Trends in preventive care: caries risk assessment and indications for sealants

Risk factors for distal caries of second molars adjacent to mesioangular or horizontal partially erupted mandibular third molars: a cross-sectional study

Introduction Impacted mandibular third molars can be asymptomatic or cause some pathologies, such as distal caries and odontogenic cysts and tumours. This study investigates the prevalence of distal caries of the mandibular second molar adjacent to the mesioangular or horizontally partially erupted mandibular third molar and its relationship regarding decayed, missing and filled teeth (DMFT) risk group, age, side (left-right) and sex.Methods The study included patients who had an appointment for mesioangular or horizontally positioned and partially erupted mandibular third molar surgery. Before the surgery, the DMFT score, age, sex and side were recorded. After extraction, the second molar was clinically examined for distal caries. The prevalence of distal caries and the correlation between the DMFT risk group, age, sex and side were determined.Results The study was conducted on 514 patients and involved 639 teeth. Men and patients in the moderate- or high-risk group are significantly prone to developing distal caries of the second molar. No statistically significant relationship exists regarding age group, side and position.Conclusion Sex and DMFT risk groups affect the prevalence of distal caries in second molars adjacent to the mesioangular or horizontally partially erupted third molars. The prophylactic extraction should be considered in men and patients in the moderate- or high-risk group.

Association between Short Stature at Grade 1 and Permanent Teeth Caries at Grade 6 in Elementary School Children in Japan: A Population-Based Cohort Study

Short stature in children is a marker of low nutritional status and has been suggested to be associated with dental caries. However, longitudinal studies on this topic are scarce. Data from a longitudinal study of elementary school children in Adachi City, Tokyo, Japan, were analyzed. In 2015, caregivers of children at grade 1 answered questionnaires, and information on dental caries and height measured at school health checkups was merged and followed to grade 6 (N = 3576; follow up rate = 83.3%). The association between short stature at grade 1 (-2.01 standard deviation (SD)--3.00 SD, or <-3.00 SD in height-for-age according to the World Health Organization criteria) and the number of decayed, missing, or filled permanent teeth (DMFT) at grade 6 was examined using multivariable Poisson regression with robust standard error. After adjusting for confounders, children with a short stature at grade 1 had a higher DMFT number at grade 6: the mean ratios (95% confidence interval) were 1.17 (0.89-1.54) and 2.18 (1.03-4.64) for children with a height-for-age -2.01 SD--3.00 SD, and those with a height-for-age < -3.00, respectively. Short stature at grade 1 could be a marker of future dental caries in the permanent teeth at grade 6.

Perception of Minimum Interventional Dentistry among Dental Undergraduate Students and Interns

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.

Fissure sealant therapy as a portable community-based care in deprived regions: Effectiveness of a clinical trial after 1 year follow-up

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.

Reliability of Class II Bulk-fill Composite Restorations With and Without Veneering: A Two-year Randomized Clinical Control Study

Bulk-fill composites are increasingly used in stress-bearing areas in posterior teeth, with a diversity of reports concerning their effectiveness and clinical reliability. The objective of this randomized clinical control study was to investigate the effectiveness of bulk-fill versus veneered bulk-fill Class II composite restorations. A double-blind split-mouth technique was employed in 80 subjects recruited for restoring Class II caries in one molar bilaterally in the same arch following respective inclusion and exclusion criteria and after obtaining written consent. While one molar was randomly restored with bulk-fill composite using the sealed-envelope technique, Tetric N-Ceram Bulk Fill (TBF), the contralateral was restored with a bulk-fill composite veneered with an increment of a heavy-body microhybrid composite-Tetric-Ceram HB (TBF/V). Box-only cavities were prepared and received etch-and-rinse adhesive bonding and Tetric N-Bond treatment before composite insertion. Restorations were assessed at 24 hours, 2 weeks, 6 months, 12 months, and 24 months for esthetic, functional, and biological quality employing the FDI ranking criteria. Friedman repeated-measures analysis of variance, the McNemar test, and the Cohen's kappa statistical test were used for statistical analysis. Over a 24-month interval, none of the test restorations were ranked as clinically unsatisfactory. In terms of functional criteria, clinically excellent restorations were significantly more prevalent in TBF/V than in TBF (p<0.05). For long-term satisfactory performance of Class II bulk-fill composites, an occlusal veneering increment of conventional heavy body microhybrid composite appears to be favorable.

Geographic variations in dental sealant utilization by Medicaid enrollees

OBJECTIVE

To investigate geographical variations and their relationship to race/ethnicity in dental sealant utilization for first molars among Wisconsin Medicaid enrollees from 2010 to 2013.

