ArticleLiterature Review

Non-surgical Management Methods of Non-Cavitated Carious Lesions

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Abstract

Objective: To critically appraise all evidence related to the efficacy of nonsurgical caries preventive methods to arrest or reverse the progression of noncavitated carious lesions (NCCls). Methods: A detailed search of Medline (via OVID), Cochrane Collaboration, Scielo, and EMBASE identified 625 publications. After title and abstract review, 103 publications were selected for further review, and 29 were finally included. The final publications evaluated the following therapies: fluorides (F) in varying vehicles (toothpaste, gel, varnish, mouthrinse, and combination), chlorhexidine (CHX) alone or in combination with F, resin infiltration (I), sealants (S), xylitol (X) in varying vehicles (lozenges, gum, or in combination with F and/or xylitol), casein phosphopeptide amorphous calcium phosphate (CPP-ACP) or in combination with calcium fluoride phosphate. All included studies were randomized clinical trials, were conducted with human subjects and natural NCCls, and reported findings that can yield outcomes measures such as caries incidence/increments, percentage of progression and/or arrest, odds ratio progression test to control, fluorescence loss/mean values, changes in lesion area/volume and lesion depth. Data were extracted from the selected studies and checked for errors. The quality of the studies was evaluated by three different methods (ADA, Cochrane, author's consensus). Results: Sample size for these trials ranged between 15 and 3903 subjects, with a duration between 2 weeks and 4.02 years. More than half of the trials assessed had moderate to high risk of bias or may be categorized as 'poor'. The great majority (65.5%) did not use intention to treat analysis, 21% did not use any blinding techniques, and 41% reported concealment allocation procedures. Slightly more than half of the trials (55%) factored in background exposure to other fluoride sources, and only 41% properly adjusted for potential confounders. Conclusions: Fluoride interventions (varnishes, gels, and toothpaste) seem to have the most consistent benefit in decreasing the progression and incidence of NCCls. Studies using xylitol, CHX, and CPP-ACP vehicles alone or in combination with fluoride therapy are very limited in number and in the majority of the cases did not show a statistically significant reduction. Sealants and resin infiltration studies point to a potential consistent benefit in slowing the progression or reversing NCCls.

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... In more recent years the focus has been on prevention as well as partial or no caries removal. With the development of new dental materials, mainly dental composites with or without antibacterial properties as well as improvements in bonding have led to less need for full caries removal and the concept of 'sealing' caries in is now well evidenced (Tellez et al., 2013). One of the strongest advocates for no caries removal is the 'Hall crown' technique which led to a large amount of interest when the results of the 5 years randomized controlled trial in 2009 by N. Innes showed that sealing caries in the tooth with a preformed metal crown significantly outperformed conventional restorations (Innes et al., 2011). ...
... When caries is left behind it is vital that the marginal seal is effective to prevent caries progression. Importantly it should be mentioned that on a similar principle, non cavitated carious lesions (NCCl) can be simply sealed with a fissure sealant (Tellez et al., 2013). ...
... For that reason, in recent years the focus of dentistry has shifted towards preventions and minimally invasive dentistry. The concept of sealing caries is now well evidenced (Tellez et al., 2013). ...
Thesis
Aim: To assess the antibacterial properties of novel dental composite formulations containing the antibacterial polylysine and varying type or amounts of monomer/glass/calcium phosphate. / Methods: Minimum inhibitory/bactericidal concentrations of polylysine against Streptococcus mutans UA159 were determined. The antibacterial activity of composite discs with polylysine was determined by immersing the discs into a suspension of S. mutans and carrying out bacterial counts. All the results were compared with commercial materials. Mass and volume change of the material as well as polylysine release were determined over time and compared for multiple formulations containing polylysine. Bacterial growth was visualised on the discs using LIVE/DEAD staining with confocal microscopy and using scanning electron microscopy. / Results: The addition of a minimum 1% polylysine to the novel formulations inhibited bacterial growth at low inoculum density and the addition of a minimum 2% polylysine inhibited bacterial growth at all inoculum densities in air. In an atmosphere of air enriched with 5% carbon dioxide and in the presence of sucrose there was a bacteriostatic effect with 5% polylysine addition. None of the commercial materials showed any antibacterial properties. Increasing the amount of polylysine in the novel composite formulations increased mass change over two months and increased polylysine release over three weeks. Volume was not significantly affected. Using SEM, bacterial growth was seen on composite discs after 4 days incubation in a suspension of S. mutans at 37oC in air with 5% carbon dioxide. It appeared that a biofilm was formed under these conditions for all formulations and commercial materials whereas in air, there was minimal growth. Using confocal microscopy an increase in dead bacteria was seen as the polylysine concentration increased in both air and in air with 5% CO2. / Conclusion: Novel composites with added polylysine are capable of reducing the load of Streptococcus mutans. These above experimental composites have novel characteristics that make them more suitable for minimally invasive tooth restorations. Key words: polylysine, composite, restoration, antibacterial properties
... The ICCMS caries care philosophy (both at the child and at the tooth-surface level) has also been included in the recent ORCA-IADR terminology consensus [38], as well as in recent evidence on best practices and effectiveness of caries management [39][40][41][42][43][44][45][46]. ...
... Finally, ICCMS is in accordance with the state of the art of caries management [38][39][40][41][42][43][44][45][46]. There is a growing shift in academia towards a similar approach to ICCMS in the dental caries teaching curricula for undergraduates (e.g. the European leading consensus; the cariology consensus achieved in Colombia, the USA, and the Caribbean countries) [6,[49][50][51][52], together with the adoption of similar caries management behaviours in dental practice [17]. ...
Article
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Objective: This 3-year multicentre randomised controlled trial compared, in 6-7-year-old Colombian children, the effectiveness of the ICCMS (International Caries Classification and Management System) with a conventional caries-management system (CCMS) in terms of individual caries-risk, caries lesions, and secondarily, oral-health-related knowledge/attitudes/practices, and number of appointments. Material and methods: With ethical approval, 240 6-7-year olds from six Colombian clinics were recruited. Trained examiners conducted the following baseline/follow-up assessments: Caries risk (Cariogram-ICCMS); caries severity/activity staging (ICDAS-merged combined radiographic/visual); sealants/fillings/missing teeth, and oral-health-related knowledge, attitudes and practices. Children received their randomly allocated (ICCMS/CCMS) care from dental practitioners. Outcomes: caries-risk control (children); caries-progression control (tooth surfaces); oral-health-related knowledge/attitudes/practices improvement (parents/children), and appointments' number (children). Descriptive and non-parametric/parametric bivariate analyses were performed. Results: Three-year-follow-up: n = 187 (77.9%; ICCMS: n = 92; CCMS: n = 95) disclosed a baseline-to-3-year overall high-caries-risk children decrease (ICCMS: 60.9-0%, p < .001; CCMS: 54.7-5.3%, p < .001) (p > .05). ICCMS versus CCMS showed: fewer tooth-surface caries progression (6.2% vs 7.1%, p = .010) and fewer active-caries lesions (49.8% vs. 59.1%, p < .05); higher proportion of children with ≥2/day fluoride-toothpaste tooth-brushing practice (p < .05); similar mean number of appointments (10.9 ± 5.9 vs. 10.0 ± 3.8, p = .15). Conclusion: Both caries-management systems showed similar effectiveness in caries-risk control, with ICCMS more effectively controlling tooth-surface caries progression and improving toothbrushing practices.
... Encontramos 11 revisiones sistemáticas (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) que incluyeron cuatro estudios primarios, todos correspondientes a ensayos clínicos aleatorizados, (17)(18)(19)(20)(21) reportados en cinco referencias. ...
... Diferencias entre este resumen y otras fuentes • Las conclusiones de este análisis coinciden con lo encontrado por cada una de las revisiones sistemáticas identificadas (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) las cuales consideran que el uso de la infiltración de resina para el tratamiento de la caries interproximal no cavitada disminuye el riesgo de progresión de caries en dientes posteriores permanentes. ...
Article
Introducción: Para evitar la progresión de la caries interproximal no cavitada en dientes permanentes, convencionalmente se utilizan técnicas mínimamente invasivas. Dentro de las técnicas más utilizadas destacan la aplicación tópica de barniz de flúor, sellantes o la infiltración de resina. Sin embargo, aún existe incertidumbre respecto a la efectividad de la infiltración en resina y el barniz de flúor cuando se usan en conjunto en dentición permanente. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metaanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Se identificaron 11 revisiones sistemáticas que en conjunto incluyeron cuatro estudios primarios que corresponden a ensayos clínicos aleatorizados. Se concluye que la infiltración de resina probablemente reduce la progresión de la caries interproximal no cavitada en dientes permanentes. No se encontraron estudios que evaluaran los eventos adversos.
... However, dental caries remains a significant problem in the United States [1, 5,6]. The majority of newly discovered caries lesions are located in pits and fissures of posterior teeth and on interproximal surfaces between adjacent teeth where they are difficult to detect [7][8][9]. If caries lesions are detected early, they can be treated via non-surgical interventions and loss of tooth structure is avoided [7,8]. ...
... The majority of newly discovered caries lesions are located in pits and fissures of posterior teeth and on interproximal surfaces between adjacent teeth where they are difficult to detect [7][8][9]. If caries lesions are detected early, they can be treated via non-surgical interventions and loss of tooth structure is avoided [7,8]. ...
Article
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Several studies have shown that near-infrared imaging has great potential for the detection of dental caries lesions. A miniature scanning fiber endoscope (SFE) operating at near-infrared (NIR) wavelengths was developed and used in this study to test whether the device could be used to discriminate demineralized enamel from sound enamel. Varying depths of artificial enamel caries lesions were prepared on 20 bovine blocks with smooth enamel surfaces. Samples were imaged with a SFE operating in the reflectance mode at 1310-nm and 1460-nm in both wet and dry conditions. The measurements acquired by the SFE operating at 1460-nm show significant difference between the sound and the demineralized enamel. There was a moderate positive correlation between the SFE measurements and micro-CT measurements, and the NIR SFE was able to detect the presence of demineralization with high sensitivity (0.96) and specificity (0.85). This study demonstrates that the NIR SFE can be used to detect early demineralization from sound enamel. In addition, the NIR SFE can differentiate varying severities of demineralization. With its very small form factor and maneuverability, the NIR SFE should allow clinicians to easily image teeth from multiple viewing angles in real-time.
... All the arginine studies (8/8) included a combination of arginine and a calcium base, and concluded that the addition of 1.5% arginine to toothpaste containing 1,450 ppm F (as MFP) with an insoluble calcium base has the potential to significantly boost the performance of fluoride-only toothpaste. The re- Chen et al. [2013]: high risk of bias; according to Tellez et al. [2013]: moderate risk of bias by Cochrane, poor quality by ADA) 0.05% sodium fluoride rinse once daily + F toothpaste (1,000-1,100 ppm F) for 6 months Baseline: 9.4 ± 9.5 12 months: 6.4 ± 7.5 (significantly less than baseline) Difference of 0 -12 months between sites that were scored 0 -1 at end: 25% The results indicate that the remineralizing toothpaste provides a significant benefit in preventing and remineralizing root caries in high-risk patients (long-term studies are needed as there is the concern on promotion of calculus with this technology) NaF toothpaste (1,100 ppm F) + caries restored at baseline and F varnish (Duraphat) applied + daily 0.05% NaF alcohol-free rinse + pilocarpine 5 mg q.i.d. 30 maining studies focusing on the addition of microbial-related strategies to a fluoride-containing vehicle (2 xylitol studies, plus 1 study using a probiotic milk) favored the combination as a booster to fluoride-only control arms. ...
... A 2013 systematic review [Tellez et al., 2013] of nonsurgical caries-preventive methods to arrest or reverse the progression of noncavitated caries lesions concluded that fluoride interventions have the most consistent benefit, while other strategies (including xylitol, chlorhexidine and CPP-ACP alone or in combination with fluoride) are very limited in number and in the majority of cases did not show a statistically significant reduction. The most recent systematic review on this topic included 8 studies (3-24 months) and concluded that there was a remineralizing effect of CPP-ACP compared to a placebo, but that the evidence regarding the clinical efficacy of CPP-ACP as a booster/supplement to fluoride-containing products is still unclear (the effect was not significantly different from that of fluorides) [Li et al., 2014]. ...
Article
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Dental caries remains a major public health problem, especially for certain high-risk population groups. The goal of this study was to assess the evidence regarding strategies meant to be used as alternatives or booster/supplements to fluoride for caries prevention and management. Articles were selected for inclusion if they had a prospective longitudinal design, with a fluoride control arm, and were conducted in human subjects. Of the included studies, 7/18 studies on calcium-based strategies favored the test product (the majority of studies included exposure of fluoride in all groups). All the arginine studies (8/8) included a combination of arginine and a calcium base, and concluded that this has the potential to significantly boost the performance of fluoride. The remaining included studies focused on the addition of microbial-related strategies to a fluoride-containing vehicle (2 xylitol studies and 1 study using a probiotic milk), and all favored the combination as a booster to fluoride. Thus, the current study did not identify evidence for any strategy to effectively be used as a substitute or alternative to fluoride, but identified some consistent evidence derived from the use of prebiotic strategies (primarily from use of arginine combined with calcium) to support their potential use to boost the mechanism of action of fluoride. Thus, fluoride-based strategies remain the standard for caries prevention and management, with some evidence that boosting the effects of fluoride by the use of prebiotic strategies is a promising possibility.
... In a systematic review in 2001, Bader et al. (2001) judged the evidence for the efficacy of any given method for arresting or reversing the progression of non-cavitated carious lesions to be insufficient for any specific type of intervention due to the small number of studies and the lack of statistical testing in most studies. A recent review (Tellez et al. 2013) confirmed, however, the potential of fluoride interventions (varnishes, gels, and toothpastes) to have benefit in decreasing the progression and incidence of non-cavitated carious lesions. Studies using xylitol, CHX, and CPP-ACP vehicles alone or in combination with fluoride therapy are very limited in number and in the majority of the cases did not show a statistically significant reduction. ...
... Studies using xylitol, CHX, and CPP-ACP vehicles alone or in combination with fluoride therapy are very limited in number and in the majority of the cases did not show a statistically significant reduction. Sealants and resin infiltration studies point to a potential consistent benefit in slowing the progression or reversing non-cavitated carious lesions (Griffin et al. 2008;Tellez et al. 2013). Martignon et al. (2010) reported that the percent of the caries progression among approximal surfaces that had been sealed was lower than those assigned to a home-based flossing control after 12 months (test: 27 %, control: 51 %) and 2.5 years (test: 46 %, control: 71 %). ...
Article
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Aim: This was to collect information for the 9th European Academy of Paediatric Dentistry Interim Seminar and Workshops to discuss the state of art on non-invasive caries therapy to be used if possible to formulate clinical guidelines by European experts in paediatric dentistry METHODS: Based on systematic reviews and additional papers were assessed for methods to prevent caries initiation and caries progression both in the state of pre-cavitation and cavitation without invasive technologies. Results: The use of fluoridated water, careful diligent daily use of fluoride toothpaste, fluoride varnishes, pit and fissure sealants and leak-proof restorative materials without excavation of caries are evidence based for caries prevention and for non-invasive treatment of pre-cavitated and cavitated caries. Other technologies are far less evidenced based and would not logically fit in guidelines for the non-invasive treatment of caries. Recent studies on cavitated lesions in the primary dentition demonstrate that thorough oral hygiene practices may arrest progression. This strategy depends heavily on the strategies in the dental surgery to change behaviour of children. An important aspect is for advice to be tailored at recall intervals to ensure compliance and to timely detect unnecessary and unwanted progression of the lesions. Conclusion: Non-invasive therapies have been proven to be effective for caries prevention and the management of pre-cavitated caries lesions. Non-invasive therapies can also be effective to arrest cavitated lesions but the success depends greatly on behavioural changes of patients to brush the lesions.
... Nowadays we mostly deal with slow-progressing, early, non-cavitated caries [3,4]. However, the restorative-focused clinical practice today does not reflect the current knowledge regarding the effectiveness of early prevention or non-invasive management strategies [5,6]. ...
