Are We Ready to Move from Operative to Non-Operative/Preventive Treatment of Dental Caries in Clinical Practice?

Remineralization of post-orthodontic white spot lesions with a fluoride varnish and a self-assembling P 11 - 4 peptides: a prospective in-vivo-study

OBJECTIVE

The objective was to evaluate the remineralization effects of fluoride varnish (Clinpro White varnish), self-assembling peptide (Curodont™ Repair) and their combined use on WSL after orthodontic treatment.

MATERIALS AND METHODS

Thirty-two subjects, aged of 10-18 (mean age 13.91 ± 2.92) with 107 post-orthodontic WSL were included in the study. Subjects were divided into four groups as control, tricalcium phosphate (TCP) containing fluoride varnish (Clinpro White varnish) group, self-assembling P11-4 peptides (Curodont™ Repair) group and combined application of the two products. At the beginning, each subjects' caries risk profile was assessed by evaluating diet cariogenicity, plaque index, gingival bleeding index and stimulated salivary flow rate. Before the application of the remineralization agents, WSL baseline demineralization values were determined with QLF Inspektor™ Pro, laser fluorescence using DIAGNOdent and color values were measured by Vita EasyShade. Remineralization data were obtained by measuring ΔF, ΔQ, and lesion area with QLF. The aesthetic improvement after the remineralization process was evaluated with a spectrophotometer at six weeks, three and six months.

RESULTS

No statistically significant differences were found between the groups in terms of criteria determining patients' caries risk profiles, DIAGNOdent data, and plaque index scores (p > 0.05). Intra-group evaluation following remineralization revealed statistically significant increases in ΔF and ΔQ with a decrease in lesion area for the fluoride varnish group at six months, for the peptide group at three months, and for the combined application group at three and six months (p < 0.05). In inter-group comparisons, ΔF and ΔQ values were found to be statistically significant only in the fluoride group at six months compared to the other groups (p < 0.05). While the L* value decreased significantly in all groups at six months, a statistically significant difference in ΔE* values was observed only in the control group between three and six months.

CONCLUSION

Fluoride varnish with TCP showed highest remineralization at 6 months, and the remineralization was positively affected in the short term (three months) after the use of self-assembling P11-4 peptides and their combined application.

CLINICAL RELEVANCE

Remineralization obtained after single application of agents tested in six months in-vivo showed parallel results. In an attempt to trigger subsurface remineralization, the combined use of fluoride with self-assembling peptides as biomimetic remineralization agent needs further evaluation.

Correlation between Matrix Metalloproteinase Presence and Caries Surface Appearance

INTRODUCTION

Cariogenic bacterial acids dissolve the inorganic elements in dentine, leaving the dentine matrix exposed. Host-derived matrix metalloproteinases (MMPs) play an essential role in caries progression as they are significant regulators of extracellular matrix turnover and can degrade exposed collagen. This paper investigates the expression of MMP2 and MMP9 across various stages of caries in primary human teeth and relate this with a diagnosis recorded by the International Caries Detection and Assessment System (ICDAS).

METHODS

Twenty-four sections (150 μm in thickness) from extracted teeth, clinically diagnosed using ICDAS, were immunohistochemically treated with monoclonal anti-MMP2 and anti-MMP9 antibodies. Positive staining was visualised by immunofluorescence using a VectorFluor Duet Double Labeling Kit. Images from triplicate samples for each ICDAS score were analysed using ImageJ software. Collagen degradation in caries lesions was detected using a hydroxyproline assay.

RESULTS

MMPs were weakly detected in caries with ICDAS 1-2 scores, and an insignificant increase was detected in ICDAS 3. However, a significant increase in MMP expression was seen in caries with an ICDAS score of 4-6. There was a strong positive correlation between the ICDAS score and MMP2 (r [6] = 0.86, p = 0.002) and between ICDAS and MMP9 (r [6] = 0.82, p = 0.004). Data were analysed using two-way ANOVA followed by Tukey multiple comparison test (*p < 0.05).

CONCLUSION

The use of ICDAS to assess the severity of caries lesions and how this correlates with the presence of MMP in these lesions validates the modern approach to caries management with a minimally invasive concept.

A novel deep learning-based perspective for tooth numbering and caries detection

OBJECTIVES

The aim of this study was automatically detecting and numbering teeth in digital bitewing radiographs obtained from patients, and evaluating the diagnostic efficiency of decayed teeth in real time, using deep learning algorithms.

METHODS

The dataset consisted of 1170 anonymized digital bitewing radiographs randomly obtained from faculty archives. After image evaluation and labeling process, the dataset was split into training and test datasets. This study proposed an end-to-end pipeline architecture consisting of three stages for matching tooth numbers and caries lesions to enhance treatment outcomes and prevent potential issues. Initially, a pre-trained convolutional neural network (CNN) utilized to determine the side of the bitewing images. Then, an improved CNN model YOLOv7 was proposed for tooth numbering and caries detection. In the final stage, our developed algorithm assessed which teeth have caries by comparing the numbered teeth with the detected caries, using the intersection over union value for the matching process.

RESULTS

According to test results, the recall, precision, and F1-score values were 0.994, 0.987 and 0.99 for teeth detection, 0.974, 0.985 and 0.979 for teeth numbering, and 0.833, 0.866 and 0.822 for caries detection, respectively. For teeth numbering and caries detection matching performance; the accuracy, recall, specificity, precision and F1-Score values were 0.934, 0.834, 0.961, 0.851 and 0.842, respectively.

CONCLUSIONS

The proposed model exhibited good achievement, highlighting the potential use of CNNs for tooth detection, numbering, and caries detection, concurrently.

CLINICAL SIGNIFICANCE

CNNs can provide valuable support to clinicians by automating the detection and numbering of teeth, as well as the detection of caries on bitewing radiographs. By enhancing overall performance, these algorithms have the capacity to efficiently save time and play a significant role in the assessment process.

In Vivo Performance of Visual Criteria, Laser-Induced Fluorescence, and Light-Induced Fluorescence for Early Caries Detection

This study aims to compare the diagnostic reliability of ICDAS-II visual criteria, light-induced fluorescence (using the VistaCam iX, Dürr Dental, Bietigheim-Bissingen, Germany), and laser-induced fluorescence (using the DIAGNOdent Pen, KaVo, Biberach, Germany) on occlusal caries. Permanent and temporary molars were selected according to the inclusion criteria. Out of 160 teeth that met the inclusion criteria, 139 were chosen and examined by two previously trained and calibrated examiners. The kappa value was 0.95 for both VistaCam iX and DIAGNOdent Pen. Results from visual examination and the readings of the two fluorescence devices were computed, lesions being divided into non-cavitated, enamel lesions, and lesions extended to dentin. All statistical analyses were performed using R (version 4.2.2). Spearman's rank correlation was computed to assess the relationship between the scores of diagnostics reliabilities of the three methods mentioned above. There was a positive, statistically significant Spearman's rank correlation coefficient, ρ = 0.25, between VistaCam iX and ICDAS II, and a positive, not statistically significant Spearman's rank correlation coefficient, ρ = 0.11, between DiagnoDent Pen and ICDAS II. Considering the temporary teeth, there was a positive, statistically significant Spearman's rank correlation coefficient, ρ = 0.52, between VistaCam iX and DiagnoDent Pen; a positive, statistically significant Spearman's rank correlation coefficient, ρ = 0.35, between VistaCam iX and ICDAS II; and the lowest, not statistically significant Spearman's rank correlation coefficient, ρ = 0.16, between DiagnoDent Pen and ICDAS II. Conclusions: In conclusion, ICDAS II and light-induced fluorescence are better diagnostic methods than the laser-induced fluorescence devices for detecting occlusal caries. Clinical Significance: This study may support clinicians in selecting the most efficient tool for diagnosing carious lesion in the earliest stages possible. Furthermore, such technologies raise the availability for more preventive approaches, as opposed to invasive procedures.

