. We further discuss various strategies by which the composition and function of the human microbiome can be modulated to exert a therapeutic effect on the host. Finally, we examine technologies such as multiomics approaches and cellular reprogramming of microbes that can enable significant advancements in microbiome research and engineering.

Dental caries at enamel and dentine level among European adolescents - a systematic review and meta-analysis

BACKGROUND

In contrast with the last century, caries epidemiology has begun integrating enamel caries into determinations of caries prevalence and experience. The objective of the present systematic review and meta-analysis was to assess the caries status including estimations of enamel caries, of European adolescents.

METHOD

Four databases (Medline Ovid, Embase, CINAHL, and SweMed+) were systematically searched from 1 January 2000 through 20 September 2021 for peer-reviewed publications on caries prevalence and caries experience in 12-19-year-olds; that also included evaluations of enamel lesions. Summary estimates were calculated using random effect model.

RESULTS

Overall, 30 publications were selected for the systematic review covering 25 observational studies. Not all studies could be used in the meta-analyses. Caries prevalence was 77% (n = 22 studies). Highest prevalence was reported in the age groups 16-19 years, and in studies where caries examinations were done before 2010. The overall mean DMFT score was 5.93 (n = 14 studies) and it was significantly lower among Scandinavian adolescents than among other European adolescents (4.43 vs. 8.89). The proportion of enamel caries (n = 7 studies) was 50%, and highest in the lowest age group (12-15 years). Results from the present systematic review reflected the caries distribution to be skewed at individual-, tooth- and surface levels; at tooth and surface level, also changed according to age.

CONCLUSIONS

Although studies in which the caries examinations had been done in 2010 or later documented a reduction in caries prevalence, caries during adolescence still constitutes a burden. Thus, the potential for preventing development of more severe caries lesions, as seen in the substantial volume of enamel caries during early adolescence, should be fully exploited. For this to happen, enamel caries should be a part of epidemiological reporting in national registers.

Oral Microorganisms and Biofilms: New Insights to Defeat the Main Etiologic Factor of Oral Diseases

The oral cavity presents a highly diverse community of microorganisms due to the unique environmental conditions for microbial adhesion and growth [...].

Does potassium iodide help in the microbial reduction of oral microcosm biofilms after photodynamic therapy with methylene blue and red laser?

OBJECTIVE

To evaluate the efficacy of methylene blue (MB)-mediated antimicrobial photodynamic therapy (aPDT) doped with potassium iodide (KI) against oral microcosms biofilms cultured in dentin.

METHODS

A saliva-glycerol stock formed from pooled human saliva was diluted in McBain artificial saliva with 1% sucrose (1:1), inoculated on bovine dentin blocks, and refreshed daily for 5 days. The biofilms were divided (n = 9/group) and treated with 0.9% NaCl (C), 0.2% chlorhexidine (CX), 0.01% MB + low-power laser 15 J, 88 mW, 180 s (PL), and 0.01% MB + 50 mM KI + laser (PKIL). Serial dilution was performed, and cellular viability (CFU/mL) was evaluated for total microorganisms, total lactobacilli, total streptococci, and S. mutans. Additional biofilms were cultured and treated (n = 4) for biomass determination (%BMR). The microscopic structure of the biofilms was observed by SEM. One-way ANOVA and Tukey tests were conducted (α=5%).

RESULTS

Total microorganisms and total streptococci significantly reduced in biofilms treated with CX and PKIL when compared to C, but the CX, PKIL, and PL treatments did not differ from each other. Total lactobacilli and S. mutans showed a significant reduction in the CX, PL, and PKIL groups when compared to C, but with no difference between them. Biomass analysis showed a significantly reduction for CX and PKIL compared to C. SEM micrographs showed noticeable changes in bacterial membrane integrity for the PKIL and CX groups.

CONCLUSION

The addition of KI to methylene blue-mediated aPDT in microcosm biofilms was effective in reducing oral microorganisms, but the effect was group dependent.

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.