Article
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Dental caries remains a significant global health issue. It was highlighted by the World Health Organization’s 2022 reports that despite the efforts and scientific advancements in caries detection and management, the situation has only marginally improved over the past three decades. The persistence of this problem may be linked to outdated concepts developed almost a century ago but are still guiding dentists’ approach to caries management today. There is a need to reconsider professional strategies for preventing and managing the disease. Contemporary dentistry could benefit from embracing new concepts and technologies for caries detection and management. Dentists should explore, among others, alternative methods for caries detection such as optical-based caries detection. These tools have been established for over a decade and they align with current disease understanding and international recommendations, emphasizing early detection and minimally invasive management. This narrative review presents the current state of knowledge and recent trends in caries detection, diagnosis, monitoring, and management, offering insights into future perspectives for clinical applications and research topics.
... However, evidence is limited regarding the effectiveness of these methods for treating incipient carious lesions in high-caries-risk children. 11 In addition, there is no clear evidence of whether tooth-or patient-related risk factors may influence the success of non-invasive or micro-invasive approaches for controlling initial carious lesions. Therefore, the aim of this retrospective longitudinal study was to evaluate the effectiveness of non-invasive and micro-invasive treatments in active enamel carious lesions of high-caries-risk children and the factors associated with caries control. ...
Article
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Abstract The aim of the study was to investigate the effectiveness of non-invasive and micro-invasive treatments in active enamel carious lesions in high-caries-risk children. Clinical records of children treated in a dental school setting were retrospectively screened for active enamel carious lesions treated non-invasively (topical fluoride applications, oral hygiene instruction, or dietary guidance) or micro-invasively (sealant). The control of active carious lesions was set as the main outcome established by the combination of inactivation and non-progression of the lesions based on Nyvad and ICDAS criteria, respectively. Individual and clinical factors associated with the outcome were analyzed by Poisson regression. The sample consisted of 105 high-caries-risk children with a mean age of 8.3 (± 2.4) years. From a total of 365 active enamel carious lesions, most lesions (84.1%) were active non-cavitated carious lesions (ICDAS scores 1 and 2) and only 15.9% presented localized enamel breakdown (ICDAS score 3). Of these, 72.6% were inactivated and 92.1% did not progress (mean time of 6.5 ± 4.1 months). The prevalence of controlled carious lesions was higher among children older than 6 years (PR:1.43; 95%CI:1.00–2.03; p = 0.04) and in those with better biofilm control (PR:0.99; 95%CI: 0.98–0.99; p = 0.03). Non-operative approaches are effective for controlling active enamel carious lesions. The majority of active enamel carious lesions became inactive and did not progress after treatment. Caries control was associated with older children and better biofilm control.
... 2,4 In order to reduce subjectivity and increase sensitivity, 2,5 a classification system has been proposed to support clinicians' appropriate treatment decisions using the currently available non-invasive and invasive approaches for different forms of caries lesion processing. [6][7][8] After undergoing various adjustments, the 2002-developed International Caries Detection and Assessment System (ICDAS) was introduced as ICDAS II in 2005. 9 ICDAS II is a basic, reasonable, and evidencebased system for identifying and categorizing dental caries. ...
Article
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Background: The International Caries Detection and Assessment System (ICDAS) was developed to integrate several criteria systems into one standard system for caries detection and assessment. The aim of this study was to identify Turkish dental practitioners' perceptions and experience about ICDAS II and assess how they could affect clinical decision-making. Methods: A web-based data collection form, including demographic characteristics, experience of caries detection systems, and two different clinical images with caries and treatment options, was given to Turkish dental practitioners. Data were analyzed with the chi-square test and logistic regression using SPSS 22.0 software (IBM, Chicago, IL) at a significance level of P < 0.05. Results: Data collection forms were completed by 382 general dental practitioners. For the first clinical scenario 70.7% of the practitioners decided that no treatment was required. For the second clinical scenario 89.5% of the practitioners decided to perform tooth restoration. Considering the clinical scenario 2 treatment options, while practitioners working in the public hospital marked amalgam restoration at a higher rate, practitioners working in private clinics marked composite resin restoration and root canal treatment at a higher rate (P < 0.05). With regard to effects on treatment choices for clinical scenarios, binary logistic regression analysis found no significant effects of gender, age, or institution (P > 0.05). Conclusion: The visual caries detection system, ICDAS II, was a useful tool in standardizing caries diagnostic skills for practitioners and improving decision-making abilities on caries treatment.
... Building on serial developments in Caries Classification from 2002 by the ICDAS Foundation, and on Caries Management Meetings held in 2010 and 2011, an international workshop was held at Temple University Maurice H. Kornberg School of Dentistry in 2012 to review different systems for caries detection, risk assessment, and caries management [1,[6][7][8]. While several systems were reviewed during that workshop, no common pathway was agreed upon. ...
... Regarding the restorative treatment threshold, although there is evidence on the probability of the cessation of proximal caries limited to the enamel, dentinoenamel junction (DEJ), or outer third of dentine [53][54][55], there were different recommendations on non-restorative treatment of these lesions in guidelines. In this guide, the expert panel members accepted recommendations on non-restorative treatment of proximal caries limited to DEJ in low-risk and medium-risk patients and proximal caries limited to outer third of dentine in lowrisk patients with uncertainty and incomplete agreement. ...
Article
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Purpose To adapt an evidence-based clinical practice guideline (CPG) for risk-based management of caries in 18–55 year-old Iranian adults. Methods A multidisciplinary adaptation team reviewed evidence-based guidelines such as the NICE, SIGN, and ADA according to the defined clinical questions. In addition, databases such as the PubMed and Google Scholar were searched and CPGs were screened and appraised using the AGREE II (Appraisal of Guidelines for Research and Evaluation II) tool. Clinical scenarios were developed and their level of evidence, clinical advantage and adaptability were assessed. Following a two-round ranking by experts, the final recommendations were selected using the RAND-UCLA appropriateness method. Results Of 17 CPGs, 5 were selected as the source guidelines for adaptation. To assess the risk of caries in the adult population, reduced Cariogram (without saliva tests) and CAMBRA were suggested as diagnostic tools. In addition, 53 risk-based recommendations on the preventive care (including the use of fluoride toothpaste, fluoride, and chlorhexidine mouthwash, at home and in-office fluoride gel, fluoride varnish, mouth buffering, and sealant), operative intervention threshold, and follow-up interval were adapted for Iranian adults. Conclusions A guideline was adapted for risk-based management of dental caries in Iranian adults. This helps local dentists in decision making and promoting oral health of adults. Further research is needed to assess the external validity and feasibility of the adapted guideline in the Iranian population.
... Fluoride ions represent the major mechanism in preventing enamel demineralization due to the formation of fluorapatite in enamel in the presence of calcium and phosphate ions produced during enamel demineralization by plaque bacterial organic acids [13][14][15]. Fluoride solutions come in low concentrations for daily use, such as toothpastes and mouthwashes, and higher concentrations for professional application, such as gels and varnishes [16]. ...
Article
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Dental remineralization represents the process of depositing calcium and phosphate ions into crystal voids in demineralized enamel, producing net mineral gain and preventing early enamel lesions progression. The aim of the present study was to qualitatively and quantitatively compare the remineralizing effectiveness of four commercially available agents on enamel artificial lesions using Scanning Electron Microscopy (SEM) combined with Energy Dispersive Spectroscopy (EDS) techniques. Thirty-six extracted third molars were collected and randomly assigned to six groups (n = 6), five of which were suspended in demineralizing solution for 72 h to create enamel artificial lesions, and one serving as control: G1, treated with a mousse of casein phosphopeptide and amorphous calcium–phosphate (CPP-ACP); G2, treated with a gel containing nano-hydroxyapatite; G3, treated with a 5% SF varnish; G4, treated with a toothpaste containing ACP functionalized with fluoride and carbonate-coated with citrate; G5, not-treated artificial enamel lesions; G6, not demineralized and not treated sound enamel. G1–G4 were subjected to pH cycling over a period of seven days. Analyses of the specimens’ enamel surfaces morphology were performed by SEM and EDS. Data were statistically analyzed for multiple group comparison by one-way ANOVA/Tukey’s test (p < 0.05). The results show that the Ca/P ratio of the G5 (2.00 ± 0.07) was statistically different (p < 0.05) from G1 (1.73 ± 0.05), G2 (1.76 ± 0.01), G3 (1.88 ± 0.06) and G6 (1.74 ± 0.04), while there were no differences (p > 0.05) between G1, G2 and G6 and between G4 (2.01 ± 0.06) and G5. We concluded that G1 and G2 showed better surface remineralization than G3 and G4, after 7 days of treatment.
... Dental research has led to the development of a number of secondary prevention strategies that are based on the prompt treatment of disease at an early stage and include measures which arrest and/or reverse the caries formation process after initiation of clinical signs. 31 Various treatment options are available to treat early carious lesions in permanent teeth. 32 ...
Technical Report
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Full text available from the Health Research Board (HRB) website at: https://www.hrb.ie/publications/publication/management-of-non-cavitated-and-cavitated-caries-in-primary-permanent-and-mixed-dentition-an-evid/returnPage/1/health Copy and paste this link for full text (directing the internet traffic to the producers of this content) . Abstract from HRB website: "The purpose of this overview of reviews is to provide evidence to assist with the development of clinical guidelines on the management of non-cavitated and cavitated caries in primary and permanent teeth. Cavitated caries include caries in both crown and root of the tooth. Caries (dental decay) is a disease of the hard tissues of the teeth caused by an imbalance in this process over time, where there is net demineralisation of tooth structure by organic acids formed from the interactions between cariogenic bacteria in dental plaque and fermentable carbohydrates (mainly sugars). This overview updates an existing evidence review that was completed in 2019 and is based on 106 systematic reviews. The HRB found that there are effective alternatives to manage early carious lesions and avoid invasive restorative procedures through non-invasive (fluoride-based and other products), and microinvasive (sealants and resin infiltration) treatments. In addition, there are viable alternatives to using dental amalgam to restore cavitated caries through either direct or indirect restorations. The promising direct alternates to dental amalgam are resin-modified glass ionomer cement, compomers, and different composite resins. In addition, there are promising indirect alternates including ceramics and resin composites. Crowns fabricated from gold, metal ceramic, all ceramic, or zirconia are other alternates in specific situations. Some of these alternatives are not quite as successful as dental amalgam and some are more successful. In addition, the HRB found that there are also improved support materials and techniques available to dentists to enhance the effectiveness of interventions and acceptability of their treatments. The techniques include methods (such as selective caries removal as well as chemical or laser caries removal methods) to maximise the conservation of dentine and reduce pain experienced by the patient. The support materials include using the most appropriate adhesive for the specific intervention."
... In contact with the dentinal tubules, its particles allow dentinal occlusion by hydroxyapatite, thus providing a strong bond [29,30]. Even fluoride solutions may be relevant against DH, both when used at low concentration in toothpastes and mouthwashes for daily care and when applied at high concentrations by professional personnel, such as fluoride gels and/or fluoride varnishes [31]. Moreover, fluoride varnishes have the advantage of requiring simple application and having prolonged contact with the demineralized surface of the enamel [32]. ...
Article
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Hyperesthesia is related to increased sensitivity of dental tissues to mechanical, chemical and thermal stimuli. The aim of this prospective clinical trial was to compare the effectiveness of a calcium-fluoride-forming agent (Tiefenfluorid®, Humanchemie GmbH, Alfeld, Germany) with that of a fluoride varnish (EnamelastTM, Ultradent Inc., Cologne, Germany) in the treatment of dental hyperesthesia in adult patients. In total, 176 individuals (106 females and 70 males, aged 18–59 years old) diagnosed with dental hyperesthesia (DH) were enrolled. The main clinical symptoms were hyperesthesia from coldness and sweetness during chewing; the types of clinical lesions were also determined and recorded. The patients were selected randomly and divided into two groups: (i) the first group of 96 patients was treated with Tiefenfluorid® applied in three appointments at 7-day intervals; (ii) the second group of 80 patients was treated with EnamelastTM, applied seven times at 7-day intervals. All the patients were recalled 7 days, 14 days, 1 month, 3 months, and 6 months from the last application. At the baseline and during every follow-up visit, the DH was measured with a pulp tester. A random intercept/random slope model was used to evaluate the effect of the treatment, at various times with respect to the initial diagnosis. Within the limits of the present study, Tiefenfluorid® was more effective than EnamelastTM against DH in that it provided long-lasting results, with a significant improvement still detected at the latest 6-month follow-up.
... It is important to know that conservative remineralizing treatments based or not on fluoride and enamel regeneration offer a promising future for the control of early lesions (21). Evidence of the effectiveness of sealing the occlusal surfaces to reduce the incidence of caries has also been shown in the scientific literature (22,23), although invasive or non-invasive pit and fissure sealing was indicated by only 1.5% and 5.5% respectively. The results of our research show that the new knowledge and concepts on the management of caries lesions have not yet been incorporated by the surveyed dentists in their daily clinical practice, results that are consistent with other studies focused on different aspects of caries management, such as the research by Crespo-Gallardo et al. (24,25) on the diagnosis and treatment of deep caries, concluding that the recommendations based on scientific evidence in caries management are not yet part of dentists' common clinical behavior. ...
Article
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Background: The diagnosis of caries, the stage of the disease and the indication of treatment are among the most controversial issues in dentistry. Studies comparing the diagnosis and treatment indication of different professionals show the lack of a unifying criterion in the diagnosis and treatment plan of the disease. The Objectives of this research is to evaluate the attitude of a group of odontostomatologists to a clinical case with lesions compatible with caries, evaluating whether their criteria and attitude in diagnosis and treatment depend on their academic level, years of professional practice, the application of minimal intervention dentistry criteria and the usual practice in conservative restorative treatments. Material and Methods: A survey was applied to dentists registered at the Illustrious Official College of Dentists of the Balearic Islands. The questionnaire was developed by the researchers from a real clinical case. A descriptive statistical analysis was performed of all the generated data and, to evaluate the association between the survey responses and the variables of interest, the χ^2 of independence test was performed. In addition, tests comparing the corresponding proportions were conducted using Fisher’s exact test. Results: Regarding pit and fissure significant differences were found in the diagnosis in 46 in terms of dentists’ qualifications and in the treatment between the application of minimal intervention dentistry criteria and the usual practice in conservative restorative treatments. No significant differences were found in the other variables analyzed. As regards caries lesions on proximal surfaces, no significant differences were found in the diagnosis or treatment in any of the variables analyzed. Conclusions: That there is no change in the professional attitude towards the diagnosis and treatment of caries lesions in this group of professionals, having very interventionist criteria and attitudes in all variables analyzed.
... It is important to know that conservative remineralizing treatments based or not on fluoride and enamel regeneration offer a promising future for the control of early lesions (21). Evidence of the effectiveness of sealing the occlusal surfaces to reduce the incidence of caries has also been shown in the scientific literature (22,23), although invasive or non-invasive pit and fissure sealing was indicated by only 1.5% and 5.5% respectively. The results of our research show that the new knowledge and concepts on the management of caries lesions have not yet been incorporated by the surveyed dentists in their daily clinical practice, results that are consistent with other studies focused on different aspects of caries management, such as the research by Crespo-Gallardo et al. (24,25) on the diagnosis and treatment of deep caries, concluding that the recommendations based on scientific evidence in caries management are not yet part of dentists' common clinical behavior. ...
Article
Full-text available
Background: The diagnosis of caries, the stage of the disease and the indication of treatment are among the most controversial issues in dentistry. Studies comparing the diagnosis and treatment indication of different professionals show the lack of a unifying criterion in the diagnosis and treatment plan of the disease. The Objectives of this research is to evaluate the attitude of a group of odontostomatologists to a clinical case with lesions compatible with caries, evaluating whether their criteria and attitude in diagnosis and treatment depend on their academic level, years of professional practice, the application of minimal intervention dentistry criteria and the usual practice in conservative restorative treatments. Material and methods: A survey was applied to dentists registered at the Illustrious Official College of Dentists of the Balearic Islands. The questionnaire was developed by the researchers from a real clinical case. A descriptive statistical analysis was performed of all the generated data and, to evaluate the association between the survey responses and the variables of interest, the χ^2 of independence test was performed. In addition, tests comparing the corresponding proportions were conducted using Fisher's exact test. Results: Regarding pit and fissure significant differences were found in the diagnosis in 46 in terms of dentists' qualifications and in the treatment between the application of minimal intervention dentistry criteria and the usual practice in conservative restorative treatments. No significant differences were found in the other variables analyzed. As regards caries lesions on proximal surfaces, no significant differences were found in the diagnosis or treatment in any of the variables analyzed. Conclusions: That there is no change in the professional attitude towards the diagnosis and treatment of caries lesions in this group of professionals, having very interventionist criteria and attitudes in all variables analyzed. Key words:Atraumatic restorative treatment, caries detection, demineralization, non-cavitated caries lesions, radiography.
