Monographs in Oral Science最新文献

Dental caries is a disease that affects people of all ages since demineralization and remineralization of tooth surfaces occur in everyone's mouths, and caries lesions develop when there is an imbalance between demineralization and remineralization. In this way, teeth are exposed to a risk of caries. Prevention strategies aiming at "zero caries" and treatments aiming at "tooth recovery and regeneration" are the two main areas of caries research, and both basic and clinical research are required in these fields. The following future perspectives of caries research were identified: The disease concept of caries is undergoing rapid structural changes, as it will increasingly become a disease of all generations: Changes in our understanding of caries etiology (from cariogenic pathogens in the specific plaque hypothesis to the oral microbiome in the ecological plaque hypothesis) will alter the concept of caries-associated bacteria (from mutans streptococci to a group of bacteria with high acid-producing capacity and acid-tolerance or acidogenic/aciduric bacteria). In the field of prevention, more individualized, site-specific, and high-precision examinations for risk assessment and diagnostic methods, including genetic tests, will be developed, and advanced preventive, curative, and regenerative treatments will become possible. To achieve this, interdisciplinary, multidisciplinary, and transdisciplinary research are essential, and collaboration and fusion with other sciences, such as material science, engineering, food science, and nutritional science, are required. Furthermore, in order to put the results of such research into practice in society, it will be necessary to promote industry-academia collaborations; promote behavioral change through sociological approaches; and correct economic, informational, and educational inequalities. The sociological approach requires the coupling of epidemiology and data science as well as the validation of clinical applications, and artificial intelligence will play a powerful role in such analyses.

In this chapter, diet is revisited to shed light on its role in caries development and management in contemporary populations. Measures applied to promote a rational consumption of sugars and changes observed in sugars consumption are also addressed. A cariogenic diet provokes an imbalance in the oral microbiome, resulting in dysbiosis with predominance of acidogenic and aciduric bacteria in the dental biofilm. Both a cariogenic diet and a balanced diet modulate caries development and progression in contemporary populations. A cariogenic diet particularly impacts high-risk groups and should be avoided. A rational consumption of sugars presents a low risk for caries development in populations with regular oral hygiene practices and exposure to fluoride-containing toothpaste or combined exposure to fluoride-containing toothpaste and fluoridated water. Some initiatives have been developed to promote a rational consumption of sugars, but further efforts should be made in this respect. Although the consumption of sugars has remained high and stable, some countries observed a decrease in caries prevalence. A reduction in the daily consumption of sugars provides general and oral health benefits. Therefore, the intake of sugars should be as low as possible in the context of a nutritionally balanced diet.

Despite all the current knowledge in cariology, research is still being carried out nowadays trying to make dental enamel resistant to dental caries. Since enamel is mainly composed by a mineral, efforts have been put together to make it more resistant to acids produced by dental biofilm when exposed to dietary sugars. Fluoride was once thought to be a micronutrient that impacted caries resistance when incorporated in the tooth mineral, but we now know that the complex interactions at the mineral surface are most important. Every slightly soluble mineral, and enamel is no exception, has a behavior that is determined by the environment where it is located, and in the case of the dental crown, saliva and biofilm fluid play an important role. Enamel can keep in balance or lose its minerals, but it can gain them back. These processes, equilibrium, and loss or gain follow Le Chatelier's principle, and physicochemically, they are known as saturating, undersaturating, and supersaturating conditions, respectively. Saliva, and even the biofilm fluid, is supersaturated with calcium (Ca2+) and phosphate (PO43-) in relation to enamel solubility, and thus the natural tendency of enamel is to gain mineral, conferring saliva with a remineralizing property. However, the decrease in pH and the presence of free fluoride ion (F-) will determine what will happen to the enamel. While lowering the pH of the medium is an imbalance factor, fluoride at micromolar concentration reduces the acid impact. This chapter provides an updated, evidence-based understanding of the interactions between enamel and oral fluids.

This chapter summarizes the clinical data on coronal caries distribution and sociodemographic drivers in children, adults, and older people, at a global level. Mapping global caries prevalence showed an extreme variation on the prevalence, revealing still high rates in several countries. The disease is presented in each group as prevalence by age and mean number of affected teeth. Differences in the prevalence of dental caries in developed and developing countries may be due to not only wide variations in the age groups studied but also ethnic, cultural, geographic, and developmental differences, as well as access to dental services, healthcare availability, oral healthcare behaviors, nutritional habits, and lifestyles. The prevalence of caries in children and adults showed a decreasing trend in Western countries, notwithstanding the distribution of the disease is highly skewed linked to individual and community determinants. In older persons, a high caries prevalence up to 98% has been reported, with a very heterogeneous distribution among and within countries. Although still highly prevalent, a declining trend for tooth loss was observed. The patterns of the association between sociodemographic indicators and caries data indicate the need of a reform of the global oral healthcare system considering all the life course and caries inequalities. Further needs are related to the production of primary data on oral health to provide support to policymakers to create the national oral healthcare policies guided by epidemiology-based models of care.

