Dental caries - A complete changeover (Part I)

To Evaluate the Efficacy of Oil Pulling on Caries Activity of Streptococcus mutans: An In Vivo Study

Aim

To evaluate efficacy of oil pulling on caries activity of Streptococcus mutans.

Materials and methods

A randomized controlled experiment was designed, with 60 children chosen at random. Following that, the participants were divided into three groups-group A: oil pulling using cold pressed coconut oil (Perfora*); group B: commercially available fluoridated mouthwash (Kidodent*); group C: distilled water as control. Saliva samples were collected at baseline, immediately, and 2 weeks postoperatively. To assess the effectiveness of coconut oil, fluoride mouthwash, and distilled water, microbiological examination was carried out and colonies were counted.

Results

Both group A (oil pulling with coconut oil) and group B (commercially available Kidodent mouthwash) experienced a statistically significant decrease in colony count.

Conclusion

Oil pulling is found to be as effective as commercially available fluoride mouthwash and can be used in conjunction with other aids for maintaining oral hygiene in children.

Clinical significance

Oil pulling is a natural, economical, and organic alternative to medicated mouthwashes; hence, it can be used as an aid for maintaining oral hygiene.

How to cite this article

Gosavi HS, Tandon S, Rai TS, et al. To Evaluate the Efficacy of Oil Pulling on Caries Activity of Streptococcus mutans: An In Vivo Study. Int J Clin Pediatr Dent 2024;17(5):580-584.

Prevalence of dental caries in a pediatric population during the COVID-19 omicron pandemic era in South India

Caries is a multifactorial disease that involves a majority of the pediatric population. If not diagnosed and treated, it can lead to severe consequences affecting the permanent dentition. The objective of this study was to assess the prevalence of oral foci of infection in a multispeciality hospital during the pandemic in Chennai, South India. The majority of the patients examined had caries.

PARENTAL EDUCATION, CARIES EXPERIENCE, PLAQUE ACCUMULATION, AND Mutans Streptococci COUNT MAY PREDICT THE INCREMENT OF EARLY CHILDHOOD CARIES IN PRESCHOOL CHILDREN OVER 24 MONTHS

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

RISK PREDICTORS OF EARLY CHILDHOOD CARIES INCREMENT-A SYSTEMATIC REVIEW AND META-ANALYSIS. Lam PPY, Chua H, Ekambaram M, Lo ECM, Yiu CKY. J Evid Based Dent Pract. 2022 Sep;22(3):101732.

SOURCE OF FUNDING

Government TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Polymerase chain reaction-based identification of various serotypes of Streptococcus mutans in adults with and without dental caries

Background

Dental caries is a multistep process which initiates the development of plaque' defined as a structured biofilm containing microbial communities. Teeth provide unique surfaces for bacterial colonization. Serotypes of Streptococcus mutans implicate the development of dental caries.

Aim

The aim of the study was to determine the prevalence and association of serotypes of S. mutans in groups with and without dental caries.

Materials and Methods

One hundred and fifty adults aged between 18 and 35 years were included in the study. Supragingival plaque samples were collected, followed by deoxyribonucleic acid extraction. Polymerase chain reaction was performed to identify S. mutans and its serotypes. Proportions of S. mutans and its serotypes were correlated with caries-active (CA) and caries-free (CF) groups.

Results

CA group showed 66.7% positivity for S. mutans and CF group showed only 42.7% of positivity. Serotype C showed a higher proportion followed by E' F, and K in the CA group, whereas in the CF group, higher proportion was observed with K followed by C' E, and F. 70.8% cases showed single serotype in the CA group and 83.3% in CF group. Multiple serotypes were seen in 29.2% in the CA group and 16.7% in the CF group.

Conclusions

The study clearly established variation in proportions of S. mutans and its serotypes between CA and CF groups. Positive correlation was observed in the CA group for S. mutans and its serotypes.

Oral foci of infection in pediatric population during COVID-19 omicron pandemic era

Caries is a multifactorial disease that involves a majority of the pediatric population. If not diagnosed and treated, it can lead to severe consequences affecting the permanent dentition. The objective of this study is to assess the prevalence of oral foci of infection in a multispeciality hospital during pandemic in Chennai, South India. Majority of the patients examined had caries.

Coffee pulp: From a by-product of coffee production to a potential anticariogenic mouth rinse! An in vivo study

Background and Objectives

Dental caries is a prevalent disease despite various efforts made toward its prevention. The drawbacks of the available preventive agents have led to the quest for a potentially more effective agent with fewer adverse effects. Coffee, a local produce of Coorg, is one such herbal alternative. This study aims to assess the potential antimicrobial activity of Robusta coffee pulp extracts on Streptococcus mutans.

Methodology

A total of 39 participants were divided into three groups with 13 participants each, after obtaining ethical clearance and informed consent: Group A (negative control), sterile water; Group B (positive control), 0.2% chlorhexidine mouth rinse; and Group C, 2.5% coffee pulp extract rinse (prepared according to minimum inhibitory concentration). The saliva samples were collected from the patients in a sterile Eppendorf tube at prerinse for baseline, at 1-h postrinse, and at the end of 2 weeks. The S. mutans colony count was done using image-based software analysis. The acquired data were statistically analyzed with one-way ANOVA and repeated measures ANOVA followed by post hoc Tukey's test.

Results

Coffee pulp mouth rinse (P = 0.035) and positive control (P = 0.036) groups showed a statistically significant reduction in the microbial count at 2 weeks postrinse (compared to the negative control group).