Effects of Photodynamic Therapy on Streptococcus mutans and Enamel Remineralization of Multifunctional TiO2-HAP Composite Nanomaterials

BACKGROUND

As photosensitizer and photocatalyst, titanium dioxide (TiO₂) can produce a photodynamic reaction for antibacterial treatment. This study aims to explore a Titanium dioxide/nano-hydroxyapatite (TiO₂-HAP) composite combined with the dental curing lamp (385-515 nm) in clinical which could inhibit the dental plaque biofilm formed by Streptococcus mutans (S. mutans) and promote the enamel surface remineralization simultaneously.

METHODS

X-ray Diffraction (XRD) and high resolution transmission electron microscope (HRTEM) were used to detect the characterization of TiO₂-HAP composite nanomaterials. Photodynamic properties of TiO₂-HAP were detected by Diffuse reflectance spectrum (DRS) and fluorescence spectroscopy. Bacterial growth was measured by reading the absorbance of bacterial cultures and confocal microscope was used to observe the biofilm removal ability of nanomaterials. The ability of TiO₂-HAP to promote enamel remineralization was measured by Scanning electron microscope (SEM).

RESULTS

The OD 600 of S. mutans was 0.76 in the control group and 0.13 in group of TiO₂-HAP with exposure to light-emitting diode (LED) (150 mW/cm²) for 5 min, suggesting its sustained antibacterial potency and inhibition of the metabolic activity of dental plaque microcosm biofilm. Also, the release of calcium and phosphorus ions in TiO₂-HAP can promote enamel mineralization simultaneously. After 15 days of remineralization, the Ca/P ratio of demineralized enamel surface increased from 1.28 to 1.67, which was similar to that of normal enamel.

CONCLUSIONS

The TiO₂-HAP exhibit a promising anti-bacterial activity and remineralization capacity which can prevent the occurrence of caries to the greatest extent and promote the biomimetic mineralization of dental tissues.

Microbial characteristics of dental caries in HIV positive individuals

Background

Dental caries is a multifactorial disease that affects many people. Even though microorganisms play a crucial role in causing dental caries, diagnosis is routinely macroscopic. In order to improve early detection especially in HIV patients who are disproportionately affected, there is need to reconcile the macroscopic and microscopic characteristics of dental caries. Therefore, the aim of this study was to characterize the oral microbiota profile along the decayed, missing, filled teeth (DMFT) index using amplicon sequencing data.

Methods

Amplicon sequencing of the V6-V8 region of the 16S rRNA gene was done on DNA recovered from whole unstimulated saliva of 59 HIV positive and 29 HIV negative individuals. The microbial structure, composition and co-occurrence networks were characterized using QIIME-2, Phyloseq, Microbiome-1.9.2 and Metacoder in R.

Results

We characterized the oral microbiota into 2,093 operational taxonomic units (OTUs), 21 phyla and 239 genera from 2.6 million high quality sequence reads. While oral microbiota did not cluster participants into distinct groups that track with the DMFT index, we observed the following: (a) The proportion of accessory microbiota was highest in the high DMFT category while the core size (∼50% of richness) remained relatively stable across all categories. (b) The abundance of core genera such as Stomatobaculum, Peptostreptococcus and Campylobacter was high at onset of dental caries, (c) A general difference in oral microbial biomass. (d) The onset of dental caries (low DMFT) was associated with significantly lower oral microbial entropy.

Conclusions

Although oral microbial shifts along the DMFT index were not distinct, we demonstrated the potential utility of microbiota dynamics to characterize oral disease. Therefore, we propose a microbial framework using the DMFT index to better understand dental caries among HIV positive people in resource limited settings.

Effect of calcium fluoride nanoparticles in prevention of demineralization during orthodontic fixed appliance treatment: a randomized clinical trial

BACKGROUND

White spot lesions (WSLs) are the most common complications of fixed appliance orthodontic treatment.

OBJECTIVES

To evaluate the effectiveness of calcium fluoride nanoparticles-containing orthodontic primer (nCaF2-primer) in preventing the incidence of WSLs during orthodontic treatment.

TRIAL DESIGN

Single-centre, double-blinded, split-mouth, randomized clinical trial.