A Systematic Review of Clinical Practice Guidelines for Caries Prevention following the AGREE II Checklist

Untreated oral diseases are detrimental to overall well-being and quality of life and are in close relationship with social and economic consequences. The presence of strong evidence for caries primary and secondary prevention is a compulsory tool for the development of clinical practice guidelines (CPGs). This paper was aimed to assess systematically the importance of clinical practice guidelines in caries prevention management considering both the adult and pediatric populations and evaluate them using the Appraisal of Guidelines for Research and Evaluation (AGREE II) Checklist. Records were extracted from EMBASE, SCOPUS, PubMed/Medline and seven other relevant guideline databases between 6 January and 14 February 2023. Two reviewers independently conducted the appraisal using the web-based platform My AGREE PLUS. Twenty-one guidelines/papers met the inclusion criteria and were reviewed. Eight CPGs included both primary and secondary prevention interventions, whereas thirteen presented a single preventive model. Overall, 12 guidelines were published in the USA. The mean AGREE II scores ranged from 35.4% to 84.3%. Of the total twenty-one included guidelines, twelve were classified as "Recommended", ranging from 56.3% to 84.3%, the others were described as "Recommended with modification", ranging from 35.4% to 68.9%. From the AGREE II analysis carried out, the CPGs included in this survey adopted a punctual methodological rigor but lacked applicative power. The present survey showed that the public, as the primary beneficiary, played a limited role in the development of the twenty-one CPGs. Hence, methodological improvement can better support high-quality CPG development in the future.

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.

Teeth Restored with Bulk–Fill Composites and Conventional Resin Composites; Investigation of Stress Distribution and Fracture Lifespan on Enamel, Dentin, and Restorative Materials via Three-Dimensional Finite Element Analysis

Objectives: the aim of this study was to examine the stress distribution of enamel, dentin, and restorative materials in sound first molar teeth with restored cavities with conventional resin composites and bulk–fill composites, as well as to determine their fracture lifetimes by using the three-dimensional finite element stress analysis method. Materials and Methods: an extracted sound number 26 tooth was scanned with a dental tomography device and recorded. Images were obtained as dicom files, and these files were transferred to the Mimics 12.00 program. In this program, different masks were created for each tooth tissue, and the density thresholds were adjusted manually to create a three-dimensional image of the tooth, and these were converted to a STL file. The obtained STL files were transferred to the Geomagic Design X program, and some necessary adjustments, such as smoothing, were made, and STP files were created. Cavity preparation and adhesive material layers were created by transferring STP files to the Solidworks program. Finally, a FE model was created in the ABAQUS program, and stress distributions were analyzed. Results: when the bulk–fill composite and conventional resin composite materials were used in the restoration of the cavity, the structures that were exposed to the most stress as a result of occlusal forces on the tooth were enamel, dentin, restorative material, and adhesive material. When the bulk–fill composite material was used in restoration, while the restorative material had the longest fracture life as a result of stresses, the enamel tissue had the shortest fracture life. When the conventional resin composite material was used as the restorative material, it had the longest fracture life, followed by dentin and enamel. Conclusion: when the bulk–fill composite material was used instead of the conventional resin composite material in the cavity, the stress values on enamel, dentin, and adhesive material increased as a result of occlusal forces, while the amount of stress on the restorative material decreased. In the fracture analysis, when the bulk–fill composite material was used instead of the conventional resin composite material, a decrease in the number of cycles required for the fracture of enamel, dentin, and restorative materials was observed as a result of the forces generated in the oral cavity.

A comprehensive review of the application of probiotics and postbiotics in oral health

Oral diseases are among the most common diseases around the world that people usually suffer from during their lifetime. Tooth decay is a multifactorial disease, and the composition of oral microbiota is a critical factor in its development. Also, Streptococcus mutans is considered the most important caries-causing species. It is expected that probiotics, as they adjust the intestinal microbiota and reduce the number of pathogenic bacteria in the human intestine, can exert their health-giving effects, especially the anti-pathogenic effect, in the oral cavity, which is part of the human gastrointestinal tract. Therefore, numerous in vitro and in vivo studies have been conducted on the role of probiotics in the prevention of tooth decay. In this review, while investigating the effect of different strains of probiotics Lactobacillus and Bifidobacteria on oral diseases, including dental caries, candida yeast infections, periodontal diseases, and halitosis, we have also discussed postbiotics as novel non-living biological compounds derived from probiotics.

Reframing perceptions in operative dentistry relating evidence-based dentistry and clinical decision making: a cross-sectional study among Jordanian dentists

BACKGROUND

The aim of the current study was to investigate current dental practice in operative dentistry in Jordan, and the relationship between evidence-based dentistry in caries research and decision making in clinical practice in operative dentistry.

MATERIALS AND METHODS

This cross-sectional study was conducted through a survey of dentists in Jordan. The survey aimed to explore the degree of knowledge and practice of evidence-based dentistry in caries research the dentists possess regarding clinical decision making in operative dentistry. The sample size was composed of (5811) dentists whom registered in Jordan Dental Association database. Descriptive statistics were generated and Chi-square test was used to examine associations between the different variables and the significance level was set at P < 0.05.

RESULTS

4000 responses were collected from the web-survey, response rate (68.83%). Nearly half of the surveyed dentists focus on the chief complaint of their patients (n = 2032, 50.8%) rather than doing full mouth assessment. Nearly two-thirds of dentists (n = 2608, 65.2%) treat lesions confined to enamel with operative treatment. Half of dentists use operative treatment when asked about the routine management of radiographically detected proximal caries confined to enamel. When treating incipient lesions, the majority (n = 3220, 80.5%) use preventive treatment. Three-quarters of dentists (n = 2992, 74.8%) treat deep dentinal caries by removing just the soft infected carious dentin, and treated old failed restorations with replacement.

CONCLUSION

In operative dentistry, the evidence-based research is not implemented clinically. To optimize relationship between evidence-based dentistry and clinical decision-making, dental curriculum has to be updated and modified constantly.