Conclusion and Clinical Relevance

The coffee pulp extract-based mouth rinse is a potential anticariogenic agent that offers few advantages over chlorhexidine as no instances of staining, altered taste, or any allergic reactions were reported by the subjects.

Influence of Sucrose and Arenga pinnata Solutions on Enamel Surface Demineralization: A Profilometric Study

Background Dental caries is a multifactorial disease that has the potential to impact individuals across various life stages. The influential role of sugar as a contributing risk element in the inception and advancement of dental caries is significantly pronounced.  Aim The research aim was to analyze and compare the enamel surface roughness in teeth exposed to sucrose and Arenga pinnata (palm sugar) solutions by using a stylus profilometer Materials and methods In this investigation, 34 freshly extracted anterior teeth were obtained and they were split into two groups depending on the solution in which they were immersed. Group A consists of 17 teeth immersed in 1% sucrose solution supplemented in brain heart infusion (BHI) broth solution and Group B consists of 17 teeth immersed in 1% Arenga pinnata BHI broth. Each sample served as its own control. Streptococcus mutans was inoculated into these groups and they were immersed in their respective solution for five days. A stylus profilometer was utilized to measure the surface roughness of the teeth in this study. Data analysis involved paired t-tests for intragroup comparisons and independent t-tests for intergroup comparisons using SPSS software version 23. Results After five days of exposure to palm sugar or sucrose, it was observed that there was demineralization of the enamel surface on both samples. Although there was no statistical significance (p<0.05) when an independent t-test was conducted among these samples, there was a visible increase in the numerical values of Ra, Rq, Rz of teeth exposed to sucrose compared to palm sugar with a p-value of 0.529, 0.122 and 0.357, respectively. Conclusion From this study, it was concluded that although both sucrose and Arenga pinnata cause demineralization of enamel, it was shown that the latter caused lesser demineralization when compared to refined sugars to a certain extent. This study establishes a foundation for forthcoming investigations that could potentially explore the utilization of natural sugars as a substitute for sucrose, while also evaluating the mechanistic aspects underlying the impact of these sugars on enamel demineralization.

Carboxymethyl Chitosan-Fluoride-doped Amorphous Calcium Phosphate: A Novel Remineralizing Gel

Background

There is a need for innovative remineralizing gel formulations based on calcium and phosphates that can slowly release fluoride ions and enhance the formation of fluorapatite crystals that are more resistant to dissolution in an acidic environment.

Aim

The aim of the work was to formulate a remineralizing agent that remineralizes enamel through the release of Ca2+, PO₄³-, and F- ions for a prolonged period of time.

Materials and methods

The gel was based on carboxymethyl chitosan (CMC) as a bioinspired gelling agent and on Fluoride-doped Amorphous Calcium Phosphate (F-ACP) as a remineralizing agent. This gel was tested in vitro on the enamel of extracted premolars after demineralization with methacrylic acid gel.

Results

When compared to the control group and demineralized enamel group, the enamel slabs remineralized with CMC/F-ACP showed a higher calcium phosphate ratio in Energy-Dispersive X-ray (EDX) and better surface morphology under scanning electron microscope (SEM).

Conclusion

Remineralization tests performed on demineralized human permanent teeth proved that CMC/F-ACP gel has excellent efficacy, inducing a complete remineralization of the outermost layers of enamel as well as a full restoration of lost mineral content.

How to cite this article

Nimbeni BS, Nimbeni SB, Divakar DD, et al. Carboxymethyl Chitosan-Fluoride-doped Amorphous Calcium Phosphate: A Novel Remineralizing Gel. Int J Clin Pediatr Dent 2023;16(5):734-739.

Comparative Evaluation of the Remineralizing Potential of Silver Diamine Fluoride, Casein Phosphopeptide-amorphous Calcium Phosphate, and Fluoride Varnish on the Enamel Surface of Primary and Permanent Teeth: An In Vitro Study

Introduction

With the paradigm shift in the management of dental caries, the focus is now laid on remineralization therapies that can arrest the progression of the disease and remineralize the subsurface lesions.

Objectives

The purpose of this study was to determine and compare the remineralizing potential of silver diamine fluoride (SDF), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and fluoride varnish (FV) on enamel surfaces in primary and permanent teeth.

Materials and methods

A total of 120 primary anterior teeth and 120 premolars were used to prepare enamel blocks in acrylic resin. The mean baseline surface microhardness (SMH) for each sample was determined using a microvickers hardness testing machine. Thereafter, the samples were randomly and equally distributed into groups and subgroups based on the materials used, that is, SDF, CPP-ACP, FV, and distilled water (control). After subjecting the samples to a pH cycling regime, SMH was determined again and the percentage change in SMH was calculated.

Results

The data were tabulated and subjected to statistical analysis using an independent t-test and one-way analysis of variance (ANOVA). In primary teeth, the least mean percentage reduction in SMH was observed after the application of FV followed by SDF, CPP-ACP, and control. In permanent teeth, both SDF and FV showed the least percentage reduction of enamel SMH followed by CPP-ACP and control.

Conclusion

Silver diamine fluoride (SDF), FV, and CPP-ACP showed remineralizing potential in both primary and permanent teeth.

How to cite this article

Kaur S, Bhola M, Bajaj N, et al. Comparative Evaluation of the Remineralizing Potential of Silver Diamine Fluoride, Casein Phosphopeptide-amorphous Calcium Phosphate, and Fluoride Varnish on the Enamel Surface of Primary and Permanent Teeth: An In Vitro Study. Int J Clin Pediatr Dent 2023;16(S-1):S91-S96.