METHODS

The sample involved 31 orthodontic patients (≥12 years). Participants were recruited using a simple nonstratified randomization. Data collection, measurements, and analysis were performed blindly. Outcome measures included comparing the effect of nCaF2-primer with control primer (Transbond) regarding the degree of demineralization (DIAGNOdent pen), Streptococcus mutans (S. mutans) bacterial counting [real-time polymerase chain reaction device (PCR)], and WSLs incidence (pre- and post-operative photographs). The measurements were performed before bonding, 1, 3, and 6 months after bonding and after appliance removal. A two-way repeated measure analysis of variance test (for DIAGNOdent pen scores), and Wilcoxon signed-rank test (for the difference between bacterial counting and WSLs incidence) were used (P < 0.05).

RESULTS

Thirty-one patients were recruited and randomized (mean age 17.9 ± 2.45 years). For the primary outcome (DIAGNOdent pen scores) and secondary outcome of S. mutans counting: 31 patients (310 teeth for each group) were included in scoring at T1 and T3, and 30 patients (300 teeth) were included at T6. While for the photographic scores, 26 patients were included after bracket bonding. The demineralization scores showed significant differences at all-time intervals within the 6 months after bracket bonding which was more noticeable after the first month. There was a significant difference in bacterial count between the two primer groups at the T1 only. Regarding photographic scores, there were no significant differences in the WSLs incidence between the two primers groups after brackets removal. No harm was detected during treatment, except the usual pain/gingival irritation.

CONCLUSIONS

nCaF2-primer effectively decreased demineralization scores within the 6 months after bracket bonding. Moreover, it significantly reduced S. mutans colonization after the first month. However, the tested primer did not have an extra advantage in preventing WSLs development at the clinical level after appliance removal.

TRIAL REGISTRATION

The trial was registered with ClinicalTrials.gov on 8 May 2021 (registration number: NCT04994314).

Strategies to Combat Caries by Maintaining the Integrity of Biofilm and Homeostasis during the Rapid Phase of Supragingival Plaque Formation

Bacteria in the oral cavity, including commensals and opportunistic pathogens, are organized into highly specialized sessile communities, coexisting in homeostasis with the host under healthy conditions. A dysbiotic environment during biofilm evolution, however, allows opportunistic pathogens to become the dominant species at caries-affected sites at the expense of health-associated taxa. Combining tooth brushing with dentifrices or rinses combat the onset of caries by partially removes plaque, but resulting in the biofilm remaining in an immature state with undesirables’ consequences on homeostasis and oral ecosystem. This leads to the need for therapeutic pathways that focus on preserving balance in the oral microbiota and applying strategies to combat caries by maintaining biofilm integrity and homeostasis during the rapid phase of supragingival plaque formation. Adhesion, nutrition, and communication are fundamental in this phase in which the bacteria that have survived these adverse conditions rebuild and reorganize the biofilm, and are considered targets for designing preventive strategies to guide the biofilm towards a composition compatible with health. The present review summarizes the most important advances and future prospects for therapies based on the maintenance of biofilm integrity and homeostasis as a preventive measure of dysbiosis focused on these three key factors during the rapid phase of plaque formation.

Potential role of Er:YAG laser and fluoride in the dental enamel remineralization: a Raman spectroscopy preliminary <i>ex vivo</i> study

Background and aims: Dental caries are a widespread oral disease and a serious public health problem, starting by teeth demineralization, which is a loss of minerals such as calcium and phosphate. Modern caries treatment is aimed at preventing the disease progression by teeth remineralization which is a supply of minerals to the enamel. The most popular remineralization method is the treatment of teeth with fluoride. Er:YAG laser has also gained research attention as a method for improving the uptake of fluoride and phosphate by introducing chemical and morphological changes into the structure of enamel but, while some researchers described it as effective, others found no significant effect from its application. This work aimed to further study the effect of Er:YAG laser, alone or combined with fluoride, to dental enamel. Materials and Methods: Twenty upper central human incisors, extracted for periodontal reasons, were used in the study. Samples were demineralized by acetic acid and divided into four groups: a) control, b) fluoride + Er:YAG laser, c) Er:YAG laser alone and d) fluoride alone. The remineralization rate of teeth was estimated by Raman Spectroscopy. Results: In comparison with the control group, the phosphate peak’s intensity increased notably for the teeth treated by fluoride, but decreased slightly for the teeth treated with Er:YAG laser and with a combination of the laser and fluoride. Conclusions: With the limits of this study, due to the limited samples number, Er:YAG laser, alone and combined with fluoride, seems to be not effective, at the parameters used, for the enamel remineralization.

