Caries Research最新文献

Introduction: Selective Outcome Reporting (SOR) is a type of bias that potentially manifests in Randomized Controlled Trials (RCTs) and is defined as the change or omission of the primary outcome in the publication compared to the protocol. Researchers may alter outcomes to emphasize statistical significant results. We aimed to assess the prevalence of SOR in RCTs related to dental caries in Pediatric Dentistry.

Methods: We conducted a search on the ClinicalTrials.gov and International Clinical Trials Registry Platform (ICTRP), using a comprehensive search strategy that included terms related to pediatric dentistry and dental caries, up to February 2023. Two independent reviewers included any trial that had two or more arms and focused on dental caries in pediatric dentistry. We excluded any registration that did not result in at least one published article. Data such as study characteristics and outcome data were extracted. The chi-square test was used with a significance level set at 5% to detect the association between SOR and the pre-specified variables.

Results: One hundred and forty-four protocols and their corresponding publications were included. SOR was observed in 58.9% (n=103), and 41.1% (n=72) having discrepancies in the primary outcome follow-up. Retrospectively registered studies accounted for 73.7%. SOR was significantly associated with discrepancies in the follow-up period (p<0.001) and with type of study design in paper (p=0.048).

Conclusion: The high prevalence of SOR in dental caries RCTs in pediatric dentistry confirms that the issue deserves attention. Achieving transparency in the process requires the implementation of an appropriate pre-registered protocol, disclosure of deviations from it, and allowing stakeholders to compare the established protocol with the submitted documents Registration DOI: https://doi.org/10.17605/OSF.IO/5UVJ8.

Introduction: The association between lower socioeconomic status and a higher risk of dental caries is well established, but the independent association between general health status and dental caries on a population level is less investigated. The aim of this study was to assess the association between self-rated general health and caries experience in an adult Norwegian population and to assess if the associations were modified by age and sex.

Methods: Data was collected as part of the Trøndelag Health Study (HUNT4) conducted 2017-2019 and a randomly selected subsample (20%) were invited for the HUNT4 Oral Health Study. This cross-sectional study included 4,880 dentate participants aged 19-94 years (response rate 67%). Participants underwent clinical and radiographic oral examinations and caries experience was measured by numbers of decayed (DT), missing (MT), and filled teeth (FT), DMFT index. The DT component consisted of primary and secondary caries in dentine, cavitated root caries and remaining roots. Questionnaires were used to assess self-rated general health and socioeconomic position, denoted by education, household income and employment status. Associations between self-rated health and caries experience (DMFT) and components (DT, MT, and FT) were assessed using negative binomial regression models. Ratios of means (RMs) with 95% confidence intervals (CI) for the associations were estimated, adjusting for socioeconomic position.

Results: Individuals with poor self-rated general health had a 29% higher mean number of MT (RM 1.29 (95%CI 1.13-1.46)), a 22% higher mean number of DT (RM 1.22 (95%CI 1.07-1.39)), and a 7% higher mean number of DMFT (RM 1.07 (95%CI 1.04-1.11)) than individuals reporting very good health. Age stratified analyses presented a more pronounced association between self-rated health and caries experience for individuals below the age of 55 years than for those 55 years or older. Similarly, the association was more evident for women, with significantly higher mean values for DMFT, MT and FT among women reporting poor health.

Conclusions: The present study demonstrated an independent association between poor self-rated health and a higher burden of caries experience, adjusted for education, income and employment status. The association was stronger for women and individuals below the age of 55 years. These findings add new evidence in understanding caries inequalities through self-rated health.

Introduction: Among the wide variety of commercially oral hygiene products, activated-charcoal-based toothpastes have irrupted the market, claiming multiple benefits. Although most are fluoride-free, others incorporate fluoride into their formulations, yet the chemical availability and stability of fluoride in these products remain unclear. Our study aimed to assess the chemical availability and stability of fluoride in commercially fluoridated toothpastes formulated with activated charcoal.

Methods: We purchased duplicate samples with different lot numbers of different brands containing fluoride (F) and activated charcoal (n=20) in the US and Chile. Three toothpastes, one non-fluoridated, one containing sodium fluoride (NaF) and another with sodium monofluorophosphate (Na2FPO3), were used as controls. All toothpastes were evaluated at the time of purchase (fresh) and after their expiration date (aged). We determined total-F and available total soluble-F (TSF), using a F specific ion electrode. Values were expressed in mg F/kg (ppm F, w/w).

