Sealing moderate caries lesions with bioactive glass-ionomer: A split-mouth clinical trial

Laboratory evidence has shown that 45S5 bioglass can help in dental remineralization, so its incorporation into resin-modified glass ionomer cement (RMGIC) has been studied. This randomized clinical trial aimed to determine the efficacy of RMGIC enriched with 10% 45S5 bioglass (RMGIC/45S5) in preventing the progression of moderate caries lesions. Sixty-six permanent molars with moderate caries lesions, were randomly sealed with RMGIC or RMGIC/45S5. After 1, 3-6 months, patients' oral health, material behavior, and caries evolution were evaluated. Chi-square and Fisher's exact test was employed. After one month, the RMGIC showed higher total retention and better clinical performance compared to RMGIC/45S5, both showed a predominance of sealed teeth or without caries progression. After 6 months, no materials retention, quality and caries progression difference was observed for both materials. Short-term clinical follow-up reveals worse retention and quality of RMGIC/45S5, only after 6 months no clinical/microscopic differences are observed between the materials.

Diagnostic validity of ICDAS clinical criteria on digital 3D models

OBJECTIVE

To assess the diagnostic validity of ICDAS clinical criteria on 3D dental models from intraoral scanning.

METHODS

This is a retrospective analysis on part of the baseline sample collected in a cohort study and included 73 participants (12-19 years) from Denmark and Greece. The assessment was made by visual inspection, and then by visual inspection associated with radiographs. All participants were scanned with TRIOS 4 which uses white light to obtain the 3D models with tooth color, as well as blue light source (415 nm) for fluorescence. The 3D models' evaluation was conducted using tooth-color texture and subsequently fluorescence. Two scores were obtained for the 3D model examination: i) ICDAS based on tooth-color information; ii) ICDAS based on tooth-color information supplemented with fluorescence. For the analysis, weighted kappa, sensitivity (SE), specificity (SP) and accuracy (ACC) were calculated.

RESULTS

Regarding all lesions the values for SE, SP, and ACC were respectively 0.804, 0.801, and 0.802 for tooth-color, and 0.819, 0.808, and 0.810 for tooth-color supplemented with fluorescence. In terms of accuracy parameters for moderate-extensive lesions, the values for SE, SP, and ACC for tooth color were 0.709, 0.948, and 0.944, while for fluorescence they were 0.815, 0.937, and 0.934.

CONCLUSION

Caries assessment with ICDAS criteria on 3D dental models produces reliable scores. Visual caries analysis using 3D models demonstrates commendable diagnostic accuracy and reasonable consistency with traditional methods. The use of intraoral scanners may be beneficial in evaluating occlusal caries.

CLINICAL SIGNIFICANCE

The importance of this study is to prove the diagnostic accuracy of caries lesions diagnosis made using and intraoral scanner and to offer greater confidence to professionals who use this diagnosis tool in their daily clinical practice. Intraoral scanners demonstrate to be an accurate tool for diagnosing occlusal caries.

Do progression rates of initial and moderate caries lesions and sound surfaces of primary teeth increase significantly after 7 years?

BACKGROUND

Initial caries lesions in primary teeth have presented a low progression rate after 2 years, but it could be higher in longer follow-ups.

AIM

To evaluate the progression rates of sound surfaces and initial and moderate caries lesions after 7 years.

DESIGN

This prospective 7-year cohort study included 639 preschool children aged 1-5 years in 2010. In 2017, 449 children were reassessed (70.3% retention rate). Dental caries was collected using the International Caries Detection and Assessment System (ICDAS) in both assessments. Incidence rate (IR) per 100 surface-years estimated the progression rates of sound surfaces and initial and moderate lesions for worse conditions. Cox regression with shared frailty evaluated the possible risk factors.

RESULTS

IR was 1.0% for sound surfaces, 2.8% and 4.2% for ICDAS scores 1 and 2, respectively, and about 17.0% for moderate lesions. The most significant risk factor for the progression was the presence of cavitated lesions in other teeth. The type of surface and tooth also influenced the outcome.

CONCLUSION

The progression rate of initial caries lesions in primary teeth remains low even after 7 years, but cavitated caries lesions in other teeth increase this risk. Moderate lesions demonstrate a higher risk of progression when compared to sound surfaces and initial caries lesions.

Is Italian Dentists' Knowledge of Enamel Development Defects Adequate? A Nationwide Survey

OBJECTIVES

Correct identification and management of Developmental Defects of Enamel (DDEs) are essential to provide the best possible treatment. The present survey aims to investigate Italian dentists' knowledge of DDEs, their ability to recognise the different clinical pictures, and to choose the most appropriate clinical approach.

METHODS

A cross-sectional survey was planned based on a questionnaire including 27 closed-ended questions, and that proposed 4 clinical pictures, molar incisor hypomineralisation (MIH), amelogenesis imperfecta (AI), dental fluorosis (DF), and an initial caries lesion (ICL). It was distributed by e-mail to all Italian dentists (N = 63,883) through the Italian Federation of Doctors and Dentists. Discrete variables were expressed as absolute and relative frequencies (%). A multivariate analysis assessed whether socio-demographic variables correlated with the answers' truthfulness.

RESULTS

About 5017 questionnaires were included and analysed. Although 90.19% of the sample stated that they had received information on DDEs, a significant percentage did not recognise MIH (36.36%), AI (48.34%), DF (71.50%), and ICL (46.62%). Only 57.07% correctly classified enamel hypomineralisation as a qualitative defect, and even fewer, 54.45%, classified enamel hypoplasia as a quantitative defect. According to the logistic regressions, female dentists, dentists who treat mainly children and received information about DDEs, were more likely to recognise the 4 clinical pictures (P < .01).

CONCLUSIONS

Italian dentists showed many knowledge gaps on DDEs that need to be filled; those who received formal training were more capable of correctly identifying the defects and were more likely to prescribe an appropriate management approach for the defects.

CLINICAL SIGNIFICANCE

Increasing university courses and continuing education on diagnosing and managing DDEs seems reasonable to fill the knowledge gap on DDEs.

Assessment of dental pulp response to carries via MR T2mapping and histological analysis

OBJECTIVES

The aim of our study was to assess the correlation between T2 relaxation times and their variability with the histopathological results of the same teeth in relation to caries progression.

MATERIALS AND METHODS

52 extracted permanent premolars were included in the study. Prior to extractions, patients underwent magnetic resonance imaging (MRI) scanning and teeth were evaluated using ICDAS classification. Pulps of extracted teeth were histologically analysed.

RESULTS

MRI T2 relaxation times (ms) were 111,9 ± 11.2 for ICDAS 0, 132.3 ± 18.5* for ICDAS 1, 124.6 ± 14.8 for ICDAS 2 and 112. 6 ± 18.2 for ICDAS 3 group (p = 0,013). A positive correlation was observed between MRI T2 relaxation times and macrophage and T lymphocyte density in healthy teeth. There was a positive correlation between vascular density and T2 relaxation times of dental pulp in teeth with ICDAS score 1. A negative correlation was found between T2 relaxation times and macrophage density. There was a positive correlation between T2 relaxation time variability and macrophage and T lymphocyte density in teeth with ICDAS score 2. In teeth with ICDAS score 3, a positive correlation between T2 relaxation times and T2 relaxation time variability and lymphocyte B density was found.

CONCLUSION

The results of our study confirm the applicability of MRI in evaluation of the true condition of the pulp tissue.

CLINICAL RELEVANCE

With the high correlation to histological validation, MRI method serves as a promising imaging implement in the field of general dentistry and endodontics.

Occlusal caries detection and monitoring using a 3D intraoral scanner system. An in vivo assessment

OBJECTIVE

To assess the agreement in detecting and monitoring occlusal caries over thirty months using conventional visual and radiographic assessment and an intraoral scanner system which supports automated caries scoring.

METHODS

Ninety-one young participants aged 12-19 years were included in the study. All occlusal surfaces were examined visually, radiographically (when indicated), and scanned with the TRIOS 4 intraoral scanner. TRIOS Patient Monitoring software (vers. 2.3, 3Shape TRIOS A/S, Denmark) was used for automated caries detection on the 3D digital models.

RESULTS

Fifty-five of the study participants were re-examined after 30-months. Significant differences regarding caries detection were found between the conventional methods and the automated caries scoring system (p < 0.01), with moderate positive percent agreement (49-61%) and high negative percent agreement (87-98%). All methods reported significant caries progression over the follow-up period (p < 0.01). However, the automated system showed significantly more caries progression than the other methods (p < 0.01).

CONCLUSIONS

The software for automated caries detection and classification showed moderate positive agreement and strong negative agreement with the conventional methods considering both the baseline and the follow-up assessments. The automated caries scoring system detected significantly fewer caries lesions and tended to underestimate the caries severity. All methods indicated significant caries progression over the follow-up period, while the automated system detected more caries progression.

CLINICAL SIGNIFICANCE

The TRIOS system supporting automated occlusal caries detection and classification can assist in detecting and monitoring occlusal caries on permanent teeth as a complementary tool to the conventional methods. However, the operator should be aware that the automated system shows a tendency to underestimate the caries presence and lesion severity.