Factors Affecting Dental Caries Experience in 12-Year-Olds, Based on Data from Two Polish Provinces

(1) Background: Dental caries is a chronic disease that affects a child’s dentition from the first stages of life. Several factors contribute to the development of the disease, including an improper diet. This cross-sectional study aimed to identify risk factors of dental caries in 12-year-old adolescents from Greater Poland and Lubusz Provinces (Poland). (2) Material and methods: The research was conducted in adolescents from five primary schools. A questionnaire consisted of close-ended questions on socioeconomic characteristics on family, diet, and oral hygiene habits. An assessment of the dentition was carried out in accordance with World Health Organization (WHO) recommendations. In addition to cavitated carious lesions, incipient caries lesions were noted according to the International Caries Detection and Assessment System, adapted for epidemiological studies (ICDASepiDMFt). (3) Results: The mean number of teeth with untreated caries; removed due to caries; and restored because of caries (DMFt) was 1.52 ± 1.90, while the ICDASepiDMFt index amounted to 2.64 ± 2.55, respectively. Children who did not brush every day had significantly higher odds of having ICDASepiDMFt > 0 than children brushing at least once daily (OR = 10.32, 95% CI = 1.36−78.32, p = 0.0240). Adolescents who drank sweet carbonated drinks every day had significantly higher ICDASepiDMTt than children who drank sweet carbonated drinks less frequently (p = 0.0477). (4) Conclusions: The research revealed that dental caries indices of 12-year-old adolescents from Greater Poland and Lubusz Provinces depend mainly on oral hygiene behaviors. The only significant nutritional factor that differentiated the caries intensity was the daily consumption of sweet carbonated drinks.

Maintaining oral health for a hundred years and more? - An analysis of microbial and salivary factors in a cohort of centenarians

Aim

To investigate associations between oral health-related conditions and the oral microbiome in a representative study sample of centenarians.

Materials and methods

Clinical and microbial parameters from 54 centenarians were assessed in the Heidelberg Dental Centenarian Study. Plaque and salivary samples were collected, and the microbiota was characterized by 16S rRNA gene sequencing.

Results

Diversity and structure of the oral microbiome were mainly influenced by the presence of natural teeth and the number of decayed, missing, and filled teeth (0.028 ≤ p ≤ 0.001 in plaque and salivary samples). Centenarians with less caries experience possessed a more diverse oral microbiome. Moreover, the number of dental visits also showed a significant influence on the microbial composition. Most centenarians presented with hyposalivation (mean stimulated flow rate = 0.84 ± 0.55 ml/min), a low buffering capacity, and an acidic pH. The latter was between 5.0 and 5.8 in 46.3% of cases, and we observed that an increased salivary pH correlated with higher alpha-diversity in both salivary and plaque samples.

Conclusion

The microbiome diversity correlated significantly with successful oral aging. In addition, regular dental visits were a beneficial factor. However, diversity can be negatively influenced by hyposalivation, associated with pH changes due to aging effects.

Pathways in the association between added sugar consumption, obesity in mother-child dyads, and chronic oral disease burden in early childhood

In this study, we modeled the pathways in the association of socioeconomic status, frequency of added sugar consumption, and obesity in mother-child dyads with chronic oral disease burden in early childhood using structural equation modeling. A population-based study was conducted on preschoolers from public daycare centers in São Luís, Brazil (n = 674) and their mothers. Chronic oral disease burden in early childhood was a latent variable, representing the shared variance of the following indicators: visible plaque index, gingivitis, and dental caries. A higher consumption frequency of added sugars by children [standardized regression coefficient (SC) = 0.219] explained the chronic oral disease burden. A higher consumption frequency of added sugars by mothers was associated with greater consumption of sugar by children (SC = 0.236), and indirectly with a greater chronic oral disease burden (SC = 0.052). Maternal obesity was associated with obesity in the offspring (SC = 0.130). The chronic oral disease burden is already present in early childhood and can be explained by the higher consumption of added sugars by the mother-child dyad. Approaches to preventing chronic oral diseases should focus on common risk factors, start early in life, and promote family involvement in this process.