Recent advances in the use of inorganic nanomaterials as anti caries agents

Caries is the most prevalent and widespread chronic oral disease. Traditional caries filling materials, due to their lack of anti-caries capabilities, can readily develop secondary caries. Nanomaterials proposed as an effective approach for caries treatment can inhibit biofilm formation. It also can not only reduce demineralization but also promote remineralization. In recent years, nanotechnology in anti-caries materials, particularly nano-adhesive and nano-composite resin, has advanced rapidly. Because inorganic nanoparticles (NPs) interfere with bacterial metabolism and inhibit biofilm development, inorganic NPs have emerged as a new trend in dental applications. Metal and metal oxide NPs by releasing metal ions, oxidative stress induction, and non-oxidative mechanisms showed significant antimicrobial activity. For applying metal and metal oxide NPs as anti caries agents, silver, zinc, titanium, copper, and calcium ions have been shown significant attention. Moreover, fluoride functionalized inorganic NPs were also employed to improve their efficacy of them. The fluoride-functionalized NPs can promote remineralization, and inhibit demineralization by enhancing apatite formation. In this review, we have provided an overview and recent advances in the use of inorganic NPs as anti caries agents. Furthermore, their antimicrobial, remineralizing, and mechanical impacts on dental materials were discussed.

Effectiveness of a Combined Toothbrushing Technique on Cariogenic Dental Biofilm in Relation to Stainless Steel and Elastomeric Ligatures in Orthodontic Patients: A Randomized Clinical Trial

Increased dental biofilm commonly occurs during orthodontic treatment. The aim of this study was to evaluate the effect of a combined toothbrushing method on dental biofilm cariogenicity in patients with stainless steel (SSL) and elastomeric (EL) ligatures. At baseline (T1), 70 participants were randomized (1:1 ratio) to the SSL or EL group. Dental biofilm maturity was evaluated using a three-color-disclosing dye. The participants were instructed to brush their teeth using a combined horizontal-Charters-modified Bass technique. Dental biofilm maturity was reassessed at the 4-week follow-up (T2). We found that at T1, new dental biofilm was the highest, followed by mature and cariogenic dental biofilm in the SSL group (p < 0.05). In the EL group, cariogenic dental biofilm was highly observed, followed by mature and new dental biofilm (p < 0.05). After intervention, cariogenic dental biofilm significantly decreased in both groups (p < 0.05). Moreover, a marked decrease in cariogenic dental biofilm was observed in the EL group compared with the SSL group (p < 0.05). However, the change in mature dental biofilm in the groups was similar (p > 0.05). Our results demonstrated that the combined toothbrushing method reduced cariogenic dental biofilm in the SSL and EL groups.

Medical and Dental Applications of Titania Nanoparticles: An Overview

Currently, titanium oxide (TiO₂) nanoparticles are successfully employed in human food, drugs, cosmetics, advanced medicine, and dentistry because of their non-cytotoxic, non-allergic, and bio-compatible nature when used in direct close contact with the human body. These NPs are the most versatile oxides as a result of their acceptable chemical stability, lower cost, strong oxidation properties, high refractive index, and enhanced aesthetics. These NPs are fabricated by conventional (physical and chemical) methods and the latest biological methods (biological, green, and biological derivatives), with their advantages and disadvantages in this epoch. The significance of TiO₂ NPs as a medical material includes drug delivery release, cancer therapy, orthopedic implants, biosensors, instruments, and devices, whereas their significance as a dental biomaterial involves dentifrices, oral antibacterial disinfectants, whitening agents, and adhesives. In addition, TiO₂ NPs play an important role in orthodontics (wires and brackets), endodontics (sealers and obturating materials), maxillofacial surgeries (implants and bone plates), prosthodontics (veneers, crowns, bridges, and acrylic resin dentures), and restorative dentistry (GIC and composites).

Knowledge of caries risk assessment among dental students in Riyadh Region Saudi Arabia

Background:

Caries is a preventable dental disease; further, it is associated with many risk factors. If risk factors are identified and evaluated in time, prevention can be achieved.

Aim:

Present study attempts to assess the knowledge of caries risk evaluation among dental students in Riyadh using a cross-sectional observational study design.

Materials and Methods:

The study comprised 390 dental students, interns, from the Riyadh region, Saudi Arabia. Questionnaire was developed to assess knowledge about Caries Risk Assessment (CRA). Questionnaire included ten straight statements with options for acceptance or refusal by marking true or false.

Results:

About 10.3% of the participants accepted dental caries as transmissible disease. About 69.5% of the participants think White spot lesions as carious lesions. 66.9% predict radiographic approximal lesions are disease indicators.

Conclusion:

Majority of the participants possessed knowledge about caries risk assessment, although prevention-oriented knowledge needs to be improved because knowledge of caries inducing aspects and risk of occurrence among clinicians help to deliver tailored preventive measures and appropriate execution of treatment.

Microbiome of Saliva and Plaque in Children According to Age and Dental Caries Experience

Dental caries are one of the chronic diseases caused by organic acids made from oral microbes. However, there was a lack of knowledge about the oral microbiome of Korean children. The aim of this study was to analyze the metagenome data of the oral microbiome obtained from Korean children and to discover bacteria highly related to dental caries with machine learning models. Saliva and plaque samples from 120 Korean children aged below 12 years were collected. Bacterial composition was identified using Illumina HiSeq sequencing based on the V3-V4 hypervariable region of the 16S rRNA gene. Ten major genera accounted for approximately 70% of the samples on average, including Streptococcus, Neisseria, Corynebacterium, and Fusobacterium. Differential abundant analyses revealed that Scardovia wiggsiae and Leptotrichia wadei were enriched in the caries samples, while Neisseria oralis was abundant in the non-caries samples of children aged below 6 years. The caries and non-caries samples of children aged 6-12 years were enriched in Streptococcus mutans and Corynebacterium durum, respectively. The machine learning models based on these differentially enriched taxa showed accuracies of up to 83%. These results confirmed significant alterations in the oral microbiome according to dental caries and age, and these differences can be used as diagnostic biomarkers.