ORCA-EFCD consensus report on clinical recommendation for caries diagnosis. Paper I: caries lesion detection and depth assessment

OBJECTIVES

The aim of the present consensus paper was to provide recommendations for clinical practice considering the use of visual examination, dental radiography and adjunct methods for primary caries detection.

MATERIALS AND METHODS

The executive councils of the European Organisation for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD) nominated ten experts each to join the expert panel. The steering committee formed three work groups that were asked to provide recommendations on (1) caries detection and diagnostic methods, (2) caries activity assessment and (3) forming individualised caries diagnoses. The experts responsible for "caries detection and diagnostic methods" searched and evaluated the relevant literature, drafted this manuscript and made provisional consensus recommendations. These recommendations were discussed and refined during the structured process in the whole work group. Finally, the agreement for each recommendation was determined using an anonymous Delphi survey.

RESULTS

Recommendations (N = 8) were approved and agreed upon by the whole expert panel: visual examination (N = 3), dental radiography (N = 3) and additional diagnostic methods (N = 2). While the quality of evidence was found to be heterogeneous, all recommendations were agreed upon by the expert panel.

CONCLUSION

Visual examination is recommended as the first-choice method for the detection and assessment of caries lesions on accessible surfaces. Intraoral radiography, preferably bitewing, is recommended as an additional method. Adjunct, non-ionising radiation methods might also be useful in certain clinical situations.

CLINICAL RELEVANCE

The expert panel merged evidence from the scientific literature with practical considerations and provided recommendations for their use in daily dental practice.

PRO-biotics? Are pre- and probiotics a valuable adjunct to fluoridated toothpaste in the battle against dental decay?

DESIGN

An investigator and participant masked, parallel-group randomised control trial examining the tooth surfaces of 288 children aged 5-9 years (n = 141 in the intervention group, n = 147 in the control group). Children in the intervention group were provided a daily lozenge containing 2% arginine (prebiotic), Lacticaseibacillus rhamnosus and Lactobacillus paracasei subsp. paracasei (probiotics). Children in the control group were provided with a placebo lozenge. Parents of participants were also provided with 1450 ppm fluoride toothpaste and advised to brush their children's teeth twice daily. Clinical and radiographic examinations were undertaken at baseline and 10-12 months assessing caries activity, progression and regression at a tooth surface level. A modified ICDAS and radiographic scoring system were used to record presence and extent of carious lesions.

CASE SELECTION

Of 343 children who met the inclusion criteria, 21,888 tooth surfaces were examined in 288 low caries risk children aged between 5-9 years. Fifty-four participants withdrew consent (n = 31 for intervention group, n = 24 for control group) and 1 child was excluded as they were pre-cooperative for their dental examination. Participants were recruited from four municipalities in Denmark. To be eligible to participate, children had to be medically healthy, cooperative for clinical and radiographic examination, and able to ingest a daily lozenge.

DATA ANALYSIS

The primary outcome for this study was relative risk reduction (RRR) of caries activity, progression and regression. Although not present in this study, the main study broadly showed equality between the two groups in terms of their social demographic, dietary, oral health-related factors. The authors used modified Poisson regression to determine any surface level differences between the intervention and placebo groups. The threshold for statistical significance was set as follows: p < 0.05 was considered statistically significant. The authors describe that a power calculation was undertaken for the main study. However, none of the outcomes in this study were powered for.

RESULTS

19,950 tooth surfaces were included in the final analysis. There was no significant difference in change in caries activity between the two groups. There was a trend towards reduction in relative risk in the intervention group, with fewer active lesions (RRR: 15.3%; -6.0%, -32.4%), more caries regression (RRR: 0.3%; -0.4%, -1.0%) and reduced caries progression (RRR: 13.6%; -8.0%, -30.9%) observed than in the control group.

CONCLUSIONS

The use of a probiotic and prebiotic daily lozenges as an adjunct to 1450 ppm fluoride toothpaste and oral hygiene instruction did not result in a significantly reduced relative risk of change in caries status compared to placebo. Further research over an increased intervention time with a higher caries risk population may identify potential advantages of adjunctive pre- and probiotics fluoride toothpaste in the prevention, arrest and regression of dental caries.

Caries Detection in Primary Teeth Using Intraoral Scanners Featuring Fluorescence: Protocol for a Diagnostic Agreement Study

BACKGROUND

Digital methods that enable early caries identification can streamline data collection in research and optimize dental examinations for young children. Intraoral scanners are devices used for creating 3D models of teeth in dentistry and are being rapidly adopted into clinical workflows. Integrating fluorescence technology into scanner hardware can support early caries detection. However, the performance of caries detection methods using 3D models featuring color and fluorescence in primary teeth is unknown.

OBJECTIVE

This study aims to assess the diagnostic agreement between visual examination (VE), on-screen assessment of 3D models in approximate natural colors with and without fluorescence, and application of an automated caries scoring system to the 3D models with fluorescence for caries detection in primary teeth.

METHODS

The study sample will be drawn from eligible participants in a randomized controlled trial at the Royal Children's Hospital, Melbourne, Australia, where a dental assessment was conducted, including VE using the International Caries Detection and Assessment System (ICDAS) and intraoral scan using the TRIOS 4 (3Shape TRIOS A/S). Participant clinical records will be collected, and all records meeting eligibility criteria will be subject to an on-screen assessment of 3D models by 4 dental practitioners. First, all primary tooth surfaces will be examined for caries based on 3D geometry and color, using a merged ICDAS index. Second, the on-screen assessment of 3D models will include fluorescence, where caries will be classified using a merged ICDAS index that has been modified to incorporate fluorescence criteria. After 4 weeks, all examiners will repeat the on-screen assessment for all 3D models. Finally, an automated caries scoring system will be used to classify caries on primary occlusal surfaces. The agreement in the total number of caries detected per person between methods will be assessed using a Bland-Altman analysis and intraclass correlation coefficients. At a tooth surface level, agreement between methods will be estimated using multilevel models to account for the clustering of dental data.

RESULTS

Automated caries scoring of 3D models was completed as of October 2023, with the publication of results expected by July 2024. On-screen assessment has commenced, with the expected completion of scoring and data analysis by March 2024. Results will be disseminated by the end of 2024.

CONCLUSIONS

The study outcomes may inform new practices that use digital models to facilitate dental assessments. Novel approaches that enable remote dental examination without compromising the accuracy of VE have wide applications in the research environment, clinical practice, and the provision of teledentistry.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12622001237774; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384632.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51578.

Prevalence of Dental Caries in Schoolchildren from the Galapagos Islands: ESSO-Gal Cohort Report

Objective

Dental caries remains a prevalent disease worldwide. Several epidemiological studies have shown that it affects the oral health of the pediatric population, and the Galapagos population in Ecuador is no exception. The aim of this study was to determine the prevalence of dental caries and its association, based on baseline information from the Galapagos Oral Health Study (ESSO-Gal), in children of the Galapagos Islands, Ecuador.

Methods

A cross-sectional study was conducted involving 804 children aged 2-11 years. The prevalence of dental caries was assessed using the International Caries Detection and Assessment System (ICDAS II) criteria, while the presence of dental biofilm was assessed using the Silness-Löe index. Descriptive statistics, including frequency analysis and measures of central tendency and dispersion, were performed. Inferential statistical analyses were conducted to identify associations between variables. Statistical analyses were performed using the SPSS version 25.0 statistical program.

Results

The caries prevalence rates based on ICDAS II codes 1-6, 1-2, and 3-6 were 98.01%, 96.9%, and 85%, respectively. A statistically significant difference was observed among the different islands regarding the cutoff point for ICDAS II codes 3-6 (p ≤ 0.001). Participants aged 6-11 years had the highest caries prevalence.

Conclusions

The results show a high prevalence of dental caries among children in the Galapagos Islands, which increases with age. Contrary to expectations, the study did not find a significant correlation between the severity of dental caries and the presence of dental biofilm.

The role of microbial interactions in dental caries: Dental plaque microbiota analysis

OBJECTIVES

Dental caries is a result of the ecological dysfunction of the polymicrobial community on the tooth surface, which evolves through microbial interactions. In this study, we conducted a thorough analysis of the dental plaque microbiome to comprehend its multi-microbial aetiology.

MATERIALS AND METHOD

In this study, plaque was collected from healthy tooth surfaces, shallow carious teeth and deep carious teeth, and bacterial composition and abundance were assessed using 16S rRNA high-throughput sequencing. Random forest and LEfSe were used to profile various microorganisms at each stage. Additionally, we developed a molecular ecological network (MEN) based on random matrix theory (RMT) to examine microbial interactions for the first time.

RESULTS

Our results reveal that Scardovia wiggsiae, Streptococcus mutans, and Propionibacterium acidifaciens may be associated with initial caries, and Propionibacterium acidifaciens differentiates between shallow and deep caries. As caries progressed, the alpha diversity index declined, indicating a decrease in microbial variety. The network topological indices such as centralization betweenness revealed that the caries network had become more complex, involving more microbial interactions. The shallow network revealed a high negative correlation ratio across nodes, indicating that microbes competed heavily. In contrast, the positive correlation ratio of deep network nodes was high, and microorganisms transitioned from a competitive to a synergistic state.