Efficacy of S-PRG filler varnishes on enamel caries remineralization

OBJECTIVES

To evaluate the remineralizing effect of varnishes containing different concentrations of S-PRG filler or sodium fluoride on enamel caries lesions.

METHODS

Enamel specimens were obtained from bovine incisors, flattened and polished. Half of the surface was protected, and artificial caries lesion was created in the unprotected area. They were assigned into six groups (n=20) according to the varnish applied: four containing S-PRG filler with different concentrations (10%, 20%, 30% and 40% w/w), one containing 5% sodium fluoride (5%NaF) as positive control, and one without treatment as a negative control (NC). Varnishes were applied on specimen's caries-affected surface and removed after 24h. Varnish application and pH cycling (8 days) were performed twice. Cross-sectional microhardness was measured (10-100 µm depth). Knoop microhardness percentage (KHN%) of caries affected/treated area in relation to the sound enamel area at the same depth was calculated. The area under the curve (AUC) and the Δ_AUC were also calculated. Statistical analysis was performed by two-way ANOVA for KHN% and one-way ANOVA for Δ_AUC, followed by Tukey test (α=5%).

RESULTS

Significant differences were found for the factors "treatment" (p=0.0001) and "depth" (p=0001). For the factor "treatment", the results of the Tukey test were: NC-62.2(10.3)a, 10%S-PRG-69.2(9.3)b, 20%S-PRG-71.8(9.7)bc, 30%S-PRG-74.5(9.4)c, 5%NaF-79.6(8.7)d, 40%S-PRG-85.6(8.4)e. In relation to Δ_AUC, significant differences were observed among the groups (p=0.0001) and better results for 40% S-PRG and 5%NaF.

CONCLUSIONS

The varnish containing 40% S-PRG fillers was the most effective to promote the enamel caries remineralization, followed by the one containing 5% sodium fluoride.

CLINICAL SIGNIFICANCE

The varnish containing 40% of S-PRG fillers represents an alternative for initial enamel caries remineralization, since it was more effective than the conventional 5% NaF based product.

Metataxonomic and metabolomic evidence of biofilm homeostasis disruption related to caries: an in vitro study

The ecological dysbiosis of a biofilm includes not only bacterial changes but also changes in their metabolism. Related to oral biofilms, changes in metabolic activity are crucial endpoint, linked directly to the pathogenicity of oral diseases. Despite the advances in caries research, detailed microbial and metabolomic etiology is yet to be fully clarified. To advance this knowledge, a meta‐taxonomic approach based on 16S rRNA gene sequencing and an untargeted metabolomic approach based on an ultra‐high performance liquid chromatography‐quadrupole time‐of‐flight mass spectrometry analysis (UHPLC/Q‐TOF‐MS) were conducted. To this end, an in vitro biofilm model derived from the saliva of healthy participants were developed, under commensal and cariogenic conditions by adding sucrose as the disease trigger. The cariogenic biofilms showed a significant increase of Firmicutes phyla (p = 0.019), due to the significant increase in the genus Streptococcus (p = 0.010), and Fusobacter (p < 0.001), by increase Fusobacterium (p < 0.001) and Sphingomonas (p = 0.024), while suffered a decrease in Actinobacteria (p < 0.001). As a consequence of the shift in microbiota composition, significant extracellular metabolomics changes were detected, showed 59 metabolites of the 120 identified significantly different in terms of relative abundance between the cariogenic/commensal biofilms (Rate of change > 2 and FDR < 0.05). Forty‐two metabolites were significantly higher in abundance in the cariogenic biofilms, whereas 17 metabolites were associated significantly with the commensal biofilms, principally related protein metabolism, with peptides and amino acids as protagonists, latter represented by histidine, arginine, l‐methionine, glutamic acid, and phenylalanine derivatives.