Effect of chewing Azadirachta indica (neem) and Ocimum sanctum (tulsi) leaves on salivary acidogenicity: A comparative study

Background:

Dental caries is an infectious disease affecting majority of children in the modern world. An acidogenic diet brings down plaque pH, leading to dental caries. However, certain foods bring about rapid reversal of plaque pH after an acidogenic challenge. Azadirachta indica and Ocimum sanctum leaves which are anticariogenic show promise in this regard.

Aim:

The aim of this study was to evaluate the salivary pH reversal phenomenon by chewing A. indica and O. sanctum leaves after an acidogenic challenge.

Materials and Methods:

Forty caries-free children were selected and randomly divided into two groups. The resting salivary pH and salivary pH after eating chocolate was measured using a pH meter at time intervals of 5, 30 and 60 min. The children were then instructed to chew A. indica and O. sanctum leaves after chocolate consumption, and salivary pH was again measured at 5, 30 and 60 min. The change in salivary pH was assessed.

Statistical Analysis:

The data obtained were analyzed using Student's t-test (two tailed, dependent) to find the significance of the study parameters. The level of significance was set at P < 0.05.

Results:

Chewing A. indica and O. sanctum leaves after chocolate consumption increased salivary pH to statistically significant values at 5, 30 and 60 min.

Conclusion:

The observations of the study show that chewing of A. indica and O. sanctum leaves reversed the drop in salivary pH levels after an acidogenic challenge.

Remineralization Potential of Nanohydroxyapatite Toothpaste Compared with Tricalcium Phosphate and Fluoride Toothpaste on Artificial Carious Lesions

Introduction

Nanohydroxyapatite (nano-HA) has been utilized as an alternative agent for dental enamel remineralization. This study compared remineralization potential of nano-HA toothpaste (NHT), functionalized tricalcium phosphate toothpaste (TCPT), and fluoride toothpaste (FT) on carious lesions.

Materials and Methods

Sixty extracted human premolars were prepared for artificial carious lesions with synthetic polymer gel. Samples were divided into four groups according to testing agents: NHT, TCPT, FT, and one group with no treatment (NT). Each group was subjected to pH-cycling with the application of toothpaste in slurry form twice a day (2-min each) for 10 days. Surface microhardness was measured before demineralization, after demineralization, and after pH-cycling. Hardness at different periods, percentage of hardness recovery (% HR), and percentage of remineralization potential (%RP) were determined and statistically analyzed with ANOVA and Tukey comparisons (α = 0.05). Polarized light microscopy (PLM) was utilized to assess lesion depth.

Results

Significant remineralization of carious lesions was observed among different toothpastes compared to NT (p < 0.05). No significant difference in remineralization potential was found among NHT, TCPT, and FT (p > 0.05). No significant difference in % HR and % RP was seen among NHT, TCPT, and FT (p > 0.05). PLM indicated a greater decrease in carious depth upon using NHT compared to TCPT and FT, with minimal increase in depth for NT.

Conclusions

NHT has comparable capability to TCPT and FT in hardness recovery. However, decrease in carious depth was evidenced with PLM for NHT more than TCPT and FT. Thus, NHT was suggested as a potential remineralization product for treating initial carious lesions. Clinical Significance. The study showed that NHT had the potential to remineralize artificial carious lesion. It was confirmed in potential in the lesion depth reduction and forming a new enamel layer. NHT showed its capability as an alternative for dental caries therapeutic.

Perspective and practice of root caries management: A multicountry study - Part II: A deeper dive into risk factors

BACKGROUND

The potential of an improved understanding to prevent and treat a complex oral condition such as root caries is important, given its correlation with multiple factors and the uncertainty surrounding the approach/material of choice. Deeper insights into risk factors may improve the quality of treatment and reduce the formation of root surface caries.

AIM

The present work aims to gain knowledge about dentists' opinions and experiences on assessing the risk factor related to the development of root caries and to help identify any overlooked factors that may contribute to less efficacious clinical outcomes.

METHODOLOGY

A questionnaire related to root surface caries was distributed among practicing dentists in nine different countries, namely the United Kingdom, Libya, Jordan, Saudi Arabia, Egypt, Brazil, India, Malaysia, and Iraq. Questionnaire responses were analyzed, and the results were compared among the groups.

RESULTS

Dentists around the world ranked the oral hygiene status of patients as the most important factor in the development of root surface caries. Patients with poor oral hygiene, active periodontal disease, reduced salivary flow, and gingival recession are perceived to have a higher risk of developing new root surface caries. There is a greater focus on prevention in the UK and greater levels of untreated dental disease in other countries, especially those recovering from civil wars.

CONCLUSION

This work identified some overlooked factors that may have contributed to the less efficacious clinical outcomes reported in the literature. It is hoped that this deep dive into risk factors coupled with the findings presented in Part I of this study will be used as a basis for a more comprehensive investigation into the management of patients with root surface caries.

Evaluation of the correlation between dental caries and periodontitis - A clinico- immunological analysis

Background:

To study the correlation between dental caries and periodontitis.

Aim:

The aim of the study was to evaluate the correlation between dental caries and periodontitis based on the clinical and immunological analysis. The null hypothesis was that there is no clinical and immunological correlation between dental caries and periodontitis.

