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Sá G, Braga MM, Junior JM, Ekstrand K, Ribeiro M, Bönecker M. The professional perception of the International Caries Classification and Management System (ICCMS): a pragmatic randomised clinical trial. Br Dent J 2024:10.1038/s41415-024-7510-9. [PMID: 38902437 DOI: 10.1038/s41415-024-7510-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/11/2024] [Accepted: 01/23/2024] [Indexed: 06/22/2024]
Abstract
Introduction The International Caries Classification and Management System (ICCMS) was developed to standardise caries diagnosis, risk assessment and treatment decisions based on overall evidence. To evaluate its criteria in practice, a clinical trial assessed professionals' perceptions of two caries management systems.Methods A perception questionnaire was administered to two groups: one using ICCMS criteria and the other based on professional experience criteria (non-ICCMS group). The online questionnaire included quantitative scale questions to measure effort and satisfaction and two open-ended questions to collect the positive and negative perceptions of dentists by using either criteria system. The questionnaires were administered six months after the study's implementation.Results Both groups showed high levels of effort and satisfaction. Professionals using ICCMS reported more positive perceptions by citing improved diagnosis (71.4%) and standardised patient care (43%). However, they also noted negative aspects, such as increased number of questionnaires and records (58%), longer clinical sessions (43%) and higher rates of patient absenteeism (29%).Conclusion Professionals who used the ICCMS had a positive outlook on the system, with benefits seen in diagnosis and patient monitoring. However, there is room for improvement in terms of automation and simplification to enhance the professional use of the system in the clinical setting.
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Affiliation(s)
- Gabriela Sá
- School of Dentistry, Universidade de São Paulo (USP), Department of Paediatric Dentistry, São Paulo, SP, Brazil.
| | - Mariana Minatel Braga
- School of Dentistry, Universidade de São Paulo (USP), Department of Paediatric Dentistry, São Paulo, SP, Brazil
| | | | - Kim Ekstrand
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - Matheus Ribeiro
- School of Dentistry, Universidade de São Paulo (USP), Department of Paediatric Dentistry, São Paulo, SP, Brazil
| | - Marcelo Bönecker
- School of Dentistry, Universidade de São Paulo (USP), Department of Paediatric Dentistry, São Paulo, SP, Brazil
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Beltrán V, Muñoz-Sepúlveda F, Acevedo C, Navarro P, Venegas B, Salgado C, Uribe P, Engelke W. A rural teledentistry care experience: a geriatric approach to assessing oral health status and treatment needs in older adults from a Mapuche community in Chile. Front Public Health 2024; 12:1356622. [PMID: 38903581 PMCID: PMC11188396 DOI: 10.3389/fpubh.2024.1356622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/08/2024] [Indexed: 06/22/2024] Open
Abstract
Background Limited attention has been given to oral health challenges faced by older Indigenous populations, especially in rural settings, where disparities exist. This study aims to assess oral health in a rural Mapuche community in southern Chile, utilizing geriatric technology support, and exploring the connection between geriatric health and oral well-being to fill a gap in this context. Methods A cross-sectional study was conducted involving 76 independent older adults from a rural Mapuche community who required dental care. Assessments were in a remote care setting gathering extensive data including comprehensive geriatric assessments, medical and dental conditions using a geriatric teledentistry platform (TEGO®). Statistical analysis involved descriptive analysis, logistic regression, and both multiple correspondence analysis and k-means cluster analysis. Results The sample comprised individuals with limited formal education and a high degree of vulnerability. Geriatric assessments unveiled cognitive deterioration, frailty, depression risk, and multimorbidity. A distribution of the DMFT index, number of remaining teeth, number of occluding pairs, number of teeth with restorative needs and other relevant clinical findings was conducted based on sociodemographic, and medical-geriatric-dental characteristics, and additionally, a Multinomial Logistic Regression Analysis of Dentition Variables in Relation to Geriatric Assessments was performed. The dental burden was substantial, with an average DMFT index of 25.96 (SD 4.38), high prevalence of non-functional dentition (89.3%), periodontal disease (83%), xerostomia (63.2%) and oral mucosal lesions (31.5%). Age, lower education, depression, daily medication number and sugary consumption frequency were associated with a decreased average number of teeth (p < 0.05). Multiple correspondence analysis and k-means cluster analysis identified 4 clusters, with the edentulous and functional dentition groups being the most distinct. Conclusion This study uncovers a substantial dental burden and intricate medical-geriatric conditions interlinked among Indigenous older adults in a rural Chilean Mapuche community. The implementation of a geriatric technological ecosystem in the community enabled the resolution of less complex oral health issues and facilitated remote consultations with specialists, reducing the necessity for travel to health centers. This underscores the need for innovative dental public health initiatives to address health disparities and improve the overall well-being of older Indigenous adults.
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Affiliation(s)
- Víctor Beltrán
- Clinical Investigation and Dental Innovation Center (CIDIC), Dental School and Center for Translational Medicine (CEMT-BIOREN), Universidad de La Frontera, Temuco, Chile
- Interuniversity Center for Healthy Aging (CIES), Santiago, Chile
| | - Fernanda Muñoz-Sepúlveda
- Clinical Investigation and Dental Innovation Center (CIDIC), Dental School and Center for Translational Medicine (CEMT-BIOREN), Universidad de La Frontera, Temuco, Chile
- Interuniversity Center for Healthy Aging (CIES), Santiago, Chile
- Program of Master in Dental Science, Dental School, Universidad de La Frontera, Temuco, Chile
| | - Claudia Acevedo
- Clinical Investigation and Dental Innovation Center (CIDIC), Dental School and Center for Translational Medicine (CEMT-BIOREN), Universidad de La Frontera, Temuco, Chile
| | - Pablo Navarro
- Research Center for Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile
- Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile
| | - Bernardo Venegas
- Stomatology Department, Faculty of Dentistry, Universidad de Talca, Talca, Chile
| | | | - Pablo Uribe
- Dental School, Universidad de La Frontera, Temuco, Chile
| | - Wilfried Engelke
- Faculty of Medicine, Georg-August University of Göttingen, Göttingen, Germany
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Tinanoff N, Banerjee A, Buzalaf MAR, Chen JW, Dhar V, Ekstrand KR, Fontana M, Innes N, Koo H, Listl S, Lo ECM, Potgieter N, Schwendicke F, Sharkov N, Twetman S, Vargas K. Principles and care pathways for caries management in children: IAPD Rome forum. Int J Paediatr Dent 2024. [PMID: 38654429 DOI: 10.1111/ipd.13192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Norman Tinanoff
- Department of Orthodontics and Pediatric Dentistry, University of Maryland, School of Dentistry, Baltimore, Maryland, USA
| | - Avijit Banerjee
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | | | - Jung-Wei Chen
- Department of Pediatric Dentistry, Loma Linda University School of Dentistry, Loma Linda, California, USA
| | - Vineets Dhar
- Department of Orthodontics and Pediatric Dentistry, University of Maryland, School of Dentistry, Baltimore, Maryland, USA
| | - Kim R Ekstrand
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - Margherita Fontana
- Department of Cariology, Restorative Sciences & Endodontics, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicola Innes
- School of Dentistry, Cardiff Dental School, Cardiff University, Cardiff, UK
| | - Hyun Koo
- Department of Orthodontics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stefan Listl
- Department of Dentistry-Quality and Safety of Oral Health, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | | | - Nicoline Potgieter
- Department of Paediatric Dentistry, University of the Western Cape, Mitchells Plain, South Africa
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research Charité-Universitätsmedizin Berlin, Universitatsmedizin, Berlin, Germany
| | - Nikolai Sharkov
- Department of Paediatric Dentistry, Faculty of Dental Medicine, Medical University, Sofia, Bulgaria
| | - Svante Twetman
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kaaren Vargas
- Private Practice, Corridor Kids Pediatric Dentistry, North Liberty, North Liberty, Iowa, USA
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Sakulratchata R, Saelow D, Banyat S, Wongto S, Sappracha A, Kriangkrai R, Norchai P, Tohnak S. Progression of proximal caries in primary molars using the radiographic ICDAS: a retrospective cohort study. Eur Arch Paediatr Dent 2024:10.1007/s40368-024-00886-7. [PMID: 38625491 DOI: 10.1007/s40368-024-00886-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 03/04/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE To evaluate the proximal caries progression in primary molars using the radiographic International Caries Detection and Assessment System (ICDAS). METHODS A study was conducted on 196 children aged 3-9 years old who underwent the clinical examination and bitewing radiography during baseline and 6-month (and over) follow-up visits. The primary molars bitewing radiographs with initial enamel caries (RA1 and RA2) or outer dentine caries (RA3) of proximal surfaces were included. Caries advancement was scored using ICDAS criteria and statistical analyses with the chi-square test. Median survival time was evaluated using Kaplan-Meier survival curves and log-rank tests. RESULTS A total of 439 surfaces of primary molars were included in this study and an averaged follow-up period of enamel and dentine caries group were 18.3 ± 9.6 months and 16.5 ± 9.5 months respectively. The progression of proximal enamel lesions significantly differed between primary maxillary and mandibular molars (p = 0.002) and among each patient's primary mandibular second molar and the others (p = 0.002). On the contrary, the outer dentine caries of each group of primary molars was not different. The median survival time of the initial enamel proximal caries (23.30 months) was non-significantly longer than that of the dentine (20.80 months). CONCLUSIONS Progressions of the initial enamel proximal caries were significantly different among primary molars at the average 18.3-month follow-up. The median survival period of the enamel proximal caries was more extended than that of dentine but without statistical difference. These results provide essential information for dentists regarding an appropriate appointment for bitewing examinations.
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Affiliation(s)
- R Sakulratchata
- Department of Preventive Dentistry, Faculty of Dentistry, Naresuan University, Phitsanulok, 65000, Thailand.
| | - D Saelow
- Faculty of Dentistry, Naresuan University, Phitsanulok, 65000, Thailand
| | - S Banyat
- Faculty of Dentistry, Naresuan University, Phitsanulok, 65000, Thailand
| | - S Wongto
- Faculty of Dentistry, Naresuan University, Phitsanulok, 65000, Thailand
| | - A Sappracha
- Faculty of Dentistry, Naresuan University, Phitsanulok, 65000, Thailand
| | - R Kriangkrai
- Department of Oral Biology, Faculty of Dentistry, Naresuan University, Phitsanulok, 65000, Thailand
| | - P Norchai
- Department of Preventive Dentistry, Faculty of Dentistry, Naresuan University, Phitsanulok, 65000, Thailand
| | - S Tohnak
- Department of Oral Diagnosis, Faculty of Dentistry, Naresuan University, Phitsanulok, 65000, Thailand
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Veneri F, Filippini T, Consolo U, Vinceti M, Generali L. Ozone Treatment for the Management of Caries in Primary Dentition: A Systematic Review of Clinical Studies. Dent J (Basel) 2024; 12:69. [PMID: 38534293 DOI: 10.3390/dj12030069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/24/2024] [Accepted: 03/01/2024] [Indexed: 03/28/2024] Open
Abstract
Dental caries in children is a frequent and debilitating condition, whose management is often challenging. The aim of this systematic review was to investigate the effectiveness of ozone applications for the treatment of caries in primary dentition. According to PRISMA guidelines, a systematic literature search was performed up to 6 January 2024. Clinical studies using ozone to treat caries of deciduous teeth were considered for inclusion. Out of the 215 records retrieved, seven studies were eventually included in the review, all of which used gaseous ozone. Four studies were judged at high risk of bias, two at low risk, and one of some concerns. The great heterogeneity of designs, outcomes, and protocols made it impossible to conduct a meta-analysis. Despite some limitations, the evidence yielded by the included studies suggests that ozone application, regardless of the protocol applied, is comparable to other interventions in terms of clinical outcomes and anti-bacterial activity, with no reported adverse effects and good patient acceptance. Therefore, ozone application may be a non-invasive approach to treat caries in primary dentition, especially in very young and poorly cooperative patients. Further standardized and rigorous studies are, however, needed to identify the best clinical protocols for this specific field.
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Affiliation(s)
- Federica Veneri
- Unit of Dentistry & Oral-Maxillo-Facial Surgery, Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO), University of Modena and Reggio Emilia, 41124 Modena, Italy
- PhD Program in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Tommaso Filippini
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
- School of Public Health, University of California Berkeley, Berkeley, CA 94704, USA
| | - Ugo Consolo
- Unit of Dentistry & Oral-Maxillo-Facial Surgery, Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO), University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Marco Vinceti
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Luigi Generali
- Unit of Dentistry & Oral-Maxillo-Facial Surgery, Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO), University of Modena and Reggio Emilia, 41124 Modena, Italy
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Bansal K, Shamoo A, Atif M, Batra P, Chaudhry R. Isolation and detection of bacterial species on mitis salivarius bacitracin agar from the plaque samples of caries active children. J Indian Soc Pedod Prev Dent 2024; 42:15-21. [PMID: 38616422 DOI: 10.4103/jisppd.jisppd_17_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/15/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND In cariology studies, mitis-salivarius-bacitracin (MSB) agar has been commonly considered as the selective medium for Streptococcusmutans growth. The present study was the part of a funded project (a noninferiority randomized controlled trial) which compared the efficacy of a plant extract-based mouth rinse with that of a fluoride mouth rinse on the S.mutans counts of the children. AIM This study aimed to identify the frequency of detection of S.mutans and nonstreptococcal bacterial species from the dental plaque of caries active children using a combined technique of anaerobic culture and matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry. SETTINGS AND METHODS Caries-active children (8-12 years old) were enrolled from a pediatric dental outpatient department at a tertiary care hospital. From each participant, dental plaque samples were collected from carious surfaces under sterilized conditions and then subjected to anaerobic culture. After 48 h of incubation, the bacterial colonies were isolated by sub-culture and identified by the MALDI-TOF. RESULTS In all, 13 different bacterial species were isolated from the MSB agar medium. Other than S.mutans species, colonies of bacterial species such as Veillonelladispar,Streptococcusanginosus, Veillonellaparvula, and Streptococcusgordonii were also frequently observed from the medium. CONCLUSIONS The study concluded that several bacterial strains, both streptococcal and nonstreptococcal, could be isolated from the MSB agar medium; hence, this medium should no longer be considered selective medium for the culture of S.mutans in clinical and epidemiological studies.