Effects of hybrid inorganic-organic nanofibers on the properties of enamel resin infiltrants - An in vitro study

This in vitro study aimed to evaluate the overall mechanical properties of resin infiltrants doped with bioactive nanofibers and their ability in inhibiting enamel demineralization or achieving remineralization of the adjacent enamel to white spots. A commercial resin infiltrant (ICON, DMG) was doped with hybrid inorganic-organic nanofibers and analyzed for degree of conversion (DC, n = 3) and surface hardness (SH, n = 6). Subsequently, enamel specimens (6 × 4 × 2 mm³) were prepared and submitted to a demineralizing/remineralizing process to produce a subsurface caries-like lesion. The specimens were treated with one of the following materials: ICON infiltrant, DMG (control); ICON + nanofibers of poly-lactic acid (PLA)-filled with silica (PLA-SiO₂); ICON + nanofibers of (PLA)-filled with calcium incorporated into a silica network (SiO₂-CaP). Then, the specimens were subjected to a pH-cycling demineralizing/remineralizing model for 7 days at 37 °C. The %ΔSH change (after treatment), %SH loss and %SH recovery (after pH-cycling regimen) were calculated after SH evaluation (n = 9/group). The Ca/P weight ratio before and after pH-cycling regimen was evaluated through SEM/EDX. The results of DC were analyzed through the T-test (p < 0.05). ANOVA followed by Tukey's test (p < 0.05) was performed for hardness and EDX. A significant SH increase was observed in the ICON/SiO₂CaP group (p < 0.05). The ICON/PLA-SiO₂ presented higher DC values than the control group (p = 0.043). All groups presented significant difference in %ΔSH (p < 0.05), although the specimens treated with ICON/SiO₂CaP presented greater values. Regarding the %SHL and %SHR, the ICON/SiO₂CaP and ICON/PLA-SiO₂ were significantly different compared to the control group (p < 0.001). However, no difference was observed between the ICON/SiO₂CaP and ICON/PLA-SiO_2. The Ca/P ratio showed that the ICON/SiO₂CaP and ICON/PLA-SiO₂ after the pH-cycling regimen differed from sound enamel and modified infiltrants before pH-cycling. In conclusion, tailored hybrid nanofibers may be incorporated into enamel resin infiltrants without compromise the mechanical properties of such experimental materials. These latter can inhibit the demineralization of enamel and increase its hardness during pH-clycling challange.

Taste perception in children with different caries activity

PURPOSE

The aim of the study was to investigate whether caries-active and caries-free children differ in terms of their taste perception for sweet, sour, salty and bitter.

METHODS

The study group consisted of 100 children aged 5-10 years: 50 caries-free children and 50 children with at least four untreated carious lesions. Taste perception was analysed using two test systems. First, filter paper strips impregnated with four taste qualities (sweet, sour, salty, and bitter) at four defined intensities were used ("taste strips"). Then a tasting spray in suprathreshold concentration of the respective taste was applied. The children were asked to name the perceived taste. The parents answered a questionnaire about the children's dietary habits.

RESULTS

The children with high caries activity scored lower on average on the taste strips than the caries-free participants. For the taste sprays, the perception of the taste quality "bitter" was significantly worse in the children with caries than in caries-free children (Mann-Whitney U test p < 0.05).

CONCLUSION

The results of this study suggest that taste preferences in children are associated with increased susceptibility to tooth decay.

Association between crack cocaine use and dental caries experience: a cross-sectional study in southern Brazil

The aim of the present study was to compare the prevalence of dental caries between crack cocaine users and a control group. The study included 106 participants in each group matched for age, sex, and exposure to tobacco. Crack cocaine users were selected from institutions for the treatment of chemical dependency, and the control group was recruited from a public school and among patients who sought dental care. A calibrated examiner determined dental caries experience [Decayed, Missing and Filled Teeth (DMFT) index]. The severity of tooth decay was determined using the Significant Caries Index (SiC). The prevalence of dental caries (DMFT ≥ 1) was 96.2 and 81.1% among the crack cocaine users and nonusers, respectively. Crack users had higher mean DMFT values (7.16 versus 4.92) for the decayed and missing components as well as a higher percentage of individuals with highly severe caries compared to nonusers. After the adjustments in the multivariate model, the prevalence of caries was 18% higher among the crack users (prevalence ratio: 1.18; 95% confidence interval: 1.08-1.30). Age, family income, crack cocaine use, and dental calculus were associated with the occurrence of dental caries. In conclusion, the prevalence of caries was higher among the crack users compared with the control group and remained associated with dental caries in the multivariate analysis.