CONCLUSIONS

This study suggests that microbial diversity and interactions are critical to caries progression and that future caries research should give greater consideration to the role of microbial interaction factors in caries progression.

Performance of near-infrared light transillumination in the detection of occlusal caries lesions in deciduous teeth

BACKGROUND

This study compared the performance of near-infrared light transillumination (NILT; DIAGNOcam [DC]) in detecting occlusal caries lesions in deciduous molars with the performance of the International Caries Detection and Assessment System (ICDAS), digital radiographic method (RX) and laser fluorescence (DIAGNOdent pen [LFpen]).

METHODS

Fifty-seven extracted deciduous molars with no frank cavitation caries lesions were selected. One site per tooth was evaluated twice each by two examiners using all methods. Then, a histological examination was performed using a stereomicroscope. The performance of the methods was assessed with respect to two thresholds: D1 (all visible caries lesions affecting enamel) and D3 (caries lesions extended into dentin).

RESULTS

A weighted kappa and intraclass correlation coefficients were calculated for intra- and inter-observer reproducibilities, varying from 0.31 (RX) to 0.89 (LFpen). The intra-observer reproducibility at D1 and D3 thresholds varied from 0.51 (ICDAS) to 0.85 (DC) and from 0.30 (ICDAS) to 1.00 (RX), respectively. The inter-observer reproducibility varied from 0.28 (RX) to 0.47 (DC) and from 0.22 (LFpen) to 0.75 (DC), respectively. At the D1 threshold, higher sensitivity and accuracy were found for LFpen (0.76/0.71) and ICDAS (0.65/0.66); and higher specificities were found for RX (0.94), DC (0.79), and ICDAS (0.71). At the D3 threshold, all methods exhibited lower sensitivities (0.13-0.35) and higher specificity, accuracy, and area under the ROC curve values (0.70-1.00). All methods showed a correlation with histological results, especially for ICDAS and DC.

CONCLUSIONS

NILT technology (DC) and LFpen exhibited similar performance for the detection of occlusal caries lesions in deciduous molars when compared with ICDAS criteria.

Treatment Approaches to Molar Incisor Hypomineralization: A Systematic Review

AIM

This systematic review aimed to comprehensively evaluate the available literature on treating molar incisor hypomineralization (MIH) or enamel hypomineralization published between 2013 and 2023, focusing on identifying relevant studies and their characteristics.

MATERIALS AND METHODS

The search process encompassed reputable academic databases, including PubMed, Scopus, Cochrane Library, and Web of Science, using a precise keyword strategy ("((molar incisor hypomineralization) OR (enamel hypomineralization)) AND (treatment)"). A total of 637 articles were initially retrieved, followed by a strict selection process adhering to PRISMA guidelines. The inclusion criteria encompassed Randomized Control Trials (RCTs), case series with more than five clinical cases (CSs), studies involving human participants, availability as free full-text or accessible with university credentials, and English-language publications. Exclusion criteria included systematic or literature reviews, editorials, single-case reports, studies conducted in vitro, those involving animals, paid articles, and non-English-language publications.

RESULTS

The search yielded 864 articles, of which 23 met the stringent inclusion criteria after a meticulous selection process. These studies will serve as the basis for a comprehensive analysis of MIH treatment approaches. The systematic review ensures the quality and relevance of the chosen studies for a detailed assessment of MIH treatment strategies.

CONCLUSIONS

This systematic review will provide valuable insights into the characteristics of selected studies, patient profiles, and available treatment options for molar incisor hypomineralization, contributing to a better understanding of this dental condition's management.

Detection and localization of caries and hypomineralization on dental photographs with a vision transformer model

Caries and molar-incisor hypomineralization (MIH) are among the most prevalent diseases worldwide and need to be reliably diagnosed. The use of dental photographs and artificial intelligence (AI) methods may potentially contribute to realizing accurate and automated diagnostic visual examinations in the future. Therefore, the present study aimed to develop an AI-based algorithm that can detect, classify and localize caries and MIH. This study included an image set of 18,179 anonymous photographs. Pixelwise image labeling was achieved by trained and calibrated annotators using the Computer Vision Annotation Tool (CVAT). All annotations were made according to standard methods and were independently checked by an experienced dentist. The entire image set was divided into training (N = 16,679), validation (N = 500) and test sets (N = 1000). The AI-based algorithm was trained and finetuned over 250 epochs by using image augmentation and adapting a vision transformer network (SegFormer-B5). Statistics included the determination of the intersection over union (IoU), average precision (AP) and accuracy (ACC). The overall diagnostic performance in terms of IoU, AP and ACC were 0.959, 0.977 and 0.978 for the finetuned model, respectively. The corresponding data for the most relevant caries classes of non-cavitations (0.630, 0.813 and 0.990) and dentin cavities (0.692, 0.830, and 0.997) were found to be high. MIH-related demarcated opacity (0.672, 0.827, and 0.993) and atypical restoration (0.829, 0.902, and 0.999) showed similar results. Here, we report that the model achieves excellent precision for pixelwise detection and localization of caries and MIH. Nevertheless, the model needs to be further improved and externally validated.

The efficacy of combined arginine and probiotics as an add-on to 1450 ppm fluoride toothpaste to prevent and control dental caries in children - A randomized controlled trial

OBJECTIVES

To determine how daily consumption of a lozenge combining arginine and two probiotic strains affects the Relative Risk Reduction (RRR) in children regarding dental caries transitions and lesion activity at tooth surface level during 10-12 months.

METHODS

A total of 21,888 tooth surfaces in 288 children were examined. The intervention group (n = 141) received a lozenge containing 2% arginine, Lacticaseibacillus rhamnosus, LGG® (DSM33156), and Lactobacillus paracasei subsp. paracasei, L. CASEI 431® (DSM33451). The placebo group (n = 147) received a placebo lozenge. Both groups received 1,450 ppm F- toothpaste. Primary canines, molars, and first permanent molars were examined clinically (ICDAS0-6) and radiographically (R0-6) at baseline and follow-up. Sealed, filled, and missing surfaces were also included. Caries activity was computed as a sum of each caries lesion's location, color, texture, cavitation, and gingival bleeding. RRRs were computed with cluster effect on surface level. ICH-GCP was followed, including external monitoring.

RESULTS

A total of 19,950 surfaces were analyzed after excluding 1,938 tooth surfaces. No statistically significant differences were found between the groups. The RRRs showed less caries progression (13.6%, p = 0.20), more regression (0.3%, p = 0.44), and fewer active caries lesions (15.3%, p = 0.15) in the intervention group.

CONCLUSION

Daily consumption of a lozenge combining arginine and probiotics for 10-12 months given to 5-9-years-old children characterized being with low caries risk demonstrated a marked, though not statistically significant RRR for caries progression, regression, and number of active lesions in the intervention group compared to the placebo-group.

CLINICALTRIALS

gov (NCT03928587).

CLINICAL SIGNIFICANCE

Since all the RRRs were in favor of the intervention group and the PF of combined arginine and probiotics is high (81.6%) compared to fluoride toothpaste (24.9%) and arginine-fluoride toothpaste alone (19.6%) the combined pre-and probiotics approach may be a future additional tool regarding caries prevention and control.

Sugar-sweetened beverage intake and convenience store shopping as mediators of the food insecurity-Tooth decay relationship among low-income children in Washington state

INTRODUCTION

There are oral health disparities in the U.S. and children in food-insecure households have a higher burden of tooth decay. Identifying the mechanisms underlying the food insecurity-tooth decay relationship could inform public health interventions. This study examined how sugar-sweetened beverage (SSB) intake and frequent convenience store shopping mediated the food insecurity-tooth decay relationship for lower-income children.

MATERIALS AND METHODS

Cross-sectional study data included a household survey, beverage questionnaire, and dental examination. The sample included 452 lower-income, racially-diverse, child-caregiver dyads in 2018 from King County in Washington state. The exposure was household food insecurity, the outcome was untreated decayed tooth surfaces, and the proposed mediators were SSB intake and frequent convenience store shopping (≥2 times/week). Causal mediation analyses via the potential outcomes framework was used to estimate natural indirect and direct effects.

RESULTS

Fifty-five percent of participants were in food-insecure households, the mean number of decayed tooth surfaces among children was 0.87 (standard deviation [SD] = 1.99), the mean SSB intake was 17 fluid ounces (fl/oz)/day (SD = 35), and 18% of households frequently shopped at a convenience store. After adjusting for confounders, household food insecurity and log-transformed SSB intake (fluid ounces/day) were positively associated with decayed tooth surfaces, but not at the a α = 0.05 level (mean ratio [MR] 1.60; 95% confidence interval [CI] 0.89, 2.88; p = .12 and MR 1.16; 95% CI 0.93, 1.46; p = .19, respectively). Frequent convenience store shopping was associated with 2.75 times more decayed tooth surfaces (95% CI 1.61, 4.67; p < .001). SSB intake mediated 10% of the food insecurity-tooth decay relationship (p = .35) and frequent convenience store shopping mediated 22% (p = .33).

CONCLUSIONS

Interventions aimed at addressing oral health disparities in children in food-insecure households could potentially focus on reducing intake of SSBs and improving access to healthful foods in lower-income communities.