... Identifying dental caries from the initial clinical beginning is extremely important, because it gives the opportunity to carry out non-surgical caries management, as fluoride interventions (varnishes, gels, and toothpaste), sealants and resin infiltration and oral health education (23)(24). All of the mentioned activities are feasible in school basedoral health programs. ...
Article
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Since 2013, the Faculty of Dentistry of the University of Costa Rica has provided a preventive and restorative oral health program at Carmen Lyra Public School. The first generation of students that received dental care from this project were examined in 2019 for caries status. A total of 62 twelve-year-old schoolchildren were examined (31 boys and 31 girls). First, all teeth surfaces were cleaned with a brush and then rinsed. Subsequently, examination was performed in each person by a calibrated examiner using the International Caries Detection and Assessment System (ICDAS). Prevalence of dental caries was 59.7%. ICDAS code 2 was the most prevalent (68.8%), followed by 1 (19.3%), 5 (4.5%), 3 (3.5%), 6 (2.5%), and 4 (1.4%). Regarding number of carious surfaces, the highest prevalence was observed in the occlusal surfaces (77.3%), followed by the vestibular (13.9%), mesial (4.2%), palatal/lingual (4,1%) and distal (0.5%). Of these carious surfaces, 7% were caries associated with restorations and were present only on the occlusal surfaces. Boys had more cavities than girls (54.1% compared to 45.9%), however, this difference was not significant. Regarding the condition of restorations in teeth, 92 dental restorations (resin or amalgam) were found in the population studied and were well adjusted. Most of these restorations were found on the occlusal surfaces (82.6%), followed by vestibular surfaces (8.7%,) palatal/lingual (5.4%) surfaces, mesial surfaces (3.3%), and no restorations were detected on the distal surfaces. Sealants were identified in 11.3% schoolchildren; 98% were identified on the occlusal surfaces and the other 2% were found on the palatal/lingual surfaces. DMFT Index was 1.6±0.71. The prevalence of dental caries in this sample was low compared to other studies in twelve-year-old schoolchildren in Costa Rica. This may suggest that the oral health program had a positive impact in the studied population.
... The patterns of dental caries reflect the risk profiles in relation to social level, economic conditions, and application of preventive program. However, it has been founded that dental caries is a reversed disease that can be arrested or reversed if it treated in its early stages (1) . According to the principle of minimum intervention, three decades ago, fluoride has been successfully giving good result in caries prevention. ...
... This is achieved by the use of ozone and chlorhexidine or resin infiltration 17 as well. Sealants could also be applied for this purpose 18,19 . Ozone has proven to be effective against bacteria (both gram-negative and gram-positive) as well as viruses and fungi 20,21 . ...
Article
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The aim of the study was to assess the efficacy of three methods of enamel remineralization on initial approximal caries: (1) a nano-hydroxyapatite gel, (2) gaseous ozone therapy, (3) combination of a nano-hydroxyapatite gel and ozone. Patients (n = 92, age 20–30 years) with initial approximal enamel lesions on premolar and molar teeth (n = 546) were randomly allocated to three groups subjected to a 6-months treatment: Group I: domestic nano-hydroxyapatite remineralizing gel, group II: in-office ozone therapy, group III: both domestic remineralizing gel and ozone therapy. Caries lesions were assessed on bitewing radiographs at baseline, after 1 year and after 2 years. At one-year follow-up, the smallest rate of lesions with remineralisation (36.5%) was found in group I, and the highest (69.3%)—in group III. In group III a significant remineralisation was noticed in after 1 year and then a demineralisation after 2 years. Thus nano-hydroxyapatite gel and ozone therapy exert some capacities to remineralize approximal enamel and dentine subsurface lesions of premolar and molar teeth. Moreover, the combination of both methods produces the best effect compared to nano-hydroxyapatite or ozone therapy applied alone. However, the treatment should be continued for a long time in order to achieve nonrestorative recovery of caries.
... Although restorations are required for cavitated lesions, non-cavitated occlusal carious lesions may benefit from non-invasive therapies and invasive restorations should be omitted when a questionable occlusal carious lesion (QOCL) exists. 14,[18][19][20] QOCLs are defined by the following criteria -non-cavitated (no break in enamel continuity); no radiographic evidence of caries, but possible presence of a carious lesion due to roughness, surface opacities; or staining of the occlusal surface. 20,21 Makhija et al. reported from a practice-based survey of American and Scandinavian practitioners that 34% of all patients seen by the practitioners had QOCLs. ...
Article
Introduction: Many questionnaire surveys evaluating caries management strategies in dental practices have been undertaken around the world; nevertheless, less is known about the care delivery specifically related to questionable occlusal carious lesions (QOCLs). Aim: The aim of the study was to investigate management strategies for two clinical cases toward QOCLs by California (CA) and French dental general practitioners (GPs). Materials and methods: A questionnaire was administrated by e-mail to 16,960 CA licensed dentists and by postal-mail to 2,000 randomly selected French GPs. Descriptive analyses were performed to characterize the responses to the different questions related to the management strategies for the two clinical cases. Results: The results showed an absence of understanding about carious lesion management for both CA and French GPs. There was a substantial variability between and within the two GPs populations with a marked tendency among the respondents of both countries to intervene surgically for the management of QOCLs that may benefit from non-invasive therapies. Conclusion: As it takes time for paradigm shifts in dentistry, it can be hypothesised that the marked tendency among the respondents of both countries to intervene surgically for the QOCL management still persists. https://fjdentalmedopen.com/management-decisions-of-questionable-occlusal-carious-lesions-by-california-and-french-dentists-a-comparison-of-scientific-evidence-and-clinical-practice/
... 53 They are also effective at stopping the progression of carious lesions 54,55 in permanent teeth, as they prevent lesion access to the carbohydrate that is necessary for the biofilm to thrive and stay actively cariogenic. 56,57 Although the pathophysiological evidence supports the efficacy of sealing-in to slow or stop progression of carious lesions, the clinical evidence for fissure sealants shows mixed success in permanent teeth. Fissure sealant materials wear and fracture and regularly need to be replaced and, therefore, require continual observation to ensure that the seal is maintained. ...
Article
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Background Historically, lack of evidence for effective management of decay in primary teeth has caused uncertainty, but there is emerging evidence to support alternative strategies to conventional fillings, which are minimally invasive and prevention orientated. Objectives The objectives were (1) to assess the clinical effectiveness and cost-effectiveness of three strategies for managing caries in primary teeth and (2) to assess quality of life, dental anxiety, the acceptability and experiences of children, parents and dental professionals, and caries development and/or progression. Design This was a multicentre, three-arm parallel-group, participant-randomised controlled trial. Allocation concealment was achieved by use of a centralised web-based randomisation facility hosted by Newcastle Clinical Trials Unit. Setting This trial was set in primary dental care in Scotland, England and Wales. Participants Participants were NHS patients aged 3–7 years who were at a high risk of tooth decay and had at least one primary molar tooth with decay into dentine, but no pain/sepsis. Interventions Three interventions were employed: (1) conventional with best-practice prevention (local anaesthetic, carious tissue removal, filling placement), (2) biological with best-practice prevention (sealing-in decay, selective carious tissue removal and fissure sealants) and (3) best-practice prevention alone (dietary and toothbrushing advice, topical fluoride and fissure sealing of permanent teeth). Main outcome measures The clinical effectiveness outcomes were the proportion of children with at least one episode (incidence) and the number of episodes, for each child, of dental pain or dental sepsis or both over the follow-up period. The cost-effectiveness outcomes were the cost per incidence of, and cost per episode of, dental pain and/or dental sepsis avoided over the follow-up period. Results A total of 72 dental practices were recruited and 1144 participants were randomised (conventional arm, n = 386; biological arm, n = 381; prevention alone arm, n = 377). Of these, 1058 were included in an intention-to-treat analysis (conventional arm, n = 352; biological arm, n = 352; prevention alone arm, n = 354). The median follow-up time was 33.8 months (interquartile range 23.8–36.7 months). The proportion of children with at least one episode of pain or sepsis or both was 42% (conventional arm), 40% (biological arm) and 45% (prevention alone arm). There was no evidence of a difference in incidence or episodes of pain/sepsis between arms. When comparing the biological arm with the conventional arm, the risk difference was –0.02 (97.5% confidence interval –0.10 to 0.06), which indicates, on average, a 2% reduced risk of dental pain and/or dental sepsis in the biological arm compared with the conventional arm. Comparing the prevention alone arm with the conventional arm, the risk difference was 0.04 (97.5% confidence interval –0.04 to 0.12), which indicates, on average, a 4% increased risk of dental pain and/or dental sepsis in the prevention alone arm compared with the conventional arm. Compared with the conventional arm, there was no evidence of a difference in episodes of pain/sepsis among children in the biological arm (incident rate ratio 0.95, 97.5% confidence interval 0.75 to 1.21, which indicates that there were slightly fewer episodes, on average, in the biological arm than the conventional arm) or in the prevention alone arm (incident rate ratio 1.18, 97.5% confidence interval 0.94 to 1.48, which indicates that there were slightly more episodes in the prevention alone arm than the conventional arm). Over the willingness-to-pay values considered, the probability of the biological treatment approach being considered cost-effective was approximately no higher than 60% to avoid an incidence of dental pain and/or dental sepsis and no higher than 70% to avoid an episode of pain/sepsis. Conclusions There was no evidence of an overall difference between the three treatment approaches for experience of, or number of episodes of, dental pain or dental sepsis or both over the follow-up period. Future work Recommendations for future work include exploring barriers to the use of conventional techniques for carious lesion detection and diagnosis (e.g. radiographs) and developing and evaluating suitable techniques and strategies for use in young children in primary care. Trial registration Current Controlled Trials ISRCTN77044005. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 24, No. 1. See the NIHR Journals Library website for further project information.
... Guidance references: 1,2,3,4,5,6,7,8,9,10,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54 Concluding key points and guidance for implementation ...
Article
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This CariesCare practice guide is derived from the International Caries Classification and Management System (ICCMS) and provides a structured update for dentists to help them deliver optimal caries care and outcomes for their patients. This '4D cycle' is a practice-building format, which both prevents and controls caries and can engage patients as long-term health partners with their practice. CariesCare International (CCI™) promotes a patient-centred, risk-based approach to caries management designed for dental practice. This comprises a health outcomes-focused system that aims to maintain oral health and preserve tooth structure in the long-term. It guides the dental team through a four-step process (4D system), leading to personalised interventions: 1st D: Determine Caries Risk; 2nd D: Detect lesions, stage their severity and assess their activity status; 3rd D: Decide on the most appropriate care plan for the specific patient at that time; and then, finally, 4th D: Do the preventive and tooth-preserving care which is needed (including risk-appropriate preventive care; control of initial non-cavitated lesions; and conservative restorative treatment of deep dentinal and cavitated caries lesions). CariesCare International has designed this practice-friendly consensus guide to summarise best practice as informed by the best available evidence. Following the guide should also increase patient satisfaction, involvement, wellbeing and value, by being less invasive and more health-focused. For the dentist it should also provide benefits at the professional and practice levels including improved medico-legal protection.
... 1,2 Fluoride solutions come in low concentration for daily use, such as toothpastes and mouthwashes, and higher concentrations for professional application, such as fluoride gels and fluoride varnishes. 3 The advantages of varnishes are their simple application and prolonged contact with the demineralized surface of the enamel. 4,5 They are also an important adjuvant in the control and treatment of white spot caries lesions. ...
Article
Full-text available
The aim of this study was to evaluate soluble and insoluble fluoride concentrations in commercial varnishes, and their remineralization effect on artificial caries enamel lesions using surface and cross-sectional microhardness evaluations. Forty bovine enamel blocks were separated into four groups (n=10): control (no treatment), Enamelast (Ultradent Products), Duraphat (Colgate-Palmolive) and Clinpro White Varnish (3M ESPE). Surface enamel microhardness evaluations were obtained, artificial enamel caries lesions were developed by dynamic pH-cycling, and the varnishes were then applied every 6 days, after which the enamel blocks were submitted to dynamic remineralization by pH cycles. After removal of the varnishes, the enamel surfaces were reassessed for microhardness. The blocks were sectioned longitudinally, and cross-sectional microhardness measurements were performed at different surface depths (up to 300 μm depth). Polarized light microscopy images (PLMI) were made to analyze subsurface caries lesions. The fluoride concentration in whole (soluble and insoluble fluoride) and centrifuged (soluble fluoride) varnishes was determined using an extraction method with acetone. The data were analyzed to evaluate the surface microhardness, making adjustments for generalized linear models. There was a significant decrease in enamel surface microhardness after performing all the treatments (p
... Results of the present study are in disagreement with other studies where toothpaste that contains 5000-ppm fluoride was significantly better compared to toothpaste that contains 1450-ppm fluoride in reversing incipient lesions without cavity formation. [42][43][44] The comparison of the present results with previous studies is difficult, and Bader and others 45 reached the same conclusion in a systematic review of 1435 articles on the effectiveness of preventive methods in high-risk individuals with incipient lesions. They concluded that the main limitations of the literature regarding the treatment of incipient lesions were the small number of studies as well as variation among patients, tooth surfaces, caries assessment and lesion progression criteria and variation in the experimental and control groups; thus, it is impossible to achieve a comparable conclusion about the effectiveness of any method. ...
Article
The aim of this study was to investigate the management of incipient caries lesions in adults with two preventive protocols. A total of 44 adult patients with high, moderate and low caries risk with 516 incipient caries took part in the study. These patients were assessed for caries with International Caries Detection and Assessment System (ICDAS) criteria and were then divided into three groups depending on their caries risk profile: a high-risk group (group A), a moderate-risk group (group B), and a low-risk group (group C). Participants in each group were further divided randomly into two subgroups. In subgroups A1, B1, and C1, an intensive preventive protocol was applied, while in subgroups A2, B2, and C2, the protocol consisted only of instructions in oral hygiene. The invasive-intensive protocol included the topical application of fluoride, brushing with 5000-ppm fluoride toothpaste, use of amorphous calcium phosphate-casein phosphopeptide, applications of sealants for occlusal lesions (ICDAS code 2), and minimal resin restorations for occlusal lesions (ICDAS code 3). There was no statistically significant difference in the number of lesions (baseline and after one year) in the high-risk and moderate-risk groups that received the intensive protocol (groups A1 and B1), while the control groups were statistically significant different (groups A2 and B2). In the low-risk group, there was no statistically significant difference in the number of lesions (groups C1 and C2). The two different preventive protocols in the high- and moderate-risk groups presented differences in effectiveness, while in the low-risk group, no significant difference was demonstrated.
... 25,36,49 This is why nonrestorative (ie, noninvasive or microinvasive) alternatives for managing carious lesions are recommended today. 50,51 The question that should be raised now is, Why do we not always resort to noninvasive or microinvasive instead of invasive (restorative) management of carious lesions? There are two reasons that restorations remain needed. ...
Article
Full-text available
Over the past 30 years and fueled by both a rapidly evolving understanding of dental diseases and technological advances in diagnostics and therapy, dentistry has been changing dramatically. Managing dental caries and carious lesions had, for nearly a century, encompassed only a small number of basic concepts that were applied to virtually all patients and lesions, namely, invasive removal of any carious tissue regardless of its activity or depth and its replacement with restorative materials (amalgams or crowns for most of the past) or tooth removal and prosthetic replacement. Grounded in a deeper understanding of the disease "caries," its management-aiming to control the causes of the disease, to slow down or alleviate existing disease, and, only as a last resort, to remove its symptoms using a bur or forceps-has become more complex and diverse. In parallel and at nearly unprecedented speed, our patients are changing, as mirrored by ongoing debates as to the demographic and, with it, the social future of most high-income countries. This article describes how these changes will have a profound future impact on how we practice dental medicine in the future. It will deduce, from both demographic and epidemiologic trends, why there is the need to apply not one but rather the whole range of existing evidence-based concepts in an individualized (personalized) manner, hence increasing the effectiveness and efficiency of dental management strategies, and also describe how these strategies should be tailored according not only to our patients (their age and risk profiles) but also to the specific tooth (or site or lesion).