Surface Accumulation of Cerium, Self-Assembling Peptide, and Fluoride on Sound Bovine Enamel

The accumulation of caries-preventive compounds on sound enamel is crucial in order to improve the inhibition of carious lesion initiation. The aim of this research was to investigate the initial accumulation of cerium, oligopeptide p11-4, and fluoride from NaF or amine fluoride (AmF) on sound enamel in vitro by means of energy dispersive X-ray spectroscopy (EDX). Polished bovine enamel specimens (n = 120 from 60 teeth) were fabricated. Out of these, 12 specimens each were treated with CeCl3 (cerium(III) chloride heptahydrate 25%), oligopeptide p11-4 (Curodont Repair, Credentis), NaF (10,000 ppm F−), AmF (amine fluoride, Elmex Fluid, CP-GABA GmbH, 10,000 ppm F−), or Aqua demin (control). After rinsing with water, the surface elemental composition (Ce, N, F, Ca, P, O, Na, Mg) was measured (EDX; EDAX Octane Elect detector, APEX v2.0), expressed in atomic percent (At%) and analyzed (non-parametric statistics, α = 0.05, error rates method). Another 12 specimens per treatment group were fabricated and used for analyzing accumulation in cross-sections with EDX linescans and two-dimensional EDX-mappings. The surface median atomic percent of cerium (At%Ce) was 0.8 for CeCl3, but no Ce was found for any other group. N, specifically for oligopeptide p11-4, could not be detected. Fluorine could only be detected on fluoridated surfaces. The median atomic percent of fluorine (At%F) was 15.2 for NaF and 17.0 for AmF. The Ca/P ratio increased significantly compared to the control following the application of NaF and AmF (p < 0.001), but decreased significantly for CeCl3 (p < 0.001). In cross-sectioned specimens of the CeCl3-group, 12.5% of the linescans revealed cerium at the enamel surface, whereas 83.3% of the NaF linescans and 95.8% of the AmF linescans revealed fluorine at the enamel surface. Following the application of oligopeptide p11-4, no traces of N were detectable. In the depth of the samples, no signal was detected for any of the corresponding elements exceeding the background noise. Cerium and fluorine (from both NaF and AmF), but not the oligopeptide p11-4, precipitated on sound enamel.

Evaluation of dental caries detection with quantitative light-induced fluorescence in comparison to different field of view devices

This study evaluated dental caries detection ability between the Qraycam and Qraypen on the same dental caries lesions. A total of 178teeth from 61patients were imaged using Qraypen C®(QC) and Qraycam Pro®(QP) devices and evaluated using analysis software (QA2). Occlusal, secondary, and proximal dental caries were evaluated and scored according to International Caries Detection and Assessment System(ICDAS II) and X-ray criteria. Bland–Altman plots were used to compare quantitative light-induced fluorescence(QLF) parameters obtained from the different QLF devices. Sensitivity, specificity, and area under the receiver operating characteristic curve(AUROC) were calculated. The ΔF_aver. of the QLF-parameters showed that the mean difference between the two different QLF devices was close to zero and that the ± 5 error value was included in the mean ± 1.96SD range for the detection of dental caries. The accuracies for diagnosing occlusal dental caries were 0.83–0.96 and 0.81–0.82 and the accuracies for diagnosing proximal dental caries were 0.52–0.62 and 0.52–0.71 for the QC and QP devices, respectively. In conclusion, the ΔF_aver. obtained from the QP showed diagnostic value mainly for screening of demineralized teeth. For teeth selected through screening, the depth of the lesion must be precisely evaluated using additional QP and radiographic imaging.

Effectiveness of the ICCMS caries management system for children: a 3-year multicentre randomised controlled trial

OBJECTIVE

This 3-year multicentre randomised controlled trial compared, in 6-7-year-old Colombian children, the effectiveness of the ICCMS (International Caries Classification and Management System) with a conventional caries-management system (CCMS) in terms of individual caries-risk, caries lesions, and secondarily, oral-health-related knowledge/attitudes/practices, and number of appointments.

MATERIAL AND METHODS

With ethical approval, 240 6-7-year olds from six Colombian clinics were recruited. Trained examiners conducted the following baseline/follow-up assessments: Caries risk (Cariogram-ICCMS); caries severity/activity staging (ICDAS-merged combined radiographic/visual); sealants/fillings/missing teeth, and oral-health-related knowledge, attitudes and practices. Children received their randomly allocated (ICCMS/CCMS) care from dental practitioners. Outcomes: caries-risk control (children); caries-progression control (tooth surfaces); oral-health-related knowledge/attitudes/practices improvement (parents/children), and appointments' number (children). Descriptive and non-parametric/parametric bivariate analyses were performed.

RESULTS

Three-year-follow-up: n = 187 (77.9%; ICCMS: n = 92; CCMS: n = 95) disclosed a baseline-to-3-year overall high-caries-risk children decrease (ICCMS: 60.9-0%, p < .001; CCMS: 54.7-5.3%, p < .001) (p > .05). ICCMS versus CCMS showed: fewer tooth-surface caries progression (6.2% vs 7.1%, p = .010) and fewer active-caries lesions (49.8% vs. 59.1%, p < .05); higher proportion of children with ≥2/day fluoride-toothpaste tooth-brushing practice (p < .05); similar mean number of appointments (10.9 ± 5.9 vs. 10.0 ± 3.8, p = .15).

CONCLUSION

Both caries-management systems showed similar effectiveness in caries-risk control, with ICCMS more effectively controlling tooth-surface caries progression and improving toothbrushing practices.

Reframing Perceptions in Restorative Dentistry: Evidence-Based Dentistry and Clinical Decision-Making

Objectives

The worldwide interest of both dentists and patients in esthetic dentistry has affected decision-making in dental practice. The aim of this study was to investigate contemporary dental practice in restorative dentistry and the relationship between evidence-based dentistry in caries research and decision-making in clinical practice in restorative dentistry.

Methods

The study was conducted through a structured questionnaire distributed randomly at the Jordanian Dental Association registered dentists in Jordan. The questionnaire aimed to clarify the degree of knowledge and practice of evidence-based dentistry in caries research the dentists hold regarding clinical decision-making in restorative dentistry.

Results

The majority of the surveyed dentists (77%) treat teeth with irreversible pulpitis with root canal treatment rather than vital pulp therapy. 13.8% routinely insert a post and 23% routinely crown the tooth after root canal treatment regardless of the remaining tooth structure. Badly damaged teeth are treated with full crowns in 72% of the cases. Regarding Hollywood smile or smile makeover, the majority of dentists choose conservative approaches, and implants were the first choice to replace missing teeth for 93.8% of the surveyed dentists.

Conclusion

A higher degree of implementation of evidence-based dentistry in clinical decision-making was found in Prosthetic Dentistry than in Endodontics. Yet, the gap between evidence-based data and clinical practice needs bridging. More emphasis on communicating these data to educators to integrate them into the dental curriculum is a must.

The Calcivis story - enamel caries activity assessment from technology to practice

The Calcivis story is one of innovation and collaboration to deliver new technology capable of helping dentists improve patient care through solving an unmet clinical need in assessing the activity of caries lesions in enamel. Presently, there is no system routinely used in dental practice that can, in a single visit, determine whether a non-cavitated caries lesion is active or not. Calcivis has evolved since 2005, when a potential link between basic science in luminescence and differentiating initial-stage caries lesions that are actively demineralising and likely to progress, from other lesions which are inactive and currently do not need interventive care, was recognised. The 16-year journey has involved clinical academic dentists, scientists and entrepreneurs, general practitioners and their patients, together with serial investors and a core team working to patent, refine, assess and develop products to submit to regulatory approval and take to the international dental market. This journey has been made possible through effective long-term collaborations between disparate groups all sharing a common vision for the possibilities of harnessing new technology to help dental professionals provide better care for their patients.