Settings and Design:

Fifty systemically healthy adults (mean age of 35 years) with decayed, missing, and filled teeth scores of more than 6 were assessed for periodontal health by recording their probing depth (PD) and bleeding on probing (BOP) values. Unstimulated whole saliva was collected, and enzyme-linked immunosorbent assay (ELISA) analysis was conducted for determining the immunoglobulin A (IgA) and immunoglobulin G (IgG) levels. The obtained clinical and immunological values were statistically analyzed.

Results:

The results of the clinical examination revealed low PD and BOP scores, whereas the ELISA analysis showed significantly higher salivary IgA levels as compared to salivary IgG.

Conclusions:

Based on the observations of this clinicoimmunological study, it was concluded that no correlation existed between dental caries and periodontal disease.

A Randomized Controlled Trial Assessing the Effects of Feeding High Water Soluble Carbohydrate (WSC) Oaten Hay Versus Low WSC Oaten Hay on Equine Peripheral Dental Caries

Equine peripheral caries (PC) can cause significant dental pathology and appears to be increasing in prevalence and recognition in many areas [1, 2]. Previous studies have identified risk factors for the condition including the feeding of oaten hay [3]. It was hypothesized that this may be due to the higher water soluble carbohydrate (WSC) or "sugar" content of the hay. A randomized control trial involving 30 horses on three properties was completed. The horses were randomly assigned to two groups: high WSC (H-WSC) or low WSC (L-WSC) oaten hay and were then sedated and intraoral photographs and endoscopy were performed for baseline levels. They were maintained on this assigned hay source for three months when they were again sedated, examined, and photographs and endoscopic videos recorded. Horses with significant PC were then changed to meadow hay (previously shown to be lower risk for PC [3]) for seven months and re-examined to assess for recovery. Images and videos were anonymized and graded for PC, and the PC grades of the teeth before and after intervention were compared using a Fisher exact test. Thirteen horses fed L-WSC hay and 15 fed H-WSC hay completed the study. Of horses fed the H-WSC oaten hay, 60% deteriorated and of horses on L-WSC oaten hay, 53.8% improved in PC grade over the trial, however, the difference was not statistically significant (P = .274). All three horses available for recheck after changing to meadow hay improved.

Salivary Redox Biomarkers in the Course of Caries and Periodontal Disease

Caries are a pathological process of extracorporeal nature, characterized by demineralization of inorganic substances as well as proteolysis triggered by acids produced by bacteria present in dental plaque, as a result of metabolism of sugars of both external and internal origin. Periodontal disease, on the other hand, is a multifactorial degenerative disease associated with inflammation, involving a group of tissues that surround the dental cervix and root of the tooth. It is believed that one of the mechanisms in the etiopathogenesis of caries and periodontitis are disorders of local and/or general oxidative stress (OS) parameters. Numerous clinical studies have confirmed the relationship between oxidative stress markers and oral diseases. In most analyzed studies, technical and biological variability was so high that none of the markers so far has proven suitable for routine clinical use. The aim of systematic reviews of the literature is to present the existing studies on OS parameters, mainly concerning the activity of antioxidant enzymes in saliva of patients with caries and periodontitis.

How Brazilian dentists work within a new community care context? A qualitative study

The aim of this study was to analyze the value and meanings that dental surgeons attribute to the Primary Health Care setting, where health promotion is encouraged over a mechanistic performance of procedures. A qualitative study, involving ten Brazilian dental surgeons working in Primary Care in 2016, was designed. In-depth semi-structured interviews were performed, with all interviews recorded, transcribed and subsequently submitted to Qualitative Content Analysis. Despite the Healthcare Promotion model proposed by the Brazilian oral health policy, dental surgeons demonstrated preferences for private and traditional dental practices. These characteristics are counterproductive in public oral health services, which aim to achieve collective health benefits. Traditional practice is based upon a specific and restricted focus, as opposed to overall patient care, hence maintaining the original professional identity, ruled by manual procedures, while demonstrating scientifically fragile understanding of disease processes. Despite the implementation of public service models that aim at change, counterproductive characteristics associated with the deeply rooted traditional management strategies were evidenced.

Reliability of colour and hardness clinical examinations in detecting dentine caries severity: a systematic review and meta-analysis

Dental caries is the most common human infectious disease and is caused by microorganisms producing acids, resulting in changes in dental tissue hardness and colour. However, the accuracy and reliability of dentine colour and hardness as indicators for carious lesion severity has never been assessed in a systematic review. By applying strict criteria, only seven papers (five randomized control trials and two diagnostic studies) were considered for full text qualitative and quantitative assessment. Only three studies produced high quality evidence and only four articles were considered for meta-analysis, as these provided log₁₀ colony forming units (CFU) data from caries biopsies following colour and hardness clinical examinations. When comparing the amount of CFU isolated from carious biopsies from different colour and hardness categories, hardness clinical examination was found to be a statistically more discriminate test than colour clinical examination. Therefore, hardness clinical examination is more specific and reliable than colour to detect dentine carious lesion severity. Further large carefully designed clinical studies are needed to consolidate the findings of this systematic review.

Recent Advances in Dental Hard Tissue Remineralization: A Review of Literature

The dental caries is not simply a continuous and unidirectional process of the demineralization of the mineral phase, but a cyclic event with periods of demineralizations and remineralisation. The remineralization process is a natural repair mechanism to restore the minerals again, in ionic forms, to the hydroxyapatite (HAP) crystal lattice. It occurs under near-neutral physiological pH conditions whereby calcium and phosphate mineral ions are redeposited within the caries lesion from saliva and plaque fluid resulting in the formation of newer HAP crystals, which are larger and more resistant to acid dissolution. Numerous types of remineralizing agents and remineralizing techniques have been researched and many of them are being used clinically, with significantly predictable positive results. The recent researches on remineralization are based on biomimetic remineralization materials, having the capability to create apatite crystals within the completely demineralized collagen fibers.

