Monographs in Oral Science最新文献

Nonoperative treatment of coronal caries is defined as a series of nonoperative measures interfering with the initiation of new caries lesions and the rate of caries lesion progression. This treatment aims to keep the caries process at subclinical level and to arrest caries lesion progression at clinical and/or radiographic levels. This chapter considers the implementation of the nonoperative treatment of caries disease in daily practice with a focus on its biological determinants. The treatment planning is based on the information gathered through patients' anamnesis, clinical and radiographic examinations together with patients' risk assessment. For most caries inactive patients, the implementation of core measures of the nonoperative treatment is sufficient to control the caries disease, while for caries active patients both professionally and self-applied additional measures are required. Clinical cases illustrating successes and limitations of the nonoperative treatment for the whole dentition are presented. Patients/parents should take responsibility for their own or their child's oral health and the dental professional team should help them to achieve this goal. It is relevant that patients/parents understand that the nonoperative treatment of caries disease is evidence-based. Nevertheless, as any other treatment, successes and failures are likely to occur, and these are to a great extent dependent on patients'/parents' compliance. Finally, the dental team should keep its knowledge constantly updated to provide the best available treatment for their patients in daily practice.

Although the discussion about the amount of carious dentin to be removed during cavity preparation is quite old, concepts for caries removal have evolved and changed considerably over the last decades. The antiquate understanding that it was necessary to eliminate the microbial contamination of a cavity before placing the restoration was replaced by the current knowledge that maintaining contaminated dentin beneath restorations is inevitable and is not associated with treatment failure. This chapter brings together the body of evidence behind carious dentin removal to indicate a conservative treatment, aiming to preserve both tooth vitality and structure. Studies that evaluated the effects of sealing contaminated dentin are described, which are focused on different outcomes, such as microbiological counts, clinical characteristics, laboratory analysis, and radiographic findings. Long-term studies and randomized clinical trials also support the current recommendations. After addressing the available literature on this topic, this chapter concludes that (1) the amount of carious dentin to be removed should be defined by lesion depth; (2) sealing and/or selective caries removal to firm dentin is recommended for the management of shallow and moderate lesions; (3) the selective caries removal to soft dentin in a single session is indicated for deep caries lesions aiming to preserve tooth vitality; and (4) the use of a cavity liner after selective caries removal seems to be an unnecessary clinical step.

This chapter considers the main principles guiding diagnosis of the disease dental caries in clinical practice by means of clinical examination and radiographs as adjunct method. Dental professionals have been trained to diagnose caries disease by assessing clinical symptoms and signs of caries lesions complemented by radiographic examination as an adjunct method. Clinical examination is the foundation of the diagnosis and should be performed after removal of dental biofilm of tooth surfaces, air-drying, and under good illumination. Clinical diagnostic methods categorize caries lesions according to their severity and in some methods according to their activity. Caries lesion activity has been determined by surface reflection and texture. The detection of thick or heavy biofilm on tooth surfaces is an additional diagnostic clinical tool to estimate caries lesion activity. Patients with no caries experience, that is, without clinical and/or radiographic signs of caries lesions in the dentition, are considered caries inactive. Other caries-inactive patients may present inactive caries lesions/restorations in their dentition. In contrast, patients are considered caries active when presenting any active caries lesion at clinical level and/or any progressing lesion as demonstrated by at least two bitewing radiographs taken at different points in time. The main concern about caries-active patients is that caries lesions are likely to progress unless effective measures are implemented to interfere with its progression. Prescribed according to individual needs, bitewing radiographs provide additional information for clinical examination in the detection of approximal enamel and outer third dentine lesions that can be inactivated by nonoperative treatment.

Bacteria, fungi, archaea, protozoa, viruses, and bacteriophages colonize the oral cavity and, in combination, they form the oral microbiome. The coexistence of different microorganisms and the microbial balance at each specific site are warranted by synergistic and antagonist interactions among members of the microbial communities. This microbiological balance suppresses the growth of potentially pathogenic microorganisms, generally keeping them at low abundance in the colonized sites. Microbial communities coexist in harmony with the host being compatible with a health condition. On the other hand, stressors exert selective pressure on the microbiota, promoting disruption in microbial homeostasis leading to dysbiosis. In this process, potentially pathogenic microorganisms become more abundant, resulting in microbial communities with altered properties and functions. Once the dysbiotic state has been reached, increased disease risk is expected. Biofilm is essential for caries development. The knowledge of the composition and metabolic interactions in the microbial community is fundamental for developing effective preventive and therapeutic measures. Studying both health and cariogenic conditions will bring an essential understanding of the disease process. Recent advances in omics approaches provide an unparalleled potential to reveal new insights about dental caries. This chapter will discuss a broader perspective on the etiology and pathogenesis of coronal dental caries from biofilm structure to microbial interactions.