Information about caries activity in non-cavitated lesions is important to help the dental team assess the care needs of both individual tooth surfaces as well as the patient as a whole.

Assessing caries activity or inactivity is different from merely detecting the presence or absence of lesions and staging their severity; visual activity assessments of initial-stage lesions are subjective and often unreliable.

The Calcivis-developed technology can, for the first time, provide an objective indication of enamel lesion activity related to the release of free calcium from demineralising lesions and a demineralisation map image can communicate the findings to both dentists and patients.

Minimally Invasive Therapies for the Management of Dental Caries—A Literature Review

In recent years, due to a better understanding of the caries pathology and advances in dental materials, the utilization of non-invasive and minimally invasive techniques that delay/obviate the need for traditional restorations has started gaining momentum. This literature review focuses on some of these approaches, including fluoride varnish, silver diamine fluoride, resin sealants, resin infiltration, chemomechanical caries removal and atraumatic restorative treatment, in the context of their chemistries, indications for use, clinical efficacy, factors determining efficacy and limitations. Additionally, we discuss strategies currently being explored to enhance the antimicrobial properties of these treatment modalities to expand the scope of their application.

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

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

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.

Cariology consensus for undergraduates at dental schools in the Caribbean region

AIM

To obtain a consensus on the domains of cariology for undergraduates in dental schools in the Caribbean.

MATERIALS AND METHODS

Dental school deans from the Dominican Republic (DR) and Puerto Rico (PR) were invited to participate. Afterwards, 24 cariology faculty members from the dental schools in the DR received a 40-h workshop on the current understanding of dental caries. Then, representatives from participating dental schools in the DR and PR were divided into six groups and tasked with exploring the cariology domains described in the European and Colombian consensus. For each domain, the competencies in what the dental student, upon graduation, would have to (1) be proficient in, (2) have knowledge of, (3) and be familiar with were described. Two cariology consensus meetings to work on the domains and suggest changes for the Caribbean region were done, and representatives from the DR and PR agreed on a cariology consensus. For the second stage, Caribbean English-speaking countries were invited to participate in the consensus. Meetings were held with representatives from dental schools in Trinidad and Tobago (TT) and Jamaica (J) to include their suggestions on each consensus domain.

RESULTS

A total of 15 dental schools (DR = 12; PR = 1; TT = 1; and J = 1) participated; they agreed on a new consensus considering the realities of the Caribbean participating countries.

CONCLUSION

A cariology consensus for undergraduates was achieved for 15 dental schools in the Caribbean region. This accomplishment will promote a shift for the Caribbean dental schools' graduates towards a current understanding of dental caries.

Efficacy of antimicrobial photodynamic therapy (aPDT) in reducing cariogenic bacteria in primary deciduous dentine

AIM

The aim is to systematically review the efficacy of aPDT in minimizing cariogenic bacteria in primary dentine when compared to tooth preparation and endodontic debridement.

MATERIALS AND METHODS

The focused question was: Is aPDT (intervention) effective in minimizing the cariogenic bacteria (outcome) in deciduous dentine (participants) after caries removal when compared to before aPDT or mechanical caries removal alone (controls). The keywords that were used were: 'antimicrobial photodynamic therapy', 'dentine', 'primary teeth' and 'deciduous teeth' in different combinations. Following the exclusion of the irrelevant studies, eight (seven clinical studies and one in vitro study) studies were included in the review. The data from each study was extracted and the quality of each article was assessed.

RESULTS

In four out of the eight studies, aPDT with methylene blue or toluidine blue had improved the efficacy of microbial reduction in deciduous dentine when compared to conventional root canal treatment or caries removal. In four studies, no significant improvement in microbial reduction was observed following aPDT compared to caries removal or endodontic debridement without aPDT. Four studies received an overall quality grading of 'medium', three studies were assessed as having a 'low' quality and only one study received an overall grading of 'high' quality.

CONCLUSION

Within the limitations of this review, aPDT may improve the anti-bacterial efficacy of restorative and endodontic procedures in deciduous teeth. However, due to lack of long-term clinical trials and robust study designs, the efficacy of aPDT in minimizing cariogenic bacteria in deciduous dentine is debatable.

Childhood caries management in the European Union: A cross-sectional study

OBJECTIVES

Dental caries is one of the most widespread childhood diseases worldwide, although it is largely preventable. In Europe, there is an observable difference between caries prevalence in Eastern and Western European states. This study aimed to gather data on the characteristics of publicly financed dental preventive services for children in European Union (EU) member states.

METHODS

Data on important indicators were collected through an online survey. National and international professional bodies specializing in pediatric dentistry and dental services were invited to participate in the study. Descriptive statistics and information gain were applied in the analysis to identify the strongest indicators of the availability and content of childhood caries services. Additionally, the reimbursement characteristics were examined.

RESULTS

We received responses from 27 EU member states. The accessibility and assessment of dental preventive services among the member states vary notably. The frequency of screenings and the screened age groups differ by country and free screenings for preschool children are not common. Monitoring systems were present in only 37% of the responding countries, but brief dental interventions are available to promote caries prevention in 25 of the 27 countries. However, these interventions are mainly focused on basic oral health education. Regarding the reimbursement characteristics, we found that the amount of reimbursement is larger for higher-cost treatments targeting already developed caries than for cost-effective preventive treatments, which are less likely publicly financed.

CONCLUSIONS

The prevention of dental caries is part of oral health promotion and education efforts in the EU; unlike the treatment of already developed dental caries, the accessibility of clinical prevention services is limited and usually not free for children. Further comprehensive studies are necessary to identify key indicators for international assessment and facilitate the standardization of the screening process, thus promoting the collection of comparable data.

Effects of healthcare policy and education on reading accuracy of bitewing radiographs for interproximal caries

Objectives

The aim of this study is to assess the accuracy of bitewing radiograph interpretation of predoctoral students, residents and general dentists who work under different core curriculum of dental education and healthcare policy.

Methods

A total of 118 examiners including predoctoral dental students, residents and general dentists from USA and Japan were tasked with evaluating a series of bitewing radiographs and diagnosing interproximal carious lesions. This study was approved by the Harvard Medical School Institutional Review Board (IRB). Participants graded interproximal aspects of those images and categorized the following criteria; “intact”, “enamel caries <1/2 width”, “enamel caries >1/2 width” or “caries into dentin”. The gold-standard was determined by the consensus of two HSDM full-time faculty.

Results

There was significant difference in the sensitivity for all three caries levels between the two groups but there was no significant difference on specificity. The positive-predictive and negative-predictive values of the USA group for the enamel caries (<1/2 of enamel) were significantly higher than the Japanese group. The average of AUC (ROC) was significantly higher in the USA group (0.885 ± 0.04) than the Japanese group (0.785 ± 0.08, p<0.01).

