The Global Prevalence and Severity of Dental Caries among Racially Minoritized Children: A Systematic Review and Meta-Analysis

Antithrombotic and anticariogenic activity of peptide fractions from cowpea (Vigna unguiculata) protein hydrolysates

BACKGROUND

Protein-derived peptide fractions can play a key role in the physiological and metabolic regulation and modulation of the body, which suggests that they could be used as functional ingredients to improve health and to reduce the risk of disease. This work aimed to evaluate the in vitro antithrombotic and anticariogenic bioactivity of hydrolysates and protein fractions obtained from cowpea (Vigna unguiculata) by biocatalysis.

RESULTS

Cowpea protein concentrate was hydrolyzed by sequential action with two enzyme systems, Pepsin-Pancreatin or Alcalase-Flavourzyme. There was extensive enzymatic hydrolysis, with degrees of hydrolysis of 34.94% and 81.43% for Pepsin-Pancreatin and Alcalase-Flavourzyme, respectively. The degree of hydrolysis for the control treatments, without the addition of the enzymes Pepsin-Pancreatin and Alcalase-Flavourzyme was 1.1% and 1.2%, respectively. The hydrolysates were subjected to fractionation by ultrafiltration, with five cut-off points according to molecular weight (<1, 1-3, 3-5, 5-10 and >10 kDa). The Alcalase-Flavourzyme hydrolysate led to 100% inhibition of platelet aggregation, while the Pepsin-Pancreatin hydrolysate showed 77.41% inhibition, but this was approximately 100% in the ultrafiltered fractions. The highest anticariogenic activity was obtained with the Pepsin-Pancreatin system, with 61.55% and 56.07% for calcium and phosphorus demineralization, respectively.

CONCLUSION

Hydrolysates and their peptide fractions from Vigna unguiculata exhibited inhibition of platelet aggregation and protection of tooth enamel and have the potential for use in the development of functional products with beneficial health effects. © 2024 Society of Chemical Industry.

Anticariogenic activity of marine brown algae Padina boergesenii and its active components towards Streptococcus mutans

Streptococcus mutans is a well-recognized bacterium that plays a predominant role in the progression of dental caries. Its pathogenicity is linked to several key characteristics, including the ability to produce organic acids (acidogenicity), thrive in low pH environments (aciduricity), synthesize exopolysaccharides (EPS) via glucosyltransferases, and form retentive biofilms. The treatment of dental caries with conventional antibiotics is often ineffective due to the bacterium's capacity to form recalcitrant biofilms. To address these challenges, strategies that specifically target the pathogen's virulence without affecting its viability have emerged as promising alternatives. In this context, we investigated the anticariogenic properties of the methanolic extract of Padina boergesenii (MEPB). MEPB demonstrated substantial, dose-dependent antibiofilm activity, with a maximum inhibition of 93% at 128 μg/mL, without compromising the viability of S. mutans. Anti-virulence assays using sub-MIC (minimum inhibitory concentration) levels of MEPB showed significant reductions in key virulence factors: 75% reduction in sucrose-dependent adherence, 65% reduction in sucrose-independent adherence, along with notable decreases in acid production, acid tolerance, and water-insoluble (85%) and water-soluble (52%) glucan synthesis. Additionally, MEPB significantly reduced cell surface hydrophobicity (55%) and extracellular DNA (eDNA) production (64%). qPCR analysis corroborated these in vitro findings, revealing that MEPB suppresses the expression of genes involved in S. mutans virulence, particularly genes related to EPS synthesis (gtfB, gtfC & gtfD) biofilm formation(gbpB & gbpC) and two-component regulatory system (vicR) were downregulated. Toxicity testing on human buccal epithelial cells confirmed the non-toxic nature of MEPB, suggesting its safety for potential therapeutic use. Furthermore, GC-MS/MS analysis identified palmitic acid, myristic acid, and stearic acid as the major active constituents of the MEPB extract. Subsequent biofilm inhibitory assays confirmed the potent antibiofilm efficacy of these compounds: palmitic acid (85%), myristic acid (72%) and stearic acid (83%). In conclusion, this study identifies P. boergesenii and its active biomolecules as potential anticariogenic agents, offering an alternative approach to combat dental caries by targeting bacterial virulence mechanisms rather than viability.

Shear bond strength evaluation of bioactive restorative materials on pretreated carious dentin-influence on silver diamine fluoride, potassium iodide, and glutathione

Background

Silver diamine fluoride (SDF) has gained popularity for its caries-arresting properties, yet its tendency to cause esthetic concerns due to black-staining limits its widespread acceptance.

Aim

The aim of the study was to evaluate and compare the shear bond strength of Activa BioActive and Giomer restorative material with different protocols of SDF pretreatment on carious dentin.