Results: Most evaluated toothpaste contained NaF (70%) or Na2FPO3 (30%) as the F salt, and all declared to contain silica. The TSF concentration ranged from 952.6 to 1438.1 and from 925.7 to 1493.7 ppm F for fresh and aged toothpaste, respectively. TSF remained close to total-F and in agreement with the F concentration reported by the manufacturer. After expiring, the commercial toothpastes did not form insoluble F, except the Na2FPO3/CaCO3-based control.

Conclusion: The silica-based toothpastes formulated with activated charcoal present fluoride potentially bioavailable and chemically stable to control caries. However, concerns regarding abrasiveness, as raised by other researchers, cast doubt on the suitability of these toothpastes for widespread use.

Introduction: The aim of this cross-sectional study was to explore the degree whereby dentists differentiate between repair versus replacement for failed restorations. A random selection of adult patients from North Norway was chosen from the larger Tromsø 7 study.

Methods: A randomized sample of 3,653 persons (11.5% of the total number of individuals invited to the Tromsø 7 study, 51.5% women, aged 40-93 years) were included. Based on FDI's clinical criteria for the evaluation of restorations - 2010, 17 calibrated dentists evaluated patients by clinical and radiographical pictures in a specially designed software developed for this purpose. The dental practitioners' opinions gave rise to the reported treatment decisions. Descriptive statistics and multivariable multilevel mixed-effect logistic regression models (STATA 17/SE) were performed.

Results: The participants' DMFT values ranged from 0 (0.9%) to 24 (8.8%) (median DMFT 21.3, mean 20.0). A total of 90.062 teeth (24.7 teeth per patient) were assessed. Re-treatment suggestions were made for 3,006 restorations, i.e., an average of 3.3% re-treatments. Of these, 25.3% (n = 814) were suggested for repair and 74.7% (n = 2,192) for replacement. Dental treatment was suggested for 1,597 patients and varying from 1 to 14 suggestions per patient. Secondary caries (37.6%) and restoration fracture (15.2%) were found to be most frequently used indications for re-treatment, surface properties the least. No significant difference was found between assessing dentists based on sex or age. Clustering by dentist level was checked using intra-class correlation coefficients, demonstrating that 16% of the variance in suggestions for restoration re-treatment was explained at the dentist level. Thus, a wide range of treatment suggestions was noted among the dentists.

Conclusion: Need for restoration revision seems low in North Norway. There is a tendency towards larger and more indirect restorations, and the diagnosis of secondary caries is still a matter of uncertainty.

Introduction: Streptococcus mutans adherence to the tooth surface and subsequent biofilm development is modulated by the carbohydrate source, but the corresponding effect on bacterial proteome has not been previously studied. This study aimed to assess the effect of different carbohydrates on S. mutans viability and bacterial proteome at 2 time points, early attachment (8 h) and biofilm maturation (24 h).

Methods: Hydroxyapatite (HAp) discs coated with parotid saliva proteins were inoculated with S. mutans UA159 in tryptone soy broth without dextrose supplemented with one of the following carbohydrates (n = 12/treatment/time point): 1% sucrose; 0.525% glucose + 0.525% fructose; 10% xylitol; 10% xylitol + 1% sucrose; or culture medium without supplementation as negative control. Once inoculated, HAp discs were incubated for 8 h or 24 h at 37°C and 10% CO2. After each incubation period, adhered bacteria were quantified using the plate-counting method for 6 HAp discs/group, and the remaining 6 HAp discs/group were used to extract bacterial cell wall proteins. Extracted proteins were analyzed using liquid chromatography coupled with mass spectrometry and then classified by their biological process. The study was conducted in three independent assays, and the number of bacteria adhered to the HAp discs was determined at each time point and analyzed by two-way ANOVA followed by Bonferroni test (α = 5%).

Results: The results suggest that xylitol significantly repressed bacterial adherence and metabolism at 8 h and 24 h; however, bacterial adherence and metabolism were significantly enhanced when xylitol was combined with sucrose, showing no negative effect on S. mutans at both time points. Bacterial proteome was modulated by the carbohydrate source.