Conclusion

Teaching and adopting BW radiographs for diagnosis of interproximal caries is integral for dental providers to accurately and efficiently use them in their practices. It is critical that all dental educators approach policymakers to explain the importance of BW radiographs and promote their efficacy for prevention and early diagnosis of interproximal caries.

Tubular Dentin Regeneration Using a CPNE7-Derived Functional Peptide

We aim to examine the effects of a newly developed peptide derived from CPNE7 (Cpne7-DP) in tertiary dentin formation and peritubular space occlusion, and comprehensively evaluate its potential as a bioactive therapeutic agent. Human dental pulp cells (HDPCs) and a mouse pre-odontoblast cell line, MDPC-23, were chosen for in vitro studies to characterize lineage-specific cell responses after Cpne7-DP treatment. Whether Cpne7-DP reproduces the dentin regenerative potential of CPNE7 was tested using a beagle dog model by generating dentinal defects of various degrees in vivo. Peritubular space occlusion was further examined by scanning electron microscopy and microleakage test, while overall mineralization capacity of Cpne7-DP was tested ex vivo. CPNE7 promotes tubular dentin formation under both shallow and deep dentinal defects, and the functional peptide Cpne7-DP induces odontoblast-like differentiation in vitro, mineralization ex vivo, and tubular dentin formation in in vivo beagle dog dentin exposure and pulp exposure models. Moreover, Cpne7-DP leads to peritubular space occlusion and maintains stability under different conditions. We show that CPNE7 and its derivative functional peptide Cpne7-DP promotes dentin regeneration in dentinal defects of various degrees and that the regenerated hard tissue demonstrates the characteristics of true dentin. Limitations of the current dental materials including post-operative hypersensitivity make biological repair of dentin a field of growing interest. Here, we suggest that the dual functions of Cpne7-DP in tubular dentin formation and peritubular space occlusion are promising for the treatment of dentinal loss and sensitivity.

Do enamel and dentine caries at 5 years of age predict caries development in newly erupted teeth? A prospective longitudinal study

Objective: To explore caries development in children from 5 to 12 years of age, and to study whether enamel caries and dentine caries at 5 years of age could predict caries prevalence at 12 years of age, controlled for child characteristics.Methods: The study included 3282 children examined at 5 and 12 years of age. Data were collected by clinical examination and questionnaire. Enamel and dentine caries were registered at surface level. Data were tested by t-test and analysed by bi- and multivariate logistic regression. The study was ethically approved.Results: In 5-year-olds, 15% of the children had dentine caries experience and 21% had enamel caries. In 12-year-olds, 32% had dentine caries experience and 47% had enamel caries. Children with dentine caries experience at 5 years of age had at 12 years of age developed more surfaces with enamel caries (mean 2.8, SD 4.2) and dentine caries experience (mean 1.8, SD 2.5) than other children (p < .05). Dentine caries experience at 12 years of age was associated with having only enamel caries (OR 1.6, CI 1.2-2.0) and dentine caries experience (OR 3.2, CI 2.6-3.9) at 5 years of age. Family status and parental education were related to caries development.Conclusion: Children with caries in primary teeth continued to be caries risk children during the mixed dentition period. In addition to dentine caries experience, enamel caries in primary teeth was a predictor for caries development in young permanent teeth and may be used to improve the caries risk assessment.

Caries Prevalence Evolution and Risk Factors among Schoolchildren and Adolescents from Valencia (Spain): Trends 1998-2018

The aim of this study was to determine the caries status and risk factors in the schoolchildren of Spain’s Valencia region in 2018 and to compare them to the 20-year evolution of caries indicators in the region. A cross-sectional survey was conducted with 1722 children and adolescents aged between 6 and 15 using cluster sampling. Caries status, using International Caries Detection and Assessment System II (ICDAS II) criteria, and sociodemographic variables were recorded. To ensure the comparison with previous studies using WHO caries criteria, the cut-off point was established at ICDAS II code 4. Caries prevalence was found to be 37.4% and the decayed and filled teeth index (dft) was 1.23 at 6 years for deciduous dentition (DD). In permanent dentition (PD) at 12 years, caries prevalence was 30.1% with a 0.66 decayed, missing and filled teeth index (DMFT), and at 15 years, prevalence was 44.6% and DMFT was 1.21. Socioeconomic status poses a major risk factor for caries prevalence in deciduous dentition; it is 1.8 times higher in the lowest socioeconomic group. Deciduous dentition status has worsened in the most recent eight-year period, whereas in permanent dentition the 12- and 15-year values are similar to those of the 2010 survey. Evolution analysis suggests that community dental care programs be enhanced, involving preventive activities staring at the first year and targeting disadvantaged groups.

Greater caries-free survival of first permanent molars: Findings from a 7-year follow-up evaluation of a community-based oral health preventive program

BACKGROUND

The occlusal surface of the first permanent molar is the most frequently affected site by dental caries.

AIM

To assess the caries-free survival of first permanent molars in children participating in a community-based oral health preventive program.

DESIGN

This was a retrospective study conducted on 426 children under 12 years of age, beneficiaries of a preventive program from 2009 to 2015, in El Cedro, Colombia. The program offered oral health care education, supervised brushing and mouth washing, and application of topical fluoride. By using parametric survival models for interval-censored data, primary and secondary caries-free survival of any first permanent molar was estimated and analyzed.

RESULTS

Before program implementation, dental caries lesions presented at an average age, adjusted by age of eruption, of 8.3 years for primary caries lesion and 9.3 years for secondary caries lesion. After 7 years of the program, the estimated average age for presenting primary dental caries lesion was delayed by 4.6 years and by 5.3 years for secondary caries.

CONCLUSION

The implementation of the oral health program led to improved caries-free survival of first permanent molars.

Mineral exchange within restorative materials following incomplete carious lesion removal using 3D non-destructive XMT subtraction methodology

OBJECTIVES

The objective of this study was to quantify the changes in mineral and selected element concentrations within residual carious dentine and restorative materials following incomplete carious lesion removal (ICLR) using different cavity liners, with non-destructive subtraction 3D-X-ray Microtomography (XMT, QMUL, London, UK).

MATERIALS AND METHODS

A total of 126 extracted teeth with deep dental caries were assessed using International Caries Risk and Assessment (ICDAS). Eight teeth were subsequently selected after radiographic evaluation. Each lesion was removed, leaving a thin layer of leathery dentine at the deepest part of cavity. Different cavity lining materials were placed; Mineral Trioxide Aggregate (MTA), calcium hydroxide, (Ca(OH)₂), resin-based material (RBM). For each, the restorative material was an encapsulated glass ionomer (GIC) and the control group had a GIC restoration alone. Each tooth was immediately placed in Simulated Body Fluid (SBF). All samples were then imaged using XMT at baseline, and three weeks after treament. The XMT images were then subtracted to show the mineral concentration changes three weeks after treatment.

RESULTS

There were significant increases in mineral concentrations within the residual demineralised dentine in individual teeth treated with Ca(OH)₂, MTA, RBM, and GIC following immersion in SBF for three weeks. GIC group without any liners showed the greatest increase in mineral concentration, followed by MTA and Ca(OH)₂.