Caries Severity, Decayed First Permanent Molars and Associated Factors in 6-7 Years Old Schoolchildren Living in Palermo (Southern Italy)

To date, there are very few epidemiologic studies on caries disease in 6-7 year old children living in Sicily (Southern Italy). The first permanent molar (FPM) is the most commonly affected tooth in this target population, and a one-unit increase in the number of decayed FPMs is predictive of caries in other teeth and in adulthood. The primary aim of this research is to estimate the prevalence of caries in 6-7 year old schoolchildren living in Palermo and, as a secondary aim, to estimate the prevalence of affected FPMs. It was designed as a cluster cross-sectional survey on 995 children from 16 schools, selected based on their geographical location, in one of the eight city districts. Caries data were recorded using the International Caries Detection and Assessment System for each tooth surface. The relation between socio-economic status, behavioural determinants, and clinical information and the number of teeth with initial caries (IC), moderate caries (MC), or extensive caries (SC) was analysed through the ordinal logistic regression. Among the 995 schoolchildren, 662 (66.5%) had at least one lesion and 742 (74.6%) had FPMs. Of the latter, 238 (32.0%) were affected by IC, 86 (11.6%) were affected by MC, and only 3 (0.4%) were affected by SC. During multivariable analysis, there was evidence of an increased risk of MC and SC related to the deprivation of the district in which the children lived and went to school, as well as to the protective role of parental education and employment. The same significant determinants were found for IC and MC FPMs. The study showed the important role of socio-economic determinants, unhealthy behaviours, and social deprivation related to the increased risk of moderate and extensive caries in 6-7 year old schoolchildren. Investigating this target population is very important, as early development of caries in FPMs may have serious consequences in the prognostics of oral health in an adult.

Caries Experience in Preschoolers in Three Ecuadorian Communities

Dental caries in the preschool population presents a significant challenge in the field of global public health, including Ecuador. Early detection of this disease is crucial for developing effective strategies for prevention and promotion of oral health, which can have a substantial impact on the quality of life of preschool-aged children. This study evaluated 600 children aged 3 to 5 years attending preschool education centers using the ICDAS II diagnostic criteria. The Student's t-test was used to analyze differences between the means of two independent groups. Additionally, an analysis of variance (ANOVA) was conducted to assess differences between the means of three or more groups. The prevalence of caries was 87%, with a dft index of 3.85 in the three provinces studied. A high treatment need was observed in 84.17% of the population. No significant differences in the DFT index were found based on gender, although both groups exhibited elevated values. No significant differences were observed in relation to province and environment. The second molar was the most affected tooth, with a caries prevalence of 58.8%. Despite the lack of significant differences among the evaluated variables, a high prevalence and experience of dental caries were found in the studied population.

Diffuse Reflectance Spectroscopy as a Novel Method of Caries Detection-An In Vitro Comparative Study in Permanent Teeth

This in vitro study aimed to compare outcomes of dental caries detection using visual inspection classified according to the International Caries Detection and Assessment System (ICDAS) with objective assessments using a well-established laser fluorescence system (Diagnodent pen) and a novel diffuse reflectance spectroscopy (DRS) device. One hundred extracted permanent premolars and molars were utilized, including sound teeth, teeth with non-cavitated caries, or teeth with small cavitated lesions. A total of 300 regions of interest (ROIs) were assessed using each detection method. Visual inspection, being a subjective method, was performed by two independent examiners. The presence and extent of caries were histologically verified according to Downer's criteria, serving as a reference for other detection methods. Histological results revealed 180 sound ROIs and 120 carious ROIs, categorized into three different extents of caries. Overall, there was no significant difference between the detection methods in sensitivity (0.90-0.93) and false negative rate (0.05-0.07). However, DRS exhibited superior performance in specificity (0.98), accuracy (0.95), and false positive rate (0.04) compared to other detection methods. Although the tested DRS prototype device exhibited limited penetration depth, it shows promise as a method, particularly for the detection of incipient caries.

Remineralization of teeth with casein phosphopeptide-amorphous calcium phosphate: analysis of salivary pH and the rate of salivary flow

AIM

To investigate the changes of salivary flow rate and salivary pH of Syrian children with mixed dentition following application of Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP).

METHODS

This study is part of a double-blind randomized controlled clinical trial. It included 50 children aged 6-8 who were randomly divided into two treatment groups to receive either CPP-ACP GC Tooth Mousse™ (Group A) or placebo (Group B) with 25 participants per group. After the application of the product in the mouth for 3 min, saliva samples were collected four times (T0, T1, T2, and T3) to measure salivary pH and the rate of salivary flow.

RESULTS

There was no significant difference between group A and B in the mean value of salivary flow rate (t = 1.08, P = 0.28, 0.57 ± 0.28 versus 0.56 ± 0.38 respectively) and salivary pH (t = 0.61, P = 0.54, 7.28 ± 0.44 versus 7.25 ± 0.36 respectively). However, there was a significant difference between different time points (T0, T1, T2, and T3) in the mean value of salivary flow rate (0.41 ± 0.30, 0.65 ± 0.36, 0.53 ± 0.28, and 0.56 ± 0.34 respectively) and salivary pH (6.99 ± 0.44, 7.46 ± 0.36, 7.36 ± 0.32, and 7.26 ± 0.32 respectively).

CONCLUSION

The application of the GC Tooth Mouse (CPP-ACP) was similar to placebo in increasing the salivary pH and salivary flow rate.

TRIAL REGISTRATION

ISRCTN17509082, Registration date 22/11/2022.

How do dental practitioners, educators and students diagnose and manage caries risk and caries lesions? A COM-B analysis

OBJECTIVE

The International Caries Classification and Management System (ICCMS™), a comprehensive, evidence-informed, best clinical practice system, comprises a 4D cycle: 1D-Determine risk; 2D-Detect and assess lesions; 3D-Decide on a personalized care plan; and 4D-Do preventive and tooth-preserving care. The aim of this study was to establish how Colombian dental practitioners, educators and students diagnose and manage caries risk and caries lesions using the COM-B model and the ICCMS™ system.

METHODS

A total of 1094 participants (practitioners: n = 277; educators: n = 212; students: n = 605) completed a previously validated 79-item questionnaire which explores, based on the COM-B model, the practitioners' self-reported caries diagnosis and management behaviours. Descriptive statistics, Welch's ANOVAs and multiple linear regressions were computed.

RESULTS

All groups generally performed the behaviours within the 4-D categories 'Most of the time' to 'Always' (students: 4.06 ± 0.95; educators: 3.94 ± 0.98; practitioners: 3.86 ± 1.01). The most frequently performed diagnosis behaviours (1D/2D) were for practitioners assessing initial/moderate lesions (4.09 ± 1.01) and for educators and students cleaning teeth before lesion assessment (4.41 ± 0.80 and 4.38 ± 0.77 respectively). The least frequently performed decision/management (3D/4D) behaviour was non-operative care for moderate-caries lesions (when applicable) (practitioners: 2.64 ± 1.23; educators: 2.68 ± 1.17; students: 3.22 ± 1.41). Opportunity (Resources and Relevance) was the best COM-B predictor for diagnostic behaviours, whereas capability and opportunity (Relevance) were the strongest predictors for management behaviours.

CONCLUSION

Colombian practitioners, educators and students diagnose and manage caries risk and caries lesions implementing best practice with a high to very high frequency.

Dental caries and dental developmental defects as adverse effects of antineoplastic treatment in childhood cancer survivors

PURPOSE

To evaluate the prevalence of dental caries and dental developmental defects (DDD) in childhood cancer survivors (CCS) and identify disease and treatment-related risk factors.

METHODS

CCS aged up to 21 years, diagnosed with a malignancy before the age of 10 years and in remission for at least one year were included. Data were collected from patients' medical records and through a clinical examination where presence of dental caries and prevalence of DDD were recorded. Fisher's exact test was used to assess possible correlations and multivariate regression analysis to determine risk factors for defect development.

RESULTS

Seventy CCS with a mean chronological age of 11.2 years at the time of examination, mean age at cancer diagnosis of 4.17 years, and a mean post-treatment follow-up time of 5.48 years were included. Mean DMFT/dmft was 1.31, with 29% of survivors presenting with at least one carious lesion. Younger patients on the day of examination and patients treated with higher radiation dose, showed significantly higher prevalence of dental caries. The prevalence of DDD was 59%, with demarcated opacities being the defect most commonly observed (40%). Age at dental examination, diagnosis, age at diagnosis, and time that have elapsed since the end of treatment were the factors significantly affecting its prevalence. Regression analysis revealed that age at examination was the only factor significantly associated with the presence of coronal defects.

CONCLUSION

A great number of CCS presented with at least one carious lesion or a DDD, with the prevalence being significantly associated with various disease-specific characteristics, but age at dental examination the only significant predictor.

DIAGNOdent versus International Caries Detection and Assessment System in detection of incipient carious lesions: A diagnostic accuracy study

Aim

The present investigation aimed at assessing the diagnostic accuracy of DIAGNOdent compared to the International Caries Detection and Assessment System-II (ICDAS-II) in the detection of facial, smooth surface noncavitated carious lesions.