... Lesions that indicate radiographically, radiolucency in the inner half of the enamel (E2), and radiolucency, in the outer third of the dentin (D1), are suitable for resin infiltration treatment. These lesions would be active, presenting no signs of cavitation (grade of recommendation A). [10][11][12][13][14][15][16][17][18][19][20] Studies with fewer methodological limitations as per ICDAS-Scores should be performed in order to create a high-level guide for predictable and effective clinical decisions. ...
Article
Objectives The purpose of the present study is to establish a guideline on the management of proximal enamel lesions with resin infiltration. Methods Each article in compliance with the inclusion criteria was evaluated by two independent authors, individually. The methodological quality assessment of the selected articles was conducted using SIGN checklists. Results A total of 15 in vivo studies, 12 systematic reviews and one economic evaluation fulfilled the selection criteria for in-depth analysis of the full text and quality assessment. Conclusions Infiltration of incipient enamel caries lesions is a clinically feasible and effective method for the treatment of interproximal lesions with high success rates, taking also into consideration the limitations of this systematic review.
... The remineralization effect of topical fluoride application has been adequately demonstrated in a recently reported systematic review [6]. However, the prognosis after professional fluoride application varies depending on the severity of the early carious lesions. ...
Article
Purpose: The aim of thisin situ study was to measure baseline fluorescence loss values (ΔF(0)) using the quantitative light-induced fluorescence (QLF) technology to screen enamel lesions for effective remineralization following fluoride application. Methods: In this single-blindedin situ study, 20 adult volunteers wore intraoral appliances containing 4 specimens of human enamel. The surfaces of the specimens were divided into 3 regions: sound, demineralized, and treated regions. After generating 80 artificial enamel lesions with varying ΔF values, all specimens were covered with 1.23% acidulated phosphate fluoride gel for 1 min. Three repeated QLF-digital measures of ΔF values were then obtained for the lesions, immediately after demineralization and at 1 and 4 weeks after fluoride application. Results and conclusion: Fluoride application was found to increase the ΔF values of lesions significantly over time (p < 0.001). The groups with lower ΔF(0) values showed significantly larger changes in ΔF values over time (p < 0.001). Receiver operating characteristics analysis showed that baseline lesion values of ΔF(0) = -17.50 and -25.50 would allow for lesion ΔF to recover to -10 at 1 and 4 weeks after fluoride application, respectively (p < 0.001). The findings of this study indicate that clinicians can establish prognostic criteria for early carious lesions using the QLF technology, and hence predict the efficacy of fluoride treatment and devise effective lesion-specific treatment plans.
... There is good evidence that preventive and sealing-in approaches to managing the non-cavitated lesion are successful, whether these are fluoride or other topical formulations or sealants applied to the teeth. 32 ...
... Secondary preventive measures such as the use of chewing gums are seldom used by dental professionals ). Since the effectiveness of such modalities has been recognized, it is essential to increase the awareness of dentists in utilizing such effective modality than can be a valid alternative to surgical measures for caries management Tellez, Gomez et al. 2013). ...
Article
Full-text available
Xylitol is a naturally occurring sweetener that cannot be metabolized by oral microorganisms. When used as sugar substitute, it can lead to a reduction in dental caries incidence. The use of xylitol and other sugar alternatives is not common practice in restorative dentistry. One reason for this could be the lack of understanding of the proper rationale for utilizing such a preventive modality. This effort aims to summarize the literature concerned with xylitol in chewing gums and provides a concise guideline for the use of this preventive approach in clinical practice.
... For "early" carious lesions, current evidence suggests the use of noninvasive and nonrestorative methods (Splieth et al. 2010;Tellez et al. 2013;Dorri et al. 2015), like sealing carious lesions (sealants and resin infiltration), and remineralization procedures mainly with fluorides (varnishes, gels, and toothpaste; Marinho et al. 2003;Marinho et al. 2013) or using CPP-ACP (casein phosphopeptide amorphous calcium phosphate) vehicles alone or in combination with fluoride interventions (Gupta et al. 2016). Remineralization focuses on inactivating the lesion, shifting the equilibrium toward remineralization by reducing the solubility of the dental tissue or increasing the surface area for mineral redeposition (Weatherell et al. 1977;Reynolds 2005). ...
Article
Modern approaches in caries treatment involve lesion management without tissue removal. Regenerative medicine focuses on replacing damaged tissues with biologically similar tissues. This article discusses the scientific evidence and clinical results for self-assembling peptides in modern caries management. The biomimetic remineralization promoted by self-assembling peptide P11-4 has been proven in vitro as an effective therapy for initial caries. P11-4 was rationally designed to promote formation of hydroxyapatite on its surface. The formulation was optimized to ensure the ability of monomeric P11-4 to penetrate past the subsurface lesions and assembly into a biomatrix within. Furthermore, P11-4 has shown that it assembles into fibers within carious lesions, and promotes the remineralization thereof. In a recent clinical study, the safety and efficacy of P11-4 in treatment of initial caries were evaluated. The additional effect of the application of P11-4 (Curodont Repair) was compared to the application of fluoride varnish (Duraphat) alone in active occlusal initial caries lesions on erupting permanent molars. In the 3- and 6-month recalls, the test group showed, both in the laser fluorescence readings and in the clinical assessment of the caries stage and activity, significantly superior lesion regression compared to the control group. No adverse events, medical complications, or allergic reactions related to the treatments were reported. Clinical applicability of treatment was regarded as satisfactory. Patients were happy to receive noninvasive caries treatments. In conclusion, biomimetic mineralization facilitated by P11-4 in combination with fluoride may present a simple, safe, and effective noninvasive treatment for early carious lesions.
... For noncavitated lesions, a great many options are available to allow such management (activity control) without any removal of tissue. 9 For example, noninvasive strategies limit the intake of carbohydrates via dietary control, thus re-balancing the composition and activities of dental biofilms. Biofilm removal or inactivation via mechanical or chemical oral hygiene control similarly target the biofilm, its composition or maturation, and activity. ...
Article
Full-text available
Objectives: Based on a changed understanding of the disease caries and its pathogenesis, strategies for carious tissue removal have changed, too. This review aims to summarize these changes and to provide clinical recommendations. Overview: Removing all carious dentin from a cavity is not needed any longer to manage caries or the carious lesion. Instead, the carious lesion should be treated in a way allowing to arrest its activity, while preserving sound tooth tissue and pulp vitality. For teeth with vital pulps, a number of removal strategies have been developed: (1) Nonselective (complete) removal, which is not recommended any longer, (2) Selective removal to firm dentin, where firm dentin is left centrally and hard dentin peripherally, allowing the placement of a long-lasting restoration while avoiding the removal of remineralizable tissue; this is recommended for shallow or moderately deep lesions; (3) Selective removal to soft dentin, where soft or leathery dentin is left in proximity to the pulp and sealed beneath a restoration; this is recommended for deep lesions; (4) Stepwise removal; which combines different strategies and is also suitable for deep lesions, at least in adult patients. Alternatives include not removing but sealing the lesions using resins (for shallow, noncavitated lesions) or stainless steel crowns (the Hall Technique, for cavitated lesions in primary molars), or opening up the lesion and regularly cleaning it (nonrestorative cavity control, currently not supported by sufficient evidence). Clinical significance: Dentists should tailor their carious tissue removal strategy according to tooth type and, more importantly, lesion depth.
... Secondary preventive measures such as the use of chewing gums are seldom used by dental professionals ). Since the effectiveness of such modalities has been recognized, it is essential to increase the awareness of dentists in utilizing such effective modality than can be a valid alternative to surgical measures for caries management Tellez, Gomez et al. 2013). ...
Conference Paper
Introduction: Sugar-free products are popular owing to their dental-related benefits. Objective: To assess the available sugar-free products in the Saudi market. Materials and Methods: Sugar-free products from five major stores were collected. Percentages of sugar substitutes were investigated by the label or by the manufacturer. Descriptive analyses of sweetener’s type and concentrations were performed. Results: The main sugar substitutes were Sorbitol and Sucralose in gums and sweeteners, respectively. Acesulfame-K was found in 64% of the products whereas xylitol was present in only 16%. Conclusion: Several products contain mixtures of different sugar substitutes. Acesulfame-K and Aspartame were the major sugar substitutes.
... Therefore, strategies and public health policies should be directed at making mothers aware of the identification of dental caries in the initial stage. The knowledge of caregivers regarding the fact that a white spot is early tooth decay could encourage mothers to seek dental treatment for their children and arrest the progression of dental caries (Tellez et al. 2013). ...
Article
Full-text available
Aim: To analyse the maternal identification of different stages of dental caries in children aged 1-3?years. Methods: A cross-sectional study was conducted with 274 children and their mothers. The mothers answered a questionnaire on the occurrence of dental caries in their children and completed questions addressing their demographic/socio-economic status. The oral examination of the children was performed using the International Caries Detection and Assessment System. Descriptive, Chi square test and Poisson regression statistical analyses were performed. Results: The prevalence of initial and established/severe dental caries lesions by age were: 1?year (23.2 and 24.2%), 2?years (17.9 and 55.7%) and 3?years (23.3 and 60.3%) respectively. Significant associations between clinical examinations and the mothers' reports were observed among children aged 1?year old who had initial stage caries lesions (p?=?0.006) and in children aged 1, 2 and 3?years old who had established/severe stage caries lesions (p?<?0.001). After adjustment for confounding variables it was found that mothers were more able to identify dental caries both at initial (PR 4.01, 95% CI 1.35-11.94) and established/severe stages (PR 9.14, 95% CI 2.49-33.56) in children aged 1?year old. In children aged 2 and 3?years, this identification was more evident in the established/severe stage (2?years, PR 2.98, 95% CI 1.42-6.26; 3?years, PR 2.75, 95% CI 1.09-6.93). Conclusions: Mothers of children aged 1?year old identified dental caries at initial and established/severe stages. Mothers of children aged 2 and 3?years identified dental caries only at established/severe stages.
... These treatments involve preparing (etching) the affected tooth surface with an acid and then either placing a sealant (cover) on top of the surface or "infiltrating" the porous demineralized tissue with resins (Dorri et al. 2015). Microinvasive treatments have resulted in less carious lesion progression than the traditional noninvasive approaches, and they appear promising (Tellez et al. 2013;Dorri et al. 2015). ...
Article
This study aimed to assess whether resin infiltration of primary molar proximal lesions is more effective than noninvasive measures in radiographically controlling carious lesion progression into the dentin. A split-mouth randomized controlled trial included 90 children, each with 2 proximal lesions confined to the inner half of the enamel or ≤0.5 mm into the dentin. For each child, lesions were randomly allocated to test (infiltration: DMG Icon preproduct and fluoride varnish) or control (fluoride varnish) status. The primary outcome measure was 24-mo radiographic lesion progression. Placement of a restoration during the study period was counted as lesion progression. Proportions of teeth with progressed lesions were compared using the McNemar test. Children also reported on the treatment’s acceptability to them. Children (46% female) ranged in age from 6 to 9 y. Their mean number of decayed, missing, and filled teeth (d3mft) was 2.8 (SD 2.6). At baseline, 58% and 42% of children were at moderate and low risk, respectively. Test and control lesions presented with similar radiographic lesions at baseline. At the 24-mo follow-up, 6 children had moved and 30 teeth had exfoliated. In the test and control groups, 15 of 66 lesions (22.7%) and 30 of 69 lesions (43.5%) had progressed, respectively (P < 0.05). The 2-y therapeutic effect (based on pairwise radiographic readings) of infiltration over fluoride varnish was 20.8% (95% confidence interval, 10.6%−30.2%). Nearly all children (96.7%) had enjoyed their visit to the clinic, and more than two-thirds (72.2%) were not worried about returning for treatment. Infiltration is more efficacious than fluoride varnish for controlling carious lesion progression in proximal lesions in primary molars, and most children find the treatment acceptable (Australian New Zealand Clinical Trials Registry ANZCTR.org.au ACTRN12611000827932).
... Traditionally, non-invasive strategies for preventing the development and progression of dental caries lesions include the control of the biofilm maturation and activity, control of the diet, and control of the mineralization, mostly by providing constant supply of low level of fluoride at plaque fluid/saliva/ tooth surface interface [1]. Among the latter, the toothpaste has been up to now the most successful way of providing this kind of fluoride delivery [2]. ...
Article
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Objectives The caries-protective effects of CO2 laser irradiation on dental enamel have been demonstrated using chemical demineralization models. We compared the effect of CO2 laser irradiation, sodium fluoride, or both on biofilm-induced mineral loss (∆Z) and Streptococcus mutans adhesion to enamel and dentin in vitro. Materials and methods Ground, polished bovine enamel, and dentin samples were allocated to four groups (n = 12/group): no treatment (C); single 22,600-ppm fluoride (F) varnish (5 % NaF) application; single CO2 laser treatment (L) with short pulses (5 μs/λ = 10.6 μm); and laser and subsequent fluoride treatment (LF). Samples were sterilized and submitted to an automated mono-species S. mutans biofilm model. Brain heart infusion plus 5 % sucrose medium was provided eight times daily, followed by rinses with artificial saliva. After 10 days, bacterial numbers in biofilms were enumerated as colony-forming units/ml (CFU/ml) (n = 7/group). ∆Z was assessed using transversal microradiography (n = 12/group). Univariate ANOVA with post hoc Tukey honestly-significant-difference test was used for statistical analysis. Results Bacterial numbers were significantly higher on dentin than enamel (p < 0.01/ANOVA). On dentin, LF yielded significantly lower CFUs than other groups (p = 0.03/Tukey), while no differences between groups were found for enamel. The lowest ∆Z in enamel was observed for L (mean/SD 2036/1353 vol%×μm), which was not only significantly lower than C (9642/2452 vol%×μm) and F (7713/1489 vol%×μm) (p < 0.05) but also not significantly different from LF (3135/2628 vol%×μm) (p > 0.05). In dentin, only LF (163/227) significantly reduced ∆Z (p < 0.05). Conclusion/clinical relevance CO2 laser irradiation did not increase adhesion of S. mutans in vitro. Laser treatment alone protected enamel against biofilm-induced demineralization, while a combined laser-fluoride application was required to protect dentin.
... Zudem wird befürchtet, dass Nachbehandlungen früher als bei invasiven (restaurativen) Maßnahmen nötig werden. Jedoch kann entgegnet werden, dass mikroinvasive Therapien weniger von der Mitarbeit des Patienten abhängen als non-invasive Therapien und daher möglicherweise wirksamer sind [38]; ebenso kann eine Verzögerung invasiver Maßnahmen die im ersten Artikel dieser Ausgabe beschriebene "Todesspirale" aus Restauration, Restaurationsversagen und Re-Restaurationen verlangsamen, wodurch Zähne langfristig bei geringeren Kosten erhalten werden könnten [4,33]. Daher ist zur prüfen, ob der Einsatz mikro-invasi-ver im Vergleich zu non-invasiven (Fluoridierung, Mundhygieneinstruktionen) oder invasiven (restaurativen) Therapien kostenwirksam ist. ...
... One could expect that children with these stages of caries lesions had a higher probability of developing extensive lesions after the follow-up than caries-free children, and consequently, this progression would be translated into higher ECOHIS scores. Different authors have advocated the early detection of caries lesions [22][23][24] , as lesions could be arrested at this stage, avoiding their progression to more severe stages of the caries process 23,25 . However, this premise was not confirmed in our study. ...
