Reproducibility of clinical caries diagnoses on coronal and root surfaces

The Association Between Seeking Urgent Dental Care and the Prevalence of Root Caries Among Patients in the United States, National Health And Nutrition Examination Survey 2017-2020: A Cross-Sectional Study

OBJECTIVE

This cross-sectional study aimed to investigate the association between seeking urgent dental care and the prevalence of root caries among patients in the United States, utilizing data from the Nutritional Health and Examination Survey (NHANES) conducted between 2017 and 2020. Our hypothesis is that patients who are seeking urgent dental care due to pain will have a high prevalence of root caries.

METHODS

The study utilized a cross-sectional design, analyzing data from NHANES 2017-March 2020 pre-pandemic data, a nationally representative survey. The sub-sample consisted of 6,186 participants aged 20 years and older who underwent oral health assessments, including the examination of root caries. Information on seeking urgent dental care was obtained through self-reported data. Statistical analyses, using SAS 9.4 (SAS Institute Inc., Cary, NC), were performed to assess the association between urgent care seeking and root caries prevalence while controlling the potential confounding variables. Descriptive statistics and multivariable logistic regression were used.  Results: The study included a total of 6,186 participants. The mean age (SD) of the participants was 49.7 (17.2). Some 52% were females and 48% were males. Some 14% (849) of the samples had root caries and 28% (1739) of the participants were seeking urgent dental care due to pain. Findings indicated a significant association between seeking urgent dental care and the prevalence of root caries (odds ratio, OR = 2.72, 95% confidence interval, CI = 2.32-3.18). Individuals who reported seeking urgent care had a higher prevalence of root caries (26% vs. 9%) compared to those who did not seek urgent care. Socioeconomic factors such as poverty and education, and other factors such as age, gender, race, marital status, and alcohol intake were identified as potential confounders.

CONCLUSION

This study provides evidence of the association between seeking urgent dental care and the prevalence of root caries among patients in the United States. The findings underscore the importance of promoting regular dental visits, preventive measures, and early interventions to mitigate the risk of root caries among individuals seeking urgent dental care. Addressing socio-economic barriers, improving access to dental services, and enhancing oral health education are crucial steps toward reducing the burden of root caries in this population. Further, longitudinal studies are recommended to establish the temporal relationship between urgent care seeking and root caries development.

Demonstration of an optical dentin hardness measuring device using bovine dentin with different demineralization times

SIGNIFICANCE

The increase in root caries is a serious problem as society ages. Root caries is diagnosed by inspection and palpation, which are qualitative. A method to objectively and quantitatively evaluate the progress of root caries in a clinical setting is strongly desired. The root caries could be diagnosed by measuring hardness because dentin becomes softer as the caries progresses. Vickers hardness has been customarily used as an indicator of tooth hardness. However, this method cannot be used to in vivo teeth because the teeth must be dried prior to measurement to make the indentation. A hardness meter using an indenter with light for tooth monitoring (HAMILTOM) is proposed as an optical device. HAMILTOM could measure hardness of teeth in wet condition as a dark area while applying a load to dentins without drying. Therefore, HAMILTOM may realize hardness measurements of in vivo teeth in a clinical setting quantitatively.

AIM

The aim of our study is to demonstrate the optical dentin hardness measuring device HAMILTOM using bovine dentin with different demineralization times and to evaluate the correlation between the dark areas measured by HAMILTOM and the Vickers hardness measured by the Vickers hardness tester.

APPROACH

The samples were 20 bovine dentins. They were demineralized by a lactic acid solution with different times and divided into groups 1 and 2 of 10 samples each. In both groups, the dark areas and Vickers hardness were measured for each sample. Group 1 was used to obtain a calibration curve to calculate Vickers hardness from the dark area. Group 2 was used to validate the calibration curve obtained from the dentin samples of group 1.

RESULTS

The areas appearing black without a total internal reflection of the indenter measured by HAMILTOM increased as the demineralization time increased. Additionally, the Vickers hardness of group 2 calculated by the dark areas of group 2 and the calibration curve obtained in group 1 and the Vickers hardness of group 2 measured by the Vickers hardness tester were strongly correlated with a determination coefficient of 0.99.