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Affiliation(s)
- Kalpana Bansal
- Department of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Azeema Shamoo
- Department of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
- College of Medicine and Dentistry, Ulster University, Birmingham, United Kingdom
| | - Mohammad Atif
- Department of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Priyam Batra
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rama Chaudhry
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Jones B, Michou S, Chen T, Moreno-Betancur M, Kilpatrick N, Burgner D, Vannahme C, Silva M. Caries Detection in Primary Teeth Using Intraoral Scanners Featuring Fluorescence: Protocol for a Diagnostic Agreement Study. JMIR Res Protoc 2023; 12:e51578. [PMID: 38096003 PMCID: PMC10755660 DOI: 10.2196/51578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 12/31/2023] Open
Abstract
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.
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Affiliation(s)
- Bree Jones
- Murdoch Children's Research Institute, Royal Children's Hospital, Darley, Australia
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Stavroula Michou
- Department of Odontology, School of Dentistry, University of Copenhagen, Copenhagen, Denmark
- 3Shape TRIOS A/S, Copenhagen, Denmark
| | - Tong Chen
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
- Clinical Epidemiology & Biostatistics Unit, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Margarita Moreno-Betancur
- Clinical Epidemiology & Biostatistics Unit, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Nicky Kilpatrick
- Murdoch Children's Research Institute, Royal Children's Hospital, Darley, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - David Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital, Darley, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | | | - Mihiri Silva
- Murdoch Children's Research Institute, Royal Children's Hospital, Darley, Australia
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
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Abdelaziz M. Detection, Diagnosis, and Monitoring of Early Caries: The Future of Individualized Dental Care. Diagnostics (Basel) 2023; 13:3649. [PMID: 38132233 PMCID: PMC10742918 DOI: 10.3390/diagnostics13243649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Dental caries remains a significant global health issue. It was highlighted by the World Health Organization's 2022 reports that despite the efforts and scientific advancements in caries detection and management, the situation has only marginally improved over the past three decades. The persistence of this problem may be linked to outdated concepts developed almost a century ago but are still guiding dentists' approach to caries management today. There is a need to reconsider professional strategies for preventing and managing the disease. Contemporary dentistry could benefit from embracing new concepts and technologies for caries detection and management. Dentists should explore, among others, alternative methods for caries detection such as optical-based caries detection. These tools have been established for over a decade and they align with current disease understanding and international recommendations, emphasizing early detection and minimally invasive management. This narrative review presents the current state of knowledge and recent trends in caries detection, diagnosis, monitoring, and management, offering insights into future perspectives for clinical applications and research topics.
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Affiliation(s)
- Marwa Abdelaziz
- Division of Cariology and Endodontology, Department of Preventive Dental Medicine and Primary Care, University Clinics of Dental Medicine, University of Geneva, Rue Michel-Servet 1, 1211 Geneva, Switzerland
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Tepox-Puga SM, Rocha-Ortiz JA, Medina-Solís CE, Castrejón-Pérez RC, Sánchez-García S, Borges-Yáñez SA. Prevalence, and Risk Indicators of Coronal and Root Caries in Mexican Older Adults in Nursing Homes. Clin Cosmet Investig Dent 2023; 15:333-347. [PMID: 38107875 PMCID: PMC10723588 DOI: 10.2147/ccide.s439342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023] Open
Abstract
Background Several factors are associated with coronal and root caries in older persons. The purpose of this study was to determine the experience, prevalence, and risk indicators (socioeconomic, sociodemographic, and dental variables) of coronal and root caries in older persons residing in nursing homes in Mexico. Methods A cross-sectional study was carried out in 227 dentate participants with natural teeth. Convenience sample, where all dentate residents were invited to participate. The dependent variables were coronal caries and root caries, which were determined through an oral clinical examination. The independent variables were sociodemographic factors, location, type of center, surfaces free of dental biofilm and calculus, surfaces with recession, retainers in contact with surfaces with recession, xerostomia, smoking, and the previous use of dental services. The binary logistic regression model was used in the analysis. Results The mean age of the participants in this study was 77.7±8.8 years, and 69.2% were women. Moreover, 71.8% live in long-term care facilities, and 48.0% live in Mexico City. The prevalence of coronal and root caries was found to be 67.8% and 50.7%, respectively. Being male and living in Mexico City were risk indicators for coronal caries, and with a 1% increase in surfaces with no biofilm, the risk decreased by 2%. Being widowed, having government or no social security, denture retainers, and coronal caries were risk indicators for root caries, while the utilization of dental services indicated lower risk. Conclusion Several variables that differ in nature were found to be risk indicators for coronal and root caries. Coronal caries increases the risk of root caries. Prevention should be aimed at identifying persons at higher risk, and dental care should be improved for persons living in long-term care institutions.
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Affiliation(s)
| | | | - Carlo Eduardo Medina-Solís
- Academic Area of Dentistry, Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca, Mexico
| | - Roberto Carlos Castrejón-Pérez
- Department of Geriatric Clinical and Epidemiological Research, National Institute of Geriatrics, National Institutes of Health, México City, México
| | - Sergio Sánchez-García
- Epidemiological and Health Services Research Unit, Aging Area, National Medical Center “Siglo XXI”, Mexican Institute of Social Security, Ciudad de Mexico, Mexico
| | - Socorro Aída Borges-Yáñez
- Department of Dental Public Health, Graduate and Research Division, Dental School, National Autonomous University of Mexico, University City, México City, Mexico
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Javed K, Nasir MZ, Jalees M, Manzoor MA. Role of diet and dietary habits in causing dental caries among adults reporting to a tertiary care hospital in Pakistan; a case-control study. Heliyon 2023; 9:e23117. [PMID: 38144297 PMCID: PMC10746458 DOI: 10.1016/j.heliyon.2023.e23117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023] Open
Abstract
Objective To determine the association of diet and dietary practices with dental caries among adults. Design A case-control study. Setting Operative Department, Rawal Institute of Health Sciences, Islamabad, Pakistan. Participants 300 participants of both genders, aged 25-50 years. Interventions A food frequency questionnaire and a patient proforma were used to determine the frequency and preferences of diet and dietary habits that may be associated with dental caries among adults, respectively. The diet and dietary habits of 150 adults with caries (cases) were compared with those of 150 adults without dental caries (control). An independent sample T-test was applied to determine the difference in mean age. Mann-Whitney and Chi-Square tests were applied to determine the significance of diet and dietary habits respectively. Multivariate logistic regression analysis determined the odd ratio change in significant variables. P-value ≤0.05 was considered significant. Results Refined sugar (p-value = 0.69), fruit juices (p-value = 0.45), carbonated beverages (p-value = 0.91), duration of consumption of sugary food (p-value = 0.07), and frequency of brushing (p-value = 0.15) were not found to be significantly associated with dental caries in adults. The gender (p-value = 0.02), preferred time for eating sugary foods (p-value <0.001), smoking (p-value <0.001), and tea consumption (p-value = 0.02) were found to be significantly associated with dental caries. Conclusion Adults who regularly consumed sugar as a snack other than regular mealtimes were more likely to be associated with dental caries. Men, smokers, and adults who frequently took shots of sugar with their tea were more likely to be associated with dental caries.
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Affiliation(s)
- Kiran Javed
- Rawal Institute of Health Sciences, Islamabad, Pakistan
| | | | - Maham Jalees
- Rawal Institute of Health Sciences, Islamabad, Pakistan
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Baima G, Shin HS, Arrica M, Laforí A, Cordaro M, Romandini M. The co-occurrence of the two main oral diseases: periodontitis and dental caries. Clin Oral Investig 2023; 27:6483-6492. [PMID: 37714978 PMCID: PMC10630193 DOI: 10.1007/s00784-023-05253-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/09/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVES Limited studies are available testing through multiple regression models the association between the two main oral diseases: dental caries and periodontitis. The aim of this cross-sectional population-based study was to verify whether dental caries and periodontitis co-occur in a representative sample of the South Korea population. MATERIALS AND METHODS A total of 23,405 subjects representative of 36.2 million of adults (KNHANES) were examined. Univariate and multiple regression analyses using 7 different models were applied, controlling for age, gender, smoking status, frequency of toothbrushing, use of interproximal toothbrushes and flossing, educational level, income, gum diseases treatment and tooth filling in the previous year, BMI, Vitamin D serum levels, alcoholism, diabetes status, stress and carbohydrates dietary intake. RESULTS In the fully adjusted model, participants with periodontitis had, respectively, a mean of 0.82 (95% CI: 0.41-1.23) and of 0.36 (95% CI: 0.22-0.50) more untreated decayed surfaces and teeth than participants without periodontitis, with an OR to have at least one untreated decayed surface of 1.96 (95% CI: 1.66-2.32). However, cumulative caries experience (DF scores) and periodontitis were not associated. CONCLUSIONS In this large nationally representative population, periodontitis and untreated dental caries co-occur. However, when considering cumulative caries experience (DF scores), the two diseases do not appear related. CLINICAL RELEVANCE In light of their possible co-occurrence, clinicians should implement integrative diagnostic, preventive and treatment strategies for both diseases.
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Affiliation(s)
- Giacomo Baima
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Hye-Sun Shin
- Department of Dental Hygiene, Dongnam Health University, Suwon-Si, Gyeonggi-Do, Korea
| | - Mariantonietta Arrica
- Department of Medical, Surgical and Experimental Sciences, School of Dentistry, University of Sassari, Sassari, Italy
| | - Andreina Laforí
- Division of Fixed Prosthodontics and Biomaterials, Clinic of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Massimo Cordaro
- Institute of Dentistry and Maxillofacial Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Mario Romandini
- Department of Periodontology, Faculty of Dentistry, University of Oslo, 69, 0455, Geitmyrsveien, Oslo, Norway.
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Wnuk K, Świtalski J, Miazga W, Tatara T, Religioni U, Gujski M. Evaluation of the effectiveness of prophylactic sealing of pits and fissures of permanent teeth with fissure sealants - umbrella review. BMC Oral Health 2023; 23:806. [PMID: 37891656 PMCID: PMC10612169 DOI: 10.1186/s12903-023-03499-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Tooth decay is an infectious disease which, in its initial phase, leads to the formation of cavities in the teeth through decalcification of the enamel and local tissue destruction. In addition to proper oral hygiene, prophylactic sealing of fissures and cavities with a sealant is a method of preventing the development of caries. The aim of this study is to summarise the effectiveness of fissure sealing of permanent teeth with fissure sealants compared to other preventive methods or no intervention. METHOD An umbrella review was carried out to achieve the purpose of our study. Searches were performed in Medline (via PubMed), Embase (via OVID), and Cochrane Library databases. Quality assessment of the included studies was performed using the AMSTAR2 tool. In addition, a manual search for recommendations/clinical practice guidelines on dental prophylaxis was performed. RESULTS 204 publications were identified, of which 15 met the inclusion criteria. Based on the results of 3 systematic reviews, there was a statistically significant reduced odds of caries occurrence or development with prophylactic sealing of permanent teeth compared with no intervention - depending on the review and follow-up period odds ratio (OR) ranged from 0.06 [95%CI: (0.01-0.32)] to 0.28 [95%CI: (0.20-0.38)]. In the eight systematic reviews that analysed different sealants, there were no statistically significant differences between the types of materials used for prophylactic tooth sealing. For systematic reviews comparing the efficacy of fissure sealants with fluoride varnish, three reported no statistically significant difference in the efficacy of caries incidence, with only one systematic review based on 1 RCT finding a statistically significant difference in favour of fissure sealants. CONCLUSION Compared to the no intervention, dental sealing is an effective method for the prevention of dental caries. However, it is not possible to conclude conclusively which type of sealant and which of the available prophylactic methods is more effective in preventing caries.
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Affiliation(s)
- Katarzyna Wnuk
- Department of Health Policy Programs, Department of Health Technology Assessment, Agency for Health Technology Assessment and Tariff System, Warsaw, 00032, Poland
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Kleczewska 61/63, Warsaw, 01826, Poland
| | - Jakub Świtalski
- Department of Health Policy Programs, Department of Health Technology Assessment, Agency for Health Technology Assessment and Tariff System, Warsaw, 00032, Poland
- Department of Health Economics and Medical Law, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, 01445, Poland
| | - Wojciech Miazga
- Department of Health Policy Programs, Department of Health Technology Assessment, Agency for Health Technology Assessment and Tariff System, Warsaw, 00032, Poland
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Kleczewska 61/63, Warsaw, 01826, Poland
| | - Tomasz Tatara
- Department of Health Policy Programs, Department of Health Technology Assessment, Agency for Health Technology Assessment and Tariff System, Warsaw, 00032, Poland.
- Department of Public Health, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, 02091, Poland.
| | - Urszula Religioni
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Kleczewska 61/63, Warsaw, 01826, Poland.
| | - Mariusz Gujski
- Department of Public Health, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, 02091, Poland
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Fan W, Chen Q, Zhang Y, Feng J, Zhai Y, He B. Case Report: Treatment and management of a child at high risk of caries. Front Pediatr 2023; 11:1103386. [PMID: 37936890 PMCID: PMC10626505 DOI: 10.3389/fped.2023.1103386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 09/26/2023] [Indexed: 11/09/2023] Open
Abstract
Introduction Caries are at the forefront of childhood diseases. Although childhood caries is usually not life-threatening, it can affect children's dental-maxillofacial development and mental health and place significant financial and psychological burdens on parents. As the focus of childhood dental caries shifts to early diagnosis and prevention rather than restorative dentistry alone, screening children at a high risk of dental caries is urgent. Appropriate caries prevention measures and treatment sequences can effectively reduce the occurrence and development of dental caries in children. Case We report the case of a 7-year-old boy presenting with a high risk of dental caries involving multiple primary teeth and premature eruption of the permanent teeth. We shifted the caries status of the child from high to moderate likelihood. At the 9-month post-treatment follow-up, the patient had no new dental caries, and the length and width of the dental arch were effectively maintained. Conclusion Oral health education, dental plaque removal in a regular basis, and fluoride application contribute to caries management.