After the caries lesion reaches a certain extent of tooth structure loss, a restoration is often needed to repair the defect. Operative interventions in cariology aim to aid biofilm removal and lesion arrest by cavity sealing, avoid pulpal damage, and restore form, function, and esthetics. There are no clear evidence-based parameters to determine the most appropriate treatment option for each clinical situation. Despite of this, direct composite resins have been the preferable restorative treatment. Scientific literature shows that composites and adhesive strategies play a minor role in treatment success. Patient-related risk factors (mainly those associated with lifestyle and health choices), in addition to the dentist's decision-making process, play a significant role in longevity of the restorations, which tend to fail for the same reasons that lead to the need for restoration (dental caries, tooth/restoration fracture, and esthetics). Therefore, monitoring old restorations in clinical service, even if those present clear signs of degradation, is possible and reasonable within the concept of minimal intervention in dentistry. Unnecessary reinterventions are harmful and costly to health systems, and the clinician's efforts must be directed to eliminating or reducing the etiological factors that can cause the restoration to fail. Thus, patient risk factors assessment is a crucial point in monitoring restorations. Clinician should - whenever possible - postpone operative reinterventions, monitoring the etiological factors that may compromise the restoration's longevity. Also, when operative reintervention is necessary, refurbishment, polishing, and repair should be prioritized over replacement.

Fluoride is the main agent used to control dental caries, with a very successful history after its widespread implementation worldwide, resulting in significant caries declines around the globe. In this chapter, the mechanism of action and peculiarities of different methods of fluoride use are revised. Fluoride controls caries progression by interfering with the processes of mineral exchanges (demineralization, remineralization) to which teeth are frequently subjected upon exposure to dental biofilm and a diet rich in fermentable sugars. Because caries is a ubiquitous disease of modern societies, different strategies have been developed to successfully keep fluoride available in oral fluids: (1) community-based approaches, such as water fluoridation, in which fluoride is delivered to communities at very low levels; (2) individual-based approaches, such as fluoride toothpastes, in which fluoride is delivered at higher concentrations, directly into the oral cavity, in a convenient combination with the act of brushing teeth to remove dental biofilm; (3) professionally-delivered approaches, such as fluoride gels and varnishes, in which very-high concentration products react with teeth resulting in local fluoride reservoirs that release the ion for weeks/months; and (4) combinations of these approaches, such as the concomitant use of fluoridated water and toothpaste, or the use of professional fluorides in caries-active patients. In conclusion, this chapter reviews the different modalities of fluoride use for coronal caries control, and summarizes the combined application of these methods according to the best evidence available.

Pathology is the science of how a tissue changes during the process of the disease. The pathology is of important knowledge for understanding subsequent treatment concepts of a disease. In the cariology field, pathological features of caries are often presented using tooth sections, whereby the sequence and spread can be monitored. It is optimal to describe such changes using thin undecalcified tooth sections as an overview can be given of both enamel demineralization and pulp-dentine reactions. Also, an optimal understanding is achieved if the clinical status of carious lesion activity is known. Different studies using human teeth have shown the principle changes in progressive stages of carious lesions; the growth of the enamel lesion reflects the growth condition of the cariogenic biofilm. Surprisingly, the pulp (the odontoblast) is aware of the cariogenic stimuli even before mineral alteration has taken place within the dentine. The microorganisms mainly invade the dentine during enamel cavitation. In this chapter, the current improvement of knowledge on advanced carious lesions has been assessed in detail both histologically and radiographically. From a radiographic point of view, well-defined deep and extremely deep carious lesions and their difference are presented. Recent advances in artificial intelligence (AI) in medicine have raised the possibility of increasing the accuracy and speed of histopathological examination techniques. However, the literature involving AI-based histopathological features of hard and soft dentinal tissue pathologic changes is still scarce.

In recent decades, dentistry has developed significantly in all areas. While in the past, caries was mainly treated operatively, the today's management has shifted toward noninvasive, minimal invasive, and, only if needed, invasive treatment options. Aiming at enabling the most noninvasive or conservative treatment option requires early caries detection, which, however, remains challenging. The progression of early or noncavitated caries lesions can nowadays be successfully controlled, as well as lesions arrested by oral hygiene procedures combined with the use of fluorides, sealants, or resin infiltration. Methods such as near-infrared light transillumination, fibre-optic transillumination, digital fibre-optic transillumination, laser fluorescence, or quantitative light fluorescence measurements were introduced in the dental market to provide X-ray-free caries detection, assessment, and monitoring. For approximal surfaces that are not directly visible, bitewing radiography is still the standard in detecting caries lesions. The use of artificial intelligence has become the most recent technological aid for the detection of caries lesions on bitewing radiographs and clinical images and has to be understood as an emerging technology, which requires extensive research in the future. The aim of this chapter is to give an overview of different possibilities to detect coronal caries lesions and suggestions of how to improve this process.

Caries risk assessment (CRA) is essential to delivering personalized/precision care in caries management. Limited formal evaluation and validation of existing CRA tools affects the ability to accurately predict new lesions. However, this should not prevent clinicians from assessing modifiable risk factors to guide preventive measures and address individual needs to personalize care. Since caries is a multifactorial and dynamic disease process, CRA is complex and impacted by multiple variables throughout the life course, demanding periodic re-assessment. Many factors can influence caries risk at the individual, family, and community level; however, unfortunately, caries experience is still considered one of the greatest indicators of future risk for caries. CRA tools that are validated, inexpensive, and easy to use should be developed and prioritized to help support decision-making to implement evidence based, and minimally invasive caries management strategies for coronal caries lesions in children, adults, and older persons. Efforts into developing CRA tools should include evaluation and reporting of internal and external validation information. In the future, approaches using big data and artificial intelligence may drive risk predictions, and cost-effectiveness analyses may help derive the selection of appropriate risk thresholds for decision-making. Because of the importance of CRA in the treatment planning and decision-making process, challenges for implementation including how to communicate risk to drive behavior change, development of tools that are quick and easy to integrate seamlessly into the busy clinical flow, and reimbursement for the time needed to implement should be considered.