CONCLUSIONS

The results demonstrate that HAMILTOM may be a suitable alternative to the conventional method. Unlike the conventional method, which cannot be used for in vivo teeth, HAMILTOM holds potential to quantitatively evaluate the progress of caries in in vivo teeth.

The burden of root caries: Updated perspectives and advances on management strategies

BACKGROUND

Root caries has gained much attention in the last few years. As the world's population is ageing and people currently tend to retain more teeth compared with older generations, there is an increased prevalence of periodontal disease and gingival recession, which may accelerate the onset of root caries.

OBJECTIVE

This review aims to summarise recent findings related to the diagnosis, prevention and treatment of root caries.

MATERIALS AND METHODS

MEDLINE (OVID) and Scopus (Elsevier) searches were performed to identify and discuss articles that address the pathogenicity and clinical management of root caries.

RESULTS

Root caries is a multifactorial disease. Cariogenic species involved in root caries are less dependent on carbohydrates since collagen degradation inside the dentinal tubules can provide nutrients and microcavities for the invading microorganisms. Furthermore, the root surface has fewer minerals in comparison with enamel, which may accelerate the onset of demineralisation. Root caries could be prevented by patient education, modification of risk factors, and the use of in-office and home remineralisation tools. The use of non-invasive approaches to control root caries is recommended, as the survival rate of root caries restorations is poor. When plaque control is impossible and a deep/large cavity is present, glass ionomer or resin-based restorations can be placed.

CONCLUSION

The assessment of root carious lesions is critical to determine the lesion activity and the required intervention. Dental practitioners should also be aware of different prevention and treatment approaches to design optimum oral health care for root caries-affected patients.

Root caries: a periodontal perspective

BACKGROUND AND OBJECTIVE

A prevailing dental problem in the periodontal patient is root caries. Specifically, periodontal involvement often results in root surfaces becoming exposed and at risk for this condition. Periodontal therapy often leads to increased gingival recession as well, and the associated increased root caries risk may compromise the long-term success and survival of periodontally treated teeth.This narrative review will address the topic of root caries in the periodontal patient, focusing on unmet research needs.

MATERIAL AND METHODS

The Medline database was searched to identify items dealing with root caries, in terms of clinical features, diagnosis, pathogenic mechanisms and histopathology, as well as epidemiology, focusing then on the relationship between root caries and periodontal disorders.

RESULTS

Although there is extensive literature on root caries, consensus is lacking regarding certain aspects, such as diagnostic criteria, prevalence within populations and indisputable risk factors. Advancing age could be an aggravating factor in susceptibility to root caries for the periodontal patient; however, definitive evidence in this regard is still missing. Similarly, full awareness of the increased risk of root caries in patients with periodontal disease or long-term periodontal treatment appears to be still lacking.

CONCLUSION

Research regarding root caries in age-specific (elderly) periodontal patients is needed. Improved oral hygiene practices, locally applied preventive measures, good dietary habits and regular dental check-ups are crucial approaches to prevent both periodontal disease progression and root caries. Periodontal patients with root exposure should follow a strict root caries prevention protocol, as an integral component of their periodontal maintenance therapy.

What is an appropriate caries diagnosis?

This aim of this paper is to spur a discussion of the direction of caries-lesion detection activities in clinical dental practice. It is argued that since the dental clinician's caries-related decision making is a script-matching enterprise in which clinical decisions are made on the basis of 'this-lesion-needs-this-kind-of-treatment' reasoning, the methods and strategies employed for caries lesion detection should accommodate this fact. This may be done by employing a clinical visual-tactile method for caries lesion detection that evaluates the two aspects that are crucial for appropriate caries management: lesion activity and surface integrity. The use of diagnostic methods that do not assess these features directly but involve assumptions about activity status and surface integrity should be avoided. This includes the use of bite-wing radiography for the detection of approximal caries lesions, as it may be shown that plain reliance on radiographs leads to considerable overtreatment. If clinical dentistry is to retain its status as a profession committed to doing good, changes in diagnostic practices along these lines are warranted.