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Affiliation(s)
- Wen Fan
- School of Stomatology, Henan University, Kaifeng, China
- Henan University Seth Stomatological Hospital, Zhengzhou, China
| | - Qianjing Chen
- School of Stomatology, Henan University, Kaifeng, China
- Henan University Seth Stomatological Hospital, Zhengzhou, China
| | - Yushan Zhang
- School of Stomatology, Henan University, Kaifeng, China
- Henan University Seth Stomatological Hospital, Zhengzhou, China
- Department of Stomatology, Weinan Central Hospital, Weinan, China
| | - Jixian Feng
- School of Stomatology, Henan University, Kaifeng, China
- Henan University Seth Stomatological Hospital, Zhengzhou, China
- Department of Stomatology, the Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Yuankun Zhai
- School of Stomatology, Henan University, Kaifeng, China
- Henan University Seth Stomatological Hospital, Zhengzhou, China
- Kaifeng Key Laboratory of Periodontal Tissue Engineering, Kaifeng, China
| | - Baojie He
- School of Stomatology, Henan University, Kaifeng, China
- Henan University Seth Stomatological Hospital, Zhengzhou, China
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Money NM, Wolf ER, Marin JR, Liang D, Thomas ET, Ho T. 2023 Update on Pediatric Medical Overuse. Pediatrics 2023; 152:e2023062650. [PMID: 37743808 DOI: 10.1542/peds.2023-062650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- Nathan M Money
- Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah
| | - Elizabeth R Wolf
- Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia
| | - Jennifer R Marin
- Departments of Pediatrics, Emergency Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Danni Liang
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Elizabeth T Thomas
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Timmy Ho
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Hynninen Y, Voltti S, Sormunen M, Nihtilä A, Siukosaari P, Koukkula L, Leskelä RL. Oral Health Outcome Measures: A Feasibility Evaluation. Int Dent J 2023; 73:685-691. [PMID: 36697290 PMCID: PMC10509398 DOI: 10.1016/j.identj.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/12/2022] [Accepted: 12/24/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES Outcomes of oral health care must be measured and analysed to improve oral health care delivery, outcomes, and quality. This study aims to develop and test outcome measures for the needs of oral health organisers and explore their feasibility using clinical data. METHODS Based on the literature review and oral health advisory board, outcome measures for oral health care were identified, developed, and tested. Data from 425,000 clinical examinations were obtained from the clinical records of 8 public oral care providers in Finland. RESULTS The advisory board selected 7 outcome measures: 1 on oral self-care, 2 on periodontitis, 3 on caries, and 1 on missing teeth. A large variation was found in the diagnostic and data entry practices of these outcome measures. The coverage of caries and missing teeth entries was good, but the quality of initial and remineralised caries entries was questionable. The caries and missing teeth measures show statistically significant differences amongst some providers. CONCLUSIONS The measures "new cavitated caries surfaces," "cavity-free clinical examinations," and "the change in the missing value" were evaluated as feasible. The results of these measures provided insight about the effectiveness of oral care and enabled the comparison between the providers and age groups. Statistically significant differences between the providers in the measures imply potential possibilities for providers to learn from each other.
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Affiliation(s)
| | | | | | - Annamari Nihtilä
- Insitute of Dentistry, University of Eastern Finland, Kuopio, Finland; Social and Health Services, City of Espoo, Finland
| | - Päivi Siukosaari
- University of Helsinki, Faculty of Medicine, Department of Oral and Maxillofacial Diseases, Helsinki, Finland; Helsinki University Hospital, Helsinki, Finland
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Godenzi D, Bommer C, Heinzel-Gutenbrunner M, Horst Keeper J, Peters K. Remineralizing potential of the biomimetic P 11-4 self-assembling peptide on noncavitated caries lesions: A retrospective cohort study evaluating semistandardized before-and-after radiographs. J Am Dent Assoc 2023; 154:885-896.e9. [PMID: 37642611 DOI: 10.1016/j.adaj.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/19/2023] [Accepted: 07/06/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Self-assembling peptide (SAP) P11-4 was introduced to treat initial caries lesions by means of guiding hydroxyapatite regeneration within the lesion. The objective of this study was to assess its effectiveness in a practical clinical setting. METHODS Caries lesions in permanent teeth treated with monomeric and polymeric SAP P11-4 from May 2015 through October 2020 were retrospectively analyzed at lesion and child levels by means of bite-wing radiography for changes in stage and cavitation and restoration. RESULTS Two hundred and nineteen children aged 10 through 19 years with a total of 405 proximal lesions in posterior teeth were followed from 0.4 through 5.5 years (median, 7 months; interquartile range, 6-19 months). Regression occurred in 37% of stage RA1 (radiolucency in the outer one-half of enamel) (95% CI, 31% to 44%), 38% of stage RA2 (radiolucency in the inner one-half of enamel plus or minus the enamel-dentin junction) (95% CI, 30% to 45%), and 40% of stage RA3 (radiolucency limited to the outer one-third of dentin) (95% CI, 16% to 68%) lesions. The proportion of lesions with no cavitation was 0.96 (95% CI, 0.94 to 0.98) after 1 year and 0.91 (95% CI, 0.88 to 0.95) after 2 years. CONCLUSIONS Real-world clinical data indicate that SAP P11-4 can lead to recovery and a healthier tooth stage. PRACTICAL IMPLICATIONS SAP P11-4 is a safe treatment for initial caries lesions in permanent teeth that remineralizes in the deepest zone of the lesion and can be introduced easily into routine dental practice.
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Lippert F, Eder JS, Eckert GJ, Mangum J, Hegarty K. Detection of artificial enamel caries-like lesions with a blue hydroxyapatite-binding porosity probe. J Dent 2023; 135:104601. [PMID: 37364728 DOI: 10.1016/j.jdent.2023.104601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/13/2023] [Accepted: 06/23/2023] [Indexed: 06/28/2023] Open
Abstract
OBJECTIVES This in vitro study investigated the ability of a blue protein-based hydroxyapatite porosity probe to selectively detect artificial enamel caries-like lesions of varying severities. METHODS Artificial caries-like lesions were formed in enamel specimens using a hydroxyethylcellulose-containing lactic acid gel for 4/12/24/72 or 168 h. One untreated group was used as a control. The probe was applied for 2 min and unbound probe rinsed off with deionized water. Surface color changes were determined spectrophotometrically (L*a*b* color space) and with digital photography. Lesions were characterized using quantitative light-induced fluorescence (QLF), Vickers surface microhardness, and transverse microradiography (TMR). Data were analyzed using one-way ANOVA. RESULTS Digital photography did not reveal any discoloration in unaffected enamel. However, all lesions stained blue with color intensity positively correlated with demineralization times. The color data reflected similar trends: lesions became significantly darker (L* decreased) and bluer (b* decreased), while overall color differences (ΔE) increased significantly after probe application (4-h lesion, mean±standard deviation: ΔL*=-2.6 ± 4.1/Δb*=0.1 ± 0.8/ΔE=5.5 ± 1.3 vs. 168-h lesion: ΔL*=-17.3 ± 1.1/Δb*=-6.0 ± 0.6/ΔE=18.7 ± 1.1). TMR analysis revealed distinct differences in integrated mineral loss (ΔZ) and lesion depth (L) between demineralization times (4-h lesion: ΔZ=391±190 vol%min × µm/L = 18.1 ± 10.9 µm vs. 168-h lesion: ΔZ=3606±499 vol%min × µm/L = 111.9 ± 13.9 µm). QLF and microhardness were also able to differentiate between demineralization times. L and ΔZ strongly correlated (Pearson correlation coefficient [r]) with Δb* (L vs. Δb*: r=-0.90/ΔZ vs. Δb*: r=-0.90), ΔE (r = 0.85/r = 0.81), and ΔL* (r=-0.79/r=-0.73). CONCLUSION Considering the limitations of this study, the blue protein-based hydroxyapatite-binding porosity probe appears to be sufficiently sensitive to distinguish between unaffected enamel and artificial caries-like lesions. CLINICAL SIGNIFICANCE Early detection of enamel caries lesions remains one of the most critical aspects in the diagnosis and management of dental caries. This study highlighted the potential of a novel porosity probe in detecting artificial caries-like demineralization by objective means.
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Affiliation(s)
- Frank Lippert
- Department of Cariology, Operative Dentistry and Dental Public Health, Oral Health Research Institute, Indiana University School of Dentistry, 415 Lansing Street, Indianapolis, IN 46202, USA.
| | - Jennifer S Eder
- Department of Cariology, Operative Dentistry and Dental Public Health, Oral Health Research Institute, Indiana University School of Dentistry, 415 Lansing Street, Indianapolis, IN 46202, USA
| | - George J Eckert
- Department of Biostatistics, Indiana University School of Medicine, 410 W. Tenth St., Suite 3000, Indianapolis, IN 46202, USA
| | - Jonathan Mangum
- Incisive Technologies Pty Ltd, Level 4, 71 Collins Street, Melbourne, Victoria 3000, Australia
| | - Kerry Hegarty
- Incisive Technologies Pty Ltd, Level 4, 71 Collins Street, Melbourne, Victoria 3000, Australia
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Gomez-Rios I, Egea-Lopez E, Ortiz Ruiz AJ. ORIENTATE: automated machine learning classifiers for oral health prediction and research. BMC Oral Health 2023; 23:408. [PMID: 37340367 DOI: 10.1186/s12903-023-03112-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/06/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND The application of data-driven methods is expected to play an increasingly important role in healthcare. However, a lack of personnel with the necessary skills to develop these models and interpret its output is preventing a wider adoption of these methods. To address this gap, we introduce and describe ORIENTATE, a software for automated application of machine learning classification algorithms by clinical practitioners lacking specific technical skills. ORIENTATE allows the selection of features and the target variable, then automatically generates a number of classification models and cross-validates them, finding the best model and evaluating it. It also implements a custom feature selection algorithm for systematic searches of the best combination of predictors for a given target variable. Finally, it outputs a comprehensive report with graphs that facilitates the explanation of the classification model results, using global interpretation methods, and an interface for the prediction of new input samples. Feature relevance and interaction plots provided by ORIENTATE allow to use it for statistical inference, which can replace and/or complement classical statistical studies. RESULTS Its application to a dataset with healthy and special health care needs (SHCN) children, treated under deep sedation, was discussed as case study. On the example dataset, despite its small size, the feature selection algorithm found a set of features able to predict the need for a second sedation with a f1 score of 0.83 and a ROC (AUC) of 0.92. Eight predictive factors for both populations were found and ordered by the relevance assigned to them by the model. A discussion of how to derive inferences from the relevance and interaction plots and a comparison with a classical study is also provided. CONCLUSIONS ORIENTATE automatically finds suitable features and generates accurate classifiers which can be used in preventive tasks. In addition, researchers without specific skills on data methods can use it for the application of machine learning classification and as a complement to classical studies for inferential analysis of features. In the case study, a high prediction accuracy for a second sedation in SHCN children was achieved. The analysis of the relevance of the features showed that the number of teeth with pulpar treatments at the first sedation is a predictive factor for a second sedation.
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Affiliation(s)
- Inmaculada Gomez-Rios
- Department of Dermatology, Stomatology, Radiology and Physical Medicine, Universidad de Murcia, Murcia, Spain
| | - Esteban Egea-Lopez
- Dept. Information Technologies and Communications, Universidad Politecnica de Cartagena (UPCT), Cartagena, Spain.
| | - Antonio José Ortiz Ruiz
- Department of Dermatology, Stomatology, Radiology and Physical Medicine, Universidad de Murcia, Murcia, Spain
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Abdelhafeez MM, Alharbi FM, Srivastava S, Eldwakhly E, Saadaldin SA, Soliman M. Perception of Minimum Interventional Dentistry among Dental Undergraduate Students and Interns. Medicina (B Aires) 2023; 59:medicina59040649. [PMID: 37109609 PMCID: PMC10143900 DOI: 10.3390/medicina59040649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
Background: The philosophy of minimum interventional dentistry (MID) is to integrate prevention, remineralization, and minimal intervention for the placement and replacement of restorations. All branches of dentistry play an important role in practicing MID, and their primary goal is to realize that any restoration is of less biological significance than the healthy original tissue Objectives: The objective of this study was to assess the perception of MID among dental undergraduate students and interns in terms of knowledge, attitude, and practice at the College of Dentistry. Materials and Methods: This cross-sectional study was conducted among undergraduate students and interns at the College of Dentistry, Qassim University, Saudi Arabia. A self-administered questionnaire was distributed, which included basic demographic profiles and questions about the knowledge, attitude, and practices toward MID. The data were tabulated in MS Excel, and all statistical analyses were performed using SPSS version 21. Results: A total of 163 dental students were recruited, with senior students comprising 73% and interns comprising 27%. Male students were slightly more prevalent (50.9%) than female students (49.1%). About 37.6% of participants received training about MID during educational courses, while 10.3% received it during their internship. A statistical test revealed that the prevalence of interns who were trained in performing MID was significantly higher (p < 0.001). Conclusions: The majority of the participants demonstrated proper knowledge, attitude, and practice in different aspects of MID. Interns reported a higher rate of knowledge, attitude, and practice in MID compared to undergraduate students. However, more education and hands-on training about MID concepts during the college curriculum are necessary to attain better knowledge, attitude, and practices that could be useful for more conservative clinical practice.
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20
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Amaechi BT, Phillips TS, Perozo BI, Kataoka Y, Movaghari Pour F, Farah R, Obiefuna AC, Farokhi MR. Evaluation of a novel caries detecting oral rinse. BDJ Open 2023; 9:12. [PMID: 36941251 PMCID: PMC10027680 DOI: 10.1038/s41405-023-00134-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 03/23/2023] Open
Abstract
AIM LumiCare™ Caries Detection Rinse (LC Rinse), a starch-based rinse, illuminates active initial caries (positive response) using dental curing light, thus augmenting the dentist's visual examination. This clinical study investigated if active caries as assessed by the International Caries Detection and Assessment System (ICDAS) were more likely to have positive LC Rinse response than sound surfaces and inactive caries. METHODS 25 subjects participated in the study. Caries was assessed on selected teeth and the entire dentition, firstly using ICDAS and then by fluorescence evaluation after LC Rinse application. Data were statistically analyzed using Diagnostic Odds Ratio (OR) and Chi-square test X2 (α = 0.05). Sensitivity (Se), specificity (Sp), and Diagnostic accuracy (DA) were calculated. RESULTS With selected teeth, active caries were 638.6 times (60.05 with full dentition) more likely to have positive LC Rinse response than sound surfaces and inactive caries combined (X2, p < 0.01) and 191.67 times (18.35 with full dentition) than inactive lesions only (X2, p < 0.01). With combined sound surfaces and inactive caries, Se, Sp, and DA of LC Rinse assessment were 0.94, 0.98, and 0.96 respectively. CONCLUSIONS LC Rinse can distinguish between active caries, inactive caries and hypomineralization, and can augment caries detection with high sensitivity, specificity, and diagnostic accuracy.
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Affiliation(s)
- Bennett Tochukwu Amaechi
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.
| | - Thais Santiago Phillips
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA
| | - Betty Isabel Perozo
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA
| | - Yuko Kataoka
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA
| | - Fatemeh Movaghari Pour
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA
| | - Rayane Farah
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA
| | | | - Moshtagh Rashid Farokhi
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA
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Kreher D, Ernst BLV, Ziebolz D, Haak R, de Fallois J, Ebert T, Schmalz G. Prevalence of Dental Caries in Patients on Renal Replacement Therapy-A Systematic Review. J Clin Med 2023; 12:jcm12041507. [PMID: 36836050 PMCID: PMC9967680 DOI: 10.3390/jcm12041507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/30/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
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.