METHODS

Wisconsin Medicaid dental claims for sealants in children aged 6-16 years were analyzed. County-level population density, urban influence code, presence of dental health professional shortage areas, and population-per-dentist ratio were considered as geographic predictors. Descriptive statistics and mixed effects Poisson regression models were used to examine the effect of county level covariates on the number of dental sealants received per person-year (PY) of eligibility adjusting for patient-level characteristics. Over-dispersion was modeled by a random residual effect, and all models adjusted for single-year age and gender interaction and race/ethnicity main effect.

RESULTS

Medicaid claims for sealants on first permanent molars for 2010-2013 totaled 288,019 over 1,130,000 PY. The age- and gender-standardized rate of first molar sealant applications per 100 PY were 27.9, 25.7, and 16.6 for White, Hispanic, and Black children, respectively. County-specific rates ranged from a low of 8.9 per 100 PY to a high of 62.6 per 100 PY. In the multivariate analysis after adjusting for geography, compared to Whites, Hispanics had highest rates (rate ratio (RR) = 1.33, 95% CI = 1.30-1.37) of dental sealant utilization followed by Blacks (RR = 1.25, 95% CI = 1.21-1.29). Population density was the only significant geographic predictor (RR = 0.56 per 10-fold increase, 95% CI = 0.45-0.69).

CONCLUSIONS

Substantial geographic variability in the utilization of sealants for first molars was identified. Lower population density was the main geographical predictor of high sealant utilization.

Increasing value, reducing waste: tailoring the application of dental sealants according to individual caries risk

OBJECTIVES

Despite a significant national investment in oral health, there is little understanding of the return in terms of quality. Value-based payments aim to refocus provider reimbursement based on the value created to the patient. Our objectives were to apply a set of dental quality measures to help determine the value of preventive dental care provided to children at two academic dental school clinics.

METHODS

We queried the institutional electronic health records (EHRs) for patients between the ages of 6-14 years with sealable first or second permanent molars, determined caries risk status, identified if dental sealants were placed, and finally if the teeth showed evidence of new caries experience. In order to determine the cost-effectiveness of EHR-based triage of applying dental sealants, we calculated the incremental cost-effectiveness ratio (ICER) for the dental quality measures supported sealing program.

RESULTS

Between the two academic sites, there were 6,155 unique children for a total of 12,302 eligible teeth without a sealant and 32,811 eligible teeth with a sealant. Teeth without a sealant were more likely to have decay (4.8 percent) than those with a sealant (1.7 percent). At both sites, patients with high caries risk were more likely to benefit from sealants compared to those patients with low risk.

CONCLUSION

Implementation of caries risk stratified fissure sealant quality measures demonstrates the potential for extracting better value in oral health care.

Autotransplantation of teeth as an alternative to dental implantation

Autotransplantation of teeth is a considerable option for tooth replacement in adults who are to undergo orthodontic treatment. Being compared with dental implantation, this procedure is more preferable as a grafted tooth functions as a normal one. In this case report, we describe successful autotransplantation of the third molar with complete root formation. To provide better adaptation of the donor tooth, we used its preoperatively printed replica. The donor tooth was immediately placed to the recipient site and splinted for 28 days. Endodontic treatment was initiated 2 weeks after transplantation. Clinical and radiographic findings at 6 and 12 months of follow-up are compared with the results described in the literature.

Prevention of Secondary Caries Using Resin-Based Pit and Fissure Sealants Containing Hydrated Calcium Silicate

The objective of this study was to investigate the effects of hydrated calcium silicate filler (hCS) on resin-based pit and fissure sealants' acid neutralization, calcium ion release, and mechanical and physical properties. To produce the hCS filler, Portland cement (CS) was mixed with distilled water and ground into fine particles. The particles were then mixed with silanized glass filler and added to a photo-activated resin matrix. To evaluate the acid neutralization and calcium ion release properties, the specimens were immersed in a pH 4.0 lactic acid solution and distilled water for 28 days. Also, the flexural strength, depth of cure, water sorption, and solubility were tested. All of the groups containing hCS and CS required less than one minute to increase the pH from 4.0 to 5.5. With 50% hCS, the calcium ion release was higher than 50% CS in the distilled water at the initial time. The flexural strength and depth of cure decreased according to the increasing proportion of hCS added. The water sorption and solubility had an increasing trend as increasing proportions of hCS were added. These findings showed that pit and fissure sealant containing hCS exhibit superior acid neutralization and calcium release properties, and may be promising for caries-inhibiting dental material.