In vitro cariostatic effects of various iron supplements on the initiation of dental caries

Previous animal and laboratory studies have shown the possible cariostatic effect of iron. The purpose of this study was to in vitro study the effect of different concentrations of four iron supplements on the initiation of dental caries.

MATERIALS AND METHODS

Four products of iron supplements were used namely fre-in-sol, ferotonic, feromin and ferose. Two hundred extracted teeth were distributed randomly into 10 groups. Eight groups were from the four iron products in two concentrations (100% and 50%) in addition to the positive and negative control groups. Mutans streptococci bacteria (6715) grown in Todd Hewitt Broth were used. Assessment of decalcification and cavitation was done daily for 60 days.

RESULTS

It showed that different iron - supplement products play cariostatic effect in the initiation of the dental caries. With the exception of 100% and 50% ferose, both 100% and 50% concentrations of all supplements have cariostatic effect. The mean dates for decalcification varied with lowest for the positive control (12.2 days) and the highest was for 50% feromin. Cavitation was seen in the positive control and 100% ferose groups with mean on the first day of cavitation of 57 days.

CONCLUSION

It was concluded that iron may have cariostatic effect on the in vitro development of dental caries in human teeth.

Visual and visuo-tactile detection of dental caries

The objective of this review is to describe and discuss the content validity of a sample of caries detection criteria reported in the literature between January 1, 1966, and May 1, 2000. Using filters to locate randomized or controlled clinical trials on dental caries, fluorides, sealants, and "restorative" care, I identified a total of 171 documents from MEDLINE and the Cochrane Collaboration's Oral Health Group (CC-OHG) special register. These articles met the following inclusion criteria: (1) Data had been collected from samples of patients or populations; and (2) dental caries was assessed clinically, and criteria were either published or described in the paper. From the selected articles, evidence tables were prepared describing each caries detection criterion. Analysis of the content validity of the criteria systems was based on evaluation of the disease process, exclusion of non-caries lesions, subjectivity, use of explorers, and drying of teeth prior to examination. This review included 29 unique criteria systems. Of those, 13 originated from the UK, 3 from the USA, 4 from Denmark, and others from the World Health Organization (WHO), Sweden, Switzerland, Norway, Netherlands, and Canada. Thirteen of the criteria systems either measured active and inactive early and cavitated lesions or defined separate criteria for smooth and occlusal tooth surfaces. Nine systems measured early as well as cavitated stages of the caries process, and 7 measured cavitation only. Eleven of the criteria systems provided explicit descriptions of the disease process measured or information on how to exclude non-caries from caries lesions. The use of explorers and drying and cleaning of teeth varied widely among the criteria. The majority of the newly developed criteria systems originated from Europe. In conclusion, this review of the content validity of the 29 criteria systems found substantial variability in disease processes measured, inclusion and exclusion criteria, and examination conditions.

Remineralisation study of artificial root caries lesions after fluoride treatment. An in vitro study using Electric Caries Monitor and Transversal Micro-Radiography

AIMS

To evaluate and compare remineralisation of root caries lesions after in vitro treatment with various fluoride (F) agents using an Electric Caries Monitor (ECM) and Transversal Micro-Radiography (TMR).

MATERIALS

Permanent human teeth were extracted and root surface specimens were sectioned, prepared (n = 35), and randomly allocated into seven different experimental groups (groups 1-7).