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Affiliation(s)
- Deborah Kreher
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04109 Leipzig, Germany
| | - Bero Luke Vincent Ernst
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04109 Leipzig, Germany
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04109 Leipzig, Germany
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04109 Leipzig, Germany
| | - Jonathan de Fallois
- Medical Department III—Endocrinology, Nephrology, Rheumatology, University of Leipzig, 04109 Leipzig, Germany
| | - Thomas Ebert
- Medical Department III—Endocrinology, Nephrology, Rheumatology, University of Leipzig, 04109 Leipzig, Germany
| | - Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04109 Leipzig, Germany
- Correspondence:
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Al-Asmar AA, Al-Hiyasat AS, Pitts NB. Reframing perceptions in operative dentistry relating evidence-based dentistry and clinical decision making: a cross-sectional study among Jordanian dentists. BMC Oral Health 2022; 22:637. [PMID: 36566180 PMCID: PMC9789303 DOI: 10.1186/s12903-022-02641-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/01/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The aim of the current study was to investigate current dental practice in operative dentistry in Jordan, and the relationship between evidence-based dentistry in caries research and decision making in clinical practice in operative dentistry. MATERIALS AND METHODS This cross-sectional study was conducted through a survey of dentists in Jordan. The survey aimed to explore the degree of knowledge and practice of evidence-based dentistry in caries research the dentists possess regarding clinical decision making in operative dentistry. The sample size was composed of (5811) dentists whom registered in Jordan Dental Association database. Descriptive statistics were generated and Chi-square test was used to examine associations between the different variables and the significance level was set at P < 0.05. RESULTS 4000 responses were collected from the web-survey, response rate (68.83%). Nearly half of the surveyed dentists focus on the chief complaint of their patients (n = 2032, 50.8%) rather than doing full mouth assessment. Nearly two-thirds of dentists (n = 2608, 65.2%) treat lesions confined to enamel with operative treatment. Half of dentists use operative treatment when asked about the routine management of radiographically detected proximal caries confined to enamel. When treating incipient lesions, the majority (n = 3220, 80.5%) use preventive treatment. Three-quarters of dentists (n = 2992, 74.8%) treat deep dentinal caries by removing just the soft infected carious dentin, and treated old failed restorations with replacement. CONCLUSION In operative dentistry, the evidence-based research is not implemented clinically. To optimize relationship between evidence-based dentistry and clinical decision-making, dental curriculum has to be updated and modified constantly.
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Affiliation(s)
- Ayah A. Al-Asmar
- grid.9670.80000 0001 2174 4509Department of Restorative Dentistry, School of Dentistry, University of Jordan, Queen Rania St, 11942 Amman, Jordan
| | - Ahmad S. Al-Hiyasat
- grid.37553.370000 0001 0097 5797Department of Conservative Dentistry, School of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Nigel B. Pitts
- grid.13097.3c0000 0001 2322 6764Dental Innovation and Impact, Faculty of Dentistry, Oral and Craniofacial Sciences, King’s College, London, UK
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23
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Algarni AA, Aljohani MA, Mohammedsaleh SA, Alrehaili RO, Zulali BH. Awareness of professional fluoride application and its caries prevention role among women in KSA. J Taibah Univ Med Sci 2022; 17:1000-1005. [PMID: 36212597 PMCID: PMC9519782 DOI: 10.1016/j.jtumed.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/14/2022] [Accepted: 06/24/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives Considering the high caries prevalence among Saudi females, spreading knowledge on caries prevention modalities such as high-concentration professional fluoride (PF) applications could decrease their risk of dental caries. However, little is known about the current level of female awareness on the important caries prevention role of PF applications. Therefore, this study assessed the level of awareness of female adults in the KSA regarding PF application and its role in caries prevention. Methods An electronic self-administered anonymous questionnaire was distributed among women in Almadinah Almunawwarah, KSA using social media groups. It consisted of four sections: demographic data, caries experience, knowledge regarding fluoride and caries prevention, and knowledge regarding PF application and caries prevention. For the statistical analyses, simple descriptive statistics as means and frequency distributions were calculated, whereas comparisons were performed using the chi-squared test. Results A total of 405 females participated in the study. Participants were mostly married non-working Saudi women aged between 18 and 55 years. The education level of the majority of participants was at least a bachelor's degree. Most of the participants reported a high caries experience indicated by the presence of cavities (69.1%), fillings (87.2%), and missing teeth due to cavities (64.7%). Regarding PF questions, 34.8% knew the role of PF in caries prevention and 35.6% responded correctly to forms of PF. Only 14.5% reported receiving PF, whereas 57.3% did not know the frequency of PF application. A significant relationship was found between a lack of knowledge regarding the role of PF application and the presence of cavities (p = 0.003). Only 30.4% of participants reported receiving advice from their dentists regarding PF application. Conclusion Most female adults in Almadinah Almunawwarah, KSA have limited knowledge of the importance of PF application in caries prevention, which could contribute to their caries experience.
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24
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Nguyen TM, Tonmukayakul U, Calache H. Evaluation of an intervention to promote minimally invasive dentistry (MID) in an Australian community dental agency-A pilot study. Int J Dent Hyg 2022; 20:627-634. [PMID: 34018672 PMCID: PMC9788196 DOI: 10.1111/idh.12523] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 04/27/2021] [Accepted: 05/10/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To evaluate the impact of an intervention consisting of a 1-day continuing professional development (CPD) education programme on the International Caries Classification and Management System (ICCMS™ ), and monthly performance feedback, and to promote minimally invasive dentistry (MID) for children aged under 12 years in an Australian community dental agency. The a priori hypotheses assumed the intervention would increase preventive services, and treatment demand was met. METHODS A quasi non-randomized controlled trial with convenience sampling method was adopted. Fourteen dental practitioners received the intervention. The prevalence of dental caries and gingivitis in Australian children was used to determine the treatment demand and used as the performance benchmark. Ten types of preventive and non-preventive dental services were examined. A Difference-in-Differences (DiD) of 12-month pre- (baseline) and post-intervention analysis was performed. RESULTS The intervention group demonstrated increases in topical fluoride application and dietary analysis and advice services. The standard care group had increases in oral prophylaxis or scale and clean, topical fluoride application and oral hygiene instructions (p-value <0.05). The DiD analysis confirmed the above findings in the intervention group, while other preventive services declined. In the intervention group, the performance benchmark for oral prophylaxis or scale and clean and oral hygiene instructions was met at baseline and post-intervention. CONCLUSIONS Only a few preventive services had already met the performance benchmark. The intervention was associated with varied changes to preventive and non-preventive dental services. More robust study design addressing the study limitations and validating the performance benchmark is required.
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Affiliation(s)
- Tan Minh Nguyen
- Deakin Health EconomicsInstitute for Health TransformationDeakin UniversityWaurn PondsVic.Australia,Community Dental ProgramPeninsula HealthFrankstonVic.Australia
| | - Utsana Tonmukayakul
- Deakin Health EconomicsInstitute for Health TransformationDeakin UniversityWaurn PondsVic.Australia
| | - Hanny Calache
- Deakin Health EconomicsInstitute for Health TransformationDeakin UniversityWaurn PondsVic.Australia,Dentistry and Oral HealthLa Trobe Rural Health SchoolLa Trobe UniversityBendigoVic.Australia
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25
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Anamali S, Pendleton C, Jin Xie X, Smith A, Jain A. Training in radiographic caries detection and staging using an interactive tool. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2022; 26:728-732. [PMID: 34939265 DOI: 10.1111/eje.12754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The objective of the study was to compare a dental student's practical ability to detect and stage radiographic caries per International Caries Detection and Assessment System (ICDAS), following a traditional lecture and a lecture containing an interactive session using an audience response system (ARS). Associations between the order of instructions and student performance were also evaluated. MATERIALS AND METHODS Eighty-three dental students were randomly assigned to groups A and B. On the first day, group A received a traditional lecture and group B received content using the ARS. All students then took an electronic quiz (T1) identifying and staging caries on radiographs per ICDAS. For the second day, group A received the content using the ARS system and group B received a traditional lecture. All students subsequently took a second electronic quiz (T2). Two survey questions about the learning experience were also included. RESULTS Wilcoxon rank-sum analysis of scores from consenting students (81) showed no difference between the quiz 1 scores of two groups (p=.61). Whilst not statistically significant (p = .07), the group that had the ARS initially scored marginally higher on quiz 2. Survey results showed that most participants preferred either the ARS alone (49.38%) or a combination of the ARS and a traditional lecture (40.74%). A majority of them (80%) found the ARS helpful. CONCLUSION When training students in practical skills of detection and staging radiographic presence of dental caries per ICDAS, hands-on learning tools, such as an ARS, complement traditional lectures.
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Affiliation(s)
- Sindhura Anamali
- Department of Oral Pathology, Radiology and Medicine, University of Iowa, Iowa City, USA
| | - Chandler Pendleton
- Department of Biostatistics and Computational Biology, University of Iowa, Iowa City, USA
| | - Xian Jin Xie
- Department of Biostatistics and Computational Biology, University of Iowa, Iowa City, USA
| | - Anna Smith
- Office of Teaching, Learning & Technology, Research & Analytics, University of Iowa, Iowa City, USA
| | - Aditi Jain
- Department of Operative Dentistry, University of Iowa, Iowa City, USA
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26
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Jones NA, Bloembergen W, Tenuta LMA, Flannagan SE, Jones GW, Pan LC, Newton M, Clarkson BH, Lahann J, Bloembergen S, González-Cabezas C. Early occlusal caries detection using targeted fluorescent starch nanoparticles. J Dent 2022; 125:104243. [PMID: 35907441 DOI: 10.1016/j.jdent.2022.104243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES We have previously shown fluorescent cationic starch nanoparticles (FCSNs) penetrate enamel surface porosity of active carious lesions, potentially aiding their detection. Here, we evaluate the in vitro diagnostic accuracy of FCSNs in detecting occlusal caries compared to histologic reference standard. METHODS 100 extracted human teeth were selected with sound (50), or either non-cavitated (25) or cavitated (25) lesions. A region of interest (ROI) on the occlusal surface was assessed for fluorescence by two independent examiners, after immersion in FCSN solution, water rinse, and illumination by dental curing lamp viewed through orange UV-filter glasses. ROIs were sectioned and evaluated by histology (Downer Criteria) as a gold standard for caries presence. Cohen's Kappa was determined for inter- and intra-examiner agreement, and sensitivity, specificity, and area under the curve of Receiver Operator Curves (ROCAUC) were calculated. The analysis was repeated for the subset of "early" lesions, defined as being limited to enamel. RESULTS FCSN use resulted in substantial inter-user (k=0.74±0.07), and high intra-user agreement (k=0.80±0.06; 0.94±0.03, by examiner). Sensitivity, specificity and ROCAUC for FCSNs were 88.9%; 94.6%; 0.92±0.06 for all, and 76.9%, 94.6%, and 0.86±0.10 for early lesions. In post hoc analysis, sensitivity seemed to be greater with the FCSN than the expert visual exam, particularly for early lesions. CONCLUSIONS/CLINICAL SIGNIFICANCE FCSNs are a reproducible and accurate novel technology for occlusal caries detection, with high sensitivity and specificity compared to histology. Future clinical validation is necessary. FCSNs can improve early caries detection and shift treatment towards non-invasive approaches, improving oral health.
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Affiliation(s)
- Nathan A Jones
- GreenMark Biomedical Inc., 1600 Huron Parkway Building 520, Room 2399, Ann Arbor, MI 48109, United States.
| | - Wendy Bloembergen
- GreenMark Biomedical Inc., 1600 Huron Parkway Building 520, Room 2399, Ann Arbor, MI 48109, United States
| | - Livia M A Tenuta
- University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Susan E Flannagan
- University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Glenn W Jones
- Saba University School of Medicine, Devens, MA, United States
| | - Li-Chi Pan
- GreenMark Biomedical Inc., 1600 Huron Parkway Building 520, Room 2399, Ann Arbor, MI 48109, United States
| | - Mariah Newton
- GreenMark Biomedical Inc., 1600 Huron Parkway Building 520, Room 2399, Ann Arbor, MI 48109, United States
| | - Brian H Clarkson
- University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Joerg Lahann
- Department of Chemical Engineering and Biointerfaces Institute, University of Michigan, Ann Arbor, MI, United States
| | - Steven Bloembergen
- GreenMark Biomedical Inc., 1600 Huron Parkway Building 520, Room 2399, Ann Arbor, MI 48109, United States
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Staszczyk M, Jamka-Kasprzyk M, Kościelniak D, Cienkosz-Stepańczak B, Krzyściak W, Jurczak A. Effect of a Short-Term Intervention with Lactobacillus salivarius Probiotic on Early Childhood Caries-An Open Label Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912447. [PMID: 36231747 PMCID: PMC9566377 DOI: 10.3390/ijerph191912447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 05/31/2023]
Abstract
ECC is a significant therapeutic and social problem and a global burden on public health. The aim of this clinical trial was to test whether a 2-week daily consumption of chewing tablets containing thermally inactivated L. salivarius reduces the 12-month caries increment compared to the control group. The investigation was a single-center, randomized, controlled open-label, blinded end-point evaluation trial in two parallel groups. At baseline, 140 generally healthy children between 3 and 6 years of age with or without ECC were randomly assigned to the probiotic test group (n = 70) or to the treatment as the usual control group (n = 70). The primary outcome measure was the 1-year increment in caries incidence and prevalence. Secondary endpoints assessed were the initial, cavitated and obvious dentinal caries increment as well as the measurement of dental plaque accumulation, as an indicator of the ECC risk. Data were collected through the clinical assessment of the children's caries (dmft and ICDAS II) and oral hygiene status (DI-S of OHI-S index). Caries incidence and prevalence were statistically significantly lower in the probiotic group versus the control group (p < 0.001 and p = 0.0075). The initial and final mean OHI-S scores in the probiotic group did not show any significant differences. In conclusion, the regular short-term intake of probiotics may reduce caries development. Our findings suggest that self-administered probiotic therapy may provide a good complement to increase the effectiveness of individual preventive home care in preschool children. This is the first clinical study evaluating the effect of a short-term probiotic intervention on reducing early childhood caries with 12 months of follow-up.