Article
Objectives: We aimed to assess the impact of the presence of initial and other stages of dental caries on the impairment of oral health-related quality of life in preschool children (COHRQoL) through a cohort study. Methods: During an epidemiological survey, 478 children (12-59 months old) were examined for dental caries using the International Caries and Detection Assessment System (ICDAS), and their parents answered the Early Childhood Oral Health Impact Scale (ECOHIS). Children were categorized based on the presence of dental caries as follows: children with no caries lesions, children with only initial lesions (ICDAS scores 1 and 2), children with at least one moderate lesion (ICDAS scores 3 and 4) and children with extensive lesions (ICDAS scores 5 and 6). After 2 years, 352 children were re-examined for the presence of dentine cavitations, and their parents completed a new ECOHIS questionnaire. Multilevel Poisson regression analysis was performed to evaluate the impact of the presence of different stages of caries lesions at the baseline on COHRQoL impairment at the follow-up, considering two outcome variables: worsening and severe worsening of COHRQoL. Relative risk values (RR) and respective 95% confidence intervals (95% CI) were calculated. Results: Worsening or severe worsening of the COHRQoL at the follow-up were observed only in children with moderate lesions (RR = 2.00; 95% CI = 1.30-3.08 and RR = 2.38; 95% CI = 1.31-4.34, respectively) or children with extensive lesions (RR = 1.59; 95% CI = 1.10-2.30 for worsening and RR = 1.88; 95% CI = 1.13-3.12 for severe worsening). On the other hand, the presence of only initial caries lesions was not a significant predictor of COHRQoL impairment. Conclusions: The presence of only initial caries lesions does not impair COHRQoL of preschool children; however, moderate and extensive lesions are risk factors for worsening of the COHRQoL.
Chapter
Tooth discoloration can be one of the most upsetting dental defects a person can encounter in their life. There are several techniques that can be employed to address esthetic concerns. Techniques include whitening agents, microabrasion, resin infiltration, and the bleach–etch–seal technique. Teeth whitening products have been marketed to help improve surface esthetics and overall color appearance of the adult dentition. Commercially and professionally applied tooth whitening agents contain either hydrogen peroxide or carbamide peroxide. Selecting a vital bleaching agent is dependent on many factors, such as expected outcome, compliance, and exposure to refractory staining agents. The American Dental Association delineates at-home products into three broad categories: whitening toothpastes, home-use bleaching agents, and in-office whitening. Microabrasion is a conservative, nonrestorative method that can be used to improve the appearance of teeth with relatively superficial defects. Resin infiltration was used to manage and arrest proximal noncavitated lesions by infiltrating porous lesion of enamel caries with low-viscosity resin.
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Purpose: To adapt an evidence based clinical practice guideline (CPG) for risk-based management of caries in 18-55 years old Iranian adults. Methods: A multidisciplinary adaptation team reviewed evidence-based guidelines such as NICE, SIGN, and ADA according to the defined clinical questions. In addition, databases such as PubMed and google scholar were searched and CPGs were screened and appraised employing AGREE II (Appraisal of Guidelines for Research & Evaluation II) tool. Clinical scenarios were developed and their level of evidence, clinical advantage and adaptability was assessed. Following a two-round of ranking by experts, final recommendations were selected using RAND-UCLA appropriateness method. Results: Of 17 guides, 5 CPGs were selected as source adaptation guidelines. For assessing risk of caries in adult population, reduced Cariogram (without saliva tests) and CAMBRA were selected. In addition, adaptation team recommended 53 risk-based recommendations on preventive measures, operative intervention threshold and follow up intervals for Iranian adults. Conclusions: Our study demonstrated an adapted guide for risk-based management of tooth decay in Iranian adults. This helps local dentists in decision making and promoting oral health of adults. Further research on the feasibility of the adapted guideline in Iranian population is needed.
Article
Objectives Based on a changing understanding of the disease, caries therapy is changing as well. For non-cavitated lesions, mere removal of carious tissues is largely rejected. Instead, control of the lesion activity via non- or micro-invasive treatments is recommended. For cavitated lesions, caries excavation is usually performed, followed by restoration of the cavity. This study evaluates why carious tissues should be excavated at all, and analyses the suitability of different criteria and methods for assessing caries excavation. For deep lesions, different caries removal strategies are presented and compared. Both the chances and risks associated with these strategies are discussed.Methods Based on original studies and systematic reviews, it is shown that caries removal is not a goal by itself: the efficacy of different criteria and methods for assessing the excavation process and results are presented and risks associated with each criterion discussed. Viable alternatives to traditional criteria and strategies are summarized and evaluated based on systematic evidence. The long-term chances and hurdles for implementing less invasive caries removal strategies are demonstrated.ResultsThe primary goal of caries therapy should be control, not mere removal of the lesion. Removing all carious tissue from a cavity does seem neither possible nor desirable. Excavating until only hard dentin remains even in proximity to the pulp risks pulpal exposure. Alternative criteria should thus be used for excavating deep dentin, but many of them are not fully validated so far, especially against clinically relevant parameters. Dentists could modify the traditional excavation criterion and leave soft deep dentin in a cavity followed by temporary (stepwise excavation) or permanent (selective excavation) restoration. Remaining microorganisms beneath such restorations do not seem to pose harm, as they are inactivated due to nutritional deprivation by the placed diffusion barrier (i.e. the restoration).DiscussionAttempting to remove all bacteria from a cavity during caries excavation might be futile. Instead, pulpo-proximal carious dentin might be left beneath a restoration to avoid pulpal exposure. The limited quality of available studies does not allow definitive conclusions.
Article
In modern dentistry, a minimally invasive management of early caries lesions or early-stage erosive tooth wear (ETW) with synthetic remineralization systems has become indispensable. In addition to fluoride, which is still the non-plus-ultra in these early caries/ETW treatments, a number of new developments are in the test phase or have already been commercialized. Some of these systems claim that they are comparable or even superior to fluoride in terms of their ability to remineralize enamel. Besides, their use can help avoid some of the risks associated with fluoride and support treatments of patients with a high risk of caries. Two individual non-fluoride systems can be distinguished; intrinsic and extrinsic remineralization approaches. Intrinsic (protein/peptide) systems adsorb to hydroxyapatite crystals/organics located within enamel prisms and accumulate endogenous calcium and phosphate ions from saliva, which ultimately leads to the re-growth of enamel crystals. Extrinsic remineralization systems function on the basis of the external (non-saliva) supply of calcium and phosphate to the crystals to be re-grown. This article, following an introduction into enamel (re)mineralization and fluoride-assisted remineralization, discusses the requirements for non-fluoride remineralization systems, particularly their mechanisms and challenges, and summarizes the findings that underpin the most promising advances in enamel remineralization therapy.
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Introduction: Xylitol can affect caries-inducing bacteria; however, different Streptococcus mutans strains might respond differently. Aim: To investigate the effect of xylitol on biofilm formation and metabolic activity of seven S. mutans strains. Methods: Seven S. mutans strains (UA159, A32-2, NG8, 10449, UA130, LM7, and OMZ175) were inoculated into 96-well microtiter plates and were tested with various xylitol concentrations (0.0, 0.0016, 0.0031, 0.0063, 0.0125, 0.025, 0.05, 0.1, 0.2, 0.4 and 0.8 g/mL) for inhibition of biofilm formation and bacterial metabolic activity by recording absorbance values. Lactate dehydrogenase and extracellular polysaccharide assays were conducted at 0.0, 0.1, 0.2, 0.4, and 0.8 g xylitol/mL. Data were analyzed by one-way analysis of variance, Tukey's, paired t, and LSD tests at 0.05 significance level. Results: Xylitol produced a significant decrease in bacterial biofilm formation compared to controls at 0.4 g/mL, with almost complete lack of biofilm formation at 0.8 g/mL. This was consistent with metabolic activity which demonstrated a significant activity reduction occurring for all strains at 0.4 g/mL, and a complete lack of activity at 0.8 g/mL for all seven strains. There was a trend for lower LDH and EPS production with the increase in xylitol concentration especially with UA159, UA130, and NG8. Conclusion: Xylitol has a clear anticariogenic effect on S. mutans which was slightly different depending on the tested strain confirming that the benefit of xylitol might vary from one patient to another. The effect is more apparent at concentrations of 0.4 g/mL and higher.
Article
Background: Nonsurgical caries management techniques (NSCMT) offer a simple, conservative approach to treating caries. Despite evidence supporting and potential advantages of NSCMT, dentists can be reluctant to adopt these techniques. To better understand this phenomenon, the authors interviewed dentists who primarily treat children regarding their thoughts, attitudes, and adoption of 3 NSCMT. Methods: The 3 NSCMT were fluoride varnish, silver diamine fluoride, and Hall stainless steel crowns. The authors interviewed dentists in North Carolina whose practices were restricted mostly to children. A nonprobabilistic maximum-variation design was used in the sampling. Using a semistructured interview guide, the authors recorded the interviews digitally and analyzed them thematically. The authors stratified the analysis according to years of practice, geographic location, and type of practice. Reporting was based on emerging and recurring themes and insightful quotes. Results: Factors most likely to promote the adoption of NSCMT were related to clinical practice, family preference, patient safety, and provider philosophy. Barriers to adoption included previous practitioner negative experiences using the techniques, high-risk caries population, and perceived likelihood of negative outcomes. Characteristics of the practice environment, patient population, communication with families, and financial considerations were influential in the clinician's determination as to whether to use these techniques. Conclusions: These findings provide valuable insight into practitioners' influences, motivations, and clinical decision making in the adoption and use of management and treatment approaches for carious lesions in the pediatric population. Practice implications: The primary factors and barriers identified in this study are possible targets for education and quality improvement programs aimed at increasing NSCMT use.
Article
Aim To assess the prevalence of proximal enamel lesions, the need for non-operative caries treatment and the quality of dental restorations in 869 students aged 16 years from Northern Norway. Methods All first year upper secondary school students in Tromsø and Balsfjord municipalities were invited to participate in an oral- and general health project (Fit Futures). The attendance rate was 90%, and all subjects born in 1994 (449 males and 420 females) were included in the present study. Dental caries was registered according to a 5-graded scale (1–2 = enamel lesions; 3–5 = dentinal lesions). Scores from 1 to 4 were used to register the quality of restorations (1 = good; 2 = acceptable; 3 = poor; 4 = unacceptable). Results Only 6% of the 16-year-olds were completely caries-free. There were 84% of the participants with proximal enamel lesions. A majority of them had either previously restored teeth (35%) or both restored teeth and untreated dentinal caries lesions (34%). When using the D-value of the DMFS-index as a diagnostic criterion, 39% of the participants were in need of restorative treatment. When proximal enamel lesions were included in the diagnosis, the number of participants in need of restorative and/or non-operative caries treatment was 85%. Over 1/3 of the participants presented with at least one restoration below an acceptable quality level. Conclusions Dental caries is still a major health problem affecting the total teenage population. A non-operative treatment strategy should be considered relevant in order to reduce the need for restorative treatment.
Article
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In situ remineralization of hydroxyapatite on a human tooth enamel surface induced by anti-caries bioactive components is an alternative restorative strategy against dental caries. In this study, a novel biomimetic peptide DE-11, inspired by the salivary phosphoprotein statherin, was developed, and it showed beneficial potentials for the restoration of demineralized tooth enamel in vitro. The peptide DE-11 contained the initial six-peptide sequence of N-terminus of statherin extended by a mineralization hydrophilic tail composed of consecutive acidic amino acids capable of adsorbing calcium and phosphate ions. A strong adsorption capacity of DE-11 to hydroxyapatite was confirmed through Langmuir adsorption isotherm experiment and confocal laser scanning microscopy. Then, the nucleation and crystallization of hydroxyapatite due to DE-11 was characterized by scanning and transmission electron microscopy and selected-area electron diffraction. Moreover, the ability of DE-11 to promote the remineralization of initial enamel caries lesions was further evaluated. Initial lesions were created in bovine enamel blocks, which were then exposed to the peptide solution and finally immersed in artificial saliva. After 7 days, a higher percentage of surface microhardness recovery, a lower mineral loss, a shallower lesion depth, and a higher mineral content were found on the surface of the lesion body in the DE-11 group as compared to that in the negative group using surface microhardness testing, polarized light microscopy, and transverse microradiography; this indicated that DE-11 could induce in situ remineralization of hydroxyapatite on the demineralized enamel surface. Overall, these findings suggest that DE-11 is highly promising as a restorative biomaterial for enamel remineralization in the anti-caries applications.
Conference Paper
Objective: The objective of this study was to investigate the affect of xylitol on the viability, and biofilm formation of seven S. muatns strains. Methods: Seven Streptococcus mutans strains (UA159, UA130, NG8, LM7, A32-2, OMZ175, and 10449) were cultured in a tryptic soy broth (TSB) solution for 24 hours in 5% CO2 incubator at 37°C. Eight concentrations (0.2, 0.1, 0.05, 0.025, 0.0125, 0.0063, 0.0031, 0.016g/mL) of xylitol with tryptic soy broth with sucrose (TSBS) were prepared through serial dilution. Sterile 96-well flat-bottom polystyrene microtiter plates were utilized and 10μL of each strain inoculum was added in each well. Microtitre plates were incubated for 24 hours and absorbance readings were recorded using a spectrophotometer. Resultant biofilms were fixed by adding 200 μL of 10% formaldehyde. Crystal violet solution was added after washing followed by 200μL Isopropanol. Biofilm absorbance readings were measured at 595nm wavelength. Two strains (10449 and A32-2) were further investigated using agar diffusion assay to observe the inhibition zones. All absorbance values were analyzed using one-way analysis of variance (ANOVA) at 0.05 significance level followed by Tukey’s post hoc pairwise comparisons. Results: 10449 was the most sensitive strain in the total absorbance assay. In the biofilm assay, OMZ175 and UA130 were the least resistant strains. For agar diffusion clear inhibition zones were observed with 10449 and A32-2 at concentrations of .0031g/mL and above. Conclusion: There was a clear difference between the seven tested strains against xylitol concentrations indicating a variation of the inhibitory effect of xylitol according to the type of S. mutans.
Article
"Modern Concepts for Caries Tissue Removal", by Falk Schwendicke The above article, published online on 15 February 2016 in Wiley Online Library (http://onlinelibrary.wiley.com/doi/10.llll/jerd.12201), has been retracted by agreement between the author, Dr. Falk Schwendicke, the journal Editor-in-Chief, Dr. Harald O. Heymann, Associate Editor, Dr. Edward Swift and Wiley Periodicals, Inc. The retraction has been agreed as the article was published in advance of other companion work which should have had precedence. The article pages have been replaced by the Retraction Statement and the article condensed accordingly. Schwendicke, F. Swift, EJ. Modern concepts for caries tissue removal. Dent J Esthet Rest 2016; 28:1; DOI: 10.1111/jerd.12201.
Article
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This randomized split-mouth controlled clinical trial aimed at assessing the therapeutic effects of infiltration vs. sealing for controlling caries progression on proximal surfaces. Out of 90 adult students/patients assessed at university clinics and agreeing to participate, 39, each with 3 proximal lesions identified radiographically around the enamel-dentin junction to the outer third of the dentin, were included. Lesions were randomly allocated for treatment to test-A (Infiltration: ICON-pre-product; DMG), test-B (Sealing: Prime-Bond-NT; Dentsply), or control-C (Placebo). Primary outcome after 1, 2, and 3 yrs of radiographically observed lesion progression was assessed by an independent examiner blinded to groups, using pair-wise and digital-subtraction readings. No adverse events occurred. In 37 participants assessed after 3 yrs, 10 lesions (A-4; B-2; C-4) progressed deep into dentin and needed operative treatment. The 3-year therapeutic effect, based on pair-wise radiographic readings between infiltration and placebo, was 37.8% (95% CI: 20.5-55.2%) and that between sealing and placebo was 29.7% (95% CI: 20.2-35.0%). One-year follow-up digital-subtraction readings showed significant differences in lesion progression between infiltration and placebo (P = 0.0012) and between sealing and placebo (P = 0.0269). The study showed that infiltration and sealing are significantly better than placebo treatment for controlling caries progression on proximal lesions. No significant difference was seen between infiltration and sealing (ClinicalTrials.gov number NCT01417832).