HOW TO CITE THIS ARTICLE

Arifa MK, Ephraim R, et al. Recent Advances in Dental Hard Tissue Remineralization: A Review of Literature. Int J Clin Pediatr Dent 2019;12(2):139-144.

Dental caries and bacterial load in saliva and dental biofilm of type 1 diabetics on continuous subcutaneous insulin infusion

Objectives

Since most of the studies evaluates diabetics on multiple daily injections therapy and continuous subcutaneous insulin infusion may help gain better metabolic control and prevent complications, the objective of this study was to evaluate the prevalence of dental caries, the unstimulated salivary flow rate and the total bacteria load, Streptococcus spp. levels and Lactobacillus spp. levels in saliva and supragingival dental biofilm of type 1 diabetics on insulin pump.

Material and Methods

Sixty patients with type 1 diabetes on insulin pump and 60 nondiabetic individuals were included. The dental caries evaluation was performed using ICDAS and the oral hygiene was assessed according to Greene and Vermillion Simplified Oral Hygiene Index. Unstimulated saliva and supragingival dental biofilm were collected. Total bacteria, Streptococcus spp. and Lactobacillus spp. was quantified by qPCR.

Results

Patients with type 1 diabetes had a higher prevalence of dental caries and filled and missing teeth when compared with the control group. These patients were associated with more risk factors for the development of dental caries, namely a lower unstimulated salivary flow rate and a higher bacterial load in saliva and dental biofilm.

Conclusion

Some risk factors related to dental caries were associated with type 1 diabetics. An early diagnosis combined with the evaluation of the risk profile of the diabetic patient is imperative, allowing the dental caries to be analyzed through a perspective of prevention and the patient to be integrated into an individualized oral health program.

Psychometric Properties of the Revised Illness Perception Questionnaire for Oral Health

Aims: The aim of this study was to test the hypothesis that, for patients with dental caries, the Spanish version of the Revised Illness Perception Questionnaire for Oral Health (IPQ-R-OH) has 7 dimensions, including personal and treatment control, timeline-acute/chronic and timeline-cyclical, illness coherence, consequences, and emotional representations. Methods: A Spanish adaptation of the IPQ-R, with a self-reported 38-item scale, was developed. Exploratory and confirmatory factor analyses were conducted using data from 520 patients with dental caries attending the Dental Clinic at Universidad Cooperativa de Colombia, Pasto, Colombia. Results: Exploratory factor analysis revealed 7 dimensions with 36 items (2 items were removed because of poor factor loadings or discriminant ability). The internal consistency coefficients of each factor ranged from 0.72 to 0.91, and all item loadings were >0.52. Confirmatory factor analysis indicated that a 7-factor model with 36 items had superior fit compared to the 38-item original model: χ2 = 1,784.291 (df = 573, p < 0.001); nonnormal fit index = 0.941; comparative fit index = 0.946; root mean square error of approximation = 0.062 (90% CI = 0.057-0.066); standardized root mean square residual = 0.072; and Akaike information criterion = 638.291. Control (integrated by items from personal control, treatment control, and timeline-acute factors) and hopelessness (PC15 and PC17) were the 2 reconfigured factors that were identified. Conclusions: These findings suggest that the modified 36-item model has satisfactory reliability and construct factorial validity; therefore, it could be a valuable instrument in the screening of illness perceptions in oral health.

The role of the saliva antioxidant barrier to reactive oxygen species with regard to caries development

OBJECTIVES

The aim of this study was to evaluate the role of the antioxidant barrier in the saliva of children with caries, and its impact on the colonization of cariogenic bacteria.

METHODS

This is a cross-sectional study of 81 children aged 1-5 years. Antioxidant levels and salivary bacterial profiles were measured. Patients were divided into two groups as follows: initial stage decay, termed non-cavitated (1-2 in International Caries Detection and Assessment System (ICDAS)), and extensive decay, termed cavitated lesions (5-6 in ICDAS). The control group includes children without caries.

RESULTS

The linear regression model demonstrated that the GSH, GSSG, GSH/GSSG, and total antioxidant capacity levels are influenced (P < 0.05) by: the stage of caries and the dominant bacterial strain. Compared with the other groups (P < 0.001), the highest antioxidant parameters were recorded in the saliva of patients with cavitated lesions.

DISCUSSION

Our results indicate that the high levels of antioxidants in saliva increase significantly in children in line with the salivary cariogenic bacterial profiles and caries progression.

A Cross-sectional Study for Assessment of Untreated Dental Caries and Its Consequences among Slum-dwelling Children

INTRODUCTION

Dental caries affects humans of all ages throughout the world and remains the major dental public health problem among children globally.

MATERIALS AND METHODS

A cross-sectional study was conducted using the cluster sampling technique to obtain the required sample size of 400 children from urban slum population of Faridabad, Haryana, India. Data were collected using World Health Organization dentition status 1997 criteria and PUFA/pufa index.

TYPE OF STUDY

Cross-sectional study.

RESULTS

Among 6- to 12-year-age group, 68.5% subjects had one or more decayed deciduous teeth, of which 65.3% subjects had one or more pufa score, and 26.4% subjects were having one or more decayed permanent teeth, of which 16.7% subjects were having one or more PUFA score. The overall caries prevalence was 79.64% and overall prevalence of one or more than one PUFA+pufa was reported in 69.2% subjects.

