Caries Research最新文献

The aim of this systematic review was to assess the available evidence related to the effectiveness of stepwise (SW) or selective excavation (SE) when compared to non-selective caries excavation (NSE) for the management of permanent teeth with deep carious lesions without signs of irreversible pulpitis. This systematic review was conducted according to Cochrane guidelines. Literature search was performed using several databases including English language only. Pairwise and network meta-analysis (NMA) was conducted. 19 out of 819 studies were included. The outcomes assessed were dental pulp exposure and the measure 'success' defined as tooth not having complications after a follow-up (i.e., without dental pulp exposure following treatment, no dental pulp complications after treatment, no periapical lesion, no severe/unbearable pain, no restoration failure or tooth extraction). The Risk of Bias analysis revealed that more than 50% of the studies had high risk of bias. In addition, the GRADE assessment for the outcomes showed that most of the evidence was low and very low quality. Based on the results of the NMA, SW had the highest success rate (RR: 1.11, 95% CI: 1.00-1.23, with NSE as the reference), followed by SE (RR: 1.06, 95% CI: 0.97-1.16, with NSE as the reference). However, the difference was not statistically significant. In most cases, SE was the treatment of choice in relation to carious lesion depths with the threshold of >2/3 of the dentine thickness and SW was advocated only in cooperative patients due to the two-step procedures. However, within the limitations of this review, the effect of remaining carious dentine could not be assessed with respect to the success rate for each intervention. Therefore, long-term well organized multi-centre randomized controlled trials (RCTs) are still required to provide concrete evidence.

Introduction: Despite efforts to reduce sugar consumption, Italy continues to experience high levels of caries, particularly among 12-year-old children. The introduction of a sugar tax is one strategy that gained traction as a mean of curbing excessive sugar intake. This study aims to assess the potential impact of a sugar tax on reducing caries prevalence through the analysis of two scenarios: a hypothetical implementation of the tax in 2008 (Scen1), compared against actual 2017 data, and a projection of the effects of the planned 2025 tax extending to 2034 (Scen2).

Methods: The evaluation utilizes a Markov model to evaluate the health and economic outcomes of a 20% ad valorem tax on sugar-sweetened beverages. Outcomes included the caries experience, as DMFT index, direct dental costs, and indirect costs as forgone earnings due to care, assuming a 100% pass-through to consumers. Outcomes included the caries experience, as DMFT index and QALYs (Quality-Adjusted-Life-Year/s), direct dental costs, and indirect costs as forgone earnings due to care, assuming a 100% pass-through to consumers. A 3% annual discount rate was applied to all costs. Sub-analysis also included geographical macro-areas of Italy (North-West, North-East, Central, Southern, Islands), based on main socio-economic determinants. A probabilistic sensitivity analysis, involving a Monte Carlo simulation with 1,000 iterations, was conducted to assess the robustness of the model, generating estimates of mean values and 95% Uncertainty Intervals.

Results: In Scen1, the simulation suggested that a 20% ad valorem tax, would have resulted in a 0.05 reduction of the DMFT, yielded a cost saving of €18.5 million, and €24,520 per QALY gained. The projected 2025-2034 implementation estimated to decrease the DMFT by 0.07, save €38.6 million, and €31,933 per QALY gained. Significant benefits were observed in Southern Italy, an area with higher caries rates and lower dental care utilization, where the impact was pronounced in both scenarios.

Conclusion: Integrating a sugar tax into a broader public health strategy can significantly reduce caries and healthcare costs, especially in disadvantaged settings. These findings highlight the need for policymakers to pair sugar taxes with additional preventive measures for optimal public health outcomes.