Article
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The prevalence of proximal caries in primary molar teeth is high in many countries. (1) To study by means of a split-mouth design the 1- and 2.5-year efficacy of sealing proximal lesions vs. flossing instructions (control) on primary molar teeth. (2) To assess children's behaviour and pain perception during the procedure. Ninety-one 4- to 6-year-old children from Bogotá, Colombia participated. Participants had to have at least two proximal lesions scored according to the following radiographic classification system: radiolucency (1) in enamel outer half, (2) restricted to enamel-dentine junction, or (3) restricted to dentine outer third. Baseline, 1- and 2.5-year follow-up bitewing radiographs were taken. Test and control lesions were randomly selected. After temporary separation test lesions were sealed (adhesive). Parents/caregivers received a flossing leaflet for their children. Progression of the lesions was assessed by means of independent reading of conventional bitewing radiographs. One-year (n = 73) test vs. control lesion progression was 27.4 vs. 50.7%, respectively (p < 0.01, McNemar's test), and 2.5-year (n = 56) test vs. control lesion progression was 46.4 vs. 71.4%, respectively (p < 0.01). The dropouts did not differ from those who remained in the study regarding relevant caries baseline data. More than 88% of the participants presented positive to definitively positive behaviour and very low or low pain intensity at both first and second appointments. The sealing technique was superior to flossing instructions both after 1 and 2.5 years of follow-up and the majority of the participants had no anxiety or pain during the treatment.
Article
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The aim of this randomized clinical trial study was to evaluate the therapeutic effect of two varnish formulations (G1 = 5% NaF, G2 = 6% NaF + 6% CaF(2)) on the remineralization of white spot lesions (WSL). The sample was composed of 15 (7- to 12-year-old) children with 45 active WSL in anterior permanent teeth. The children were randomly divided into two groups providing 22 lesions for G1 and 23 for G2. The children were submitted to weekly varnish applications 4 times. The WSL were evaluated twice: baseline and on week 4. Maximum lesion dimensions (mesiodistal and incisogingival) were measured in millimeters and classified in four grades of size. WSL were also assessed regarding lesion activity by one calibrated examiner. The Pearson chi-square and Fisher's exact tests were used (P < 0.01). WSL reductions were observed in both varnish groups (Chi-square = 0.15, d.f. = 1, P = 0.90), and with similar magnitude (in mm): 1.19 and 1.29 for G1 and G2, respectively. Thirty-six WSL (15 in G1 and 21 in G2) were classified as inactive on week 4, reaching an overall value of 80%. No difference was observed between G1 and G2 regarding activity scores (Fisher's exact test, p > 0.01). It was concluded that after 4 applications the two varnish formulations tested produced similar clinical effects, indicating the reduction and the control of carious activity in most WSL.
Article
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This report describes the prevalence of non-cavitated and cavitated carious lesions in 911 randomly selected children in grades one through three on the Island of Montreal, Quebec, Canada. The criteria for diagnosis were developed for a longitudinal epidemiological study of restorative treatment decisions by dentists practising under a provincial dental insurance program for children. The intra- and inter-examiner reliability correlation coefficients of the two examiners were excellent (Kappa > or = 0.80). The most frequent carious lesion found in the examined children were non-cavitated carious lesions (incipient) within 1.5 of the gingival line on smooth tooth surfaces, and stained or non-cavitated carious lesions on pits and fissures. Out of 911 children in the study, 19.6% had sealants. Children whose parents completed a university education had a significantly lower prevalence of non-cavitated and cavitated carious lesions and fillings, and a significantly higher mean number of sealants than children whose parents had only primary school education. Education status of the parents was a significant risk marker of children with high caries experience and these children had a significantly higher mean number of non-cavitated carious lesions. This study has found that non-cavitated carious lesions are significantly more prevalent than cavitated carious lesions in children.
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The purpose of this study was to evaluate the efficacy of non-invasive methods of treatment for active incipent occlusal caries. Anamnesis, professional prophylaxis, and visual inspection were used to classify 250 Brazilian pre-school-children. First permanent decayed molars (n=98) from thirty-one subjects (6 years+ 6 months) were selected and divided into three groups. Group 1: fissure sealants with resin-modified glass ionomer - Vitremer (n=29); Group 2: fluoride varnish -Duraphat (n=36) and control group: tooth brushing and 0.2 percent NaF weekly mouthwashes (n=33). Four clinical evaluations were carried out over three, six, nine, and twelve months. Caries activity and progression were observed through clinical and radiographic evaluation. The results were analyzed by Fisher=s Exact test. After twelve months, the results showed 100 percent of arrestment of caries activity for Group 1, 83.3 percent for group 2, and 72.7 percent for control group. At the same time, the results showed 0 percent of caries progression for group 1, 5.5 percent for Group 2, and 6.1 percent for control group. Group 1 showed a better inactivation property than the other groups (p<0.05). There were no statistically significant differences in caries progression among these groups (p>0.05). It was concluded that this non-invasive methods were able to arrest the progression of occlusal caries, but fissure sealant showed better results in controlling caries activity.
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The diagnosis of early carious lesions is essential for nonsurgical management of dental caries. This report describes the prevalence of early noncavitated and cavitated carious lesions in the primary dentition of 5-year-old Head Start schoolchildren in Alachua, Fla. As part of the Fluoride Varnish Study conducted at the University of Florida, modified caries diagnostic criteria-which differentiated caries lesion activity and severity-were developed for the primary teeth. Dental examinations were conducted on 221 children ages 5 years by 2 calibrated examiners. Overall, 86% of the children had experienced noncavitated or cavitated caries lesions in the primary dentition. Prevalence of cavitated dentinal lesions was 48%, and prevalence of active noncavitated enamel lesions was 71%. The mean number of active noncavitated enamel lesions (mean +/- SEM: 2.91 +/- 0.21) was slightly higher than the mean number of cavitated dentinal lesions (2.52 +/- 0.31). The mean number of restored surfaces was 1.24 (+/- 0.42), and only 8% of the children had 1 or more restored surfaces. Noncavitated lesions were most common on occlusal surfaces, especially in mandibular second molars. African-American children had a higher prevalence of noncavitated lesions (81%) than whites (69%) or others (33%; P<.0001). Prevalence of cavitated lesions was 49% for African Americans, 46% for whites, and 48% for others. This study shows that noncavitated enamel and cavitated dentinal lesions are common in this study population's primary dentition. There is a need for preventive measures and treatment of decay in these children living in low-income families.
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This study assessed the efficacy of sealing proximal lesions on adult patients using a split-mouth design. Eighty-two 15- to 39-year-olds from the Dental Faculties in Copenhagen and Bogotá participated, each having 2 or more proximal lesions in the following radiographic stages: (1) lesion restricted to the outer half of enamel; (2) lesion from the inner half of enamel including the enamel dentine junction, and (3) lesion restricted to the outer third of dentine. Standardized geometrically aligned baseline and follow-up radiographs were obtained. One randomly selected lesion (test) in each patient was sealed with 1 of 2 resins. The patients were instructed to floss all the proximal lesions 3 times per week. The baseline to 18 months difference in caries lesion progression status was assessed using 3 methods: (1) radiographs were independently assessed visually; (2) radiographs were read in pairs, and (3) using subtraction radiography of digitized images. A total of 72 subjects finished the study (12.2% dropout). The compliance concerning flossing was poor (15%). For the repeated examinations kappa was 0.84 for the visual examination, 0.44 for the paired readings and 0.84 for the subtraction examination. Two test lesions and 1 control lesion were restored. For the independent radiograph assessment method 10 and 26% progressed in the test and control group, respectively (p > 0.05); with the paired radiograph method the corresponding data were 22% in the test and 47% in the control groups (p < 0.01). By subtraction radiography 44% of the test group and 84% of the control were judged to have progressed (p < 0.001). The sealing technique was superior to instructing patients to floss, and subtraction radiography appeared to be the most sensitive method for assessing lesion progression.
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This paper describes early findings of evaluations of the International Caries Detection and Assessment System (ICDAS) conducted by the Detroit Center for Research on Oral Health Disparities (DCR-OHD). The lack of consistency among the contemporary criteria systems limits the comparability of outcomes measured in epidemiological and clinical studies. The ICDAS criteria were developed by an international team of caries researchers to integrate several new criteria systems into one standard system for caries detection and assessment. Using ICDAS in the DCR-OHD cohort study, dental examiners first determined whether a clean and dry tooth surface is sound, sealed, restored, crowned, or missing. Afterwards, the examiners classified the carious status of each tooth surface using a seven-point ordinal scale ranging from sound to extensive cavitation. Histological examination of extracted teeth found increased likelihood of carious demineralization in dentin as the ICDAS codes increased in severity. The criteria were also found to have discriminatory validity in analyses of social, behavioral and dietary factors associated with dental caries. The reliability of six examiners to classify tooth surfaces by their ICDAS carious status ranged between good to excellent (kappa coefficients ranged between 0.59 and 0.82). While further work is still needed to define caries activity, validate the criteria and their reliability in assessing dental caries on smooth surfaces, and develop a classification system for assessing preventive and restorative treatment needs, this early evaluation of the ICDAS platform has found that the system is practical; has content validity, correlational validity with histological examination of pits and fissures in extracted teeth; and discriminatory validity.
Article
Background. In this article, the authors present evidence-based clinical recommendations regarding the use of nonfluoride caries-preventive agents. The recommendations were developed by an expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs. The panel addressed several questions regarding the efficacy of nonfluoride agents in reducing the incidence of caries and arresting or reversing the progression of caries. Types of Studies Reviewed. A panel of experts convened by the ADA Council on Scientific Affairs, in collaboration with ADA Division of Science staff, conducted a MEDLINE search to identify all randomized and nonrandomized clinical studies regarding the use of nonfluoride caries-preventive agents. Results. The panel reviewed evidence from 50 randomized controlled trials and 15 nonrandomized studies to assess the efficacy of various nonfluoride caries-preventive agents. Clinical Implications. The panel concluded that certain nonfluoride agents may provide some benefit as adjunctive therapies in children and adults at higher risk of developing caries. These recommendations are presented as a resource for dentists to consider in the clinical decision-making process. As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences. (The full report can be accessed at "http://ebd.ada.org/ClinicalRecommendations.aspx".)
Article
Background: This article presents evidence-based clinical recommendations for use of pit-and-fissure sealants developed by an expert panel convened by the American Dental Association Council on Scientific Affairs. The panel addressed the following clinical questions: Under what circumstances should sealants be placed to prevent caries? Does placing sealants over early (noncavitated) lesions prevent progression of the lesion? Are there conditions that favor the placement of resin-based versus. glass ionomer cement sealants in terms of retention or caries prevention? Are there any techniques that could improve sealants' retention and effectiveness in caries prevention? Types of studies reviewed: Staff of the ADA Division of Science conducted a MEDLINE search to identify systematic reviews and clinical studies published after the identified systematic reviews. At the panel's request, the ADA Division of Science staff conducted additional searches for clinical studies related to specific topics. The Centers for Disease Control and Prevention also provided unpublished systematic reviews that since have been accepted for publication. Results: The expert panel developed clinical recommendations for each clinical question. The panel concluded that sealants are effective in caries prevention and that sealants can prevent the progression of early noncavitated carious lesions. Clinical implications: These recommendations are presented as a resource to be considered in the clinical decision-making process. As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences. The evidence indicates that sealants can be used effectively to prevent the initiation and progression of dental caries.
Article
The purpose of the study was to determine if longitudinal measurements of enamel autofluorescence (quantitative light-induced fluorescence, QLF) could detect differences in remineralization of early enamel caries on buccal surfaces of anterior teeth following supervised daily brushing with either sodium fluoride (NaF; 1,450 ppm F), sodium monofluorophosphate (MFP; 1,450 ppm F) dentifrices or a herbal, non-fluoride placebo dentifrice. The study was a pragmatic cluster-randomized controlled trial with schools as the unit of randomization. Twenty-one schools in Chengdu, China, comprised the clusters; 296 children with at least 1 visible white-spot lesion were examined using QLF at baseline and after 3 and 6 months. Each of the 21 clusters was randomly assigned 1 of the 3 dentifrices, and the childrenbrushed under supervision once per day for 2 min. The primary outcome measure was ΔQ (product of fluorescence loss and area) at a 5&percnt; threshold after 6 months of product use. A multi-level model was fitted to the data at the site level, taking into account the hierarchical structure with baseline ΔQ, age and sex as covariates. After 3 months there was a significant difference between the MFP group and placebo (p = 0.02) and after 6 months between the NaF group (p = 0.002), MFP group (p < 0.001) and the placebo. QLF methodology could detect, within 3- and 6-month periods of supervised brushing, a difference in remineralization between fluoride-containing and non-fluoride-containing dentifrices. Typically lesions in all 3 treatment groups demonstrated improvement. Groups receiving fluoride experienced a more rapid and more substantial remineralization than those in the placebo group.
Article
In this article, the authors present evidence-based clinical recommendations regarding the use of nonfluoride caries preventive agents. The recommendations were developed by an expert panel convened by the American Dental Association (ADA)Council on Scientific Affairs. The panel addressed several questions regarding the efficacy of nonfluoride agents in reducing the incidence of caries and arresting or reversing the progression of caries. A panel of experts convened by the ADA Council on Scientific Affairs, in collaboration with ADA Division of Science staff, conducted a MEDLINE search to identify all randomized and nonrandomized clinical studies regarding the use of non fluoride caries-preventive agents. The panel reviewed evidence from 50 randomized controlled trials and 15 nonrandomized studies to assess the efficacy of various nonfluoride caries-preventive agents. The panel concluded that certain nonfluoride agents may provide some benefit as adjunctive therapies in children and adults at higher risk of developing caries. These recommendations are presented as a resource for dentists to consider in the clinical decision-making process. As part of the evidence based approach to care, these clinical recommendations should be integrated with the practitioner’s professional judgment and the patient’s needs and preferences.
Article
A community intervention trial was conducted to assess the feasibility of APF gel as a caries-preventive agent in a high-risk group of school children in Bangalore City. The study was conducted in two schools, randomly selected from a list of schools catering to underprivileged children. These schools were randomly allocated into experimental and control groups. Children aged 9-16 years having three or more incipient or cavitated primary or secondary carious lesions were enrolled in the study. In the experimental group, APF gel was applied and oral health education was provided to both groups at baseline and 6 months. Follow-up examination was performed at 6 and 12 months and the caries status was recorded by an investigator who was blinded to the allocation of intervention. There was no statistically significant difference in DMFT and DMFS values, but a significant difference was seen in incipient carious lesions between the experimental and control groups at 6 and 12 months. These results suggest that biannual APF gel application is an effective preventive measure in reversing incipient carious lesions.
Article
The purpose of this study was to determine the efficacy of fluoride varnish (5% sodium fluoride, Duraphat(®), Colgate) in reverting white spot lesions (WSLs) after fixed orthodontic treatment. This study was a randomized, parallel group, controlled clinical trial. Using saline solution as control, 110 participants (mean age ± standard deviation: 16.6 ± 3.2 years) ranging from 12 to 22 years old were randomly assigned to either the test group (group 1) or the control group (group 2). Application of fluoride varnish or saline was applied onto tooth surfaces with WSLs every month during the first 6 months after debonding. The labial (buccal) surfaces of the teeth were assessed by the use of a DIAGNOdent pen (DD) at the baseline, 3- and 6-month follow-up visits. After 6 months, 96 subjects with a total of 209 study teeth (47 subjects, 104 teeth in group 1; 49 subjects, 105 teeth in group 2) remained. The WSLs had a mean DD reading at baseline of 17.66 ± 5.36 in group 1 and 16.19 ± 5.70 in group 2, which decreased by 5.78 and 2.44, respectively, at the 3-month follow-up visit and decreased by 7.56 and 3.09, respectively, at the 6-month follow-up visit. The mean baseline DD readings in the two groups were similar (t test, P > 0.05). There was statistically significant differences between the mean DD readings of the two groups at the 3-month (P < 0.05) and at the 6-month follow-up visits (P < 0.01). Topical fluoride varnish application is effective in reversing WSLs after debonding and should be advocated as a routine caries prevention measure after orthodontic treatment.
Article
To evaluate the effect of casein phosphopeptides (CPP) and amorphous calcium phosphate (ACP), as an adjunct to average oral hygiene, on the fluorescence of initial carious fissures and pits in vivo. For this investigator-blind in vivo study 32 volunteers were recruited. Subjects with premolars and molars showing DIAGNOdent-values between 15 and 20 were randomly assigned to two treatment groups. During a wash-out period of 2 weeks and during the 3-week treatment period all subjects were instructed to use only standard fluoride toothpaste (1450 ppm F- as NaF) and to abstain from any oral hygiene products other than dental tape. During the treatment period, one group additionally applied a CPP-ACP containing cream on the respective fissures for 3 minutes, once per day. At Days 1, 8, 15, and 22, DIAGNOdent measurements and a visual assessment of the fissures were performed by two calibrated independent examiners. No significant changes of DIAGNOdent values were found in the control group during the study period. Fissures additionally treated with the CPP-ACP containing cream showed significantly lower laser fluorescence values after Day 15 (P = 0.001) and Day 22 (P < 0.001) compared to the control group. No significant difference in the visual classification between the two groups could be found.