METHODS

Root surfaces were demineralised in an acidified gel (pH = 5.0) for 3 weeks followed by various F treatments and stored in a standardised remineralising solution at 37 degrees C for 6 weeks. The root surfaces were treated twice daily with different dentifrice slurries for 2 min, either with a neutral placebo dentifrice without F (group 5); or a neutral sodium fluoride (NaF) 1400 p.p.m. F dentifrice (group 1); or a neutral 1250 p.p.m. F dentifrice (group 6); or an acid dentifrice (pH 4.7) with 1400 p.p.m. F containing amine fluoride (AmF) (groups 3 and 4) or a 1250 p.p.m. (pH 4.7) AmF dentifrice (group 6). In groups 1, 2, 5, 6, and 7, the root surfaces were additionally rinsed for 2 min with a neutral non-F placebo solution. In groups 3 and 4, rinsing were performed for 2 min with an acid (pH 4.7) 250 p.p.m. F solution, containing 125 p.p.m. F as AmF and 125 p.p.m. F as potassium fluoride (KF), once or twice per day respectively. ECM was used to measure electrical resistance on root surfaces at baseline and after 3 and 6 weeks respectively. TMR technique was used to measure and compare root surface lesion depths and mineral loss.

RESULTS

Six weeks daily treatment with a dentifrice slurry containing AmF followed by rinsing with a combination of equal amounts of AmF and KF solution twice a day showed a statistical significant higher ECM values compared with the other groups. TMR data measuring lesion depths and mineral loss reduction supported the results of the ECM findings.

CONCLUSIONS

Daily application of a dentifrice slurry containing 1400 p.p.m. F as AmF combined with twice daily rinsing with a 250 p.p.m. F solution containing equal amount of AmF and KF significantly remineralise primary root caries lesions in vitro. ECM and TMR are valuable complementary methods in order to analyse the remineralisation processes.

The use of fluorescein-enhanced quantitative light-induced fluorescence to monitor de- and re-mineralization of in vitro root caries

The use of fluorescein-enhanced quantitative light-induced fluorescence (QLF) in the detection of in vitro root caries demineralization and reminerlization was investigated. Fourteen previously extracted human premolar roots were selected and determined to be caries-free. Cementum was removed and nail varnish applied leaving an exposed window. Positive and negative controls were selected. During a demineralizing regimen, roots were removed at regular intervals (12, 48, 72 and 120 h) and immersed in sodium fluorescein (0.2 mg L(-1)). Following gentle rinsing, each root was examined using QLF before being returned to the demineralizing solution. Following 120 h, each tooth was sectioned through the lesion and one-half retained for transverse micro radiography (TMR) analysis. The remaining half were subjected to a remineralizing regimen undergoing the same fluorescein and QLF examinations at 7, 28 and 36 days. Results showed that QLF effectively monitored demineralization/remineralization of root dentine as represented by fluorescein penetration. TMR analysis showed good correlations with QLF (DeltaZ/DeltaQ) after demineralization (r = 0.89) and remineralization (r = 0.84). The technique could represent an in vivo method for root caries detection and classification.

Explorer probing of root caries lesions: an in vitro study

Probing with a dental explorer is the preferred method of root caries diagnoses. However, studies suggest that use of a dental explorer in coronal caries detection may damage tooth structure. This pilot study investigated the effect of probing on remineralization of root surface lesions in vitro. Root-surface lesions were created on 10 extracted teeth by exposing them to a demineralizing solution for 21 days. One side of each lesion was then randomly selected and probed with an explorer, while the other side was not probed. The teeth then were placed in a remineralizing solution containing 10 parts per million (ppm) fluoride for 21 days. Of the 9 teeth with usable sections, all showed frank evidence of defects on the probed halves. Sites of remineralization were seen in the non-probed halves and adjacent to the probed defects, but not within or at the base of these defects. These results suggest that probing of root surfaces may create defects that do not fully remineralize.

Evaluation of a dental benefit plan for children conducted in Auvergne, France, since 1992