The effectiveness of completely and incompletely sealed first permanent molars on caries prevention

Fissure sealants are effective caries preventive measure. However, a dilemma has been expressed more than once, whether incompletely sealed fissures provides sufficient protection against caries. Dental examinations were performed in 88 children, aged 8 and then 4 years later at 12 years. All first permanent molars (FPMs), as diagnosed at the age of 8, were divided into three groups: nonsealed, incompletely and completely sealed. Four years later caries incidence and changes in presence and quality of fissure sealant were analyzed. At the age of 8 and 12 mean DMFT were 0.73 ± 1.24 and 3.48 ± 3.04, respectively. 71.59% of the 8‐year‐olds and 78.41% of the 12‐year‐olds had at least one sealed FPM. At the age of 8, 154 FPMs were completely sealed and 42 FPMs were incompletely sealed. Four years later, 81.17%, 71.43% and 69.4% of FPMs were healthy (sound or with noncavitated caries) in the baseline groups completely sealed, incompletely sealed and nonsealed FPMs, respectively. Incompletely sealed fissures were more susceptible to caries development than completely sealed fissures. It is important that incompletely sealed fissures are resealed as soon as possible.

Retention rates and caries-preventive effects of two different sealant materials: a randomised clinical trial

OBJECTIVES

The aim of this study was to compare the caries-preventive effect and the retention rates of sealants prepared with a new modified and a high-viscosity glass-ionomer cement (GIC) in recently erupted first permanent molars.  MATERIALS AND METHODS: Fifty-six children (224 teeth) were included in a split-mouth randomised clinical trial. All children had their four first permanent molars sealed with either Clinpro XT Varnish (CXT) or Fuji IX GP FAST (FJ). FJ sealants were placed according to the ART protocol. Retention rates and caries-preventive effect of both materials were assessed clinically after 24 months, and survival curves were created according to the Kaplan-Meier method. For sealant retention rates, analyses were performed according to both the traditional method and modified sealant retention categorisation.

RESULTS

FJ sealants were retained longer in comparison to CXT sealants (p < 0.05), regardless of the categorisation used. In relation to the caries-preventive effect, no statistically significant differences were observed between materials (p = 0.99). Sealants prepared with the high-viscosity GIC according to the ART protocol survived longer than those prepared with the modified GIC, but both materials were equally effective in preventing cavitated dentine lesions over 24 months.

CONCLUSION

We concluded that GIC-based sealants are effective in preventing dentine caries lesions.

Comparison of risk assessment based on clinical judgement and Cariogram in addition to patient perceived treatment need

Background

Predicting future risk for oral diseases, treatment need and prognosis are tasks performed daily in clinical practice. A large variety of methods have been reported, ranging from clinical judgement or “gut feeling” or even patient interviewing, to complex assessments of combinations of known risk factors. In clinical practice, there is an ongoing continuous search for less complicated and more valid tools for risk assessment. There is also a lack of knowledge how different common methods relates to one another. The aim of this study was to investigate if caries risk assessment (CRA) based on clinical judgement and the Cariogram model give similar results. In addition, to assess which factors from clinical status and history agree best with the CRA based on clinical judgement and how the patient’s own perception of future oral treatment need correspond with the sum of examiners risk score.

Methods

Clinical examinations were performed on randomly selected individuals 20–89 years old living in Skåne, Sweden. In total, 451 individuals were examined, 51 % women. The clinical examination included caries detection, saliva samples and radiographic examination together with history and a questionnaire. The examiners made a risk classification and the authors made a second risk calculation according to the Cariogram.

Results

For those assessed as low risk using the Cariogram 69 % also were assessed as low risk based on clinical judgement. For the other risk groups the agreement was lower. Clinical variables that significantly related to CRA based on clinical judgement were DS (decayed surfaces) and combining DS and incipient lesions, DMFT (decayed, missed, filled teeth), plaque amount, history and soft drink intake. Patients’ perception of future oral treatment need correlated to some extent with the sum of examiners risk score.

Conclusions

The main finding was that CRA based on clinical judgement and the Cariogram model gave similar results for the groups that were predicted at low level of future disease, but not so well for the other groups. CRA based on clinical judgement agreed best with the number of DS plus incipient lesions.