Conclusion: The cariogenicity of S. mutans biofilms may be reduced by the alternative sweetener xylitol; however, the combination with fermentable sugars may inhibit such a beneficial effect.

Introduction: This study aims to investigate the effectiveness of a nutritional counseling program for mothers of newborns to prevent sugar consumption in the first year of the child's life on the occurrence of Early Childhood Caries (ECC).

Methods: A multicentric randomized clinical trial (ClinicalTrials.gov NCT03841123) was conducted in three state capitals of Brazil (n=516). Mothers were randomly assigned to the intervention group (IG) or control group (CG) after delivery. The IG received face-to-face nutritional counseling based on UNICEF dietary guidelines, followed by monthly phone calls. The CG received standard counseling. Dietary intake was measured through structured questionnaires and 24-hour recalls at six and 12 months. Calibrated dentists performed a dental clinical examination for ECC diagnosis after the children completed their first year of life.

Results: The prevalence of ECC was 17.4% in the overall sample (49/290). The number of affected teeth ranged from 0 to 6 (mean 0.43). The IG had a 2.4 times probability of not consuming sugar in the first six months of the child's life (RR 2.44; 95% CI 1.18-5.00) and they had Fa significantly lower mean number of sweet items consumed at 12 months (p=0.016). No significant differences between groups were found concerning the occurrence of ECC (RR 1.33; 95% CI 0.79-2.25) or the number of teeth affected by caries (p=0.273).

Conclusion: The intervention to prevent and reduce sugar intake in the first year of life was not effective at reducing the occurrence of early childhood caries or the number of teeth with carious lesions.

Introduction: Despite the notable progress in developing artificial intelligence (AI)-based tools for caries detection in bitewings, limited research has addressed the detection and staging of secondary caries. Therefore, we aimed to develop a Convolutional neural network (CNN)-based algorithm for these purposes using a novel approach for determining lesion severity.

Methods: We used a dataset from a Dutch dental practice-based research network containing 2,612 restored teeth in 413 bitewings from 383 patients aged 15 to 88 years and trained the Mask R-CNN architecture with a Swin Transformer backbone. Two-stage training fine-tuned caries detection accuracy and severity assessment. Annotations of caries around restorations were made by two evaluators and checked by two other experts. Aggregated accuracy metrics (mean ± Standard Deviation - SD) in detecting teeth with secondary caries were calculated considering two thresholds: detecting all lesions and dentine lesions. The correlation between the lesion severity scores obtained with the algorithm and the annotators' consensus was determined using the Pearson correlation coefficient and Bland-Altman plots.

Results: Our refined algorithm showed high specificity in detecting all lesions (0.966 ± 0.025) and dentine lesions (0.964 ± 0.019). Sensitivity values were lower: 0.737 ± 0.079 for all lesions and 0.808 ± 0.083 for dentine lesions. The areas under ROC curves (SD) were 0.940 (0.025) for all lesions and 0.946 (0.023) for dentine lesions. The correlation coefficient for severity scores was 0.802.

Conclusion: We developed an improved algorithm to support clinicians in detecting and staging secondary caries in bitewing, incorporating an innovative approach for annotation, considering the lesion severity as a continuous outcome.

Introduction: Hydroxyapatite (HAP) is promoted as biomimetic material in dentistry. The aim of the study was to investigate whether HAP-containing formulations can reduce erosive/abrasive tissue loss and to analyse components in these formulations.

Methods: Two HAP toothpastes with and two without fluoride and a HAP mouthrinse were investigated, controls were active agent-free toothpaste, SnF2 toothpaste and F/Sn mouthrinse. For 10 days, human enamel samples were eroded for 2 min, 6×/day in 0.5% citric acid and immersed for 2 min, 2×/day in toothpaste slurries or mouthrinse. Half were additionally brushed for 15 s, 2×/day. The particulate fraction was extracted and examined morphologically and with element analyses. Other parameters were REA, RDA, fluoride and calcium content.

Results: The F/Sn mouthrinse almost completely prevented tissue loss; none of the HAP formulations reduced tissue loss compared to the negative control, two increased it instead. Brushing increased tissue loss in all groups except the F/Sn mouthrinse. All toothpastes contained amorphous particles of different sizes. Elemental analysis identified Si and O, and additionally, Ca and P were present in small amounts on the particles of the HAP toothpastes and one HAP+F toothpaste. In the liquid phase, elevated calcium levels were found in one HAP toothpaste and in both HAP+F toothpastes; in the formulation with the highest value, the fluoride concentration was low. REA and RDA values were not associated with tissue loss.