Materials and Methods

Ninety-two extracted teeth were decoronated at the cementoenamel junction, sectioned 1 mm into dentin, mounted in acrylic resin and randomly divided into four (n = 8) control and six (n = 10) experimental groups. Seventy-six samples underwent demineralization process for a period of 14 days for artificial carious dentin (ACD) formation. The samples categorized based on the dentin substrate (sound or ACD) were subjected to various SDF pretreatment protocols, i.e., only SDF, SDF with potassium iodide (KI), and SDF with glutathione (GSH). Further, bioactive restorative materials, i.e., Activa BioActive and Giomer (Beautifil II), were placed on it, and the samples were subjected to shear bond strength testing.

Statistical Analysis

Independent t-test was run to analyze the values obtained.

Results

Giomer exhibited better mean bond strength with SDF, SDF + KI, and SDF + GSH (6.56, 4.67, and 3.34 mega-pascals [MPa], respectively) compared to Activa BioActive (3.42, 3.27, and 2.96 MPa, respectively).

Conclusion

This study contributes to understanding the interplay between SDF application protocols, esthetic concerns, and the adhesive properties of bioactive restorative materials. Giomer exhibited enhanced bond strength after SDF application, unlike Activa BioActive. In addition, incorporation of KI or GSH adversely affected the bond strength of both the restorative materials, underscoring the critical need for cautious clinical application.

Clinical Relevance

This study highlights the importance of selecting appropriate dentin pretreatment agents to maximize the bond strength of bioactive restorative materials with carious dentin. SDF application significantly enhanced the bond strength of Giomer with carious dentin compared to Activa BioActive, thus, making it a good choice for restoring nonesthetic areas. In addition, the application of KI or GSH to mitigate discoloration of carious dentin negatively affected the bond strength of both, Activa BioActive and Giomer. Thus, the clinicians should weigh the benefits of SDF against potential bond strength reductions when using KI or GSH, especially for esthetic restorations.

Effectiveness of school dental screening programme and different referral mechanisms on caries experience among 6-11-year-old children

BACKGROUND

School-based dental screening and referral mechanism is a potential intervention that impacts utilization of dental services.

AIM

The present study aims to evaluate the effectiveness of school dental screening programme with referral to specific dental hospital on caries experience among 6-11-year-old children.

SETTINGS AND DESIGN

A cluster randomized control trial was conducted with 694 children assigned to test group (n = 351) and control group (n = 343).

MATERIALS AND METHODS

Children in test group were referred to specific dental hospital, while those of control group to nonspecific dental hospital for treatments.

STATISTICAL ANALYSIS USED

Wilcoxon test and Mann-Whitney U tests were used for intragroup and intergroup comparison of decayed, missing, filled teeth/decayed, extraction needed, filled teeth scores.

RESULTS

A statistically significant difference (P < 0.001) in decayed (dt + DT) and filled (ft + FT) teeth scores was observed on intergroup comparison at 12 months. There was a significant increase in filled teeth (FT) scores in children of both the groups. However, the decayed teeth (dt + DT) scores were significantly decreased in children of test group (P < 0.001), while increased in control group (P = 0.004).

CONCLUSION

School dental screening programs with referral to specific dental hospital had a highly significant impact in reducing decayed teeth and increasing the number of FT 27 in children.

Evaluation of Antibacterial Effects of an Oral Rinse Containing Ocimum tenuiflorum and Ocimum gratissimum on Streptococcus mutans and Lactobacillus Species

BACKGROUND AND AIM

Dental caries, primarily caused by Streptococcus mutans and Lactobacillus spp., is a major global health issue. There is a growing need for effective, natural antimicrobial treatments. Ocimum tenuiflorum and Ocimum gratissimum are known for their medicinal properties, including antimicrobial activity. This study investigates the antibacterial efficacy of a herbal oral rinse derived from these plants. This study aimed to evaluate the antibacterial activity of an herbal formulation-based oral rinse prepared from Ocimum tenuiflorum and Ocimum gratissimum against Streptococcus mutans and Lactobacillus spp.

METHODS

Fresh leaves of Ocimum tenuiflorum and Ocimum gratissimum were shade-dried, powdered, and extracted in distilled water. The extract was incorporated into an oral rinse formulation. The antibacterial activity was assessed using the agar well diffusion method, protein leakage and cytoplasmic leakage assays, and time-kill curve analysis. A commercial oral rinse was used as a standard.

