Does caries risk assessment predict the incidence of caries for special needs patients requiring general anesthesia?

Classification of Approximal Caries in Bitewing Radiographs Using Convolutional Neural Networks

Dental caries is an extremely common problem in dentistry that affects a significant part of the population. Approximal caries are especially difficult to identify because their position makes clinical analysis difficult. Radiographic evaluation-more specifically, bitewing images-are mostly used in such cases. However, incorrect interpretations may interfere with the diagnostic process. To aid dentists in caries evaluation, computational methods and tools can be used. In this work, we propose a new method that combines image processing techniques and convolutional neural networks to identify approximal dental caries in bitewing radiographic images and classify them according to lesion severity. For this study, we acquired 112 bitewing radiographs. From these exams, we extracted individual tooth images from each exam, applied a data augmentation process, and used the resulting images to train CNN classification models. The tooth images were previously labeled by experts to denote the defined classes. We evaluated classification models based on the Inception and ResNet architectures using three different learning rates: 0.1, 0.01, and 0.001. The training process included 2000 iterations, and the best results were achieved by the Inception model with a 0.001 learning rate, whose accuracy on the test set was 73.3%. The results can be considered promising and suggest that the proposed method could be used to assist dentists in the evaluation of bitewing images, and the definition of lesion severity and appropriate treatments.

Dental treatment under general anesthesia for patients with severe disabilities

Patients with disabilities have difficulties tolerating in-office dental treatment due to limitations relating to cooperation and/or physical problems. Therefore, they often require general anesthesia or sedation to facilitate safe treatment. When deciding on dental treatment under general anesthesia, the plan should be carefully determined because compared to general patients, patients with disabilities are more likely to experience anesthetic complications because of their underlying medical conditions and potential drug interactions. Clinicians prefer simpler and more aggressive dental treatment procedures, such as extraction, since patients with impairment have difficulty maintaining oral hygiene, resulting in a high incidence of recurrent caries or restorative failures. This study aimed to review the available literature and discuss what dentists and anesthesiologists should consider when providing dental treatment to patients with severe disability under general anesthesia.

Assessing a possible vulnerability to dental caries in individuals with rare genetic diseases that affect the skeletal development

Background

Individuals diagnosed with a rare genetic disease that affects skeletal development often have physical limitations and orofacial problems that exert an impact on oral health. The aim of the present study was to analyze the possible vulnerability to dental caries in individuals with rare genetic diseases that affect skeletal development.

Methods

A paired cross-sectional study was carried out with a sample of 140 individuals [70 with rare genetic diseases affecting skeletal development: mucopolysaccharidosis (MPS) (n = 29) and osteogenesis imperfecta (OI) (n = 41) and 70 without rare diseases] and their parents/caregivers. The participants in the first group were recruited from two reference hospitals specialized in rare genetic diseases in the city of Belo Horizonte, Brazil. All participants were examined for the evaluation of breathing type, malocclusion, dental anomalies, oral hygiene and dental caries. The parents/caregivers answered a structured questionnaire addressing the individual/behavioral characteristics and medical/dental history of the participants. Statistical analysis involved the chi-square test and multiple logistic regression analysis for the dependent variable (dental caries) (α = 5%). This study received approval from the Human Research Ethics Committee of the Universidade Federal de Minas Gerais.

Results

The mean age of the individuals was 10.34 ± 6.55 years (median: 9.50 years). Individuals with inadequate oral hygiene were 4.70–fold more likely to have dental caries (95% CI: 2.13–10.40) and those with the rare genetic diseases (MPS/OI) were 2.92-fold more likely to have dental caries (95% CI: 1.38–6.17).

Conclusion

Individuals with inadequate oral hygiene and those with MPS and OI had a greater chance of belonging to the group with dental caries. Based on the present findings, individuals with the rare genetic diseases may be considered vulnerable to caries.

Periapical Healing in Single-visit Endodontics under General Anesthesia in Special Needs Patients

INTRODUCTION

The aim of this study was to determine the prognostic factors of periapical healing of teeth after single-visit nonsurgical endodontic treatment under general anesthesia in special needs patients.