Article
Beerens MW, van der Veen MH, van Beek H, ten Cate JM. Effects of casein phosphopeptide amorphous calcium fluoride phosphate paste on white spot lesions and dental plaque after orthodontic treatment: a 3-month follow-up. Eur J Oral Sci 2010; 118: 610–617. © 2010 Eur J Oral Sci The effects of casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP) paste vs. control paste on the remineralization of white spot caries lesions and on plaque composition were tested in a double-blind prospective randomized clinical trial. Fifty-four orthodontic patients, with multiple white spot lesions observed upon the removal of fixed appliances, were followed up for 3 months. Subjects were included and randomly assigned to either CPP-ACFP paste or control paste, for use supplementary to their normal oral hygiene. Caries regression was assessed on quantitative light-induced fluorescence (QLF) images captured directly after debonding and 6 and 12 wk thereafter. The total counts and proportions of aciduric bacteria, Streptococcus mutans, and Lactobacillus spp. were measured in plaque samples obtained just before debonding, and 6 and 12 wk afterwards. A significant decrease in fluorescence loss was found with respect to baseline for both groups and no difference was found between groups. The size of the lesion area did not change significantly over time or between the groups. The percentages of aciduric bacteria and of S. mutans decreased from 47.4 to 38.1% and from 9.6 to 6.6%, respectively. No differences were found between groups. We observed no clinical advantage for use of the CPP-ACFP paste supplementary to normal oral hygiene over the time span of 12 wk.
Article
Resin infiltration is an innovative approach to arrest progression of caries lesions. The aim of this randomized split-mouth placebo-controlled clinical trial was to assess whether resin infiltration of proximal lesions is more effective than non-operative measures alone with respect to the inhibition of caries progression. In 22 young adults, 29 pairs of interproximal lesions with radiological extension into the inner half of enamel or the outer third of dentin were randomly allocated to two treatment groups. In the test group, lesions were infiltrated (Icon, pre-product; DMG). A placebo treatment was performed in the control group. All participants received instructions for diet, flossing, and fluoridation. The primary outcome after 18 months was radiographic lesion progression (assessed by digital subtraction radiography). No unwanted effects could be observed. In the effect group, 2/27 lesions (7%) and in the control group 10/27 lesions (37%) showed progression (p = 0.021; McNemar). Infiltration of interproximal caries lesions is efficacious in reducing lesion progression.
Article
This study aims to investigate the effect of topical applications of 10% casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on white spot lesions (WSL) detected after treatment with fixed orthodontic appliances. Sixty healthy adolescents with ≥1 clinically visible WSL at debonding were recruited and randomly allocated to a randomised controlled trial with two parallel groups. The intervention group was instructed to topically apply a CPP-ACP -containing agent (Tooth Mousse, GC Europe) once daily and the subjects of the control group brushed their teeth with standard fluoride toothpaste. The intervention period was 4 weeks and the endpoints were quantitative light-induced fluorescence (QLF) on buccal surfaces of the upper incisors, cuspids and first premolars and visual scoring from digital photos. The attrition rate was 15%, mostly due to technical errors, and 327 lesions were included in the final evaluation. A statistically significant (p < 0.05) regression of the WSL was disclosed in both study groups compared to baseline, but there was no difference between the groups. The mean area of the lesions decreased by 58% in the CPP-ACP group and 26% in the fluoride group (p = 0.06). The QLF findings were largely reflected by the clinical scores. No side effects were reported. Topical treatment of white spot lesions after debonding of orthodontic appliances with a casein phosphopeptide-stabilised amorphous calcium phosphate agent resulted in significantly reduced fluorescence and a reduced area of the lesions after 4 weeks as assessed by QLF. The improvement was however not superior to the "natural" regression following daily use of fluoride toothpaste.
Article
Orthodontic patients have an increased risk of white-spot lesion formation. A clinical trial was conducted to test whether, in a post-orthodontic population using fluoride toothpastes and receiving supervised fluoride mouthrinses, more lesions would regress in participants using a remineralizing cream containing casein phosphopeptide- amorphous calcium phosphate compared with a placebo. Forty-five participants (aged 12-18 yrs) with 408 white-spot lesions were recruited, with 23 participants randomized to the remineralizing cream and 22 to the placebo. Product was applied twice daily after fluoride toothpaste use for 12 weeks. Clinical assessments were performed according to ICDAS II criteria. Transitions between examinations were coded as progressing, regressing, or stable. Ninety-two percent of lesions were assessed as code 2 or 3. For these lesions, 31% more had regressed with the remineralizing cream than with the placebo (OR = 2.3, P = 0.04) at 12 weeks. Significantly more post-orthodontic white-spot lesions regressed with the remineralizing cream compared with a placebo over 12 weeks.
Article
In March 2009, the American Dental Association (ADA) launched a new evidence-based dentistry (EBD) website (ebd.ada.org). The site has been established to provide the dental profession with access to evidence from high-quality systematic reviews and is supported by a grant from the National Library of Medicine and the National Institute for Dental and Craniofacial Research(Grant Number G08 LM008956).
Article
A number of novel preventive treatment options which, as with traditional methods, can be differentiated into 3 categories of prevention (primary, secondary and tertiary), have been and are being currently investigated. Those reviewed are either commercially available or appear relatively close to that point. These include: approximal sealants; fluoride applications, including slow-release devices; measures to help remineralize demineralized tissue, including 3 different methods of delivering amorphous calcium phosphate; measures to help modify the biofilm to reduce the cariogenic challenge, including ozone therapy and probiotics; measures to increase enamel resistance to demineralization, including laser treatment of enamel, and a novel 'hybrid' technique for the treatment of primary molar caries which involves 'overlapping' of secondary and tertiary prevention--the Hall technique. Although many of these techniques show considerable promise and dentists should be aware of these developments and follow their progress, the evidence for each of these novel preventive treatment options is currently insufficient to make widespread recommendations. Changes in dental practice should be explored to see how oral health can be best supported through novel preventive systems. Further research is also required involving double-blind randomized controlled trials in order to bring further benefits of more effective caries control to patients. Implementation in practice should follow promptly as new techniques are shown to be clinically valuable for individual patients.
Article
Preventive treatment options can be divided into primary, secondary and tertiary prevention techniques, which can involve patient- or professionally applied methods. These include: oral hygiene (instruction), pit and fissure sealants ('temporary' or 'permanent'), fluoride applications (patient- or professionally applied), dietary assessment and advice (modification), other measures to help remineralize demineralized tissue and other measures to help modify the biofilm to reduce the cariogenic challenge. There is a considerable body of strong evidence supporting the use of specific techniques for primary prevention of caries in children, e.g. pit and fissure sealants and topically applied fluorides (including patient-applied fluoride toothpastes and professionally applied fluoride varnishes), but limited strong evidence for these techniques for secondary prevention--i.e. where early to established lesions with ICDAS codes 1-4 (and also the severer lesions coded 5 or 6) are involved--and in relation to adults. This lack of evidence reflects a shortage of high-quality trials in the area, as opposed to a series of good studies showing no effect. Since there is also limited longitudinal evidence supporting conventional operative care, and since controlling the caries process prior to first restoration is the key to breaking the repair cycle and improving care for patients, future research should address the shortcomings in the current level of supporting evidence for the various traditional preventive treatment options.
Article
Several non-invasive and novel aids for the detection of (and in some cases monitoring of) caries lesions have been introduced in the field of 'caries diagnostics' over the last 15 years. This chapter focusses on those available to dentists at the time of writing; continuing research is bound to lead to further developments in the coming years. Laser fluorescence is based on measurements of back-scattered fluorescence of a 655-nm light source. It enhances occlusal and (potentially) approximal lesion detection and enables semi-quantitative caries monitoring. Systematic reviews have identified false-positive results as a limitation. Quantitative light-induced fluorescence is another sensitive method to quantitatively detect and measure mineral loss both in enamel and some dentine lesions; again, the trade-offs with lower specificity when compared with clinical visual detection must be considered. Subtraction radiography is based on the principle of digitally superimposing two radiographs with exactly the same projection geometry. This method is applicable for approximal surfaces and occlusal caries involving dentine but is not yet widely available. Electrical caries measurements gather either site-specific or surface-specific information of teeth and tooth structure. Fixed-frequency devices perform best for occlusal dentine caries but the method has also shown promise for lesions in enamel and other tooth surfaces with multi-frequency approaches. All methods require further research and further validation in well-designed clinical trials. In the future, they could have useful applications in clinical practice as part of a personalized, comprehensive caries management system.
Article
The main purpose of the split-mouth design is to remove all components related to differences between subjects from the treatment comparisons. By making within-patient comparisons, rather than between-patient comparisons, the error variance (noise) of the experiment can be reduced, thereby obtaining a more powerful statistical test. Unfortunately, comparisons made on a within-patient basis have potential disadvantages. Treatments may have effects on experimental units other than those which they were assigned to (carry-across effects). Such effects cannot be estimated from split-mouth data. Neither can treatment effects be estimated. The estimable parameter in a split-mouth design is the treatment effect plus the sum of all carry-across effects. Unless a priori knowledge indicates that no carry-across effects exist, reported estimates of treatment efficacy are potentially biased. In the design of split-mouth clinical trials, potential gain in precision should be carefully weighed against a potential decrease in validity.
Article
The development of new carious lesions during orthodontic treatment with fixed appliances was studied in patients with high levels of caries inducing oral microflora (S. mutans) in saliva prior to treatment. All patients were given an oral hygiene education and fluoride applications prior to the active orthodontic treatment period, and were divided into one test and one control group. In the test group, chlorhexidine treatments were performed throughout the active orthodontic treatment period whenever the amount of S. mutans in saliva exceeded the level of selection. A difference in caries incidence was recorded between the groups primarily on buccal surfaces of bonded teeth; but this was not found to be statistically significant.
Article
Assessing the quality of randomized controlled trials (RCTs) is important and relatively new. Quality gives us an estimate of the likelihood that the results are a valid estimate of the truth. We present an annotated bibliography of scales and checklists developed to assess quality. Twenty-five scales and nine checklists have been developed to assess quality. The checklists are most useful in providing investigators with guidelines as to what information should be included in reporting RCTs. The scales give readers a quantitative index of the likelihood that the reported methodology and results are free of bias. There are several shortcomings with these scales. Future scale development is likely to be most beneficial if questions common to all trials are assessed, if the scale is easy to use, and if it is developed with sufficient rigor.
Article
Assessing the quality of randomized controlled trials is a relatively new and important development. Three approaches have been developed: component, checklist, and scale assessment. Component approaches evaluate selected aspects of trials, such as masking. Checklists and scales involve lists of items thought to be integral to study quality. Scales, unlike the other methods, provide a summary numeric score of quality, which can be formally incorporated into a systematic review. Most scales to date have not been developed with sufficient rigor, however. Empirical evidence indicates that differences in scale development can lead to important differences in quality assessment. Several methods for including quality scores in systematic reviews have been proposed, but since little empirical evidence supports any given method, results must be interpreted cautiously. Future efforts may be best focused on gathering more empirical evidence to identify trial characteristics directly related to bias in the estimates of intervention effects and on improving the way in which trials are reported.
Article
Experimental evidence has clearly demonstrated that the early stages of lesion formation (enamel demineralization) are reversible following exposure to saliva and/or fluoride. Clinical evidence for remineralization has also been reported extensively in the literature. However, the literature is lacking with respect to data from well-controlled clinical studies regarding the quantitative contribution of remineralization to arrestment and reversal of caries. Retrospective analysis of an existing clinical trial database provided an opportunity to examine the incidence of clinical lesion reversals in a placebo-controlled, double-blinded caries clinical study. The clinical study examined three treatment groups: 1) 0.243% sodium fluoride/silica dentifrice, 2) 0.4% stannous fluoride/calcium pyrophosphate (positive control) dentifrice and 3) non-fluoridated placebo/calcium pyrophosphate (negative control) dentifrice. Clinical measures in this study included both radiographic and visual-tactile assessments of caries. Examination of all subjects revealed a statistically greater frequency for caries reversals in the sodium fluoride group as compared to the placebo group at Year 3, for both total and radiographic caries. In contrast, while caries reversals in the stannous fluoride group occurred with greater frequency than in the placebo group at Year 3, for both total and radiographic caries, the differences were not statistically significant. When only subjects who were "at risk" for potential reversals (i.e., those with a minimum of one carious lesion at baseline) were examined, a statistically greater frequency in caries reversals was observed in both the sodium fluoride (total, incipient, and radiographic caries) and stannous fluoride (total and radiographic caries) groups as compared to the placebo group at Year 3. Collectively, these data confirm the ability of both 0.243% sodium fluoride/silica and 0.4% stannous fluoride/calcium pyrophosphate dentifrices to clinically reverse caries. The results suggest that sodium fluoride may deliver a greater frequency of caries reversals than stannous fluoride, although these treatments were not found to be significantly different.
Article
This paper describes some of the statistical considerations in the intent-to-treat design and analysis of clinical trials. The pivotal property of a clinical trial is the assignment of treatments to patients at random. Randomization alone, however, is not sufficient to provide an unbiased comparison of therapies. An additional requirement is that the set of patients contributing to an analysis provides an unbiased assessment of treatment effects, or that any missing data are ignorable. A sufficient condition to provide an unbiased comparison is to obtain complete data on all randomized subjects. This can be achieved by an intent-to-treat design wherein all patients are followed until death or the end of the trial, or until the outcome event is reached in a time-to-event trial, irrespective of whether the patient is still receiving or complying with the assigned treatment. The properties of this strategy are contrasted with those of an efficacy subset analysis in which patients and observable patient data are excluded from the analysis on the basis of information obtained postrandomization. I describe the potential bias that can be introduced by such postrandomization exclusions and the pursuant effects on type I error probabilities. Especially in a large study, the inflation in type I error probability can be severe, 0.50 or higher, even when the null hypothesis is true. Standard statistical methods for the analysis of censored or incomplete observations all require the assumption of missing at random to some degree, and none of these methods adjust for the potential bias introduced by post hoc subset selection. Nor is such adjustment possible unless one posits a model that relates the missing observations to other observed information for each subject-models that are inherently untestable. Further, the subset selection bias is confounded with the subset-specific treatment effect, and the two components are not identifiable without additional untestable assumptions. Methods for sensitivity analysis to assess the impact of bias in the efficacy subset analysis are described. It is generally believed that the efficacy subset analysis has greater power than the intent-to-treat analysis. However, even when the efficacy subset analysis is assumed to be unbiased, or have a true type I error probability equal to the desired level alpha, situations are described where the intent-to-treat analysis in fact has greater power than the efficacy subset analysis. The intent-to-treat design, wherein all possible patients continue to be followed, is especially powerful when an effective treatment arrests progression of disease during its administration. Thus, a patient benefits long after the patient becomes noncompliant or the treatment is terminated. In such cases, a landmark analysis using the observations from the last patient evaluation is likely to prove more powerful than life-table or longitudinal analyses. Examples are described.
Article
The aim of this study was to apply the quantitative light-induced fluorescence (QLF) method in a randomised controlled study, comparing treatment with fluoride varnish and professional tooth cleaning for remineralisation of white spot lesions in caries-active adolescents. In the fluoride varnish group (n = 13; 32 lesions), professional tooth-cleaning was followed by application of fluoride varnish at the beginning of the study, after 1 wk, and then once every 6 wk for 6 months. The other group (n = 18; 30 lesions) underwent professional tooth-cleaning once every 6 wk for 6 months. Enamel fluorescence was measured at baseline and at each visit. In the fluoride varnish group there was a significant change over time (baseline: 6 months) for both lesion area: and average change in fluorescence (decreased lesion area and increased fluorescence radiance). The corresponding changes in the professional tooth-cleaning group were not significant. There was a significant difference in average change in fluorescence between the two test groups. For lesion area, there was no significant difference, but a tendency towards a difference between the test groups. It was concluded that (a) the QLF method is a sensitive method, suitable for longitudinal quantification of incipient caries lesions on smooth surfaces; and (b) that repeated fluoride applications had a favourable effect on the remineralisation of white spot lesions as measured after 6 months.