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Affiliation(s)
- Małgorzata Staszczyk
- Department of Pediatric Dentistry, Institute of Dentistry, Jagiellonian University Medical College, 31-155 Krakow, Poland
| | - Małgorzata Jamka-Kasprzyk
- Department of Pediatric Dentistry, Institute of Dentistry, Jagiellonian University Medical College, 31-155 Krakow, Poland
| | - Dorota Kościelniak
- Department of Pediatric Dentistry, Institute of Dentistry, Jagiellonian University Medical College, 31-155 Krakow, Poland
| | - Beata Cienkosz-Stepańczak
- Laboratory of Anthropology, Institute of Zoology and Biomedical Research, Jagiellonian University, 30-387 Krakow, Poland
| | - Wirginia Krzyściak
- Department of Medical Diagnostics, Faculty of Pharmacy, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Anna Jurczak
- Department of Pediatric Dentistry, Institute of Dentistry, Jagiellonian University Medical College, 31-155 Krakow, Poland
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Arora S, Cooper PR, Friedlander LT, Seo B, Rizwan SB, Rich AM, Hussaini HM. Potentiality and Inflammatory Marker Expression Are Maintained in Dental Pulp Cell Cultures from Carious Teeth. Int J Mol Sci 2022; 23:ijms23169425. [PMID: 36012689 PMCID: PMC9409171 DOI: 10.3390/ijms23169425] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: This investigation aimed to isolate and culture human dental pulp cells from carious teeth (cHDPCs) and compare their growth characteristics, colony-forming efficiency, mineralization potential and gene expression of Toll-like receptors (TLR)-2, TLR-4, TLR-9, tumour necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, IL-8, IL-17A, 1L-17R, IL-23A, nuclear factor-kappa B (NF-κB), mitogen-activated protein kinase (MAPK1), dentin matrix protein (DMP)-1, dentin sialophospho protein (DSPP), sex determining region Y-box 2 (SOX2) and marker of proliferation Ki-67 (MKi67) with cells isolated from healthy or non-carious teeth (ncHDPCs). Methods: Pulp tissues were obtained from both healthy and carious teeth (n = 5, each) to generate primary cell lines using the explant culture technique. Cell cultures studies were undertaken by generating growth curves, a colony forming unit and a mineralization assay analysis. The expression of vimentin was assessed using immunocytochemistry (ICC), and the gene expression of above-mentioned genes was determined using quantitative real-time reverse-transcription polymerase chain reaction. Results: ncHDPCs and cHDPCs were successfully isolated and cultured from healthy and inflamed human dental pulp tissue. At passage 4, both HDPC types demonstrated a typical spindle morphology with positive vimentin expression. No statistical difference was observed between ncHDPCs and cHDPCs in their growth characteristics or ability to differentiate into a mineralizing phenotype. ncHDPCs showed a statistically significant higher colony forming efficiency than cHDPCs. The gene expression levels of TLR-2, TLR-4, TLR-9, TNF-α, IL-6, IL-8, IL-17R, IL-23A, NF-κB, MAPK1, DMP1, DSPP and SOX2 were significantly higher in cHDPCs compared with ncHDPC cultures. Conclusion: cHDPCs retain their differentiation potential and inflammatory phenotype in vitro. The inflamed tooth pulp contains viable stem/progenitor cell populations which have the potential for expansion, proliferation and differentiation into a mineralizing lineage, similar to cells obtained from healthy pulp tissue. These findings have positive implications for regenerative endodontic procedures.
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Affiliation(s)
- Shelly Arora
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - Paul R. Cooper
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - Lara T. Friedlander
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - Benedict Seo
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - Shakila B. Rizwan
- School of Pharmacy, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - Alison M. Rich
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - Haizal Mohd Hussaini
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
- Faculty of Dental Medicine, Airlangga University, Surabaya 60132, Jawa Timur, Indonesia
- Correspondence:
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Taqi M, Razak IA, Ab-Murat N, Zaidi SJA. Establishing risk-based recall interval for caries management among 11-12-year-old Pakistani children. BMC Oral Health 2022; 22:349. [PMID: 35964068 PMCID: PMC9375350 DOI: 10.1186/s12903-022-02383-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/05/2022] [Indexed: 11/12/2022] Open
Abstract
Background This study aims to investigate the rate of caries increment among 11-12-year-old Pakistani children over 18 months using modified International Caries Detection and Assessment Systems II (ICDAS) and subsequently establish an appropriate dental recall interval for our targeted population according to their caries risk intensity.
Methods A prospective longitudinal study was conducted in Bhakkar, Punjab, Pakistan. The 226 children from seven schools of Bhakkar with the highest student enrolment were conveniently selected. Caries risk assessment was performed using a computer-based reduced Cariogram program. Caries increment among cavitated lesions was measured by modified Beck's method or adjusted caries increment. Two ICDAS II cutoffs were created for the analysis of cavitated lesion (ICDAS code 3–6) and cavitated plus non-cavitated lesion (ICDAS code A-6).
Results At the risk assessment stage, 39.8% of the children were classified as low risk, 30.5% as medium risk, and 29.7% as high risk. Caries increment at both cutoff points increased with caries risk at all follow-ups. The highest caries increment was recorded at the third follow-up among high-risk children at cutoff 3–6 (1.95 ± 3.18) and A-6 (4.01 ± 4.31). However, the lowest caries increment was recorded at the third follow-up among low-risk children at cutoff 3–6 (0.18 ± 1.42) and A-6 (1.11 ± 3.33). Conclusion Based on the study findings for Pakistani children with cavitated lesions, the recommended risk-based recall interval for caries management is 18 months for those with low and medium caries risk and six months for those with high caries risk. On the other hand, recommendations for risk-based recall intervals for caries management in non-cavitated and cavitated lesions are six months for low-risk, moderate risk and high-risk for Pakistani 11-12-year-old children.
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Affiliation(s)
- Muhammad Taqi
- Department of Community Dentistry, Dow Dental College, Dow University of Health Sciences, Karachi, 74200, Sindh, Pakistan.
| | - Ishak Abdul Razak
- Faculty of Dentistry, MAHSA University, Bandar Saujana Putra, 42610, Jenjarom, Selangor, Malaysia
| | - Norintan Ab-Murat
- Department of Community Oral Health & Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Syed Jaffar Abbas Zaidi
- Department of Oral Biology, Dow Dental College, Dow University of Health Sciences, Karachi, 74200, Pakistan
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Prevalence of Caries According to the ICDAS II in Children from 6 and 12 Years of Age from Southern Ecuadorian Regions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127266. [PMID: 35742515 PMCID: PMC9223782 DOI: 10.3390/ijerph19127266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 12/04/2022]
Abstract
In Ecuador, national data on dental caries are scarce and the detection of incipient enamel lesions has been omitted. The objective of this study was to determine the prevalence of caries in school children aged 6 and 12 years of both sexes, belonging to urban and rural areas of three provinces of the country, using the International Caries Detection and Assessment System (ICDAS II). The sample consisted of 665 children from public schools, examined according to ICDASII. Caries prevalence and caries index were established using ICDAS II 2-6/C-G and ICDAS II 4-6/E-G criteria for comparison with WHO indicators. The Mann−Whitney U statistical test was used for comparison of two groups, the effect size was measured with the correlation coefficient. and the Kruskal−Wallis H test (p < 0.05) for multiple comparisons. Caries prevalence exceeded 87% for primary and permanent dentition. There were no significant differences according to province (p ≤ 0.05). The caries index at 6 years was 6.57 and at 12 years 9.21. The SIC was high at 12 years in rural areas. The prevalence of caries in the population studied was high despite the preventive measures established by health agencies.
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31
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Jablonski-Momeni A, Korbmacher-Steiner H, Temming A, Wernke P, Heinzel-Gutenbrunner M, Haak R, Krause F. Knowledge of undergraduate dental students regarding management of caries lesions. BDJ Open 2022; 8:9. [PMID: 35365612 PMCID: PMC8976014 DOI: 10.1038/s41405-022-00101-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives Understanding of lifelong control of disease processes associated with caries and its management is an essential part of dental education. This study evaluated the dental students’ knowledge of caries diagnosis and management using the International Caries Classification and Management System (ICCMS). Methods A survey was conducted among undergraduate dental students at two dental schools, attending the sixth (centre 1) and seventh semester (centre 2), respectively. Medical histories, clinical images and radiographs of 12 patients were compiled as anonymous cases. For each case, a specific lesion was to be assessed. In addition, the students should determine the patient’s caries risk and select a treatment option. An expert report (consensus decision) was used as the reference standard. For statistical analysis, kappa statistics and binomial tests were used. Results A total of 46 students participated in this study. The percentage of agreement of responses to the reference was: centre 1: 40.7–51.3%, centre 2: 57.9–67.9%. The corresponding Kappa values were: centre 1: 0.073–0.175, centre 2: 0.315–0.432. Overall, students tended to underestimate the codes compared to the reference standard (p < 0.001). Conclusion Introducing systematic content about caries diagnosis and management such as ICDAS and ICCMS in the learning objectives of undergraduate dental students can be proposed. However, in order to improve diagnosis and enable a more reliable choice of treatment options, attention should also be given to the way they are didactically taught.
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Affiliation(s)
- Anahita Jablonski-Momeni
- Department of Orthodontics, Medical Faculty, Dental School, Philipps-University Marburg, Marburg, Germany.
| | - Heike Korbmacher-Steiner
- Department of Orthodontics, Medical Faculty, Dental School, Philipps-University Marburg, Marburg, Germany
| | - Alexa Temming
- Department of Orthodontics, Medical Faculty, Dental School, Philipps-University Marburg, Marburg, Germany
| | - Pia Wernke
- Department of Orthodontics, Medical Faculty, Dental School, Philipps-University Marburg, Marburg, Germany
| | | | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Felix Krause
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany.,Clinic for Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital RWTH Aachen, Aachen, Germany
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Rupe C, Basco A, Schiavelli A, Cassano A, Micciche’ F, Galli J, Cordaro M, Lajolo C. Oral Health Status in Patients with Head and Neck Cancer before Radiotherapy: Baseline Description of an Observational Prospective Study. Cancers (Basel) 2022; 14:cancers14061411. [PMID: 35326564 PMCID: PMC8945997 DOI: 10.3390/cancers14061411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/23/2022] [Accepted: 03/04/2022] [Indexed: 01/27/2023] Open
Abstract
(1) Background: The general hypothesis that HNC patients show compromised oral health (OH) is generally accepted, but it is not evidence-based. The objective of this baseline report of a prospective observational study was to describe the oral health of a cohort of patients with HNC at the time of dental evaluation prior to radiotherapy (RT). (2) Materials and Methods: Two hundred and thirteen patients affected by HNC who had received an indication for RT were examined with the support of orthopantomography (OPT). The DMFt of all included subjects, their periodontal status and the grade of mouth opening were recorded. (3) Results: A total of 195 patients were ultimately included: 146/195 patients (74.9%) showed poor OH (defined as having a DMFt score ≥ 13 and severe periodontitis). The following clinical characteristics were correlated with poor oral health in the univariate analysis: tumor site, smoking habit and age of the patients (in decades); χ2 test, p < 0.05. (4) Conclusions: This study confirms that the OH of HNC patients is often compromised even before the beginning of cancer treatment and, consequently, highlights how important it is to promptly schedule a dental evaluation at the moment of diagnosis of the cancer.
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Affiliation(s)
- Cosimo Rupe
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli—IRCCS, School of Dentistry, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy; (C.R.); (A.B.); (M.C.); (C.L.)
| | - Alessia Basco
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli—IRCCS, School of Dentistry, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy; (C.R.); (A.B.); (M.C.); (C.L.)
| | - Anna Schiavelli
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli—IRCCS, School of Dentistry, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy; (C.R.); (A.B.); (M.C.); (C.L.)
- Correspondence:
| | - Alessandra Cassano
- Department of Medical Oncology, Fondazione Policlinico Universitario A. Gemelli—IRCCS, Institute of Radiology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy;
| | - Francesco Micciche’
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli—IRCCS, Institute of Radiology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy;
| | - Jacopo Galli
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli—IRCCS, Institute of Otolaryngology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy;
| | - Massimo Cordaro
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli—IRCCS, School of Dentistry, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy; (C.R.); (A.B.); (M.C.); (C.L.)
| | - Carlo Lajolo
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli—IRCCS, School of Dentistry, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy; (C.R.); (A.B.); (M.C.); (C.L.)
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Al-Yaseen W, Seifo N, Bhatia S, Innes N. When Less is More: Minimally Invasive, Evidence-Based Treatments for Dentine Caries in Primary Teeth - The Hall Technique and Silver Diamine Fluoride. Prim Dent J 2022; 10:33-42. [PMID: 35088639 DOI: 10.1177/20501684211067354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Evidence supports minimally invasive dentistry, and we have a better understanding of dental caries as a biofilm-mediated disease. These factors, together with the current need to reduce aerosol generation, make treatment approaches such as the Hall Technique and the use of silver diamine fluoride (SDF) more relevant than ever.Successful treatment planning depends on carious lesions being detected, their status accurately assessed, and a correct diagnosis made. Choosing the most appropriate treatment options for the tooth and child relies on marrying this with a precise history and an understanding of indications and contraindications for treatments.This article outlines the optimal use of the Hall Technique and SDF, allowing dental practitioners and therapists to use these modalities as less invasive approaches to provide the highest quality treatment for children with dental caries; less is more.