CONCLUSION

Mineral changes in demineralised dentine and within restorative materials are quantifiable using non-destructive 3D-XMT subtraction methodology. This laboratory study suggested that calcium, phosphate and strontium ion-exchange occurs with GIC, MTA and Ca(OH)₂ in deep dentinal lesions following ICLR.

CLINICAL RELEVANCE

In clinical practice, incomplete carious lesion removal could be performed to avoid the dental pulp exposure. 3D non-destructive XMT subtraction methodology in a laboratory setting is advantageous to provide evidence for different restorative materials on deep carious lesions prior to clinical investigations.

Evaluation of CRAFT as a Tool for Caries Risk Assessment in 3- to 6-year-old Children and its Validation against Alban's Test: A Pilot Study

Introduction

Dental caries is a multifactorial disease and a dynamic process that can be prevented and reversed during the early stage. Risk assessment is an important step in decision-making and treatment planning. There are no valid tools available for the Indian population. Caries risk assessment for treatment (CRAFT) is a chairside tool for caries risk assessment and management. Valid, reliable, economical, and chairside caries risk assessment tool is the need of the hour for general and pediatric dentists.

Aim

To evaluate CRAFT as a tool for caries risk prediction among 3-years to 6-years-old children and to validate it against Alban test.

Materials and methods

A pilot study was conducted, including forty 3-years to 6-years-old children. Salivary samples were collected and inoculated on B.C.G.-Dextrose Agar. Caries activity was assessed using Alban test. Their parents/guardians completed the CRAFT assessment in entirety.

Results

The data were tabulated and subjected to suitable statistical analysis. High positive correlation between CRAFT scores and Alban's test (Spearman's Rho = 0.874) was found.

Conclusion

CRAFT scores were highly correlated with Alban scores in 3- to 6-year-old children. CRAFT could be successfully employed as a reliable, economical, chairside, and clinically feasible risk assessment tool with further research on a larger sample size.

Clinical significance

CRAFT can provide a framework for the clinician for preventive care and enhance patient–participation for CRA.

How to cite this article

Thakur JH, Subhadra HN, Jawdekar A. Evaluation of CRAFT as a Tool for Caries Risk Assessment in 3- to 6-year-old Children and its Validation against Alban's Test: A Pilot Study. Int J Clin Pediatr Dent 2019;12(6):538–542.

Prevention of dental caries by grape seed extract supplementation: A systematic review

BACKGROUND

Dental caries are the most prominent chronic disease of children and adults worldwide, and facilitating evidence-based, preventative care for their prevention is critical. Caries are traditionally and successfully prevented by regular fluoride use, but there are opportunities to halt and restore caries with alternative agents in addition to fluoride use. Grape seed extract (GSE) is a readily available plant-based supplement that, due to its concentrated levels of proanthocyanidins, has promising characteristics that may assist in dental caries prevention.

AIM

The goal of this review was to investigate whether current research supports use of grape seed extract to prevent dental caries formation.

METHODS

A systematic review of articles related to grape seed extract, prevention of dental caries, inhibition of Streptococcus mutans, and remineralization was conducted. Articles were first chosen by inclusion of dental models that used grape seed extract as an intervention, and then by strength of study design.

RESULTS

Twenty articles were reviewed. Studies overall supported three unique grape seed extract properties facilitating dental caries prevention. In the first articles reviewed, grape seed extract inhibited proliferation of bacterial biofilms on tooth surfaces. In addition, studies reviewed indicated that grape seed extract promoted dental remineralization.

CONCLUSIONS

Caries prevention by grape seed extract may be unique compared with fluoride, and is linked to grape seed extract's bacteriostatic and collagen crosslinking properties. Future research should investigate potential delivery methods, and benefits of combined grape seed extract use with known caries preventative agents, in human participants.

Assessment of diagnostic accuracy of a direct digital radiographic-CMOS image with four types of filtered images for the detection of occlusal caries

BACKGROUND

Digital imaging has the potential to improve diagnostic accuracy and make quantitative diagnoses. In the recent decades, software for radiographic analysis has been investigated and developed for the detection of lesions and the quantitative assessment of the depth of a caries lesion. In addition, the accuracy of diagnosis may also be enhanced by programs that filter the images. These programs can adjust the brightness and contrast, determine the gray level, invert the shades of gray, and apply pseudocolors. Few studies compared different types of digital images in the diagnosis of changes in the tooth crown.

AIM

The main aim of this study was to assess the the diagnostic accuracy of a direct digital radiography (DDR)-CMOS image with four types of filtered images for the detection of occlusal caries.

MATERIALS AND METHODS

Fifty randomly selected patients' teeth were clinically examined and digitally radiographed. Radiographed images are converted into four filter images with the help of software. Filtered images were then selected for inter- and intraobserver examination and the result was subjected to statistical analysis.

CONCLUSION

DDR-CMOS and negative image were found to be more useful in diagnosing occlusal caries.

In Vitro Influence of Prophylaxis Cleaning on Enamel Remineralization with Casein Phosphopeptide-Amorphous Calcium Phosphate

Objectives

This randomized controlled in vitro 4-arm trial study aimed to study the remineralization potential of Recaldent™ and assess the effects of prophylaxis cleaning and MI Varnish^® on enhancing this remineralization potential.

Material and Methods

Sixty human teeth were randomly assigned into equal samples (A/B). Sample A was prophylactically cleaned, randomly divided into equal samples (1/2). Sample A1 received treatment with MI Varnish^® and Recaldent™ for 30 days. Sample A2 was treated similarly but without MI Varnish^®. Sample B did not receive prophylaxis cleaning and was divided into equal samples (1/2). Sample B1 was treated as A1 and sample B2 as A2. The teeth were examined for mineral composition at baseline, after the interventions (T1), and after prophylaxis cleaning (T2). Study outcomes were mineral content (% weight of carbon [C], phosphorus [P], calcium [Ca], oxygen [O], chlorine [Cl], sodium [Na] and silicon [Si]) and calcium-phosphorus ratio (Ca/P).

Results

All groups had similar mineral composition at baseline. At T1, sample B2 exhibited least P, Ca and Ca/P content. Samples A1 and B1 showed higher content of P and Ca, compared to B2 (A1 only exhibited higher Ca/P). Sample A2 exhibited lowest Cl and Na content. At T2, sample A1 exhibited lowest C, P, O and Si content (highest Ca/P). Sample A2 showed least Ca/P, and highest Na content.

Conclusions

Teeth treated by Recaldent™ proceeded by prophylaxis cleaning or MI Varnish^® showed remineralization, especially when receiving both interventions. This superior effect persisted even after a second cleaning. Further trials are necessary to provide conclusive evidence in humans.

Formation and assessment of enamel subsurface lesions in vitro

The present study compared two pH-cycling models designed to induce subsurface lesions (SLs) with a less demineralized surface layer on teeth, with the aim of developing new technologies for assessment of such lesions by examining the performance of confocal Raman microscopy for detection of white spot lesions (WSLs). Twelve sound premolars were exposed to two sets of model conditions (A, B) designed to induce SLs. Teeth on which white lesions had formed in vivo were used as positive controls. All specimens were inspected using an intraoral camera and Raman microscopy to detect small changes in the appearance and structure of the enamel. Changes in the natural color of the teeth during the treatment were recorded via the camera. Phosphate maps with their spectra were constructed from the phosphate peak at 960 cm^-1. The depth of lesions was measured on the basis of variations in phosphate peak intensity. Protocol B was reliable for reproducing SLs in a relatively short period. Both protocols had intrinsic limitations in not completely simulating the complex intraoral conditions leading to WSL formation with respect to lesion depth and preservation of an intact surface layer. Raman microscopy can be considered the gold standard for analysis of hard tissue mineralization.