Settings and Design

Sixty patients were enrolled in the current study according to the eligibility criteria. There were 161 teeth with noncavitated, white spot carious lesions and 32 sound teeth.

Materials and Methods

Before examination, teeth were cleaned and polished and all patients were assessed under standardized operating conditions: preset dental unit position, operating light, and prolonged air drying (approximately 5 s). All teeth were assessed by two calibrated examiners individually without any contact using ICDAS-II and DIAGNOdent.

Statistical Analysis

The diagnostic accuracy of DIAGNOdent device was determined, including sensitivity, specificity, overall accuracy, positive and negative predictive values, and receiver operating characteristic curve analysis. Chi-square test was conducted to compare the distribution of ICDAS-II and DIAGNOdent scores. Inter-observer agreement between assessors was evaluated using Cohen's kappa test.

Results

In the current study, DIAGNOdent had an overall accuracy of 84.45% with sensitivity and specificity of 87.58% and 96.87%, respectively, and +PV and -PV of 97.7% and 83.9%, respectively, when score 0 represented sound tooth surface, while scores 1 and 2 were considered clinically noncavitated carious lesions. Moreover, when only ICDAS score 1 was considered representing first visual change in enamel, DIAGNOdent had an accuracy of 74.15% with sensitivity and specificity of 83.53% and 90.62%, respectively, and +PV and -PV of 93% and 78.6%, respectively. In the present study, when only ICDAS score 2 was considered representing distinct visual change in enamel, DIAGNOdent had an accuracy of 100% with sensitivity and specificity of 100% and 100%, respectively, and +PV and -PV of 100% and 100%, respectively.

Conclusions

The overall performance of DIAGNOdent was equivalent to the visual inspection using ICDAS-II. DIAGNOdent might be considered a useful adjunctive device for detection and monitoring development of noncavitated carious lesions on facial smooth surfaces.

Occlusal caries detection on 3D models obtained with an intraoral scanner. A validation study

OBJECTIVES

To evaluate the diagnostic performance of visual caries assessment on 3D dental models obtained using an intraoral scanner and to compare it with the performance of the clinical visual inspection.

METHODS

Fifty-three permanent posterior teeth scheduled for extraction were randomly selected and included in this study. One to three independent examination sites on the occlusal surface of each tooth were clinically inspected using International Caries Detection and Assessment System (ICDAS) criteria. Afterwards, the examined teeth were scanned intraorally with a 3D intraoral scanner (TRIOS 4, 3Shape TRIOS A/S, Copenhagen, Denmark) using white and blue-violet light (415 nm wavelength) to capture the colour and fluorescence signal from the tissues. Six months after the clinical examination, the same examiner conducted the on-screen assessment of the obtained 3D digital dental models at the selected examination sites using modified ICDAS criteria. Both tooth colour and fluorescence texture with high resolution were assessed. Lastly, an independent examiner conducted the histological examination of all teeth after extraction. Using histology as the reference test, Sensitivity (SE), Specificity (SP), Accuracy (ACC), area under the Receiver Operating Characteristic (ROC) curve, and Spearman's correlation coefficient were calculated for the clinical and on-screen ICDAS assessments.

RESULTS

The ACC values of the evaluated methods varied between 0.59-0.79 for initial caries lesions and 0.77-0.99 for moderate-extensive caries lesions. Apart from SE values corresponding to caries in the inner half of enamel, no significant difference was observed between clinical visual inspection and on-screen assessment. In addition, no difference was found in the assessment of 3D models with tooth colour alone or supplemented with fluorescence for all the evaluated diagnostic measures.

CONCLUSIONS

On-screen visual assessment of 3D digital dental models with tooth colour or fluorescence showed a similar diagnostic performance to the clinical visual inspection when detecting and classifying occlusal caries lesions on permanent teeth.

CLINICAL SIGNIFICANCE

3D intraoral scanning can aid the detection and classification of occlusal caries as part of patient screening and can potentially be used in remote caries assessment for clinical and research purposes.

Prevalence of Dental Caries in Patients on Renal Replacement Therapy-A Systematic Review

Patients under renal replacement therapy (RRT) often show oral problems, including dry mouth, periodontal and dental diseases. This systematic review aimed to evaluate the caries burden in patients on RRT. Therefore, a systematic literature search based on the databases PubMed, Web of Science and Scopus was performed by two independent individuals in August 2022. Search terms were: "caries" AND "dialysis", "caries" AND "renal replacement therapy", "caries" AND "kidney". The systematic process was complemented by manual search. Studies on adult patients (age ≥ 18 years), treated by any form of RRT and explicitly reporting caries prevalence or incidence were checked for their eligibility and subsequently analyzed qualitatively. For all included studies, a quality appraisal was applied. From the systematic search, 653 studies were identified, of which 33 clinical investigations were included in the qualitative analysis. The majority (31 studies) of all included patients underwent hemodialysis (HD), with a sample size between 28 and 512 participants. Eleven studies investigated a healthy control group. Oral examinations were heterogeneous across studies; the caries burden was primarily assessed by decayed-(D-T), missing- and filled-teeth index (DMF-T). The number of decayed teeth ranged between 0.7 and 3.87 across studies. Only six out of these 11 studies found significant differences in caries prevalence/incidence between RRT and controls, whereby only four studies confirmed worse caries burden in RRT individuals. No information was provided on caries stadium (initial caries, advanced caries, invasive treatment need), caries activity or location (e.g., root caries) across studies. Most of the included studies were assessed to be of moderate quality. In conclusion, patients on RRT suffer from a high prevalence of dental caries. Alongside a need for further research in the field, improved, multidisciplinary, patient-centered dental care concepts are required to support dental and overall oral health in individuals on RRT.

Association between dental caries and obesity among Libyan schoolchildren during the armed conflict in Benghazi

BACKGROUND

Dental caries and Obesity in children are issues of public health concern. Even though researching the relationship between these two noncommunicable diseases has been conducted for many years, the results remain equivocal. This paper aimed to examine the association between dental caries and obesity among 12-year-old schoolchildren living in war-affected environment in Benghazi.

METHODS

A secondary analysis of a cross-sectional study was conducted to determine the prevalence of caries among 12-year-old school children in Benghazi in 2017 during the armed conflict that affected the city. The data extracted for the analysis included sociodemographic of the participants (gender, maternal education and school type), caries experience (DMFT index), and anthropometric measures (height in cm, weight in kg, BMI and Z score for BMI). Comparisons of anthropometric measures were conducted according to caries experience. Linear regression models were developed to determine the association between Body Mass Index and Z score as outcome variables, caries as an explanatory variable, and covariates (gender, maternal education and school type). Beta coefficient (β) and 95% confidence intervals were calculated. All statistical tests were conducted at p ≤ 0.05.

RESULTS

There were 782 children with a mean (SD) BMI of 20.7 SD5.09 and an average z (SD) score of 0.56 SD1.51. Also, 159 (20%) children had obesity. No significant association was observed between caries and anthropometric measures. However, higher BMI was observed in children from a private school (p ≤ 0.001***), females (p ≤ 0.001***) and self-reported regular sugary drinks consumers (p ≤ 0.001***).

CONCLUSION

The present study shows no significant association between dental caries and anthropometric measures. However, the study findings support the notion of tackling sugar intake as a common risk factor for caries and obesity, which should be encouraged in the Libyan culture.

Assessment of the oral health status of children with chronic kidney disease

BACKGROUND

There are various oral symptoms related to the disease and its management in individuals with chronic kidney disease (CKD). The aim of the study was to investigate the oral health status of children with different stages of CKD, kidney transplant recipients (KTR), and healthy children.

METHODS

A total of seventy-one children diagnosed with CKD and fifty-two healthy children were included in the study. Each patient was examined for dental caries by the decayed-missing-filled-teeth (DMFT/dmft) index and the International Caries Detection and Assessment System (ICDAS-II), developmental defects of enamel (DDE) by the DDE index, and oral hygiene by the debris (DI), calculus (CI), and simplified oral hygiene (OHI-S) indices.

RESULTS

The median number of DMFT/dmft was 1.00 (interquartile range (IQR):1.00-4.00) in children with stage 1-3 CKD, 0.00 (IQR: 0.00-2.50) in stage 4-5 children, 0.00 (IQR: 1.00-3.00) in KTR, and 8.00 (IQR: 1.00-13.00) in healthy children. According to ICDAS-II categories, the percentage of children with severe caries was 53.8% in healthy children, while it was 44.4% in KTR, 25.9% in stage 1-3, and 11.4% in stage 4-5 children. While the percentage of children with DDE was 88.8% in KTR, 80% in stage 4-5, and 66.7% in stage 1-3 children, this rate was 44.2% in healthy children. The highest mean OHI-S score was observed in stage 4-5 children (2.10 ± 1.08), followed by KTR (1.46 ± 1.19), stage 1-3 (1.27 ± 0.61), and healthy children (0.45 ± 0.44), respectively.

CONCLUSIONS

Compared to healthy children, children with CKD had more debris accumulation, calculus formation, and more DDE but a lower severity of dental caries. A higher resolution version of the Graphical abstract is available as Supplementary information.