METHODS

This retrospective study collected 448 teeth from 241 patients (mean age = 27.4 years, standard deviation = 13.9 years). A total of 271 teeth (60.5%) with clinical and radiographic follow-up records longer than 12 months (mean [standard deviation] = 56.1 [27.9]) were included in the outcome analysis. Demographic, systemic, and dental information about the cases were compared between the healed and nonhealed groups using the Pearson chi-square test. Factors contributing to periapical healing were determined with multivariate logistic regression analysis.

RESULTS

Complete periapical healing without clinical signs was observed in 221 teeth (81.5%), uncertain healing with decreased size of the periapical lesion was shown in 43 teeth (15.9%), and no reduction in lesion size was observed in 7 cases (2.6%). In the multivariate analysis, diet type, oral hygiene maintenance, pulp vitality, and root filling length were detected as contributing factors for complete resolution of periapical lesions (P < .05).

CONCLUSIONS

Successful outcomes of single-visit endodontic treatment under general anesthesia were shown in special needs patients. The prognoses were influenced by the clinical circumstances of the patients and the preoperative conditions of their teeth.

Are standardized caries risk assessment models effective in assessing actual caries status and future caries increment? A systematic review

BACKGROUND

Assessing caries risk is an essential element in the planning of preventive and therapeutic strategies. Different caries risk assessment (CRA) models have been proposed for the identification of individuals running a risk of future caries. This systematic review was designed to evaluate whether standardized caries risk assessment (CRA) models are able to evaluate the risk according to the actual caries status and/or the future caries increment.

METHODS

Randomized clinical trials, cross-sectional studies, cohort studies, comparative studies, validation studies and evaluation studies, reporting caries risk assessment using standardized models (Cariogram, CAMBRA, PreViser, NUS-CRA and CAT) in patients of any age related to caries data recorded by DMFT/S or ICDAS indices, were included. PubMed, Scopus and Embase were searched from 2000 to 2016. A search string was developed. All the papers meeting the inclusion criteria were subjected to a quality assessment.

RESULTS

One thousand three-undred ninety-two papers were identified and 32 were included. In all but one, the Cariogram was used both as sole model or in conjunction with other models. All the papers on children (n = 16) and adults (n = 12) found a statistically significant association between the risk levels and the actual caries status and/or the future caries increment. Nineteen papers, all using the Cariogram except one, were classified as being of good quality. Three of four papers comprising children and adults found a positive association. For seven of the included papers, Cariogram sensibility and specificity were calculated; sensibility ranged from low (41.0) to fairly low (75.0), while specificity was higher, ranging from 65.8 to 88.0. Wide 95% confidence intervals for both parameters were found, indicating that the reliability of the model differed in different caries risk levels.

CONCLUSIONS

The scientific evidence relating to standardized CRA models is still limited; even if Cariogram was tested in children and adults in few studies of good quality, no sufficient evidence is available to affirm the method is effective in caries assessment and prediction. New options of diagnosis, prognosis and therapy are now available to dentists but the validity of standardized CRA models still remains limited.

Prognostic factors of single-visit endodontic and restorative treatment under general anaesthesia for special needs patients

The aim of this study was to evaluate the longevity of teeth with single-visit endodontic and restorative treatment under general anaesthesia (GA) for special needs patients and to investigate factors associated with survival and success. Data were collected from 381 teeth in 203 patients [mean (s.d.) age = 27·0 (14·1)]. All endodontic and restorative procedures were performed during a single GA session except for cementation of crowns in the cases requiring crown restoration (38%). A total of 267 teeth (70·6%) were followed-up for 6-81 months [mean (s.d.): 32·7 (20·0)]. Patients and teeth with and without follow-up were compared. Kaplan-Meier analysis with generalised Wilcoxon test was used to compare the mean survival and success period. Cox proportion hazard regression model was applied for multivariate analysis. At the end of the observation period, 10 teeth had a crown fracture (5-year survival rate = 89·8%), and an additional 10 teeth had primary or secondary caries (5-year success rate = 86·4%). Risk factors associated with survival were age (>40), non-parental caregiver, cooperation level and periodontal disease. A soft diet was an additional risk factor against the success of teeth. Single-visit endodontic and restorative treatment under GA showed favourable outcomes, suggesting a promising treatment option for special needs patients. Patient- and dental-specific circumstances need to be carefully considered to enhance the longevity of reconstructed teeth.