Management of initial carious lesions: Iowa survey

BACKGROUND

The authors explore Iowa dentists' agreement with the International Caries Classification and Management System (ICCMS) in the nonsurgical management of initial carious lesions in patients at low, moderate, and high caries risk and identify factors related to their agreement.

METHODS

Electronic surveys were mailed to 916 actively practicing dentists who are alumni of the College of Dentistry at The University of Iowa. Questions included clinical scenarios that used text, clinical photographs, and radiographic images of initial carious lesions. Dentists were asked what type of treatment they would recommend. Treatment options included no treatment, nonsurgical treatment, or surgical treatment. Logistic regression analyses were used to assess associations among agreement with ICCMS, characteristics of the dentist's practice, and patients' caries risk level.

RESULTS

A total of 138 Iowa dentists responded to the survey. Agreement with ICCMS regarding nonsurgical management of initial carious lesions for patients at low, moderate, and high risk levels were 73%, 59%, and 51% respectively. Compared with their counterparts, dentists who agreed with the recommendations for nonsurgical treatment were more likely to dry the teeth during caries detection (95% confidence interval [CI], 1.02 to 12.67, P = .0468), use magnification (95% CI, 1.16 to 7.17, P = .0225) for caries detection, have graduated less than 20 years ago (P = .0024), practice in public health settings (P = .0089), and perform a caries risk assessment (95% CI, 1.10 to 4.29, P = .0262).

CONCLUSIONS

Dentists who dry teeth, use magnification for caries detection, graduated in the past 20 years, practice in a public health setting, and perform a caries risk assessment were significantly more likely to make decisions that were consistent with the guidelines of the ICCMS.

PRACTICAL IMPLICATIONS

Knowledge of evidence-based options personalized for a patient's risk status is essential for applying the best management of initial caries lesions.

Patient-Specific, Risk-Based Prevention, Maintenance, and Supportive Care: A Need for Action and Innovation in Education

PURPOSE

To develop a competency-based curriculum framework for prevention, supportive care, and maintenance for use in educational and patient care programs and to seek consensus on an overarching competency statement that embraces these critical learning and patient care concepts.

MATERIALS AND METHODS

A preliminary survey of current preventive and maintenance practices in U.S. dental and prosthodontic programs was completed and summarized with quantitative analysis. The American College of Prosthodontists organized a one-day consensus workshop with 14 participants from various U.S. dental schools with diverse backgrounds to develop a curriculum framework. The curriculum framework was used in the development of a joint competency statement using an iterative, online consensus process of debate and feedback.

RESULTS

The preliminary survey helped frame the initiative and identify potential educational needs and gaps. Consensus was achieved for a recommended competency statement: "Graduates must be competent in promoting oral health through risk assessment, diagnosis, prevention, and management of the hard tissue, soft tissue, and prostheses, and as part of professional recall and home maintenance." This competency statement complements the proposed curriculum framework designed around 3 domains-caries prevention, periodontal supportive care, and prosthesis supportive care-with a set of recommended learning objectives.

CONCLUSIONS

Commission on Dental Accreditation (CODA) learning standards do not outline patient-customized, evidence-based recall and home maintenance programs that highlight prevention of dental caries, periodontal supportive care, prosthesis maintenance, and patient education. The proposed competency-based curricular framework serves as an initial step in addressing student learning and patient care within the context of a recall system and home maintenance program while offering schools the needed flexibility for implementation within their curriculum.

Antimicrobial photodynamic therapy using a plaque disclosing solution on Streptococcus mutans

OBJECTIVES

Photodynamic therapy with a bactericidal action is called antimicrobial photodynamic therapy (aPDT),which is a method of staining an object with a photosensitizing dye and then sterilizing by irradiating the dye at it's excitation wavelength. In this study, we aimed to investigate a caries pathogenic bactericidal method in a site difficult to mechanically remove, by examining aPDT effect on Streptococcus mutans (S. mutans), which is a typical caries pathogenic bacteria by applying the plaque disclosing solution as photosensitizing dye.

METHODS

The absorption wavelength spectrum of irradiating plaque staining agent phloxine B (PB) was analyzed using UV-vis. Reactive oxygen species (ROS) generated by photo excitation with blue LED irradiation was measured by electron spin resonance technique. S. mutans was cultured according to a conventional method and the effect of aPDT after PB staining was evaluated by a Colony Forming Unit (CFU). In addition, protein carbonyl (PC), an oxidative stress marker, was also measured by western blotting.

RESULTS

Singlet oxygen was generated by PB with blue light. As a result of aPDT treatment on S. mutans under this condition, it was recognized that CFU was suppressed dependent on irradiation intensity of blue light. In addition, the expression of PC was enhanced by aPDT.

CONCLUSIONS

aPDT is demonstrated by staining S. mutans with PB and irradiating blue light used for resin polymerization and tooth bleaching to generate ROS. Therefore, plaque-disclosing solution-based aPDT against S. mutans might represent a new method for cleaning pit and fissure grooves.

Reminova and EAER: Keeping Enamel Whole through Caries Remineralization

This article aims to outline the early development of a King's College London dental spinout company, Reminova, formed to commercialize a novel clinical method of caries remineralization: electrically accelerated and enhanced remineralization (EAER). This method is being developed to address the unmet clinical need identified by modern caries management strategies to keep enamel "whole" through remineralization of clinical caries as a form of nonoperative caries treatment for initial-stage and moderate lesions. A progressive movement within dentistry is shifting away from the restorative-only model, which, it is suggested, has failed. The high prevalence of initial-stage caries across populations provides a significant opportunity to prevent restorations and reduce repeat restorations over a patient's lifetime. Reminova has set out to provide a method to repair lesions without drilling, filling, pain, or injections. The article outlines the rationale for and the chronological stages of the technology and company development. It then outlines corroborative evidence to show that EAER treatment can, in this preliminary in vitro investigation, remineralize clinically significant caries throughout the depth of the lesion as measured by Knoop microhardness and corroborated by scanning electron microscopy. Furthermore, the presented data show that EAER-treated enamel is harder than the healthy enamel measured nearby in each sample and is very similar in appearance to healthy enamel from the subjective interpretation made possible by scanning electron microscopy imagery. The data presented also show that this more "complete" remineralization to a high hardness level has been achieved with 2 remineralizing agents via in vitro human tooth samples. The broad clinical potential of this new treatment methodology seems to be very encouraging from these results. Reminova will strive to continue its mission, to ensure that, in the future, dental teams will not need to drill holes for the treatment of initial-stage and moderate caries lesions.

Need of non-operative caries treatment in 16-year-olds from Northern Norway

AIM

To assess the prevalence of proximal enamel lesions, the need for non-operative caries treatment and the quality of dental restorations in 869 students aged 16 years from Northern Norway.