Effect of new light curing units on microleakage and microhardness of resin sealants

To determine new developed light curing units with shorter curing times effects on microleakage and microhardness values for resin fissure sealants. Resin filled sealant (UltraSeal-XT), resin unfilled sealant (Delton Type-II) and ormocer-based sealant (Admira-Seal) were light cured with a quartz-tungsten-halogen (QTH), two LED light and a high power LED. Two hundred and forty extracted human molars were randomly allocated into four groups according to used light-curing unit and three subgroups were formed for three different fissure sealant materials. Specimens were immersed in 0.5% basic fuchsin for 24 h, sectioned and examined under a stereomicroscope, and scored for marginal microleakage. Knoop hardness number (KHN) readings were measured after 48 h. Statistical analyses of test were found in significant difference both microleakage and microhardness values between the various light curing units. The time saving approaches in the curing light were determined higher microhardness, although it was found in higher microleakage.

Fissure sealants: Knowledge and practice of Yemeni dental practitioners

OBJECTIVES

This study was conducted to evaluate Yemeni dental practitioners' knowledge and practices concerning fissure sealants.

MATERIALS AND METHODS

A modified questionnaire consisted of 25-items was distributed to 500 dentists working in Sana'a City. Descriptive statistics and Chi-square/Fisher's exact tests were used for statistical analyses.

RESULTS

The response rate was 74%. Most of the respondents were male (61.3%), general practitioners (84.2%), and had <5 years of clinical experience (48.3%). The respondents showed a reasonable level of knowledge about sealants, with the majority (88%) believed that there is strong scientific evidence about fissure sealants effectiveness and around 90% showed a good understanding of sealant placement instructions. On the other hand, respondents showed insufficient knowledge about sealants clinical practice.

CONCLUSION

Although a high proportion of dental practitioners showed adequate knowledge about dental sealant, following guidelines and standardized procedures in clinical practice is lacking. These emphasize the need for regular continuing education courses for dental professional.

Surface-specific efficacy of fluoride varnish in caries prevention in the primary dentition: results of a community randomized clinical trial

OBJECTIVES

Fluoride varnish (FV) is efficacious in caries prevention although its effects among different tooth surfaces are poorly understood. This study sought to determine the extent to which caries-preventive effects of a community intervention that included FV application among preschool-aged children varied according to primary tooth anatomy and baseline tooth pathology.

METHODS

Secondary analysis was undertaken of data from a community-randomized controlled trial among 543 3- to 5-year-old Aboriginal children in 30 Northern Territory Australian communities. Children in intervention communities received community health promotion and FV application once every 6 months. Net caries (d(3)mfs) risk and 95% confidence limits (CL) were estimated for the control and intervention arms, and stratified according to tooth anatomy/location and baseline pathology (sound, enamel opacity, hypoplastic defect or precavitated carious lesion). The intervention's efficacy was quantified using generalized estimating equation modeling accounting for study design and clustering. The assumption of efficacy homogeneity was tested using a Wald χ(2) test with a p < 0.2 criterion and post hoc pairwise comparisons.

RESULTS

The intervention resulted in a 25% reduction (relative risk, RR = 0.75; 95% CL = 0.71, 0.80) in the 2-year surface-level caries risk. There was substantial heterogeneity in FV efficacy by baseline surface pathology: RRs were 0.73 for sound, 0.77 for opaque, 0.90 for precavitated, and 0.92 for hypoplastic surfaces. Among sound surfaces, maxillary anterior facials received significantly more benefit (RR = 0.62) compared to pits and fissures (RR = 0.78).

CONCLUSION

The intervention had greatest efficacy on surfaces that were sound at baseline. Among those sound surfaces, maxillary anterior facials received most caries-preventive benefit.

Racial/ethnic disparities in provision of dental procedures to children enrolled in Delta Dental insurance in Milwaukee, Wisconsin

OBJECTIVES

Most studies on the provision of dental procedures have focused on Medicaid enrollees known to have inadequate access to dental care. Little information on private insurance enrollees exists. This study documents the rates of preventive, restorative, endodontic, and surgical dental procedures provided to children enrolled in Delta Dental of Wisconsin (DDWI) in Milwaukee.

METHODS

We analyzed DDWI claims data for Milwaukee children aged 0-18 years between 2002 and 2008. We linked the ZIP codes of enrollees to the 2000 U.S. Census information to derive racial/ethnic estimates in the different ZIP codes. We estimated the rates of preventive, restorative, endodontic, and surgical procedures provided to children in different racial/ethnic groups based on the population estimates derived from the U.S. Census data. Descriptive and multivariable analysis was done using Poisson regression modeling on dental procedures per year.

RESULTS

In 7 years, a total of 266,380 enrollees were covered in 46 ZIP codes in the database. Approximately, 64 percent, 44 percent, and 49 percent of White, African American, and Hispanic children had at least one dental visit during the study period, respectively. The rates of preventive procedures increased up to the age of 9 years and decreased thereafter among children in all three racial groups included in the analysis. African American and Hispanic children received half as many preventive procedures as White children.