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Affiliation(s)
- Waraf Al-Yaseen
- Lecturer in Dental Therapy and Hygiene, School of Dentistry, Cardiff University, Cardiff, UK
| | - Nassar Seifo
- Clinical Trial Administrator, School of Dentistry, University of Dundee, Dundee, UK
| | - Shannu Bhatia
- Senior Lecturer, Honorary Consultant in Paediatric Dentistry, School of Dentistry, Cardiff University, Cardiff, UK
| | - Nicola Innes
- Professor of Paediatric Dentistry, School of Dentistry, Cardiff University, Cardiff, UK
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Bangar S, Neumann A, White JM, Yansane A, Johnson TR, Olson GW, Kumar SV, Kookal KK, Kim A, Obadan-Udoh E, Mertz E, Simmons K, Mullins J, Brandon R, Walji MF, Kalenderian E. Caries Risk Documentation And Prevention: eMeasures For Dental Electronic Health Records. Appl Clin Inform 2022; 13:80-90. [PMID: 35045582 PMCID: PMC8769809 DOI: 10.1055/s-0041-1740920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 10/30/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Longitudinal patient level data available in the electronic health record (EHR) allows for the development, implementation, and validations of dental quality measures (eMeasures). OBJECTIVE We report the feasibility and validity of implementing two eMeasures. The eMeasures determined the proportion of patients receiving a caries risk assessment (eCRA) and corresponding appropriate risk-based preventative treatments for patients at elevated risk of caries (appropriateness of care [eAoC]) in two academic institutions and one accountable care organization, in the 2019 reporting year. METHODS Both eMeasures define the numerator and denominator beginning at the patient level, populations' specifications, and validated the automated queries. For eCRA, patients who completed a comprehensive or periodic oral evaluation formed the denominator, and patients of any age who received a CRA formed the numerator. The eAoC evaluated the proportion of patients at elevated caries risk who received the corresponding appropriate risk-based preventative treatments. RESULTS EHR automated queries identified in three sites 269,536 patients who met the inclusion criteria for receiving a CRA. The overall proportion of patients who received a CRA was 94.4% (eCRA). In eAoC, patients at elevated caries risk levels (moderate, high, or extreme) received fluoride preventive treatment ranging from 56 to 93.8%. For patients at high and extreme risk, antimicrobials were prescribed more frequently site 3 (80.6%) than sites 2 (16.7%) and 1 (2.9%). CONCLUSION Patient-level data available in the EHRs can be used to implement process-of-care dental eCRA and AoC, eAoC measures identify gaps in clinical practice. EHR-based measures can be useful in improving delivery of evidence-based preventative treatments to reduce risk, prevent tooth decay, and improve oral health.
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Affiliation(s)
- Suhasini Bangar
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Ana Neumann
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Joel M. White
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco School of Dentistry, San Francisco, California, United States
| | - Alfa Yansane
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco School of Dentistry, San Francisco, California, United States
| | - Todd R. Johnson
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Gregory W. Olson
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Shwetha V. Kumar
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Krishna K. Kookal
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Aram Kim
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, United States
| | - Enihomo Obadan-Udoh
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco School of Dentistry, San Francisco, California, United States
| | - Elizabeth Mertz
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco School of Dentistry, San Francisco, California, United States
| | | | - Joanna Mullins
- Willamette Dental Group, Hillsboro, Oregon, United States
| | - Ryan Brandon
- Willamette Dental Group, Hillsboro, Oregon, United States
| | - Muhammad F. Walji
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Elsbeth Kalenderian
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco School of Dentistry, San Francisco, California, United States
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, United States
- Department of Dental Management, School of Dentistry, University of Pretoria, Pretoria, South Africa
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From 'ICDAS' to 'CariesCare International': the 20-year journey building international consensus to take caries evidence into clinical practice. Br Dent J 2021; 231:769-774. [PMID: 34921275 PMCID: PMC8680063 DOI: 10.1038/s41415-021-3732-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/20/2021] [Indexed: 11/08/2022]
Abstract
This paper charts the 20-year collaborative journey made by international teams of dental researchers, educators and practitioners. Following the initial development of the International Caries Detection and Assessment System (ICDAS) in 2002, the International Caries Classification and Management System (ICCMS) was collaboratively developed between 2010-2017 with several dental research and practice organisations, and influenced by best evidence judged via SIGN methodology, the UNEP Minamata Treaty (and linked phasing down of dental amalgam), three Dental Policy Labs and an international movement in operative dentistry to move towards minimally invasive dentistry. The FDI World Dental Federation publicised and advocated the ICCMS in 2019, when the 'CariesCare International' Consensus Guide and 4D caries management system was published to aid the delivery of ICCMS into practice. This system, which is designed to help practitioners deliver optimal caries care for patients, is now being adapted internationally for post-pandemic use in the 'Caries OUT' study. It is also being used as a vehicle for implementing the updated Delivering better oral health guidance on caries, as part of the minimum intervention oral healthcare delivery framework in the UK. The International Caries Detection and Assessment System (ICDAS) has synthesised and harmonised international evidence on caries detection and assessment in order to enable better integration/communication of knowledge across caries research, education, public health and clinical practice. The International Caries Classification and Management System (ICCMS) has built on the ICDAS to provide an international consensus on comprehensive, risk-based, minimally invasive and preventively orientated caries management. CariesCare International 4D Caries Management has again been built through international consensus on how best to deliver ICCMS in dental practice and is now being adapted internationally for post-pandemic use and for implementing the updated Delivering better oral health guidance on caries, as part of the minimum intervention oral healthcare delivery framework, in the UK.
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Menegaz AM, Oliveira TTDV, Braga MM, Raggio DP, Cenci MS, Mendes FM, Azevedo MS. Randomized clinical trial to evaluate two methods of caries risk assessment in schoolchildren: the CARDEC-PEL 04 study protocol. BMC Oral Health 2021; 21:654. [PMID: 34922527 PMCID: PMC8684335 DOI: 10.1186/s12903-021-02010-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Caries risk assessment is an essential element for managing and preventing dental caries in children. Individual caries risk assessment can be conducted to evaluate the presence or absence of single factors, or using multivariate models, a combination of factors. The subject has been extensively studied, but no previous research has compared whether a more elaborate and individualized method of caries risk benefits the patient than more straightforward strategies. Thus, this protocol evaluates the efficacy of two risk assessment methods for caries control in children, a simplified method based on caries experience evaluation and a multivariate method described in the literature. Methods This is a randomized, double-blind, controlled, parallel-treatment trial protocol. Two groups will be tested for two forms of caries risk assessment: an individualized and detailed multivariate method based on the guidelines of the Caries Care International 4D and another simplified process, based only on caries experience in primary and/or permanent dentition, considering the presence of decayed, missing and filled teeth using the DMFT/dmft index. Participants will be children aged 8 to 11 years, followed up at 12 and 24 months. The primary outcome will be a composite outcome representing the number of tooth surfaces requiring operative intervention (account variable). In addition, the Shapiro–Wilk normality test and Student's t-test will be performed. A multivariate analysis using negative binomial regression will compare groups in the intention-to-treat population, considering a two-tailed significance level of 5%. Discussion This is the first randomized clinical trial aiming to compare dental caries-related treatment and follow-up based on a detailed, multivariate and individualized assessment of caries risk in school-age children to a simpler risk assessment strategy based on caries experience. This study will define whether there are essential benefits to the patient that justify the choice of one method over the other. Trial registration Clinicaltrials.gov registration: NCT03969628. Registered on May 31th, 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-02010-3.
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Affiliation(s)
| | | | - Mariana Minatel Braga
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Daniela Prócida Raggio
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | - Fausto Medeiros Mendes
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Oliveira SCMD, Floriano I, Tedesco TK, Gimenez T, Imparato JCP, Calvo AFB. Cost analysis of endodontic treatment in primary teeth: results from a randomized clinical trial. Braz Oral Res 2021; 35:e126. [PMID: 34878081 DOI: 10.1590/1807-3107bor-2021.vol35.0126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 04/28/2021] [Indexed: 11/22/2022] Open
Abstract
This study compared the cost of endodontic treatment in primary teeth involving a technique that does not require root canal instrumentation using antibiotic paste (CTZ) with that of the instrumented technique using iodoform paste (GP). This study is part of a randomized, controlled, parallel arm, noninferiority, 1:1 allocation, blinded (patient) multioperator study of 52 primary incisors of children aged 3 to 6 years with caries lesion and pulp involvement. Each technique was performed according to the creators' descriptions. The cost was assessed by analyzing the costs of capital, dental supplies, and professional labor according to the time taken to perform the procedure and the CHEERS guidelines were used to report the cost assessment. Endodontic treatment with CTZ had a 58.33% lower execution cost than GP (US$6.73 and US$16.15, respectively). The t-test showed significant differences between groups regarding treatment time and total cost (p < 0.0001). The CTZ technique seems to be more economically viable than GP for endodontic treatment of primary teeth, requiring a shorter treatment time and lower costs.
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Affiliation(s)
| | - Isabela Floriano
- Centro Universitário Uninovafapi, Dentistry Course, Teresina, PI, Brazil
| | - Tamara Kerber Tedesco
- Universidade Ibirapuera - UNIB, Graduate Program in Dentistry, São Paulo, SP, Brazil
| | - Thaís Gimenez
- Universidade Ibirapuera - UNIB, Graduate Program in Dentistry, São Paulo, SP, Brazil
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What Are the Chances of Resilon to Dominate the Market Filling Materials for Endodontics? METALS 2021. [DOI: 10.3390/met11111744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This paper is a literature review with additional virtual analyses of the authors’ own experimental research results. Knowledge from various areas was synergistically combined, appropriately for concurrent engineering, presenting several possible methodological approaches used in research, optimizing the selection of engineering materials and the conditions of their application with particular application in endodontics. Particular attention was paid to the theoretical aspects of filling material strengths, weaknesses, opportunities, and threats SWOT analysis. Attention was paid to the original concepts of Sustainable Dentistry Development in conjunction with Dentistry 4.0, which includes endodontics as an important element. The dentists’ actions, among others, in conservative dentistry, along with endodontics, requires close cooperation with engineers and the enginering sciences. Methods of root canal preparation were described, together with selected tools, including those made of nitinol. Principles concerning the process of cleaning and shaping the pulp complex are presented. The importance of obturation methods, including the Thermo-Hydraulic-Condensation THC technique, and the selection of filling materials with the necessary sealants for the success of endodontic treatment are discussed. The experimental studies were carried out in vitro on human teeth removed for medical reasons, except for caries, for which two groups of 16 teeth were separated. After the root canal was prepared, it was filled with studs and pellets of a filling material based on polyester materials, which has gained the common trade name of resilon or, less frequently, RealSeal (SybronEndo) with an epiphany sealant. The teeth for the first group were obturated by cold lateral condensation. In the second case the obturation was performed using the Thermo-Hydraulic-Condensation technique using System B and Obtura III. The experimental leakage testing was done using a scanning electron microscope SEM and a light stereoscopic microscope LSM, as typical research tools used in materialography. The research results, in a confrontation with the data taken from the literature studies, do not indicate the domination of resilon in endodontics.
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ICCMS™ root caries lesions stages and their underlying depth towards the pulp: an in vitro study with histologic evaluation. Clin Oral Investig 2021; 26:2597-2605. [PMID: 34671845 DOI: 10.1007/s00784-021-04229-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
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.
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Yu OY, Lam WYH, Wong AWY, Duangthip D, Chu CH. Nonrestorative Management of Dental Caries. Dent J (Basel) 2021; 9:121. [PMID: 34677183 PMCID: PMC8534976 DOI: 10.3390/dj9100121] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/10/2021] [Accepted: 10/12/2021] [Indexed: 11/30/2022] Open
Abstract
The World Dental Federation (FDI) policy statement in 2016 advocated evidence-based caries-control measures for managing dental caries. The caries management philosophy has shifted from the traditional surgical manners to minimal intervention dentistry. Minimal intervention dentistry aims to extend the longevity of natural teeth. It places the nonrestorative approaches as a priority. The nonrestorative approaches for caries management aim to tackle the etiological factors of dental caries. Caries can be prevented or reversed by restricting the sugar intake and its frequency in the diet, improving oral hygiene practices, and using fluoride toothpaste. This article aims to present strategies for the nonrestorative management of dental caries, which are divided into four components to address the different etiological factors of dental caries. The first component is controlling dental plaque. Strategies for plaque control include oral hygiene instruction, motivational interviewing, mechanical plaque control, and chemical plaque control. The second component for nonrestorative management is reducing the risk of caries by identifying caries risk factors and protective factors, assessing personal caries risk, and customizing a treatment plan. Evidence-based measures for caries prevention include using fluoride, and dental sealants should be provided. The third component includes topical treatment to remineralise early carious lesions. The last component is long-term follow-up. Appropriate strategy adoption for the nonrestorative management of dental caries prolongs the life span of the teeth and sustains the good oral health of patients.
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Affiliation(s)
- Ollie Yiru Yu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong; (W.Y.-H.L.); (A.W.-Y.W.); (D.D.); (C.-H.C.)
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Dalla Nora Â, Alves LS, de Castro NC, Maltz M, Zenkner JEDA. Radiographic pattern of inactive occlusal enamel lesions and its relationship with caries progression over 4-5 years. J Dent 2021; 114:103839. [PMID: 34624419 DOI: 10.1016/j.jdent.2021.103839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the radiographic pattern of inactive enamel caries lesions (IECL) in the occlusal surfaces of permanent molars and to investigate whether the presence of radiolucency at baseline could predict lesion progression over 4-5 years. METHODS A prospective cohort study followed 193 schoolchildren from southern Brazil. At baseline, clinical and radiographic examinations were performed. After 4-5 years, clinical examination was repeated following the same protocol. Logistic regression models were used to investigate the relationship between the presence of radiolucency at baseline and caries progression. RESULTS This study included 916 permanent molars, classified as sound occlusal surfaces (n = 434), non-cavitated IECL (n = 438), or cavitated IECL (n = 44) at baseline. The proportion of lesions with radiolucency increased as lesion severity increased (p<0.001, chi-square test). The proportion of cases that progressed was significantly higher among teeth showing radiolucency at baseline than among teeth without radiolucency (p<0.001, chi-square test). The presence of radiolucency at baseline was found to be a predictor of caries progression (activity criteria, adjusted OR=3.37, 95%CI=1.66-6.82, p<0.001; severity criteria, adjusted OR=4.01, 95%CI=1.85-8.72, p<0.001). CONCLUSION Occlusal surfaces (either sound or with IECL) presenting radiolucency at baseline were more likely to progress over 4-5 years of monitoring and should be monitored more closely. CLINICAL RELEVANCE Bitewing radiographs, when available, may be used to identify which surfaces/lesions are more likely to progress and thus, to define proper recall intervals for patient monitoring.