CONCLUSION

The findings of the study showed the relevance of PUFA/pufa index to address the neglected problem of untreated caries and its consequences. The study also suggests the importance for implementation of the primary oral care programs for this deprived population.

HOW TO CITE THIS ARTICLE

Marya C, Kataria S, Nagpal R, Oberoi SS, Dhingra C, Arora D. A Cross-sectional Study for Assessment of Untreated Dental Caries and Its Consequences among Slum-dwelling Children. Int J Clin Pediatr Dent 2017;10(1):29-33.

Salivary Proteins-A Barrier on Enamel Demineralization: An in vitro Study

AIM

The aim of this study is to evaluate the protective effect of the salivary proteins on the demineralization of enamel.

MATERIALS AND METHODS

Twenty freshly extracted human molar teeth were used in this study. Enamel samples (2 mm thickness) were prepared from the buccal and lingual surfaces of the teeth selected. An acid-resistant nail varnish was used to cover every aspect of the sample, except an area of 5 * 5 mm limited by an adhesive tape. After drying, the adhesive tape was removed, exhibiting a rectangular area on the enamel surface. Samples were divided into two groups: Group I (10 samples): Each sample was coated by 100 μg of albumin for 2 hours at 37°C. Group II (10samples): Each sample was exposed to 100 μL of deionized water.Samples were washed by dipping once in deionized water. They were then disposed into individual tubes containing demineralization solution for 1, 2, 3, and 4 minutes at 37°C with gentle agitation. The demineralization solution was utilized to determine the calcium loss from specimens at 1, 2, 3, 4 minutes using an ultraviolet-visible spectrophotometer.

RESULTS

Calcium loss was less from the albumin-coated samples than control group at all times and was statistically significant (p < 0.05). Also, calcium loss was maximum at the end of 1 minute, and it decreased as time interval increased and was statistically significant (p < 0.001).

CONCLUSION

Albumin has provided a strong protection against enamel demineralization at all times compared to the one without it.

HOW TO CITE THIS ARTICLE

Hegde MN, Sajnani AR. Salivary Proteins-A Barrier on Enamel Demineralization: An in vitro Study. Int J Clin Pediatr Dent 2017;10(1):10-13.

A comparative evaluation of remineralizing ability of bioactive glass and amorphous calcium phosphate casein phosphopeptide on early enamel lesion

Background:

This study was done to evaluate remineralizing potential of bioactive glasses (BAGs) and amorphous calcium phosphate-casein phosphopeptide (ACP-CPP) on early enamel lesion.

Materials and Methods:

Twenty freshly extracted mandibular premolars were sectioned sagittally. The buccal half was impregnated in acrylic resin blocks and treated with 37% phosphoric acid in liquid form, to demineralize enamel surface to simulate early enamel lesion. The samples were divided into two groups. The samples in Group I were treated with ACP-CPP (GC Tooth Mousse) and in Group II with BAG (Sensodyne Repair and Protect) and stored in saliva to prevent dehydration. The samples were tested for microhardness. The data obtained was analyzed using ANOVA post hoc multiple comparison and independent sample t- test and presented as a mean and standard deviation.

Results:

All the samples showed a decrease in the microhardness after demineralization. After application of remineralizing agents, Group II showed a highly significant increase in the microhardness (P < 0.05) after 10 days, while Group I showed a significant increase in microhardness after 15 days (P < 0.05).

Conclusion:

Both the remineralizing agents tested in this study can be considered effective in repair and prevention of demineralization. BAG showed better results initially, but eventually both have similar remineralizing potential.

Effect of Green and White Tea Pretreatment on Remineralization of Demineralized Dentin by CPP-ACFP-An Invitro Microhardness Analysis

INTRODUCTION

Mechanical performance of dentine is of major significance for the overall function of the teeth. Remineralization of carious dentine is the ultimate goal in re-establishing the functionality of the affected tissue so as to regain and maintain the mechanical properties of dentine. Functional remineralization of the affected dentin involves stabilization of both inorganic and organic component, but Caesin Phosphopeptide Amorphous Calcium Flurophosphate (CPP-ACFP) stabilizes only inorganic content. Hence to stabilize organic content and to bring in functional remineralization the use of anticollagenolytic and antielastastic agent was considered for this study.

AIM

To assess and compare the remineralization of artificial carious dentin pre treated with white and green tea, before and after application of CPP-ACFP using microhardness test. Null hypothesis was that both teas did not have any effect on remineralization potential of CPP ACFP.

MATERIALS AND METHODS

Forty specimens were subjected to artificial caries lesions and were randomly divided into 4 groups based on the application of tea extract followed by CPP-ACFP (groups A & B) and CPP-ACFP followed by tea extracts (groups C & D). All the specimens were subjected to two pH cycling regimen. The specimens were subjected to Vickers microhardness test to obtain the microhardness values. The values were statistically analysed using one-way ANOVA and multiple comparisons with Tukey's HSD procedure.

RESULTS

After the 1(st) and 2(nd) pH cycling in groups A and B, Group B showed significant increase in microhardness values (35.79± 3.12 VHN). But after the pH cycling regimen in groups C and D, microhardness values increased in 1(st) pH cycling (50.03± 3.64 VHN); (50.03±3.64 VHN), respectively but decreased during the 2(nd) pH cycling, (33.94±6.45 VHN); (33.11±6.11 VHN) respectively with the level of significance <0.05.

CONCLUSION

The results of this study rejects the hypothesis tested and showed that both the tea extracts increased the microharness values when used prior to the application of remineralizing agent. However, 10% white tea showed better microhardness indicating stabilization of collagen in dentine resulting in functional remineralization.