CONCLUSION

Our study shows that substantial racial disparities may exist in the types of dental procedures that were received by children.

Contemporary fluid intake and dental caries in Australian children

In Australia, caries experience of 6-year-old and 12-year-old children has increased since the mid to late 1990s. Previously, caries rates had declined, attributable to community water fluoridation. The recent caries increase has been attributed speculatively to changes in fluid intake, including increased consumption of sweet drinks and bottled waters. Increasing urbanization and globalization have altered children's diets worldwide, promoting availability and access to processed foods and sweet drinks. Studies in Australia and internationally have demonstrated significant associations between sweet drink intake and caries experience. Despite widespread fluoride availability in contemporary Australian society, the relationship between sugar consumption and caries development continues and restricting sugar intake remains key to caries prevention. Caries risk assessment should be included in treatment planning for all children; parents should be advised of their child's risk level and given information on oral health promotion. Readily-implemented caries risk assessment tools applicable to parents and clinicians are now available. Public health information should increase awareness that consuming sweet drinks can have deleterious effects on the dentition as well as the potential for promoting systemic disease. Restricting sales of sweet drinks and sweet foods and providing healthy food and drinks for purchase in schools is paramount.

Attitudes, knowledge and utilization of fissure sealants among Greek dentists: a national survey

AIM

This was to evaluate the attitudes and knowledge of Greek Dentists concerning fissure sealants (FS) and other preventive measurements, together with the extent and the reasons for using or not using FS in their clinical practice.

METHODS

1,221 general dental practitioners (GDPs) including 50 Paediatric Dentists (PD) were randomly selected from 35 local dental societies of Greece and asked to answer a telephone questionnaire regarding their attitudes to prevention, use of FS and variables influencing their placement. Non parametric Pearson's Chi square test and multifactorial logistic regression models were used for analysing the data.

RESULTS

Although 87.6% of all Greek dentists believe and apply prevention, only 35.8% are using them routinely. Factors highly correlated with FS usage for all dentists were using fluoride regimens (p<0.001), being in practice for 5-14 years (p=0.004) and practicing in urban areas (p<0.001). By contrast, all PD were using FS, regardless of any parameter (p>0.01). Concerning the type of surfaces sealed, 45.6% of GDP used FS on intact surfaces and 41.1% on questionable, while only 15% of them sealed incipient caries. Overall, fewer GDPs compared with PD sealed premolars, primary teeth, questionable surfaces, incipient enamel caries and molars in high risk patients (p<0.001), while fewer PD sealed intact surfaces (p<0.001). The reasons mentioned for not using FS were: 76.3% that parents were unwilling to pay, 61.9% did not know how to use them, while 43.0% believed that oral hygiene was sufficient in order to reduce caries.

CONCLUSIONS

Insufficient knowledge and lack of clinical practice guidelines for the use of FS by GDPs in Greece, leads to low usage rates. Appropriate professional and scientific authorities should join efforts to improve knowledge of GDP and instil confidence in using FS.

Prevention strategies for dental caries in the adolescent

The adolescent period presents a challenge for the dental health care professional--dentally, behaviorally, and developmentally. Changes in the frequency, distribution, and rate of progression for dental caries demand a re-evaluation of the treatment paradigm. The purpose of this article is to suggest dental caries preventive strategies for the adolescent dental patient.

Dental hygiene participation in managing incipient and hidden caries

With the advent of new caries detection devices that allow early detection, dental hygienists can intervene in the demineralization process and work with the patient toward remineralization through patient self-care procedures and the professional application of topical fluorides. The focus of this article is on caries detection devices, caries risk assessment, agents used to prevent dental caries, and the development of self-care plans for patients that include prevention, intervention, and therapeutic components.

Making clinical decisions for dental care: concepts to consider

Clinical decisions are often made with incomplete information, yet patient care decisions are made every day. Patients vary clinically, uncertainty exists in diagnostic and prognostic information, and many preventive and treatment alternatives have not been formally assessed for their effectiveness. Because scientific information will never answer all clinical questions, clinical decisions are partially based on probabilistic information. This paper describes how to apply clinical decision making to diagnosing and managing dental caries and periodontal diseases. By using explicit information to quantify probabilities and outcomes, clinical decision making analyzes decisions made under uncertain conditions and the uncertain impact of clinical information. Clinical decision making incorporates concepts for preventing, diagnosing and treating dental caries and periodontal diseases: risk assessment, evidence-based dentistry, and multiple oral health outcomes. This information can serve as a tool for clinicians to augment clinical judgment and expertise.