Usually, the French dental insurance system covers the cost of restorative treatment but does not reimburse the cost of preventive therapies. A French sick-fund covering self-employed persons tested a new dental benefit plan for children intended to provide an incentive to develop office-based preventive activities. The programme, which started in 1992, concerns all 4-year-old children of self-employed workers in a single French region (Auvergne). Participants undergo an annual examination by the dentist of their choice until their 15th birthday. If the child is seen every year, all services related to dental caries (preventive and restorative) are provided free of charge. An ongoing evaluation of the programme was necessary to determine its influence on the development of office-based preventive activities and the dental health of the participants. A cohort of children enrolled in the programme in 1992 was followed over 4 years to examine the patterns of service use. In addition, a cross-sectional study comparing the caries experience of all 8-year-old children participating continuously in the programme (test sample) with that of a sample of control children (n=90) was conducted in 1996. Data from the longitudinal follow-up indicate that 43.37% of the 551 children to whom the programme was offered in 1992 underwent an annual examination in the first year. Of the children enrolled in 1992, 55.2% were still participating in the programme in 1996. Results showed that independent practitioners continued to focus on restorative treatment rather than preventive therapy. Results from the cross-sectional study are in accordance with this trend. The number of caries-free children was identical in test and control samples and the mean dft, DMFT, DT and dt did not vary between the two groups (Student's t-test, P>0.05). However the mean number of filled teeth was significantly higher in the test children than in the controls (P<0.01). For children with caries, the mean dft was 23.5% greater in the test group than in the control group (P<0.05). In Auvergne, a large number of families were not ready to participate in a plan that required them to take their child to the dentist every year. There was not a perceived need for regular preventive dental care, an attitude probably reinforced by the interventionist approach undertaken by the dentists over the survey period. Moreover, the plan did not provide an incentive for dentists to develop office-based preventive activities.

Longevity and cariostatic effects of everyday conventional glass-ionomer and amalgam restorations in primary teeth: three-year results

The aim of this study was to compare the longevity and cariostatic effects of everyday conventional glass-ionomer and amalgam restorations in primary teeth. The materials consisted of 515 Ketac-Fil glass-ionomer restorations and 543 Dispersalloy amalgam restorations prepared in 666 children, from 3 to 13 years of age, by 14 dentists within the Danish Public Dental Health Service in the municipalities of Vaerløse and Hillerød. The restorations, of which 79% were of the Class II type, were in contact with 593 unrestored surfaces in adjacent primary and permanent teeth. After 3 years, 6% of the patients had dropped out of the study, and 33% of the teeth were exfoliated with the restoration in situ. A further 37% of the glass-ionomer and 18% of th amalgam restorations were recorded as failed (p < 0.001). The frequency of failures was highest for Class II glass-ionomer restorations, which showed a 50% median survival time of only 34 1/2 months, because of many fractures, while the 75% survival time for Class II amalgam restorations just exceeded the actual 36 months (p < 0.001). Caries progression was most often recorded in surfaces adjacent to amalgam restorations, and 21% of these surfaces needed restorative treatment vs. 12% of the surfaces adjacent to glass-ionomer restorations (p < 0.001). The three-year results indicated that conventional glass ionomer is not an appropriate alternative to amalgam for all types of restorations in primary teeth. In particular, the short longevity of Class II glass-ionomer restorations could not be compensated for by the reduced caries progression and need for restorative therapy of adjacent surfaces.

Assessing the stage of caries lesion activity on the basis of clinical and microbiological examination

The dynamic nature of caries lesion progression may require that classification of caries lesions makes distinctions in activity status. The aim of the present review was to compile and discuss the literature which pertains to clinical assessment of caries lesion activity, and to examine whether recent developments in microbiological research may justify the use of microbiological methods for evaluation of caries activity. Clinical observations suggest that caries lesion progression can be arrested at any stage of lesion development, provided that clinically plaque-free conditions are obtained. However, there is no universal level of oral hygiene to be recommended. The diagnoses "active" and "inactive/arrested" caries have been validated by a range of histological and chemical methods which have supported a separation into distinct clinical categories. Simple microbiological methods have so far not been useful in differentiating between active and inactive caries lesions. Very few studies have evaluated the inter- and intraexaminer reliability of caries diagnostic criteria based on assessment of the activity state of lesions, but recent data indicate that active and inactive caries lesions can be diagnosed with a high degree of reliability. A decision-making tree for dental caries is presented by means of which it is possible to associate the assessment of caries lesion activity with an appropriate treatment modality. It is concluded that research into better methods of assessing caries lesion activity clinically should be stimulated.