Anorexia and bulimia nervosa in the practice of the paediatric dentist

OBJECTIVE

This systematic review aimed to highlight the usefulness of the clinical examination of the oral cavity for the diagnostic suspicion of anorexia (AN) and bulimia nervosa (BN), being of main interest to the paediatric dentist and paediatrician due to the early onset of symptoms in Eating Disorders (EDs).

METHOD

A systematic search, applying PICO question, was carried out in biomedical and other electronic databases from 2005 to 2020. Both case reports and case series of patients under 65 years of age with AN and BN were included. Data were extracted and statistically analysed.

RESULTS

A sample of 111 studies was obtained (n = 192; 92.78% female). The most prevalent diagnosis was restrictive type AN (n = 110; 57.29%). Only 16 (8.33%) patients had been clinically examined at the oral cavity, indicating the presence or absence of oral manifestations (OM) and showing dental erosion (n = 10) as the most frequent.

CONCLUSION

There is a lack of information about the oral examination of anorexic and bulimic patients. Dental erosion and other oral manifestations can help us to make an early ED diagnosis. Clinical observation and basic erosive wear examination (BEWE) Index are necessary steps to detect and record any anomaly in oral cavity during the evaluation of these patients.

Special Care Patients and Caries Prevalence in Permanent Dentition: A Systematic Review

Due to the increase in the population with special needs and the significant difficulty in their dental management, it is essential to analyze the caries prevalence in this group of patients. The systematic review was conducted following the PRISMA statement. A search was performed on 9 May 2022 and updated on 5 June 2022, in three databases: Pubmed, Scielo, and Cochrane library. Studies involving the analysis of caries in permanent teeth in patients with special needs were included. A total of 1277 studies were analyzed and 21 studies were selected. Quality assessments were performed using an adapted version of the STROBE guidelines. Among the analyzed groups (intellectual disabilities, human immunodeficiency virus infection, schizophrenia, down syndrome, drug addicts, adult heart transplant, kidney disease, diabetic, autism, psychiatric patients, cerebral palsy, and hemophilia), the highest prevalence of caries was observed in patients with intellectual disability, without differences between genders. However, there is a need for more studies with standardized methods for caries diagnosis to further investigate the prevalence of caries in permanent teeth in patients with special needs.

Dental and Dental Hygiene Students' Knowledge and Capacity to Discriminate the Developmental Defects of Enamel: A Self-Submitted Questionnaire Survey

Background: A prompt and accurate diagnosis of developmental defects of enamel (DDE) is mandatory for proper treatment management. This cross-sectional survey, designed and carried out using anonymous self-administered questionnaires, aimed to assess dental and dental hygiene students’ knowledge and their capability to identify different enamel development defects. Methods: The questionnaire consisted of twenty-eight closed-ended questions. Two different samples of undergraduate students were selected and enrolled: a group of dental hygiene (GDH) students and a group of dental (GD) students. A multivariate logistic regression was performed by adopting the correct answers as explanatory variables to assess the difference between the two groups. Results: Overall, 301 completed questionnaires were analyzed: 157 from the GDH and 144 from the GD. The dental student group showed better knowledge than the GDH of enamel hypomineralization and hypoplasia (p = 0.03 for both). A quarter (25.25%) of the total sample correctly identified the period of development of dental fluorosis with a statistically significant difference between the groups (p < 0.01). Amelogenesis imperfecta (AI) was identified as a genetic disease by 64.45% of the sample, with a better performance from the GD (p = 0.01), while no statistical differences were found between the groups regarding molar incisor hypomineralization. Multivariate analysis showed that AI (OR = 0.40, [0.23;0.69], p < 0.01) and caries lesion (OR = 0.58, [0.34;0.94], p = 0.03) were better recognized by the GD. Conclusions: Disparities exist in the knowledge and management of DDE among dental and dental hygiene students in Italy; however, significant knowledge gaps were found in both groups. Education on the diagnosis and treatment of DDE during the training for dental and dental hygiene students needs to be strongly implemented.

Design for a cluster randomized controlled trial to evaluate the effects of the CATCH Healthy Smiles school-based oral health promotion intervention among elementary school children

Background

The top two oral diseases (tooth decay and gum disease) are preventable, yet dental caries is the most common childhood disease with 68% of children entering kindergarten having tooth decay. CATCH Healthy Smiles is a coordinated school health program to prevent cavities for students in kindergarten, 1st, and 2nd grade, and is based on the framework of Coordinated Approach to Child Health (CATCH), an evidence-based coordinated school health program. CATCH has undergone several cluster-randomized controlled trials (CRCT) demonstrating sustainable long-term effectiveness in incorporating the factors surrounding children, in improving eating and physical activity behaviors, and reductions in obesity prevalence among low-income, ethnically diverse children. The aim of this paper is to describe the design of the CATCH Healthy Smiles CRCT to determine the effectiveness of an oral health school-based behavioral intervention in reducing incidence of dental caries among children.

Methods

In this CRCT, 30 schools serving low-income, ethnically-diverse children in greater Houston area are recruited and randomized into intervention and comparison groups. From which, 1020 kindergarten children (n = 510 children from 15 schools for each group) will be recruited and followed through 2nd grade. The intervention consists of four components (classroom curriculum, toothbrushing routine, family outreach, and schoolwide coordinated activities) will be implemented for three years in the intervention schools, whereas the control schools will be offered free trainings and materials to implement a sun safety curriculum in the meantime. Outcome evaluation will be conducted at four time points throughout the study period, each consists of three components: dental assessment, child anthropometric measures, and parent survey. The dental assessment will use International Caries Detection and Assessment System (ICDAS) to measures the primary outcome of this study: incidence of dental caries in primary teeth as measured at the tooth surface level (dfs). The parent self-report survey measures secondary outcomes of this study, such as oral health related behavioral and psychosocial factors. A modified crude caries increment (mCCI) will be used to calculate the primary outcome of the CATCH Healthy Smiles CRCT, and a two-tailed test of the null hypothesis will be conducted to evaluate the intervention effect, while considering between- and within-cluster variances through computing the weighted-average of the mCCI ratios by cluster.

Conclusion

If found to be effective, a platform for scalability, sustainability and dissemination of CATCH already exists, and opens a new line of research in school oral health.

Clinical trials identifier

At ClinicalTrials.gov - NCT04632667.

Prevalence of early childhood caries in three regions of China: A cross-sectional study

BACKGROUND

The burden of early childhood caries (ECC) in different regions of China with different levels of economic development has been of interest to policymakers and public health workers.

AIM

To investigate regional differences in ECC prevalence in China and to identify associated risk factors.

METHODS

A total of 11 612 three- to five-year-old children from three geographic regions of China were included in this cross-sectional study. The dmft index was assessed for each child. A questionnaire regarding children's dietary habits, oral health behaviors, parents' socioeconomic status, and attitudes toward oral health was administered. Odds ratios and 95% confidence intervals were calculated to evaluate associated factors.

RESULTS

Caries prevalence in the Eastern, Central and Northwestern regions of China was 63.4% (95% CI: 61.4%-64.5%), 59.4% (95% CI: 58.6%-61.7%), and 59.0% (95% CI: 58.5%-61.6%), respectively. Children from the Northwestern (OR = 0.83, 95% CI: 0.75-0.92) and Central (OR = 0.83, CI: 0.75-0.92) regions of China had a lower risk of experiencing ECC. Dietary habits and parents' specific oral health knowledge and attitudes were associated with ECC.

CONCLUSIONS

Differences in ECC prevalence were found in the three regions of China. Multiple factors were associated with ECC. Overall, the burden of ECC was heavy in the examined regions.

Caries experience and gingival health in children and adolescents with type 1 diabetes mellitus-A cross-sectional study

AIM

To investigate the oral health of children and adolescents with type 1 diabetes (T1D) and its associations with diabetes-related and lifestyle factors.

DESIGN

Cross-sectional study at a large tertiary hospital pediatric diabetes clinic. Oral examination determined dental caries experience and gingival health. Secondary outcome measures included salivary characteristics, oral hygiene and dietary practices, and diabetes-related factors.

RESULTS

Eighty children and adolescents with T1D participated; mean (SD) age and HbA_1c were 13.4(2.6) years and 7.7(0.9)%, respectively. Forty-seven (59%) participants had one or more decayed, missing or filled teeth; 75 (94%) participants had gingivitis. Half (50%) reported ≥3 hypoglycemic episodes necessitating rapid-acting carbohydrate in the previous week. Sixty-two participants (78%) had normal saliva flow, however, 42 (52%) had reduced salivary buffering capacity. Glycemic control (HbA_1c ) was not associated with caries experience, gingival health or salivary characteristics. Increased frequency of tooth brushing (OR, 0.11; 95%CI 0.01-0.97, p = 0.05) and interdental flossing (OR, 0.31; 95%CI 0.12-0.81, p = 0.02) were associated with lower caries experience. Interdental flossing (OR, 0.31; 95% CI 0.12-0.80, p = 0.02) and good oral hygiene (OR, 0.06; 95% CI 0.01-0.22, p < 0.001) were associated with less gingivitis.

CONCLUSION

Poor oral health is common in children with T1D, regardless of HbA1c. Given potential implications for short- and long-term systemic health, this study demonstrates the need for targeted strategies to improve oral health in children with T1D.