Antibacterial Activity of Copaiba Oil Gel on Dental Biofilm

Amazonian biodiversity products that have been used for years in folk medicine, have emerged as feasible and promising alternatives for the inhibition of microorganisms in dental biofilm. Copaiba oil, a phytotherapic agent widely used by the Amazonian populations, is known for its antibacterial, anti-inflammatory, anesthetic, healing and antitumor medicinal properties.

Screening the Drug Resistance Property Among Aerobic Pathogenic Microorganisms of Dental Caries in North-Western Indian Population: A Preliminary Study

AIMS AND OBJECTIVES

To evaluate the emerging drug resistance among the caries pathogens isolated from carious dentine microbiologically.

MATERIALS AND METHODS

Specimens from dental caries were collected from 75 patients referred to Department of Conservative Dentistry and Endodontics, Vyas Dental College. Microbiological processing of all the samples was done within three hours to isolate the caries pathogens. The samples were inoculated on agar medium (Nutrient agar, Mac-conkey's agar) at 370C for 48 hours aerobically. The identification of strains was done by observing colony morphology and gram's staining. The predominant isolates were subjected to antimicrobial sensitivity test (Kirby Bauer's method). Statistical analysis of the isolates was done using paired t-test.

RESULTS

Out of 75 patients more common isolates were Staphylococcus aureus, Klebsiella, Pseudomonas aeruginosa, Yeast. The predominant were Staphylococcus and Pseudomonas species. Newer antibiotics were proved to be effective against these predominant strains after evaluating antibiotic sensitivity tests.

CONCLUSION

Although Streptococcus mutans (S.mutans) is the most prevalent microorganism seen in dental caries, the role of other microorganisms like Staphylococcus, Pseudomonas in initiation and progression of caries is evident from this study. Further extensive and large scale studies need to be conducted for better understanding the role of these microorganisms in dental caries.

Conceptualization of Dental Caries by Undergraduate Dental Students from the First to the Last Year

Dental caries, still one of the most common diseases affecting people around the world, has a multifactorial nature encompassing necessary (biofilm accumulation), determinant (exposure to sugars and fluoride) and modulating factors (biological and social). The concepts about caries learned at dental schools may directly influence the conduct of the future dentists regarding the control and treatment of this disease. The aim of this study was to determine the concept that students at the Piracicaba Dental School, University of Campinas, Brazil, have about dental caries. In this cross-sectional descriptive study, 274 students answered the discursive question “Conceptualize dental caries”. Students' answers were analyzed by a content analysis technique that allowed the creation of response categories and classification of the concepts in categories. Frequencies were expressed as absolute numbers and percentages. Differences between the responses according to the students' class years were tested by the chi-square test. Differences with p<0.05 were considered statistically significant. The response categories were: biological concept (53.6%), restrictive multifactorial concept (12.1%), comprehensive multifactorial concept (8.1%), transmissibility concept (15.8%), and other (10.4%). Differences in response category frequencies were seen between the class years (p<0.001). There was no consensus on the disease definition, although students predominantly had a biological concept of dental caries.

Ultrashort echo time (UTE) MRI for the assessment of caries lesions

OBJECTIVE

Direct in vivo MRI of dental hard tissues by applying ultrashort echo time (UTE) MRI techniques has recently been reported. The objective of the presented study is to clinically evaluate the applicability of UTE MRI for the identification of caries lesions.

METHODS

40 randomly selected patients (mean age 41 ± 15 years) were enrolled in this study. 39 patients underwent a conventional clinical assessment, dental bitewing X-ray and a dental MRI investigation comprising a conventional turbo-spin echo (TSE) and a dedicated UTE scan. One patient had to be excluded owing to claustrophobia. In four patients, the clinical treatment of the lesions was documented by intraoral pictures, and the resulting volume of the cavity after excavation was documented by dental imprints and compared with the MRI findings.

RESULTS

In total, 161 lesions were identified. 157 (97%) were visible in the UTE images, 27 (17%) in the conventional TSE images and 137 (85%) in the X-ray images. In total, 14 teeth could not be analysed by MR owing to artefacts caused by dental fillings. All lesions appear significantly larger in the UTE images as compared with the X-ray and TSE images. In situ measurements confirm the accuracy of the lesion dimensions as observed in the UTE images.

CONCLUSION

The presented data provide evidence that UTE MR imaging can be applied for the identification of caries lesions. Although the current data suggest an even higher sensitivity of UTE MRI, some limitations must be expected from dental fillings.

Dental caries: A complete changeover (Part II)-Changeover in the diagnosis and prognosis

Realization that dental caries is a reversible, dynamic biochemical event at a micron level has changed the way the profession recognizes the caries disease and the caries lesion. The diagnosis of dental caries poses challenges due to the complex interaction of multiple endogenous causal factors. The most appropriate diagnostic aid for this purpose is the risk model of caries risk assessment. The analyses of the biological determinants provide clues to the dominant causal factor. The detection of a carious lesion has undergone a rigorous revision and revolution in order to identify the earliest mineral change so that it can be controlled without resorting to invasive management options. Apart from detection, it became mandatory to assess the extent of the lesion (noncavitated/cavitated), assess the activity status of the lesion (active/arrested), monitor the lesion progress (progression/regression over a period of time), and finally to predict the prognosis of the lesion as well as the disease. The prognosis of the disease can be best assessed by analyzing the predictor factors in caries risk assessment. The ultimate objective of such a meticulous and methodical approach aids in devising a tailor-made treatment plan, using preventing measures precisely and restorative measures minimally. This ensures the best oral health outcome of the patient.