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Affiliation(s)
- Ângela Dalla Nora
- School of Dentistry, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Luana Severo Alves
- School of Dentistry, Federal University of Santa Maria, Santa Maria, RS, Brazil.
| | | | - Marisa Maltz
- Faculty of Odontology, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Ghotane SG, Don-Davis P, Kamara D, Harper PR, Challacombe SJ, Gallagher JE. Needs-led human resource planning for Sierra Leone in support of oral health. HUMAN RESOURCES FOR HEALTH 2021; 19:106. [PMID: 34470631 PMCID: PMC8411531 DOI: 10.1186/s12960-021-00623-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 06/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND In Sierra Leone (SL), a low-income country in West Africa, dental care is very limited, largely private, and with services focused in the capital Freetown. There is no formal dental education. Ten dentists supported by a similar number of dental care professionals (DCPs) serve a population of over 7.5 million people. The objective of this research was to estimate needs-led requirements for dental care and human resources for oral health to inform capacity building, based on a national survey of oral health in SL. METHODS A dedicated operational research (OR) decision tool was constructed in Microsoft Excel to support this project. First, total treatment needs were estimated from our national epidemiological survey data for three key ages (6, 12 and 15 years), collected using the 'International Caries Classification and Management System (ICCMS)' tool. Second, oral health needs were extrapolated to whole population levels for each year-group, based on census demographic data. Third, full time equivalent (FTE) workforce capacity needs were estimated for mid-level providers in the form of Dental Therapists (DTs) and non-dental personnel based on current oral disease management approaches and clinical timings for treatment procedures. Fourth, informed by an expert panel, three oral disease management scenarios were explored for the national population: (1) Conventional care (CC): comprising oral health promotion (including prevention), restorations and tooth extraction; (2) Surgical and Preventive care (S5&6P and S6P): comprising oral health promotion (inc. prevention) and tooth extraction (D5 and D6 together, & at D6 level only); and (3) Prevention only (P): consisting of oral health promotion (inc. prevention). Fifth, the findings were extrapolated to the whole population based on demography, assuming similar levels of treatment need. RESULTS To meet the needs of a single year-group of childrens' needs, an average of 163 DTs (range: 133-188) would be required to deliver Conventional care (CC); 39 DTs (range: 30-45) to deliver basic Surgical and Preventive care (S6P); 54 DTs for more extended Surgical and Preventive care (S5&6P) (range 38-68); and 27 DTs (range: 25-32) to deliver Prevention only (P). When scaled up to the total population, an estimated 6,147 DTs (range: 5,565-6,870) would be required to deliver Conventional care (CC); 1,413 DTs (range: 1255-1438 DTs) to deliver basic Surgical and Preventive care (S6P); 2,000 DTs (range 1590-2236) for more extended Surgical and Preventive care (S5&6P) (range 1590-2236); and 1,028 DTs to deliver Prevention only (P) (range: 1016-1046). Furthermore, if oral health promotion activities, including individualised prevention, could be delivered by non-dental personnel, then the remaining surgical care could be delivered by 385 DTs (range: 251-488) for the S6P scenario which was deemed as the minimum basic baseline service involving extracting all teeth with extensive caries into dentine. More realistically, 972 DTs (range: 586-1179) would be needed for the S5&6P scenario in which all teeth with distinctive and extensive caries into dentine are extracted. CONCLUSION The study demonstrates the huge dental workforce needs required to deliver even minimal oral health care to the Sierra Leone population. The gap between the current workforce and the oral health needs of the population is stark and requires urgent action. The study also demonstrates the potential for contemporary epidemiological tools to predict dental treatment needs and inform workforce capacity building in a low-income country, exploring a range of solutions involving mid-level providers and non-dental personnel.
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Affiliation(s)
- Swapnil Gajendra Ghotane
- Faculty of Dentistry, Oral & Craniofacial Sciences At King’s College London, Centre for Host Microbiome Interactions, Denmark Hill Campus, Bessemer Road, London, SE5 9RS United Kingdom
| | - Patric Don-Davis
- College of Medicine and Allied Health Sciences, Connaught Hospital, Freetown, Sierra Leone
| | - David Kamara
- Oral Health Department, Connaught Hospital, Freetown, Sierra Leone
| | - Paul R. Harper
- School of Mathematics, Cardiff University, Cardiff, CF24 4AG UK
| | - Stephen J. Challacombe
- Faculty of Dentistry, Oral and Craniofacial Sciences At King’s College London, Centre for Host Microbiome Interactions, Guys Campus, London, SE1 9RT UK
| | - Jennifer E. Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences At King’s College London, Centre for Host Microbiome Interactions, Denmark Hill Campus, Bessemer Road, London, SE5 9RS United Kingdom
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Tahani B, Asgari I, Saied Moallemi Z, Azarpazhooh A. Fissure sealant therapy as a portable community-based care in deprived regions: Effectiveness of a clinical trial after 1 year follow-up. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1368-1377. [PMID: 33000539 DOI: 10.1111/hsc.13183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 08/11/2020] [Accepted: 09/03/2020] [Indexed: 06/11/2023]
Abstract
The aim of this study was to evaluate the effectiveness of the fissure sealant therapy in suboptimal setting (as part of a community-based program using the portable equipment and provided by dental students) on the caries status of school children. This pragmatic split-mouth randomised clinical trial was conducted in rural area of Iran. At baseline, 124 patients, including 185 paired teeth with deep pits and fissures of opposite quadrants that were either healthy or at early stages of enamel decay (International Caries Detection and Assessment System [ICDAS] 0-2), were randomly allocated to receive fissure sealant or acted as control. The incidence of new caries (ICDAS code 3-6) and the sealant's retention status after 1-year follow-up were evaluated. Using chi-square test, the relative risk (RR) and the Number Needed to Treat (NNT) to prevent new caries were calculated. After 1 year, 109 patients including 163 paired teeth were available. Sixty-seven (41.4%) and 44 (27.2%) teeth had complete and partial retained sealants respectively. The risk of caries incidence in non-sealed teeth was almost three times more than sealed teeth (RR = 2.88, 95% CI: 1.4-1.97, p = 0.002) and the NNT was 10 (95% CI: 6-26). A significant association was noted between the status of sealant retention after 1 year and the incidence of new caries (p < 0.001). Fissure sealant as part of a community-based program was effective in controlling caries incidence.
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Affiliation(s)
- Bahareh Tahani
- Department of Oral Public Health, Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Imaneh Asgari
- Department of Oral Public Health, Dental Material Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Saied Moallemi
- Department of Oral Public Health, Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Azarpazhooh
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
- Clinical Epidemiology & Health Care Research, Faculty of Medicine, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Divisions of Endodontics and Research, Department of Dentistry, Mount Sinai Hospital, Toronto, ON, Canada
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Is Gutta-Percha Still the “Gold Standard” among Filling Materials in Endodontic Treatment? Processes (Basel) 2021. [DOI: 10.3390/pr9081467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The paper is an extensive monographic review of the literature, and also uses the results of the authors’ own experimental research illustrating the noticed developmental tendencies of the filling material based on gutta-percha. The whole body of literature proves the correctness of the research thesis that this material is the best currently that can be used in endodontics. Caries is one of the most common global infectious diseases. Since the dawn of humankind, the consequence of the disease has been the loss of dentition over time through dental extractions. Both tooth caries and tooth loss cause numerous complications and systemic diseases, which have a serious impact on insurance systems and on the well-being, quality, and length of human life. Endodontic treatment, which has been developing since 1836, is an alternative to tooth extraction. Based on an extensive literature review, the methodology of qualifying patients for endodontic treatment was analyzed. The importance of selecting filling material and techniques for the development and obturation of the root canal during endodontic treatment was described. Particular attention was paid to the materials science aspects and the sequence of phase transformations and precipitation processes, as well as the need to ensure the stoichiometric chemical composition of Ni–Ti alloys, and the vacuum metallurgical processes and material processing technologies for the effects of shape memory and superelasticity, which determine the suitability of tools made of this alloy for endodontic purposes. The phenomena accompanying the sterilization of such tools, limiting the relatively small number of times of their use, play an important role. The methods of root canal preparation and obturation methods through cold side condensation and thermoplastic methods, including the most modern of them, the thermo-hydraulic condensation (THC) technique, were analyzed. An important element of the research hypothesis was to prove the assumption that to optimize the technology of development and obturation of root canals, tests of filling effectiveness are identified by the density and size of the gaps between the root canal wall, and the filling methods used and devices appropriate for material research, using mainly microscopy such as light stereoscopic (LSM) and scanning electron (SEM). The most beneficial preparations were obtained by making a longitudinal breakthrough of 48 natural human teeth, extracted for medical reasons, different from caries, with compliance with all ethical principles in this field. The teeth were prepared using various methods and filled with multiple obturation techniques, using a virtual selection of experimental variants. The breakthroughs were made in liquid nitrogen after a one-sided incision with a narrow gap created by a diamond disc using a materialographic cutter. The best effectiveness of the root canal filling was ensured by the technology of preparing the root canals with K3 rotary nitinol tools and filling the teeth with the THC thermoplastic method using the System B and Obtura III devices with studs and pellets of filling material based on gutta-percha after covering the root canal walls with a thin layer of AH Plus sealant. In this way, the research thesis was confirmed.
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Arnaud M, Junior PC, Lima MG, E Silva AV, Araujo JT, Gallembeck A, de França Caldas Júnior A, Rosenblatt A. Nano-silver Fluoride at Higher Concentration for Caries Arrest in Primary Molars: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2021; 14:207-211. [PMID: 34413593 PMCID: PMC8343678 DOI: 10.5005/jp-journals-10005-1920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim and objective To compare the arresting caries effectiveness of two different silver nanoparticle (AgNP) concentrations of nano-silver fluoride (NSF), namely 400 and 600 ppm. The hypothesis is that in posterior primary teeth with occlusal and approximal active dentin carious lesions, NSF 600's effectiveness will be higher than that of the NSF 400 solution over a 6-month follow-up period. Materials and methods This was a double-blind randomized clinical trial (RCT) conducted in the city of Recife, Brazil. A total of 337 children aged 5–7 years who attended the University of Pernambuco Dental School's clinics were examined. A single-blinded investigator conducted the examinations and treatment of the children. After baseline examination and recording of the dmft index, children were allocated to one of two study groups (NSF 600—intervention and NSF 400—positive control). In both groups, each tooth received two drops of NSF and treatments were performed only once in 6 months. The follow-up examinations were visual and tactile, performed in 30, 90, and 180 days to determine the activity of caries. The carious lesions that were not arrested in 30 days were recorded and referred for restorative treatment. Results The NSF 600 showed higher rate of success in arresting caries (72.7%, p = 0.025) compared with NSF 400 (56.5%). Conclusion The higher rate of success of NSF 600 can be explained by the higher concentration of AgNPs. Clinical significance Nano-silver fluoride has emerged as an excellent alternative to silver diamine fluoride (SDF), as it adds a high antibacterial effect to better esthetic results. Treatment is simple, non-invasive, and incurs low cost. It is ideal for use in community-based programs to increase the access to dental care without staining teeth black like other silver products. How to cite this article Arnaud M, Junior PCM, Lima MGS, et al. Nano-silver Fluoride at Higher Concentration for Caries Arrest in Primary Molars: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2021;14(2):207–211.
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Affiliation(s)
- Manuela Arnaud
- Department of Pediatric Dentistry, University of Pernambuco, Recife, Pernambuco, Brazil
| | - Paulo Cm Junior
- Department of Pediatric Dentistry, University of Pernambuco, Recife, Pernambuco, Brazil
| | - Maria Gs Lima
- Department of Pediatric Dentistry, University of Pernambuco, Recife, Pernambuco, Brazil
| | - Amitis Vc E Silva
- Department of Pediatric Dentistry, University of Pernambuco, Recife, Pernambuco, Brazil
| | - Joas T Araujo
- Department of Pediatric Dentistry, University of Pernambuco, Recife, Pernambuco, Brazil
| | - Andre Gallembeck
- Department of Chemistry, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | - Aronita Rosenblatt
- Department of Postgraduation/Pediatric Dentistry, University of Pernambuco, Camaragibe, Brazil
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Kapor S, Rankovic MJ, Khazaei Y, Crispin A, Schüler I, Krause F, Lussi A, Neuhaus K, Eggmann F, Michou S, Ekstrand K, Huysmans MC, Kühnisch J. Systematic review and meta-analysis of diagnostic methods for occlusal surface caries. Clin Oral Investig 2021; 25:4801-4815. [PMID: 34128130 PMCID: PMC8342337 DOI: 10.1007/s00784-021-04024-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 06/01/2021] [Indexed: 02/01/2023]
Abstract
AIM This systematic review and meta-analysis aimed to assess the diagnostic performance of commonly used methods for occlusal caries diagnostics, such as visual examination (VE), bitewing radiography (BW) and laser fluorescence (LF), in relation to their ability to detect (dentin) caries under clinical and laboratory conditions. MATERIALS AND METHODS A systematic search of the literature was performed to identify studies meeting the inclusion criteria using the PIRDS concept (N = 1090). A risk of bias (RoB) assessment tool was used for quality evaluation. Reports with low/moderate RoB, well-matching thresholds for index and reference tests and appropriate reporting were included in the meta-analysis (N = 37; 29 in vivo/8 in vitro). The pooled sensitivity (SE), specificity (SP), diagnostic odds ratio (DOR) and areas under ROC curves (AUCs) were computed. RESULTS SP ranged from 0.50 (fibre-optic transillumination/caries detection level) to 0.97 (conventional BW/dentine detection level) in vitro. AUCs were typically higher for BW or LF than for VE. The highest AUC of 0.89 was observed for VE at the 1/3 dentin caries detection level; SE (0.70) was registered to be higher than SP (0.47) for VE at the caries detection level in vivo. CONCLUSION The number of included studies was found to be low. This underlines the need for high-quality caries diagnostic studies that further provide data in relation to multiple caries thresholds. CLINICAL RELEVANCE VE, BW and LF provide acceptable measures for their diagnostic performance on occlusal surfaces, but the results should be interpreted with caution due to the limited data in many categories.
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Affiliation(s)
- Svetlana Kapor
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilian University, Munich, Germany
| | - Mila Janjic Rankovic
- Department of Orthodontics and Dentofacial Orthopedics, University Hospital, Ludwig-Maximilian Universität München, Munich, Germany
| | - Yegane Khazaei
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilian University, Munich, Germany
- Institute of Medical Biometry and Epidemiology, Ludwig-Maximilian University of Munich, Munich, Germany
| | - Alexander Crispin
- Institute of Medical Biometry and Epidemiology, Ludwig-Maximilian University of Munich, Munich, Germany
| | - Ina Schüler
- Department of Orthodontics, Section of Preventive and Paediatric Dentistry, University Hospital, Jena, Germany
| | - Felix Krause
- Clinic for Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital RWTH Aachen, Aachen, Germany
| | - Adrian Lussi
- Department of Operative Dentistry and Periodontology, Faculty of Dentistry, University Medical Centre, Freiburg, Germany
- School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Klaus Neuhaus
- Clinic of Periodontology, Endodontology and Cariology, University Centre for Dental Medicine Basel, University of Basel, Basel, Switzerland
- Department of Dermatology, Inselspital-Bern University Hospital, Bern, Switzerland
| | - Florin Eggmann
- Clinic of Periodontology, Endodontology and Cariology, University Centre for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Stavroula Michou
- Department of Odontology, University Copenhagen, Copenhagen, Denmark
| | - Kim Ekstrand
- Department of Odontology, University Copenhagen, Copenhagen, Denmark
| | | | - Jan Kühnisch
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilian University, Munich, Germany.