In Vitro and In Vivo Anti-infective Potential of Thymol Against Early Childhood Caries Causing Dual Species Candida albicans and Streptococcus mutans

Early childhood caries (ECC), a severe form of caries due to cross-kingdom interaction of Candida albicans and Streptococcus mutans, is a serious childhood dental disease that affects majority of the children with poor background. The present study investigated the anti-infective potential of thymol against C. albicans and S. mutans dual species for the management of ECC. Thymol, a plant derivative of the monoterpene group, has been well known for its numerous biological activities. Thymol at 300 μg/ml concentration completely arrested growth and proliferation of dual species of C. albicans and S. mutans. Rapid killing efficacy of pathogens, within a span of 2 min, was observed in the time kill assay. In addition, at sub-inhibitory concentrations, thymol effectively diminished the biofilm formation and virulence of both C. albicans and S. mutans such as yeast-to-hyphal transition, hyphal-to-yeast transition, filamentation, and acidogenicity and acidurity, respectively, in single and dual species state. qPCR analysis was consistent with virulence assays. Also, through the invertebrate model system Galleria mellonella, in vivo toxicity and efficacy of the phytocompound was assessed, and it was found that no significant toxic effect was observed. Moreover, thymol was found to be proficient in diminishing the infection under single and dual state in in vivo condition. Overall, the results from the present study illustrate the anti-infective potential of thymol against the ECC-causing dual species, C. albicans and S. mutans, and the applicability of thymol in medicated dentifrice formulation.

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”.

Aspirations and Worries: The Role of Parental Intrinsic Motivation in Establishing Oral Health Practices for Indigenous Children

Aboriginal and Torres Strait Islander (respectfully, subsequently referred to as Indigenous) children in Australia experience oral disease at a higher rate than non-Indigenous children. A history of colonisation, government-enforced assimilation, racism, and cultural annihilation has had profound impacts on Indigenous health, reflected in oral health inequities sustained by Indigenous communities. Motivational interviewing was one of four components utilised in this project, which aimed to identify factors related to the increased occurrence of early childhood caries in Indigenous children. This qualitative analysis represents motivational interviews with 226 participants and explores parents’ motivations for establishing oral health and nutrition practices for their children. Findings suggest that parental aspirations and worries underscored motivations to establish oral health and nutrition behaviours for children in this project. Within aspirations, parents desired for children to ‘keep their teeth’ and avoid false teeth, have a positive appearance, and preserve self-esteem. Parental worries related to child pain, negative appearance, sugar consumption, poor community oral health and rotten teeth. A discussion of findings results in the following recommendations: (1) consideration of the whole self, including mental health, in future oral health programming and research; (2) implementation of community-wide oral health programming, beyond parent-child dyads; and (3) prioritisation of community knowledge and traditions in oral health programming.

Analysis of ENAM gene single-nucleotide polymorphism rs3796704 with caries susceptibility in young adult Tamil population

Background:

Dental caries is as primeval as humanity, but still, investigations are undergoing regarding the etiopathogenesis behind this multifactorial disease. Genetics is known to play a vital role in the etiology behind dental caries in addition to environmental and socioeconomic factors. Genetic variations like single-nucleotide polymorphisms (SNPs) were extensively studied in the past decade to portray the etiopathogenesis contributing to dental caries.

Aim:

This investigation was undertaken to analyze the ENAM gene SNP rs3796704 with caries susceptibility in ethnic young adult Tamil population of India.

Materials and Methods:

Out of 370 patients included, 215 patients belonged to the high caries group (Decayed, Missing and Filled Tooth [DMFT] ≥2) and 155 patients belonged to the low caries group (DMFT ≤ 1). DNA was extracted from the blood of all the individuals. SNP genotyping was performed utilizing tetra-primer amplification refractory mutation system–polymerase chain reaction with specific primers.

Results:

The genotyping results showed that there were no differences in allelic (P = 0.114) and genotypic frequencies (P = 0.159) between the high caries and low caries groups.

Conclusion:

Future studies can be conducted in larger samples and different ethnicities around the globe to analyze the role played by SNPs of enamel formation genes in cariogenesis.