The development of the human dentition is prone to disruption due to its delicate and complex nature - including variations in tooth number and anatomical form and in the characteristics of enamel, dentine, and cementum. This chapter will focus on developmental defects of dental enamel (DDE) and dentine (DDD), which can be associated with considerable treatment burden on an individual, often related to the change in dental hard tissue characteristics in those at increased caries risk. DDE are prevalent and can be related to genetic conditions such as amelogenesis imperfecta and environmental challenges such as direct physical trauma to the developing tooth or systemic insults during the different phases of amelogenesis. Phenotypical variability can be great, making diagnosis difficult in many cases. There are two major enamel defects - the quantitative defect of hypoplasia and the qualitative defect of hypomineralization. DDDs are less prevalent than DDEs, with two major DDD types: dentinogenesis imperfecta and dentine dysplasia. The main features of the DDDs are enamel fracture exposing the dentine and subsequent wear, with enlarged pulp spaces in some variants. The appearance may be affected, with bulbous teeth and grey-blue to brown opalescent colouring. With respect to dental caries, developmental defects of the teeth, in themselves, do not cause caries risk; however, they can change the manifestation of the disease due to creating niches for biofilm accumulation and thereby increasing cleaning difficulty and changing the physical and chemical characteristics of dental hard tissues and how they react to cariogenic challenges.

Dental caries is the most prevalent oral health disease and affects the health of individual and populations. The conventional disease metrics do not represent the impact of caries on people's lives. Oral-health-related quality of life measures were developed to help understand which aspects of dental caries have the greatest impact on well-being. How these measures were developed follows a standardized process of development and testing, with the ultimate aim of the entire process being that they be used in clinical dentistry, dental epidemiology, and health services research. There has been ongoing debate about whether these measures have adequate discriminative ability for the wide range of caries experience, and whether they are responsive to changes in disease experience. Whether these measures are "perfect" or not, what we do know after two decades is that numerous studies have found them to be sufficiently discriminative for caries in adults and children alike. There is also evidence for their responsiveness, chiefly from studies of children undergoing dental treatment under general anesthetic for early childhood caries. The influence of environmental, social, and psychological characteristics is another consideration in how people self-rate their oral health. Is there a need to improve the quality of these measures by refining existing ones or developing new ones which may represent those broader concepts? Regardless of the future, the most pressing challenge is the need for health systems work to ensure the routine use of these measures in clinical and public health practice.

Biofilm formation has become a significant problem in dental unit water lines (DUWLs). The formation of biofilms and microbial growth in DUWLs leads to an unacceptably high number of microorganisms in the water used for spraying, cooling, and ultrasonication procedures. These procedures form aerosols which can be inhaled by the patients, and consequently dentistry constitutes an area of specific concern for patient safety. In particular, older and immunocompromised patients are at risk of serious respiratory tract infections if the water contains pathogens such as Legionella pneumophila and Pseudomonas spp. In the EU it is recommended that the water in DUWLs should not exceed 200 colony-forming units (CFU) of heterotrophic bacteria (bacteria living on organic material) per milliliter of water to be acceptable in dental work. A number of efficient products are available on the market that can be applied onto dental units. New dental units are nowadays equipped with "inbuilt" systems. Such measures have resulted in an acceptable standard of water in 95% of the 1,200 dental units in the Public Dental Health Service of the Västra Götalands region of Sweden that were followed yearly for 4 years. For the majority of the remaining DUWLs with an unacceptable standard this is due to neglect or inappropriate routines for water-cleaning procedures. It is the ability to follow instructions rather than the cleaning procedure itself that is decisive if clinics and dental units are to have an appropriate standard of water in their systems.

The present narrative review provides a summary of the temporal and spatial reactions of the oral microbiome to the placement of a dental implant into the oral cavity, depicting the most important interactions between the oral microbiota and the host response involved in the development of peri-implant infections in humans (i.e., peri-implant mucositis and peri-implantitis). Starting with the formation of a pellicle to acute and rampant peri-implant inflammation, a number of steps, including biofilm formation, aggressive bacterial invasion, and host defense mechanisms, are involved. Better understanding of the factors related to the host response and changes in the composition of microbiota has led to the development of novel treatment modalities. Finally, a short outlook into the future is provided.

Dental biofilms can cause major oral diseases like gingivitis, periodontitis, and caries. Orthodontic appliances promote supra- and subgingival biofilm accumulation, alter the oral microbiome, and hamper oral hygiene. Orthodontic treatment can be associated with adverse effects, such as enamel decalcification, gingivitis, and periodontal disease. The aim of this review is to summarize the changes in supra- and subgingival biofilm and periodontal tissues during and after orthodontic treatment. Studies have reported elevated levels of Streptococcus mutans and periodontopathogenic bacteria in patients undergoing orthodontic treatment. In general, the microbial changes and periodontal parameters decreased to pretreatment levels after appliance removal. Nevertheless, some adverse effects associated with orthodontic treatment are not reversible, such as enamel decalcifications caused by metabolic products of high levels of cariogenic bacteria. The evidence suggests that the roughness and constituents of the orthodontic materials influence the bacterial colonization. Therefore, several antibacterial orthodontic bonding systems, which show antibacterial effects in vitro, have been developed. The importance of adequate oral hygiene should be emphasized to all orthodontic patients. They should be frequently reminded and motivated to obtain a good oral hygiene. The evidence from the current literature suggests the safest way for orthodontic treatment in periodontally diseased patients may be after successful completion of the periodontal therapy. However, the exact time point needs to be better clarified in future studies.