Conclusions: Whether alone or in combination with fluoride, HAP formulations had either no or a detrimental effect on erosive tissue loss and could not reduce abrasion. In the context of erosive tooth wear, HAP seems to be neither an alternative to fluoride nor a suitable supplement to it.

Introduction: This study aimed to examine the effects of age, period (historical events), and cohort (generational impact) (APC) on caries prevalence and mean DMFT among Singapore schoolchildren from 2007 to 2019.

Methods: Anonymised records of all 6-year-old primary 1 (P1), 11-year-old primary 6 (P6), and 14-year-old secondary 3 (S3) students before the start of each school year between 2007 and 2019 were extracted from the Integrated Dental Electronic Assessment System (IDEAS), categorised by school level, ethnicity, and sex. Poisson regression and partial least squares regressions were applied to estimate APC effects.

Results: In total, 502,339 P1, 535,579 P6, and 496,725 S3 records were included from 2007 to 2019, with 1,058,589 (69.0%) Chinese, 187,948 (12.2%) Malay, and 152,618 (9.9%) Indian students; 245,447 (48.8%) P1, 259,389 (48.4%) P6, and 243,941 (49.1%) S3 students were girls. Overall, the APC effects on caries prevalence and mean DMFT showed a strong age effect, with the lowest prevalence in the youngest P1 group and the highest in the oldest S3 group. Period and cohort effects were identified, with the prevalence decreasing among those born after 1995 and the lowest prevalence rate in 2013. Similarly, period and cohort effects on mean DMFT were also detected, with decreased mean DMFT after period 2009 and the highest mean DMFT (0.72 in P6 and 1.13 in S3) in cohort 1995.

Conclusion: Caries prevalence and DMFT increased with age. While both decreased in individuals born after 1995, mean DMFT began to rise again in those born after 2003.

Introduction: Acquired pellicle (AP) acts as a membrane preventing acids from coming into direct contact with the tooth. Possibly, individuals with different dental health status present changes in its composition that could disrupt this function. Thus, the aim of this study was to compare the protein composition of the AP in adolescents with erosive tooth wear (ETW), caries, or sound.

Methods: Calibrated examiners in BEWE index and ICDAS-merged Epi criteria assessed ETW and caries in a sample of 454 systemically healthy adolescents aged 12-15 years old. Thirty subjects from that sample were selected for this study: ETW group (n = 10; total BEWE ≥9 and absence of dentinal caries lesions); caries group (n = 10; total BEWE <9 and with at least one dentinal caries lesion), and sound group (n = 10; total BEWE <9 and absence of dentinal caries lesions). Two-hour-formation AP samples were taken from buccal, occlusal/incisal, palatal/lingual tooth surfaces. Protein composition was analysed by liquid chromatography-tandem mass spectrometry. Using mean reporter ion values, relative abundances of proteins were compared among the three groups to calculate for fold changes. Twofold protein increases or decreases were reported (t test, p < 0.05). Gene Ontology (GO) of included proteins was assigned.

Results: Mean age of participants was 13.1 ± 1.14 years and 56.6% were females. The prevalence of ETW was of 66.6% and of dentinal caries of 33.3%. The GO analyses showed that the majority of detected proteins were stress response related. The ETW group disclosed upregulated relative abundance of antileukoprotease (2.85-fold in ETW vs. sound and 2.34-fold in ETW group vs. caries group); histatin (2.42-fold in ETW group vs. sound group and 2.20-fold in ETW group vs. caries group), and prolactin-induced protein (2.30-fold in ETW group vs. sound group and 2.06-fold in ETW group vs. caries group) (p < 0.05). Hemoglobin subunits alpha (HBA) and beta (HBB) showed decreased relative abundances in the ETW and caries groups when compared to the sound group (HBA: 0.42-fold in ETW group and 0.40-fold in caries group; HBB: 0.45-fold in ETW group and 0.38-fold in caries group; p < 0.05).

Conclusion: AP from individuals with ETW showed differences when compared to other dental conditions, with relative abundance increasing of some stress response-associated proteins in ETW and a decrease in proteins related to salivary protection against acid challenges.