- Poliklinik Für Zahnerhaltung Und Parodontologie, Klinikum Der Universität München, LMU München, Goethestraße 70, 80336, München, Germany.
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Decup F, Dantony E, Chevalier C, David A, Garyga V, Tohmé M, Gueyffier F, Nony P, Maucort-Boulch D, Grosgogeat B. Needs for re-intervention on restored teeth in adults: a practice-based study. Clin Oral Investig 2021; 26:789-801. [PMID: 34302555 DOI: 10.1007/s00784-021-04058-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/26/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Evaluate the need for re-intervention on dental coronal restorations in adults seen in a network of general dental practitioners (ReCOL). MATERIALS AND METHODS: This observational, cross-sectional, multicenter study involved 40 practitioners and 400 patients. Coronal restoration failures (needing re-intervention for unsatisfactory outcomes) were assessed with a simplified rating scale of seven criteria from the FDI World Dental Federation. The oral health status, the risk factors, and Oral Health Impact Profile-14 were also examined. Previous restoration characteristics (extent, technique, material) were analyzed according to the need for re-intervention (yes/no), the age group, and the risk profile. Qualitative variables were compared between "re-intervention" and "no re-intervention" group using Fisher exact test. RESULTS The need for re-intervention was estimated at 74% (95% CI: 70; 79); it increased with age (49 to 90%), unfavorable risk profile (82 vs. 62%), and extent of the filling (32, 39, 44, and 44% on 1, 2, 3 surfaces, and crowns, respectively). More posterior than anterior teeth were restored (median per patient: 6 vs. 1) or needed re-intervention (median per patient: 1 vs. 0). CONCLUSIONS The needs for re-intervention in adults are still high within a context of ever-changing materials and techniques, simplified and rationalized decision-makings, and demands for patient involvement. CLINICAL RELEVANCE Meeting these needs requires the following: (i) consensus definitions and assessment methods for "failure" and (ii) reliable feedbacks on materials, procedures, and satisfaction. Building large and detailed databases fed by networks of motivated practitioners will help analyzing complex success/failure data by artificial intelligence and guiding treatment and research.
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Affiliation(s)
- Franck Decup
- Service de Médecine Bucco-Dentaire, Hôpital Charles Foix, Assistance Publique - Hôpitaux de Paris, Ivry sur Seine, France
- Université de Paris, UR 2496, Pathologies, Imagerie Et Biothérapie Orofaciales, Montrouge, France
| | - Emmanuelle Dantony
- Université de Lyon, Lyon, France
- Université Lyon 1, Villeurbanne, France
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
- Équipe Biostatistique-Santé, Laboratoire de Biométrie Et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
| | - Charlène Chevalier
- Université de Lyon, Lyon, France
- Université Lyon 1, Lyon, France
- Laboratoire Des Multimatériaux Et Des Interfaces, UMR CNRS 5615, Lyon, France
- Faculté d'odontologie, 11 rue Guillaume Paradin, 69008, Lyon, France
| | - Alexandra David
- Université de Lyon, Lyon, France
- Université Lyon 1, Lyon, France
- Service d'odontologie, Hospices Civils de Lyon, Lyon, France
- Laboratoire Des Multimatériaux Et Des Interfaces, UMR CNRS 5615, Lyon, France
- Faculté d'odontologie, 11 rue Guillaume Paradin, 69008, Lyon, France
| | - Valentin Garyga
- Université de Lyon, Lyon, France
- Université Lyon 1, Villeurbanne, France
- Service d'odontologie, Hospices Civils de Lyon, Lyon, France
- Faculté d'odontologie, 11 rue Guillaume Paradin, 69008, Lyon, France
| | - Marie Tohmé
- Université de Lyon, Lyon, France
- Université Lyon 1, Villeurbanne, France
- Service d'odontologie, Hospices Civils de Lyon, Lyon, France
- Faculté d'odontologie, 11 rue Guillaume Paradin, 69008, Lyon, France
| | - François Gueyffier
- Équipe Biostatistique-Santé, Laboratoire de Biométrie Et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
- Université Lyon 1, Lyon, France
- Hôpital Cardiologique, Hospices Civils de Lyon, Bron, France
| | - Patrice Nony
- Équipe Biostatistique-Santé, Laboratoire de Biométrie Et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
- Université Lyon 1, Lyon, France
- Hôpital Cardiologique, Hospices Civils de Lyon, Bron, France
| | - Delphine Maucort-Boulch
- Université de Lyon, Lyon, France
- Université Lyon 1, Villeurbanne, France
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
- Équipe Biostatistique-Santé, Laboratoire de Biométrie Et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
| | - Brigitte Grosgogeat
- Université de Lyon, Lyon, France.
- Université Lyon 1, Lyon, France.
- Service d'odontologie, Hospices Civils de Lyon, Lyon, France.
- Laboratoire Des Multimatériaux Et Des Interfaces, UMR CNRS 5615, Lyon, France.
- Faculté d'odontologie, 11 rue Guillaume Paradin, 69008, Lyon, France.
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Khallaf YS, Hafez S, Shaalan OO. Evaluation of ICCMS versus CAMBRA Caries Risk Assessment Models Acquisition on Treatment Plan in Young Adult Population: A Randomized Clinical Trial. Clin Cosmet Investig Dent 2021; 13:293-304. [PMID: 34290532 PMCID: PMC8289689 DOI: 10.2147/ccide.s318313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/22/2021] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To evaluate the difference between ICCMS and CAMBRA models on treatment plan of young adults. SETTINGS AND DESIGN A total of 104 young adult patients were randomly divided into two groups, either ICCMS or CAMBRA. PATIENTS AND METHODS Patients were examined according to the criteria of the ICDAS-II and caries risk was analyzed according to CAMBRA and divided into two equal groups according to treatment protocol. Caries incidence was assessed according to ICDAS-II criteria after 6 and 12 months. Statistical analysis used Chi-square test. A value of P ≤ 0.05 was considered statistically significant. Relative risk (RR) was used to determine the clinical significance. RESULTS The current study has revealed no statistically significant difference between both caries risk assessment models tested at baseline (P = 0.317), 6 months (P = 0.164) and 1 year (P = 0.287). Intra-group assessment of CAMBRA group showed a statistically significant difference in ICDAS scores (P = 0.002) after 12 months in high- and moderate-risk groups while low-risk group did not show statistically significant difference in ICDAS scores between different follow-up periods (P = 0.593) and (P = 1.000), respectively. ICCMS groups did not show statistically significant differences in any group along follow-up periods. CONCLUSION ICCMS and CAMBRA were equivalent in preventing new decay. The ICCMS treatment plan is a safe approach and its preventive products are available over the counter. However, it is more complicated than CAMBRA. While CAMBRA is simpler, it is less comprehensive, some of its products are not available over the counter worldwide (e.g. Duraphat 5000 ppm) and some of them may be accompanied by several side effects (e.g. chlorhexidine mouthwash), which may weaken its management protocol.
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Affiliation(s)
- Yomna Sayed Khallaf
- Conservative Dentistry Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Shereen Hafez
- Conservative Dentistry Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Omar Osama Shaalan
- Conservative Dentistry Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
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How different time intervals between repeated applications of CPP-ACP fluoride varnish effect smooth surface enamel demineralization? J Dent 2021; 112:103742. [PMID: 34224791 DOI: 10.1016/j.jdent.2021.103742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To evaluate the preventive effects of different time intervals between repeated applications of the CPP-ACP fluoride varnish on enamel demineralization. METHODS Human teeth were sectioned and randomly allocated to three groups: 4-week, 6-week, and 12-week (N = 22/group). Baseline images of the enamel surfaces were obtained using the FluoreCam recording the area, intensity, and impact of baseline enamel demineralization. All groups received fluoride varnish applications at the beginning of the experiment. The varnish was reapplied every 4 or 6 weeks in the 4-week and 6-week groups, respectively. Following each application, the groups underwent thermo-cycling, tooth brushing and pH cycling to simulate the time effect. After 12 weeks, the enamel surfaces were reimaged using the FluoreCam. Within and between-group differences in the area, intensity and impact of demineralization were evaluated. RESULTS At baseline, there were no significant between-group differences for area, intensity, or impact. Statistically significant (p<0.001) enamel demineralization occurred over time within each group. There were significant between-group differences in the changes that occurred in area (P = 0.004), impact (P = 0.022), but not intensity. The 12-week had significantly larger areas of demineralization than the 6-week (P = 0.041) and 4-week (P = 0.001) groups. Changes in impact was significantly (P = 0.007) greater in the 12-week group than 4-week group, but not greater than the 6-week group. There were no statistically significant differences between 4- and 6-week groups in the changes of area, intensity, or impact. CONCLUSION Reapplication of the CPP-ACP fluoride varnish every 4-6 weeks, is more effective in reducing enamel demineralization compared to every 12 weeks.
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Macey R, Walsh T, Riley P, Glenny AM, Worthington HV, O'Malley L, Clarkson JE, Ricketts D. Visual or visual-tactile examination to detect and inform the diagnosis of enamel caries. Cochrane Database Syst Rev 2021; 6:CD014546. [PMID: 34124773 PMCID: PMC8428329 DOI: 10.1002/14651858.cd014546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The detection and diagnosis of caries at the initial (non-cavitated) and moderate (enamel) levels of severity is fundamental to achieving and maintaining good oral health and prevention of oral diseases. An increasing array of methods of early caries detection have been proposed that could potentially support traditional methods of detection and diagnosis. Earlier identification of disease could afford patients the opportunity of less invasive treatment with less destruction of tooth tissue, reduce the need for treatment with aerosol-generating procedures, and potentially result in a reduced cost of care to the patient and to healthcare services. OBJECTIVES To determine the diagnostic accuracy of different visual classification systems for the detection and diagnosis of non-cavitated coronal dental caries for different purposes (detection and diagnosis) and in different populations (children or adults). SEARCH METHODS Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 30 April 2020); Embase Ovid (1980 to 30 April 2020); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 30 April 2020); and the World Health Organization International Clinical Trials Registry Platform (to 30 April 2020). We studied reference lists as well as published systematic review articles. SELECTION CRITERIA We included diagnostic accuracy study designs that compared a visual classification system (index test) with a reference standard (histology, excavation, radiographs). This included cross-sectional studies that evaluated the diagnostic accuracy of single index tests and studies that directly compared two or more index tests. Studies reporting at both the patient or tooth surface level were included. In vitro and in vivo studies were considered. Studies that explicitly recruited participants with caries into dentine or frank cavitation were excluded. We also excluded studies that artificially created carious lesions and those that used an index test during the excavation of dental caries to ascertain the optimum depth of excavation. DATA COLLECTION AND ANALYSIS We extracted data independently and in duplicate using a standardised data extraction and quality assessment form based on QUADAS-2 specific to the review context. Estimates of diagnostic accuracy were determined using the bivariate hierarchical method to produce summary points of sensitivity and specificity with 95% confidence intervals (CIs) and regions, and 95% prediction regions. The comparative accuracy of different classification systems was conducted based on indirect comparisons. Potential sources of heterogeneity were pre-specified and explored visually and more formally through meta-regression. MAIN RESULTS We included 71 datasets from 67 studies (48 completed in vitro) reporting a total of 19,590 tooth sites/surfaces. The most frequently reported classification systems were the International Caries Detection and Assessment System (ICDAS) (36 studies) and Ekstrand-Ricketts-Kidd (ERK) (15 studies). In reporting the results, no distinction was made between detection and diagnosis. Only two studies were at low risk of bias across all four domains, and 15 studies were at low concern for applicability across all three domains. The patient selection domain had the highest proportion of high risk of bias studies (49 studies). Four studies were assessed at high risk of bias for the index test domain, nine for the reference standard domain, and seven for the flow and timing domain. Due to the high number of studies on extracted teeth concerns regarding applicability were high for the patient selection and index test domains (49 and 46 studies respectively). Studies were synthesised using a hierarchical bivariate method for meta-analysis. There was substantial variability in the results of the individual studies: sensitivities ranged from 0.16 to 1.00 and specificities from 0 to 1.00. For all visual classification systems the estimated summary sensitivity and specificity point was 0.86 (95% CI 0.80 to 0.90) and 0.77 (95% CI 0.72 to 0.82) respectively, diagnostic odds ratio (DOR) 20.38 (95% CI 14.33 to 28.98). In a cohort of 1000 tooth surfaces with 28% prevalence of enamel caries, this would result in 40 being classified as disease free when enamel caries was truly present (false negatives), and 163 being classified as diseased in the absence of enamel caries (false positives). The addition of test type to the model did not result in any meaningful difference to the sensitivity or specificity estimates (Chi2(4) = 3.78, P = 0.44), nor did the addition of primary or permanent dentition (Chi2(2) = 0.90, P = 0.64). The variability of results could not be explained by tooth surface (occlusal or approximal), prevalence of dentinal caries in the sample, nor reference standard. Only one study intentionally included restored teeth in its sample and no studies reported the inclusion of sealants. We rated the certainty of the evidence as low, and downgraded two levels in total for risk of bias due to limitations in the design and conduct of the included studies, indirectness arising from the in vitro studies, and inconsistency of results. AUTHORS' CONCLUSIONS Whilst the confidence intervals for the summary points of the different visual classification systems indicated reasonable performance, they do not reflect the confidence that one can have in the accuracy of assessment using these systems due to the considerable unexplained heterogeneity evident across the studies. The prediction regions in which the sensitivity and specificity of a future study should lie are very broad, an important consideration when interpreting the results of this review. Should treatment be provided as a consequence of a false-positive result then this would be non-invasive, typically the application of fluoride varnish where it was not required, with low potential for an adverse event but healthcare resource and finance costs. Despite the robust methodology applied in this comprehensive review, the results should be interpreted with some caution due to shortcomings in the design and execution of many of the included studies. Studies to determine the diagnostic accuracy of methods to detect and diagnose caries in situ are particularly challenging. Wherever possible future studies should be carried out in a clinical setting, to provide a realistic assessment of performance within the oral cavity with the challenges of plaque, tooth staining, and restorations, and consider methods to minimise bias arising from the use of imperfect reference standards in clinical studies.
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Affiliation(s)
- Richard Macey
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Philip Riley
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Anne-Marie Glenny
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Lucy O'Malley
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Janet E Clarkson
- Division of Oral Health Sciences, Dundee Dental School, University of Dundee, Dundee, UK
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