Current Status and Trends in Research on Caries Diagnosis: A Bibliometric Analysis

There are a wide variety of devices for the detection and diagnosis of caries from the initial stages. The purpose of this study was to perform a bibliometric study on research regarding caries diagnosis by identifying the contributing researchers, organizations, countries or regions, journals, and to provide an analysis of keyword co-occurrence and co-authorship networks. An advanced search was performed in Web of Science (WOS) Core Collection database, using the terms “caries diagno*” and “caries detect*” in the “topic” field, from 2013 to 2021. Bibliometric parameters were extracted using WOS’s analyze results tools and VOSviewer software. A total of 816 documents were identified. Most of them, (61.3%) are included in “Dentistry Oral Surgery & Medicine” category within WOS. The largest scientific production on the subject is observed between 2018 and 2021, with a total of 344 records. The most productive author is Mendes FM, followed by Braga MM. The journal with the most articles published on caries diagnosis is Caries Research, with 55 articles (6.74%). The terms with the highest co-occurrence refer to the validity of diagnostic methods, tools or principles used in diagnosis or general aspects related to caries detection and diagnosis.

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.

Caries Detection on Intraoral Images Using Artificial Intelligence

Although visual examination (VE) is the preferred method for caries detection, the analysis of intraoral digital photographs in machine-readable form can be considered equivalent to VE. While photographic images are rarely used in clinical practice for diagnostic purposes, they are the fundamental requirement for automated image analysis when using artificial intelligence (AI) methods. Considering that AI has not been used for automatic caries detection on intraoral images so far, this diagnostic study aimed to develop a deep learning approach with convolutional neural networks (CNNs) for caries detection and categorization (test method) and to compare the diagnostic performance with respect to expert standards. The study material consisted of 2,417 anonymized photographs from permanent teeth with 1,317 occlusal and 1,100 smooth surfaces. All the images were evaluated into the following categories: caries free, noncavitated caries lesion, or caries-related cavitation. Each expert diagnosis served as a reference standard for cyclic training and repeated evaluation of the AI methods. The CNN was trained using image augmentation and transfer learning. Before training, the entire image set was divided into a training and test set. Validation was conducted by selecting 25%, 50%, 75%, and 100% of the available images from the training set. The statistical analysis included calculations of the sensitivity (SE), specificity (SP), and area under the receiver operating characteristic (ROC) curve (AUC). The CNN was able to correctly detect caries in 92.5% of cases when all test images were considered (SE, 89.6; SP, 94.3; AUC, 0.964). If the threshold of caries-related cavitation was chosen, 93.3% of all tooth surfaces were correctly classified (SE, 95.7; SP, 81.5; AUC, 0.955). It can be concluded that it was possible to achieve more than 90% agreement in caries detection using the AI method with standardized, single-tooth photographs. Nevertheless, the current approach needs further improvement.

Effectiveness of Visual-Tactile Examination and DIAGNOdent Pen in Detecting Early Enamel Caries and Its Remineralisation: An In Vitro Study

Background

The caries preventive effect of Colgate Duraphat® and GC Tooth Mousse Plus® has been widely studied, but the remineralisation potential of initial occlusal caries using these two remineralisation materials remains unclear.

Aim

This study is aimed at evaluating and comparing the remineralisation of early enamel caries on the occlusal surface of permanent posterior teeth using ICDAS II caries scoring system and DIAGNOdent Pen (DDPen) after remineralisation with Colgate Duraphat® and GC Tooth Mousse Plus®.

Materials and Methods

Extracted posterior teeth (N = 120) with incipient occlusal caries were included in this study. The occlusal surface of each tooth was scored using DDPen and ICDAS II scoring before remineralisation. Then, remineralisation of the teeth of the experimental group was carried out using either CPP-ACP-F or fluoride varnish. After the remineralisation procedures, the occlusal surface of each tooth was again scored using DDPen and ICDAS II scoring. The teeth were then fixed in dental stone blocks and sectioned longitudinally for histological examination using a stereomicroscope. Statistical analysis was performed to calculate the sensitivity and specificity of DDPen and ICDAS II to detect remineralisation and compare with the gold standard histological examination.

Results

According to ICDAS-II scores, a significant difference was noted in GC Tooth Mousse Plus® and Duraphat® study samples, whereas the difference between the pre-and post-remineralisation of the control group was not significant. According to the DDPen score criteria, a statistically significant difference was noted among all study groups; however, a greater significance level was noted in the GC Tooth Mousse Plus® and Duraphat® study samples compared with the control group. The Spearman's rank correlation of ICDAS-II and DDPen with Downer's histological score (gold standard) revealed a higher association of DDPen score (.738) as compared to ICDAS-II scores (.430).

Conclusion

The study concluded that both ICDAS II and DDPen could detect remineralisation of early enamel occlusal caries. DDPen was more sensitive than ICDAS-II to detect remineralisation compared with the Downers histological scores.

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.

The value of bitewing radiographs in the management of carious primary molars

Introduction Bitewing radiographs (BWs) are under-utilised for children, and reliance on visual diagnosis alone is likely to under-diagnose caries. Quantification of the level of the under-reporting of caries and the vital role of BWs would be beneficial when providing dental care to the paediatric population.Aim To quantify the diagnostic value of bitewings in the management of proximal caries in primary molars.Design Cross-sectional study.Materials and methods Thirty children (mean age 6.2 ± 1.3 years) were recruited. A visual inspection (VI) of the primary molars was carried out and bitewings were taken. Radiographic assessment (RA) for primary molar proximal caries was completed separately. VI and RA were compared statistically against three caries thresholds, using the Fisher's exact test. A p value <0.05 was considered statistically significant. Sensitivity and specificity analyses were performed.Results A total of 480 proximal surfaces were assessed. Bitewings detected 44.6% of additional proximal carious lesions (p <0.0001). At d₃ threshold, VI under-reported 51.2% proximal caries (p <0.0001) and 34.1% dentinal proximal caries (p = 0.0012). VI showed high specificity (99%) and low sensitivity (53%).Conclusion Bitewings play a vital role in proximal caries diagnoses of primary molars.

In vivo effectiveness of visual inspection and laser fluorescence in the diagnosis of early pit-and-fissure carious lesions: A cross-sectional study in a group of Romanian children

General practitioners are still facing great challenges in the management of occlusal caries. Therefore, the development of better diagnostic protocols and assessment of caries activity might improve the results of nonoperative treatment. This study aimed to evaluate the effectiveness of visual inspection based on ICDAS-II (International Caries Detection and Assessment System) and DiagnoDent pen in the detection of pit-and-fissure early lesions in young permanent molars. The evaluation of 237 occlusal surfaces and caries risk assessment were performed in 96 children aged 7 to 15 years. The presence of pit-and-fissure noncavitated lesions was recorded using ICDAS-II scoring system and laser fluorescence. Statistical analysis was performed using McNemar test, with a level of significance of P < .05. The caries risk was measured for all participants. In 109 occlusal surfaces both methods identified enamel changes (46%) and in 62 cases both methods excluded the carious lesion (26.2%). The statistical analysis showed a significant moderate agreement between ICDAS-II code and DiagnoDent pen measurements (McNemar chi-squared statistic 9.5, P = .002 and Cohen kappa coefficient = 0.427). The majority of children (69.8%) had moderate caries risk and the most frequent risk factors recorded were sugar intake between meals, lack of regular dental control and poor oral hygiene. We concluded that ICDAS-II is a valuable and reliable diagnostic tool for early pit-and-fissure lesions and could be used alone during dental examination in children. The evaluation of caries risk should become clinical routine, as parameters belonging to high risk were frequently recorded in our study group.

Systematic review and meta-analysis of diagnostic studies of proximal surface caries

AIM

This systematic review and meta-analysis aimed to assess the diagnostic accuracy and reliability of commonly used caries detection methods for proximal caries diagnostics. Visual examination (VE), bitewing radiography (BWR), laser fluorescence (LF), and fibre-optic transillumination (FOTI) were considered in detail.

MATERIAL AND METHODS

PRISMA guidelines for the reporting of systematic reviews and meta-analyses were applied. The mnemonic PIRDS (problem, index test, reference test, diagnostic and study type) concept was used to guide the literature search. Next, studies that met the inclusion criteria were stepwise selected and evaluated for their quality with a risk of bias (RoB) assessment tool. Studies with low/moderate bias and sufficient reporting were considered for meta-analysis. The pooled sensitivity (SE), specificity (SP), diagnostic odds ratio (DOR), and area under the ROC curve (AUC) were calculated.

RESULTS

From 129 studies meeting the selection criteria, 31 in vitro studies and five clinical studies were finally included in the meta-analysis. The AUC values for in vitro VE amounted to 0.84 (caries detection) and 0.85 (dentin caries detection). BWR ranged in vitro from 0.55 to 0.82 (caries detection) and 0.81-0.92 (dentin caries detection). LF showed higher AUC values for overall caries detection (0.91) and dentin caries detection (0.83) than did other methods. Clinical data are limited.

CONCLUSION

The number of diagnostic studies with low/moderate RoB was found to be low and indicates a need for high-quality, well-designed caries diagnostic studies.