METHODS

All first year upper secondary school students in Tromsø and Balsfjord municipalities were invited to participate in an oral- and general health project (Fit Futures). The attendance rate was 90%, and all subjects born in 1994 (449 males and 420 females) were included in the present study. Dental caries was registered according to a 5-graded scale (1-2 = enamel lesions; 3-5 = dentinal lesions). Scores from 1 to 4 were used to register the quality of restorations (1 = good; 2 = acceptable; 3 = poor; 4 = unacceptable).

RESULTS

Only 6% of the 16-year-olds were completely caries-free. There were 84% of the participants with proximal enamel lesions. A majority of them had either previously restored teeth (35%) or both restored teeth and untreated dentinal caries lesions (34%). When using the D-value of the DMFS-index as a diagnostic criterion, 39% of the participants were in need of restorative treatment. When proximal enamel lesions were included in the diagnosis, the number of participants in need of restorative and/or non-operative caries treatment was 85%. Over 1/3 of the participants presented with at least one restoration below an acceptable quality level.

CONCLUSIONS

Dental caries is still a major health problem affecting the total teenage population. A non-operative treatment strategy should be considered relevant in order to reduce the need for restorative treatment.

State of the Art Enamel Remineralization Systems: The Next Frontier in Caries Management

The principles of minimally invasive dentistry clearly dictate the need for clinically effective measures to remineralize early enamel caries lesions. While fluoride-mediated remineralization is the cornerstone of current caries management philosophies, a number of new remineralization strategies have been commercialized or are under development that claim to promote deeper remineralization of lesions, reduce the potential risks associated with high-fluoride oral care products, and facilitate caries control over a lifetime. These non-fluoride remineralizing systems can be broadly categorized into biomimetic enamel regenerative technologies and the approaches that repair caries lesions by enhancing fluoride efficacy. This paper discusses the rationale for non-fluoride remineralization and the mechanism of action, challenges, and evidence behind some of the most promising advances in enamel remineralization therapies.

Has the implementation of the Minamata convention had an impact on the practice of operative dentistry in Jordan?

Objective

To assess Jordanian dentists’ current perception and attitudes towards amalgam and composite restorations four years after the Minamata treaty was endorsed and suggest decision making factors that may influence the type of restoration requested by patients.

Methods

The cross-sectional study was conducted through structured questionnaires distributed to dentists in Amman, Jordan from June 2017 to February 2018.

Results

Of the 1686 dentists who were contacted 758 dentists (response rate 45%) responded to the questionnaire either by email or via field visits. Jordanian dentists used more composite restorations than amalgam. Recurrent caries followed by fracture of the restoration were the main reasons for replacement of both fillings by dentists. However, dentists suggested that the main reason patients requested replacement of amalgam was for ‘staining’. In addition, a large proportion of the dentists had experienced patients who had asked either for replacement of amalgam (77%) or refused an amalgam filling (99%) for aesthetic reasons. In the opinion of the dentists, only 20% patients requested replacement of amalgam because of the mercury content.

Conclusion

The findings of this survey suggest that a ‘phase-down’ of dental amalgam is being implemented in Jordan's dental clinics but it is not associated with commitment to the Minamata Convention, rather to current dental practice trends and patients’ aesthetic demands.

Effects of different resin sealing therapies on nanoleakage within artificial non-cavitated enamel lesions

The aim of this study was to evaluate nanoleakage within the different lesion-sealing therapies applied to artificial non-cavitated enamel lesions. Thirty-two human anterior teeth were used. Artificial subsurface enamel lesions were produced on the labial surfaces of teeth. The specimens were then randomly divided into three groups (n=10): Group I- Clinpro Sealant application; Group II- ExciTE F adhesive resin application; and Group III- ICON resin infiltrant application. Each group was further divided into two subgroups: control and thermocycler. Nanoleakage was calculated by the digital image analysis software. In the control and thermocycled groups, there was no statistically significant difference between the Groups I, II, and III (p>0.05). The only significant leakage scores were obtained between the Group III control and thermocycler groups (p=0.027). ICON infiltrant can be used as an alternative to dental adhesives and fissure sealants in the sealing of initial non-cavitated enamel lesions. But the resin may become more affected by the water sorption than other resin materials over time. More studies are needed to evaluate long-term durability of resin infiltrants.

Complex patterns of response to oral hygiene instructions: longitudinal evaluation of periodontal patients

Background

Oral hygiene instruction is an intervention widely practiced but increased knowledge about oral health does not necessarily dramatically impact oral disease prevalence in populations. We aimed to measure plaque and bleeding in periodontal patients over time to determine patterns of patient response to oral hygiene instructions.

Methods

Longitudinal plaque and bleeding index data were evaluated in 227 periodontal patients to determine the impact of oral hygiene instructions. Over multiple visits, we determined relative plaque accumulation and gingival bleeding for each patient. Subsequently, we grouped them in three types of oral hygiene status in response to initial instructions, using the longitudinal data over the period they were treated and followed for their periodontal needs. These patterns of oral hygiene based on the plaque and gingival bleeding indexes were evaluated based on age, sex, ethnic background, interleukin 1 alpha and beta genotypes, diabetes status, smoking habits, and other concomitant diseases. Chi-square and Fisher’s exact tests were used to determine if any differences between these variables were statistically significant with alpha set at 0.05.

Results

Three patterns in response to oral hygiene instructions emerged. Plaque and gingival bleeding indexes improved, worsened, or fluctuated over time in the periodontal patients studied. Out of all the confounders considered, only ethnic background showed statistically significant differences. White individuals more often than other ethnic groups fluctuated in regards to oral hygiene quality after instructions.

Conclusions

There are different responses to professional oral hygiene instructions. These responses may be related to ethnicity.

Electronic supplementary material

The online version of this article (10.1186/s12903-018-0537-z) contains supplementary material, which is available to authorized users.

Efficacy of fluorides and CPP-ACP vs fluorides monotherapy on early caries lesions: A systematic review and meta-analysis

The study aimed to evaluate the efficacy of the combination of CPP-ACP and fluorides compared with fluorides monotherapy on patients with early caries lesions. The Medline, Embase and Cochrane databases up to August 2017 were scanned, with no restrictions. Studies satisfied the guideline of randomised controlled trials (RCTs), the patients with early caries lesions and data considering the efficacy of fluorides and CPP-ACP versus fluorides alone were selected. There was no language restriction during the literature search process, however, only papers in English or Chinese were included during the selection process. Outcome variables include laser fluorescence, quantitative light-induced fluorescence, lesion area and visual inspection scores. Mean differences were calculated during the data extraction process. Ten studies including 559 patients were selected in the meta-analysis. Fluorides combined with CPP-ACP achieved the same efficacy for early caries lesions on smooth surfaces compared with fluorides monotherapy (mean difference: -13.90, 95% confidence interval: [-39.25, 11.46], P = 0.28), and the combination treatment showed significantly better efficacy than fluorides monotherapy for occlusal early caries lesions (mean difference: -21.02, 95% confidence interval: [-27.94, -14.10], P<0.01). However, further well-designed studies are still needed.