RESULTS

The herbal oral rinse exhibited significant antibacterial activity against both Streptococcus mutans and Lactobacillus spp. The zones of inhibition for Streptococcus mutans were 10 mm, 13 mm, and 15 mm at concentrations of 25 µg/mL, 50 µg/mL, and 100 µg/mL, respectively. For Lactobacillus spp., the inhibition zones were 10 mm, 12 mm, and 14 mm at the same concentrations. The protein leakage and cytoplasmic leakage analysis supported these findings, demonstrating the formulation's efficacy at low concentrations. Time-kill curve assays showed rapid bactericidal action, particularly at higher concentrations.

CONCLUSION

The Ocimum tenuiflorum and Ocimum gratissimum-based herbal oral rinse demonstrates strong antibacterial activity against key oral pathogens, suggesting that it could be a natural alternative to conventional oral rinses.

Reliability of impedance spectroscopy versus digital radiograph and ICDAS-II in occlusal caries detection: a prospective clinical trial

The traditional methods in early caries detection had many limitations. So, this study aimed to evaluate the clinical performance of alternating current impedance spectroscopy ACIST in comparison with digital radiograph and ICDAS-II in detection of occlusal carious lesions. Occlusal surfaces of molar and premolar teeth from 40 adult participants were examined by two observers using three diagnostic methods: (1) international caries detection and assessment system (ICDAS-II) (2) digital radiograph (DR) and (3) Cariescan Pro device (ACIST). Agreement analysis and the difference in sensitivities and specificities were evaluated. The results showed an excellent agreement in the different groups. The difference from the visual tactile against ACIST scoring for enamel caries detection, was statistically significant (p = 0.012) and the agreement was moderate (k = 0.509). For dentinal caries the difference was not statistically significant (p > 0.05) and the agreement was similarly moderate (k < 0.6). The difference from the digital radiograph against ACIST scoring, for enamel caries, digital radiography had significantly higher sensitivity and specificity than ACIST (p < 0.001) while for dentinal caries detection and overall, ACIST had higher sensitivity and digital radiography had higher specificity and the difference was statistically significant (p < 0.001). Visual-tactile examination is a considered as feasible and valid technique for occlusal caries detection, digital radiography is superior to ACIST in diagnosing enamel caries, but it could underestimate the caries depth, ACIST is a reliable tool for detecting occlusal caries in dentin.

School-based caries prevention using silver diamine fluoride: A pragmatic randomized trial in low-income rural children

Background

Dental caries is the world's most prevalent noncommunicable disease, disproportionately affecting children from low-income families and rural geographic areas.

Methods

The CariedAway 3.0 study was a cluster-randomized pragmatic non-inferiority trial comparing silver diamine fluoride (SDF) to sealants and atraumatic restorations (ART) for the prevention and control of dental caries. All participants also received fluoride varnish. Analysis consisted of mixed-effects logistic regression for caries prevalence and weighted least squares and mixed-effects negative binomial regression for caries incidence. A non-inferiority margin of 10% for the difference between groups was used. Dental caries was defined as an ICDAS score of four or greater.

Results

A total of 3345 children were enrolled across 35 schools; however there was a large proportion of children who were noncompliant and received external dental care over the course of the trial. In adjusted analyses of compliant participants (n=1083; 543 in the SDF group and 540 in the sealant and ART group), there was no difference in the weighted risk difference between treatment groups (B=0.003, 95% CI = -0.0001, 0.0008). The odds of caries prevalence was elevated in the SDF group in longitudinal analyses (OR = 1.35, 95% CI = 0.86, 2.11) but was not significant and was below the non-inferiority margin. There were no significant differences between groups for caries incidence in adjusted models (IRR = 1.19, 95% CI = 0.81, 1.74). Results for intent to treat analyses were similar to that of per-protocol.

Discussion

In this school-based clinical trial, the prevalence of dental caries in children treated with SDF and fluoride varnish was non-inferior compared to those treated with sealants, ART, and fluoride varnish, although the overall risk was slightly higher. Unfortunately, a high rate of dropout and participant noncompliance was observed, likely due to the impacts of COVID-19 on study procedures. As a result, observed effects may be unreliable beyond the short-term.

Trial Registration

NCT03448107.

Development of a novel in vitro model for non-cavitated carious lesion formation reflecting carious lesion activity

BACKGROUND

Oral biofilms are a critical component in dental caries formation. However, current remineralization studies often overlook the impact of microbial factors. Therefore, a comprehensive clinically relevant assessment of caries is needed. This study aimed to develop a novel in vitro model capable of generating non-cavitated carious lesions that incorporates both mineral loss and microbial activity using quantitative light-induced fluorescence-digital (QLF-D) technology.