CLINICAL RELEVANCE

BWR and LF showed good diagnostic performance on proximal surfaces. However, because of the low number of includable clinical studies, these data should be interpreted with caution.

Automated caries detection in vivo using a 3D intraoral scanner

The use of 3D intraoral scanners (IOS) and software that can support automated detection and objective monitoring of oral diseases such as caries, tooth wear or periodontal diseases, is increasingly receiving attention from researchers and industry. This study clinically validates an automated caries scoring system for occlusal caries detection and classification, previously defined for an IOS system featuring fluorescence (TRIOS 4, 3Shape TRIOS A/S, Denmark). Four algorithms (ALG1, ALG2, ALG3, ALG4) are assessed for the IOS; the first three are based only on fluorescence information, while ALG4 also takes into account the tooth color information. The diagnostic performance of these automated algorithms is compared with the diagnostic performance of the clinical visual examination, while histological assessment is used as reference. Additionally, possible differences between in vitro and in vivo diagnostic performance of the IOS system are investigated. The algorithms show comparable in vivo diagnostic performance to the visual examination with no significant difference in the area under the ROC curves (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$p>0.05$$\end{document}p>0.05). Only minor differences between their in vitro and in vivo diagnostic performance are noted but no significant differences in the area under the ROC curves, (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$p>0.05$$\end{document}p>0.05). This novel IOS system exhibits encouraging performance for clinical application on occlusal caries detection and classification. Different approaches can be investigated for possible optimization of the system.

ICCMS™ root caries lesions stages and their underlying depth towards the pulp: an in vitro study with histologic evaluation

OBJECTIVE

To examine the relationship between the ICCMS™ (International Caries Classification and Managing System) features of root caries lesions and the underlying depth of the lesion towards the pulp. In order to control for bias, the study followed the tailored document for risk of bias assessment (RoB-tool) recently published. A pilot study showed that the outline of the pulp was much clearer on horizontal compared to vertical sections through the lesions (p = 0.03) and that the histological stereomicroscopical (SM) assessed lesion depth towards the pulp was not influenced by the cutting direction (p = 0.155).

MATERIAL AND METHODS

A sample of extracted permanent molar teeth (n = 100) were classified independently by two of the authors according to ICCMS™ as no sign of root caries lesion 0 = sound; 1 = initial lesion (non-cavitated); 2 = moderate lesion (cavity depth ≤ 2 mm) and 3 = extensive lesion (cavity depth > 2 mm). After horizontal sectioning (HS) through the lesion, the depth of the underlying lesion was SM assessed independently by two of the authors as 0 = no lesion; 1 = lesion in outer 1/3; 2 = middle 1/3; and 3 = inner 1/3 of the dentine towards the pulp.

RESULTS

Intra- and inter-reproducibility (weighted kappa values ≥ 0.83); the accuracy (Spearman's rho-values) = 0.94 and 0.95; and specificity/sensitivities/AUC values (three different thresholds) were ≥ 0.91, ≥ 0.93, and ≥ 0.96, respectively.

CONCLUSION

Under the umbrella of the RoB-tool, the validity in terms of the reproducibility and accuracy of the ICCMS™ root caries scoring system was high.

CLINICAL RELEVANCE

By means of the ICCMS™ root caries scoring system, the underlying lesion depth can be estimated, which must be considered when managing the lesion.

STAndard Reporting of CAries Detection and Diagnostic Studies (STARCARDDS)

Aim

The aim of this paper is to present recommendations from an international workshop which evaluated the methodology and reporting of caries diagnostic studies. As a unique feature, this type of studies is focused on caries lesion detection and assessment, and many of them are carried out in vitro, because of the possibility of histological validation of the whole caries spectrum. This feature is not well covered in the existing reporting STARD guideline within the EQUATOR Network.

Participants and methods

An international working group of 13 cariology researchers was formed. The STARD checklist was reviewed and modified for caries detection and diagnosis purposes, in a three-step process of evaluation, consensual modification, and delivery during three 2-day workshops over 18 months. Special attention was paid to reporting requirements of caries studies that solely focus on reliability.

Results

The STARD checklist was modified in 14/30 items, with an emphasis on issues of sample selection (tooth selection in in vitro studies), blinding, and detailed reporting of results.

Conclusion

Following STARCARDDS (STAndard Reporting of CAries Detection and Diagnostic Studies) is expected to result in complete reporting of study design and methodology in future caries diagnosis and detection experiments both in vivo and in vitro, thus allowing for better comparability of studies and higher quality of systematic reviews.

Clinical relevance

Standardization of caries diagnostic studies leads to a better comparability among future studies, both in vivo and in vitro.

Intraoral scanner featuring transillumination for proximal caries detection. An in vitro validation study on permanent posterior teeth

OBJECTIVES

To assess the validity of an intraoral scanner system featuring near-infrared (NIR) transillumination to aid the detection of proximal caries lesions, and to compare the diagnostic performance of this system with that of conventional caries detection methods and with that of an intraoral camera featuring NIR transillumination (DIAGNOcam).

METHODS

Ninety-five permanent posterior teeth were examined using a prototype tip functioning with TRIOS 4 intraoral scanner system (3Shape TRIOS A/S, Denmark) and emitting NIR light, DIAGNOcam, and visual and radiographic examination employing ICDAS criteria. One or two approximal surfaces per tooth, sound or with caries lesions at different stages, were examined (N₁=158). Histological assessment was used as the reference standard.

RESULTS

All methods showed excellent intra-examiner reliability (κ_intra ≥0.80). Two independent examiners assessed the NIR images obtained with both devices. The first examiner, who obtained and assessed the images, showed improved diagnostic performance than the second examiner, who only had access to the images. The inter-examiner agreement between the two examiners assessing the NIR images was substantial (κ_inter 0.57-0.72). The intraoral scanner and DIAGNOcam showed similar diagnostic performance. Regarding initial caries lesions, the NIR image assessment resulted in equal or improved sensitivity (SE 0.50-0.89) compared to radiographic assessment (SE 0.49-0.51) and higher than visual examination (SE 0.28-0.39). Radiographic and NIR image assessment resulted in similar SE in detecting moderate-extensive dentin caries lesions (SE 0.59-0.70), while visual examination showed an inferior value (SE 0.30).

CONCLUSIONS

The intraoral scanner system featuring NIR transillumination and DIAGNOcam showed an overall good diagnostic performance. The conventional caries detection methods showed inferior sensitivity at initial caries lesion stages.

CLINICAL SIGNIFICANCE

Considering the promising diagnostic performance of the intraoral scanner featuring transillumination and the advantages offered by combining the NIR images with the 3D models of the teeth, this system has the potential to contribute towards more reliable caries detection and monitoring in clinical practice without the use of ionizing radiation.

Assessment of the Potential Ability to Penetrate into the Hard Tissues of the Root of an Experimental Preparation with the Characteristics of a Dental Infiltratant, Enriched with an Antimicrobial Component-Preliminary Study

Infiltration is a method of penetration with a low viscosity resin that penetrates deep into demineralised tooth tissue and fills the intergranular spaces, hence reducing porosity. Carious lesions initially located at the enamel–cement junction are usually found in elderly patients. Those spots are predisposed to bacterial adhesion originating both from biofilm and from gingival pocket bacteria. The aim of this study was to evaluate the penetration of an experimental preparation, which has the characteristics of a dental infiltrant, enriched with an antibacterial component, into the decalcified root cement tissues of extracted human teeth in elderly patients. An experimental preparation with the characteristics of a dental infiltrant was prepared, applied, and polymerised on the surface of extracted, previously decalcified human teeth. The control sample was Icon (DMG, Hamburg, Germany). The ability of the preparations to penetrate deep into the root cement was evaluated using scanning electron and light microscopy. The study showed that an experimental preparation could potentially be used for treatment of early carious lesions within the tooth root in elderly patients, among others, as it penetrates deep into demineralised tissues. More research is needed.

Ability of Dentists and Students to Detect Caries by Using the International Caries Detection and Assessment System

Objective

To evaluate the ability of dentists and dental students to detect caries by using the International Caries Detection and Assessment System (ICDAS).

Materials and Methods

A cross-sectional study was conducted in Riyadh city and in the College of Dentistry at King Saud University (KSU) in Saudi Arabia. The study sample included a cluster sampling of 50 private clinics (100 dentists) and all 3rd-, 4th-, and 5th-year students (393 students). Data were collected using an electronic questionnaire. The ability score of detecting caries for each group was identified by calculating the mean percentages of the score. The data were entered into SPSS Version 20. One-way ANOVA was used for comparing quantitative data.

Results

The overall response rate of the survey was 64.5% (318/493). A total of 62.6% (199) of respondents know about ICDAS. All groups had difficulty assessing the activity of caries in Code 2. There were significant differences among all groups in the ability to detect caries (P-value: 0:00). Moreover, 4th- and 5th-year students had the highest mean of percentage ability score (53.8% and 57.6%, respectively) to detect caries using ICDAS compared to 3rd-year students and general practitioners (38.6% and 38.7%, respectively).

Conclusion

Overall, detection of early dental caries limited to enamel was confusing and difficult. The abilities of dentists and dental students to detect caries using ICDAS were low and require improvement by continuing further clinical training.