Article
A randomized prospective clinical study, with 220 patients scheduled for fixed orthodontic therapy, was conducted to test the hypothesis that application of an antimicrobial varnish in combination with a fluoride varnish (group 1) is significantly more efficient in reducing white spot lesions on the labial surfaces than application of the fluoride varnish alone (group 2). The effects of the antimicrobial varnish on the occurrence of gingivitis and plaque formation were also studied. A third aim was to investigate whether white spot lesion development could be predicted early during treatment. The antimicrobial varnish significantly reduced the number of mutans streptococci in plaque during the first 48 weeks of treatment. This effect did not result in significantly less development of white spot lesions on the labial surfaces compared with the group receiving only the fluoride varnish application. There was however a clear trend that the combination of the antimicrobial and fluoride varnishes more effectively reduced the increments of new lesions on the maxillary incisors. It was speculated that this could be due partly to an inhibiting effect of the antimicrobial varnish in an area with low oral clearance (with low pH and loss of fluoride) and partly to an inhibiting effect of the varnish on mutans streptococci. No significant differences between the groups with respect to gingivitis and plaque were found. Lesion development was difficult to predict early after bonding, despite a number of caries-relevant parameters of orthodontic importance. The best predictors for white spot lesions at debonding were visible plaque and mutans streptococci (eg, the level of oral hygiene and thus the cariogenic challenge) around the appliance shortly after bonding.
Article
A systematic review of the periodic scientific literature was undertaken to determine the strength of the evidence for the efficacy of professional caries preventive methods applied to high risk individuals, and the efficacy of professionally applied methods to arrest or reverse non-cavitated carious lesions. An initial search identified 1435 articles, of which 27 were eventually included in the review. Among the 22 studies addressing the prevention of carious lesions in caries-active or high risk individuals, the strength of the evidence was judged to be fair for fluoride varnishes and insufficient for all other methods. Among the seven studies addressing the management of non-cavitated carious lesions, the strength of the evidence for efficacy was judged to be insufficient for all methods. The results do not indicate that the preventive and management methods reviewed are not efficacious; rather, they demonstrate that not enough is known to determine the efficacy of the methods. Suggestions for strengthening the limited evidence base involve the following: i) increasing the number of studies that examine prevention among high risk individuals and non-surgical management of non-cavitated lesions, ii) including a wider variety of subject ages, iii) targeting aspects of the efficacy questions not yet addressed, iv) strengthening research methods employed in the studies, and v) reporting methods and outcomes more completely.
Article
Repeated topical application of concentrated fluorides is known to reduce caries. Little is known about fluoride retention and remineralization in incipient caries lesions following a single application. We investigated fluoride and the remineralization kinetics of a single application of elmex fluid (GABA International AG, Münchenstein, Switzerland; 10,000 ppm F) in initial enamel lesions. In this double-blind, placebo-controlled, randomized, crossover in situ study that conformed to good clinical practice, volunteers received intra-oral removable appliances carrying demineralized enamel samples after application of elmex fluid or placebo. After 5 min, 1, 2, 3, and 4 weeks in situ, KOH-soluble fluoride (KOHF), structurally bound fluoride (SBF), mineral gain, and lesion depth reduction were measured. Elmex fluid promoted higher KOHF and SBF at all times, decreased KOHF with time, increased SBF up to 3 weeks, and registered a higher mineral gain than placebo. Volunteers with higher stimulated salivary flow rates had lower fluoride uptake, but higher mineral gain. In conclusion, a single application of highly concentrated fluoride solution increases remineralization.
Article
The clinical trial is a planned experiment, strictly on human subjects, which is conducted with a view to investigating the efficacy of one or more treatments for a given condition. It is possible to use statistical techniques to make inferences about the population of patients who will present to the practitioner in the future using information obtained from the sample of patients in the trial. Consequently, the results of the trial may be expected to influence the way in which patients with the condition are treated in the future.
Article
In a double-blind randomized controlled clinical trial, the caries-reducing effect of semi-annually applied fluoride gel in a low-caries child population initially aged 4.5-6.5 years (n = 773) has been investigated. Secondary analyses of the data were performed to study the caries reduction including non-cavitated lesions. The treatment effect of fluoride gel was calculated as preventive fraction (PF). When enamel lesions were included in DFS count (D(2) grade), the PF was 22% as compared to 26% counting dentinal lesions. The PFs showed that the mean effect of professionally applied fluoride gel was highest (71%) for D(3)S in the permanent dentition and lowest for d(3)s in the primary dentition (5%). The PFs for approximal and buccal and lingual surfaces of the permanent dentition significantly decreased from 80 to 25% and from 60 to 37% when enamel lesions (D(2)S) were included. With the exception of the buccal and lingual surfaces, in the primary dentition the PFs varied slightly when enamel lesions were included. Inclusion of non-cavitated lesions in the treatment effect statistics did not change the former conclusion that the treatment effect of fluoride gel application on dental caries reduction in a low-caries child population was considered not clinically relevant.
Article
The objective was to evaluate the clinical performance of a therapeutic sealant to arrest the progression of noncavitated approximal posterior carious lesions. The study population comprised 50 adolescents in whom bitewing radiographs had been taken for diagnosis of caries. Approximal noncavitated lesions in premolars and molars (4d-7m) were selected. One group (n=17) had a sealant placed after tooth separation on all enamel lesions. A second group (n=7) received sealant and fluoride varnish in a split-mouth design. A control group (n=26) received a standard fluoride varnish treatment without tooth separation. Follow-up radiographs were taken after 2 years and were analyzed together with the baseline radiographs in a blind study setting. About 93% of the sealed initial carious lesions showed no progression. The corresponding value for the fluoride varnish control group was 88%. In the split-mouth study, 92 and 88% of the surfaces with enamel caries showed no progression after sealant or fluoride varnish treatment, respectively. The difference between the two treatment procedures was not statistically significant. The incidence rate for the transition from enamel caries to dentin caries or fillings was 3.5-3.9 surfaces/100 years in the sealant groups and 5.9-6.1 surfaces/100 years in the fluoride varnish groups. The results show the potential of sealants to act as a noninvasive treatment of early approximal enamel lesions.
Article
To evaluate the efficacy of weekly supervised tooth-brushing with a toothpaste and a 1.23% acidulated phosphate fluoride gel (APF) gel on white lesion reversal to treat incipient enamel lesions. A double-blind and randomized controlled trial. Three-hundred seven to 12-year-old Brazilian schoolchildren who presented with white spots on the buccal surfaces of permanent upper incisors were randomly allocated to three groups. In group I, children underwent supervised tooth-brushing and APF gel (1.23%) for one minute once a week. In group II, children were subjected to a weekly supervised tooth-brushing and a topical application of placebo, whereas group III (control) received no intervention. An expert dental examiner performed all intra-oral examinations for dental caries (DMF-s and dmf-s) and oral hygiene (Visible Plaque Index, Gingival Blood Index). After three months, 258 children and 460 lesions were analyzed. The results of the clinical evaluation of arrested white spots did not differ significantly (p = 0.95) between the two experimental groups (57.9% in group I and 56.8% in group II) but differed significantly between them and the control group (p = 0.022). Logistic regression analysis identified gingival blood index (OR = 1.70, CI = 1.13 -2.55), DMF-s2 (OR = 1.61, CI = 1.07-2.43) and number of white spot lesions (OR = 1.76, CI = 1.04 to 2.98) as independent 'risk' factors for white spot lesion activities. On the other hand, supervised tooth-brushing with APF (OR = 0.55, CI = 0.34-0.91) or without APF (OR = 0.58, CI = 0.35-0.94) was a protective factor. These results suggest that the weekly supervised tooth-brushing was able to arrest enamel white spots and that poor oral hygiene increases the probability of keeping white spots active.
Article
The aim of this examiner-blind, clinical monitoring was to observe long-existing white spot lesions over a period of 6 months and to evaluate the effectiveness of fluoridated toothpastes on these lesions. Thirty-nine subjects with at least one lesion participated in the study. They were randomly divided into two groups (n=20 and n=19) and instructed to brush their teeth either with toothpaste containing sodium fluoride (1500 ppm) (group 1) or with toothpaste containing amine fluoride (1250 ppm) (group 2). Lesions were measured with quantitative light-induced fluorescence (QLF) and alterations were quantified by DeltaQ as fluorescence loss integrated over the lesion area (% x mm(2)). All QLF images were taken by one examiner at baseline (DeltaQ1) and follow-up visits after 2, 4, 6, 8, 10, and 12 weeks, and after 4, 5, and 6 months (DeltaQ10). The results showed a slight but not significant progression of DeltaQ (% x mm(2)) in group 1 ((p>0.05; t-test), DeltaQ1 -20.31 (+/-41.06); DeltaQ10 -26.2 (+/-47.69)) and in group 2 ((p>0.05), DeltaQ1 -22.28 (+/-43.86); DeltaQ10 -26.39 (+/-46.4)). The results indicated no significant differences regarding the influence of the fluoridated toothpastes (p>0.05). It can be concluded that within 6?months the long-existing white spot lesions are stable concerning fluorescence loss over the lesion area. Moreover, fluoride does not seem to have any effect on long-existing white spot lesions.
Article
Recent years have seen an increase in research activity surrounding diagnostic methods, particularly in the assessment of early caries lesions. The drive for this has come from two disparate directions. The first is from the dentifrice industry who are keen to develop techniques that would permit caries clinical trials (CCTs) to be reduced in duration and subject numbers to permit the investigation of novel new anti-caries actives. The second is from clinicians who, armed with the therapies to remineralise early lesions are now seeking methods to reliably detect such demineralised areas and implement true preventative dentistry. This review examines novel technologies and the research supporting their use. Techniques based on visual, optical, radiographic and some emerging technologies are discussed. Each have their benefits although systems based on the auto-fluorescence (such as QLF) of teeth and electrical resistance (such as ECM) seem to offer the most hope for achieving reliable, accurate detection of the earliest stages of enamel demineralisation.
Article
Secondary analyses were performed to study the cariostatic efficacy of semi-annual professional fluoride gel application on incipient carious lesions in low-caries children initially aged 9.5-11.5 years. Double-blind randomized controlled clinical trial. The mean treatment effect of fluoride gel for enamel and dentinal caries lesions after 4 years' follow-up was 0.92 D(2,3)FS and 0.20 D(3)FS, respectively. When enamel lesions were included in the DFS count (i.e. D(2,3)FS), the preventive fraction (PF) showed borderline significance (23%; P = 0.05). No significant treatment effect of professionally applied fluoride gel was found for D(2,3)FS and D(3)FS scores of the second molars. The PF for D(2,3)FS of occlusal, approximal, buccal and lingual surfaces and for buccal and palatal pits and fissures differed not significantly. Professionally applied fluoride gel showed no statistically significant caries-inhibiting effect on both enamel and dentine lesions in the permanent dentition of low-caries children.
Article
To investigate whether supplementary daily use of amine fluoride toothpaste with weekly brushing with amine fluoride gel enhances the remineralization of white spot lesions on smooth surfaces and also to investigate the possible effect of this treatment on salivary bacterial counts and oral hygiene. The participants comprised 135 caries-active adolescents living in suburban Stockholm. They were given an amine fluoride dentifrice (1250 ppm F) to be used twice a day, and either a test gel (4000 ppm F) or a placebo gel for brushing for 2 min once a week. During the 12-month study period, the subjects were recalled every 3rd month (baseline, 3, 6, 9, and 12 months). At each visit, DF(average change in fluorescence, in%) and lesion area (in mm2) were measured using quantitative light-induced fluorescence(QLF), followed by dietary counseling, oral hygiene instruction, and professional tooth-cleaning. At baseline, 6, and 12 months, saliva was sampled for Streptococcus mutans and lactobacillus counts, and gingival bleeding index was registered. QLF indicated no enhancement of remineralization of white spot lesions by additional weekly brushing with amine fluoride gel. No inter-group differences emerged with regard to salivary bacterial counts. However, the oral hygiene of both groups improved, with a strong significance over time. Adjunctive weekly brushing of amine fluoride gel achieved no significant enhancement of remineralization of white spot lesions monitored with the QLF method.
Article
This randomized clinical trial compared the ability of two dentifrices, one containing 5000 ppm fluoride (Duraphat) and the other 1450 ppm fluoride (Caries Protection, control) to reverse non-cavitated fissure carious lesions. 30 adults having occlusal lesions with DIAGNOdent values between 10 and 20 were randomly assigned to two groups of 15 participants each. DIAGNOdent measurements were performed after cleaning the teeth with cleaning brushes and after additional cleaning using an airflow device. The participants were instructed to brush their teeth three times a day for 3 minutes after the meals with a 2 cm line of their assigned dentifrice. After a period of 2 weeks, the teeth were cleaned again with the airflow device and laser fluorescence measurement was performed. The group using the dentifrice containing 5000 ppm showed a significantly higher decrease in laser fluorescence (21%) over the test period than the control group (4%; P< 0.001; repeated measures ANOVA). The decrease in laser fluorescence in the test group was significant (P< 0.001; Wilcoxon signed-rank test). The difference between cleaning the teeth with cleaning brushes and additional cleaning with airflow before DIAGNOdent measurement was not statistically different (P> 0.05; Wilcoxon signed-rank test).
Article
To investigate and compare the effects of a dental cream containing complexes of casein phosphoprotein-amorphous calcium phosphate (CPP-ACP) and fluoride mouthwashes on the regression of white spot lesions (WSL). The study group consisted of 26 healthy adolescents (mean age 14.6 years) exhibiting 60 teeth with 152 visible WSL sites on incisors and canines immediately after debonding of fixed orthodontic appliances. After bracket removal, professional tooth cleaning and drying, a visual scoring (0-4) and laser fluorescence (LF) readings were carried out. The patients were randomly assigned to two different treatment protocols with the aim of remineralising the lesions: A) daily topical applications of a dental cream containing CPP-ACP (Topacal) for 3 months followed by a 3-month period of daily toothbrushing with fluoridated dentifrice, or B) daily 0.05% sodium fluoride mouthwash combined with fluoridated dentifrice for 6 months. The registrations were repeated after 1, 3, 6 and 12 months and follow-up data were compared with baseline with aid of chi-square and paired t-tests. A significant improvement of the clinical WSL-scores was found over time in both groups, but there was a statistically significant difference (p < 0.01) concerning the number of sites that totally disappeared after 12 months in favour of the CPP-ACP regime, 63% compared with 25% respectively. The clinical registrations were mirrored by a statistically significant decrease (p < 0.05) in the LF readings at the 6- and 12-month follow-ups compared with baseline. No significant differences were displayed between the groups. Clinical scoring and LF assessment suggested that both regimens could promote regression of WSL after debonding of fixed orthodontic appliances. The visual evaluation suggested an aesthetically more favourable outcome of the amorphous calcium phosphate treatments.
Article
This article presents evidence-based clinical recommendations for use of pit-and-fissure sealants developed by an expert panel convened by the American Dental Association Council on Scientific Affairs. The panel addressed the following clinical questions: Under what circumstances should sealants be placed to prevent caries? Does placing sealants over early (noncavitated) lesions prevent progression of the lesion? Are there conditions that favor the placement of resin-based versus. glass ionomer cement sealants in terms of retention or caries prevention? Are there any techniques that could improve sealants' retention and effectiveness in caries prevention? Staff of the ADA Division of Science conducted a MEDLINE search to identify systematic reviews and clinical studies published after the identified systematic reviews. At the panel's request, the ADA Division of Science staff conducted additional searches for clinical studies related to specific topics. The Centers for Disease Control and Prevention also provided unpublished systematic reviews that since have been accepted for publication. The expert panel developed clinical recommendations for each clinical question. The panel concluded that sealants are effective in caries prevention and that sealants can prevent the progression of early noncavitated carious lesions. These recommendations are presented as a resource to be considered in the clinical decision-making process. As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences. The evidence indicates that sealants can be used effectively to prevent the initiation and progression of dental caries.