METHODS

A total of 44 artificial early carious lesions were formed using bovine incisors. The extent of fluorescence loss (ΔF) was analyzed using a QLF-D camera. Oral microcosm biofilms were then employed to construct 22 active and 22 inactive carious lesions. The red fluorescence emission rate (ΔR) and bacterial viability (RatioG/G+R) was measured using QLF-D camera and a live-dead bacterial assay, respectively. Independent t-tests were performed to compare ΔF, ΔR, and bacterial viability of artificial carious lesions according to their activity status.

RESULTS

No significant difference in ΔF between the lesions was found based on activity status (p = 0.361). However, the ΔR of active lesions was 1.82 times higher than that of inactive lesions, and the RatioG/G+R was 1.49 times higher in active lesions than in inactive lesions (both p < 0.001).

CONCLUSIONS

The significant differences observed in ΔR and RatioG/G+R between active and inactive lesions emphasize the importance of considering lesion activity status when evaluating the potential efficacy of remineralization agents. This study presents a novel in vitro remineralization assessment model that reflects carious lesion activity while controlling baseline mineral distributions of lesions.

Dental divisions: exploring racial inequities of dental caries amongst children

DATA SOURCES

The search strategy involved three sequential stages. Initially, MEDLINE/PubMed was explored for relevant articles, identifying pertinent terms for formal searching. Using the terms ethnic, race, minoritised and dental caries, a strategy was formed and nine databases searched. Finally, hand-searching of reference lists of included articles and sourcing grey literature from relevant government reports, national oral health surveys, and registries which had comparative data for dental caries between racial groups, completed the search.

STUDY SELECTION

Studies included were original primary research which reported dental caries and compared racially minoritised children, aged 5-11 years, to similarly aged from national, majority, or privileged populations. Dental caries had to be recorded from a clinical examination which assessed decayed, missing, and filled teeth (dmft) in primary dentitions. Studies were excluded if they used immigration status as a basis of racial status, or they were a case report, case series, in vitro study, or literature review.

DATA EXTRACTION AND SYNTHESIS

After removing duplicates, two independent researchers screened abstracts, prior to extracting critical data following full-text reviews of included articles. Information collected included study and participant characteristics, definitions of race, and dental caries measurement. The authors of studies which had missing data were contacted, whilst those not written in the English language were translated. Methodological quality of each study was independently assessed by two reviewers using a modified version of the Newcastle-Ottawa scale. All studies were included in the review regardless of quality. A narrative overview of all included studies was conducted. Meta-analyses were completed using studies that reported the mean and standard deviation of the caries outcomes in both groups. Caries outcomes included severity (defined as mean dmft) or prevalence (percentage of teeth with untreated dental caries > 0%). Due to anticipated heterogeneity, statistical analyses approaches such as I2 statistics were used to estimate between-study variability. Additional sub-group analyses were conducted based on country of study and world income index. Contour-enhanced funnel plots and trim-and-fill analysis were completed to explore potential publication bias. Sensitivity analyses were performed to ensure robustness of the findings.

RESULTS

Seventy-five studies were included from a variety of countries. A higher mean dmft score of 2.30 (0.45, 4.15) and prevalence of decayed teeth (d > 0) was 23% (95% CI: 16, 31) was noted amongst racially minoritised children compared to privileged children's populations. Notable disparities were reported in high-income countries, with minoritised children burdening the greatest distribution of caries incidence. The study faced challenges in consistent racial classification and encountered high heterogeneity in its findings, leading to varied GRADE assessment scores.

CONCLUSIONS

The study calls for global, social, and political changes to tackle the substantial disparities in dental caries among minoritised children to achieve oral health equity.

Interplay between dental caries pathogens, periodontal pathogens, and sugar molecules: approaches for prevention and treatment

Globally, oral diseases affect nearly 3.5 billion people, accounting for 4.6% of the healthcare expenditure. Common oral diseases include dental caries and periodontal disease, associated with biofilms formed by cariogenic pathogens. Epidemiological studies associate carbohydrates with these diseases due to  the sugars metabolized by cariogenic pathogens. This review focuses on dental caries and periodontal pathogens, quorum sensing, lectin-carbohydrate interactions, and various sugar molecules. Cariogenic sugars significantly influence biofilms by enhancing pathogen adhesion, viability, and gene expressions associated with biofilm formation. Moreover, lectin-carbohydrate interactions contribute to biofilm stability. Disrupting these interactions is a potential strategy for oral disease prevention. The use of nanoparticles, such as quantum dots, provides novel insights into lectin-sugar interactions and the development of inhibitors. Additionally, nanomaterials like calcium phosphate nanoparticles neutralize acids and inhibit microbial growth. This overview emphasizes understanding the relationships between oral diseases, microbial communities, and sugars to devise preventive and therapeutic strategies against oral diseases.