Objectives The study aims to assess the direct and indirect effect of parental locus of control (LoC) on child oral health related quality of life. Methods As part of the Growing Up in Singapore Towards healthy Outcomes (GUSTO) multicenter longitudinal cohort study, sociodemographic characteristics of parents and their children were obtained at recruitment. Oral health status and dental caries outcomes were assessed at the 5th year post-natal visit and administered alongside the LoC questionnaire. Intra-oral examinations were carried out by 3 trained calibrated dental professionals using the modified International Caries Detection and Assessment System (ICDAS-II) criteria. At the 6th year postnatal visit, the Early Childhood Oral Health Impact Scale (ECOHIS) was administered to mothers to assess the oral health-related quality of life (OHRQoL) of their child. Statistical analysis of direct effects of parental LoC on OHRQoL and causal mediation effects of dental caries were carried out using the potential outcomes approach with 1000 simulations. Results A total of 312 parent-child dyads were included in this prospective cohort study. At the 5th year post-natal visit, the median decayed missing and filled surfaces (dmfs) was 2 (IQR 0 - 5), while the median locus of control was 47 (IQR 43 - 50). The total effect of parental LoC on ECOHIS was -2.05 (95% CI -4.03 - -0.08), of which the direct effect through dmfs was -1.45 (95% CI, -3.41 - 0.47). The percentage of the total effect of parental locus of control on ECOHIS that was mediated by the presence of dental caries was 29.5% for dmfs including incipient caries (ICDAS 1-6). The proportion mediated was lower if only active decayed surfaces (ds) were considered (23.7%) and higher if only cavitated lesions (ICDAS 3-6) (30.1%) were considered. Conclusions The effect of parental LoC on child OHRQoL was mediated in part through the development of dental caries.

Introduction: Sealing of occlusal dentin caries has shown promise in studies, but long-term outcomes remain inconclusive. This RCT aimed to investigate the potential of postponing restorative interventions of manifest occlusal caries by sealing.

Methods: After randomization (ratio 2:1), 341 resin sealings and 152 composite restorations in 493 patients (6-17 years) were performed by 66 dentists in nine Danish municipalities. All lesions were pre-designated to require restorative treatment by the treating dentists. The treatments were controlled annually both clinically and radiographically. The primary objectives, assessed at different observation intervals, were to analyze the survival of sealing until replacement by restoration, the survival of sealing and restoration until retreatment, caries progression beneath sealing and restoration, and the longevity of repaired versus unrepaired sealing until replacement by restoration. The secondary objectives identified factors influencing survival of sealings and restorations. Chi-square/Kaplan-Meier/Cox-regression were used for statistical analyses.

Results: After 11 years, dropout rate was 10%, and 22% of sealings were repaired/renewed. 58% of sealings and 81% of restorations remained sealed/restored until completion due to age 18 or primary caries. Additionally, 33% of sealings were replaced by restorations, and 12% of restorations were repaired/replaced (p-values<0.001). No endodontics were performed. The mean annual failure rates were 4%-7% for sealings and 1% for restorations. The survival of sealings were affected by various predictor variables across the outcomes and observation intervals. The survival rate of repaired/renewed sealings was comparable to that of new sealings (p=0.96).

Conclusions: This long-term study provided a comprehensive overview regarding reasons and time for retreatments of occlusal sealings and restorations. The results indicate that sealing is an effective treatment for occlusal enamel and dentin caries.

Introduction: This study evaluated the Toddler Oral Health Intervention (TOHI) for preventing early childhood caries (ECC) by 48 months. TOHI, an add-on to standard care in well-baby clinics (WBCs), aims to reduce ECC incidence and severity.

Methods: Dyads were randomised into TOHI (added to care as usual) or care as usual (CAU). The primary outcome was ECC (incidence and severity); secondary outcomes included plaque and pufa scores, and oral health behaviour changes. TOHI combined Non-Operative Caries Treatment and Prevention, Motivational Interviewing, and the Health Action Process Approach. Oral health coaches applied TOHI from enrolment (age 6-12 months) to 48 months. Data were collected at baseline, 24, and 48 months through questionnaires and clinical assessments. Blinding was maintained for clinical assessment and analysis. Intention-to-treat analysis used a Negative Binomial Hurdle Model with one-sided statistical testing.

Results: Of the 402 enrolled dyads, 353 (88%) completed the study (TOHI: 176/205, 86%; CAU: 177/197, 90%). At 48 months, 61% of TOHI toddlers and 54% of CAU toddlers remained free of any caries lesions (ICDAS ≥1). Among toddlers with caries, TOHI reduced dmfs scores by 40% (RR: 0.60; UL95% CI: 0.98, p = 0.04). For cavitated lesions (ICDAS ≥3), TOHI reduced dmfs scores by 53% (RR: 0.47; UL95% CI: 1.04, p = 0.06), and 84% of TOHI toddlers remained free of cavitated lesions versus 78% in CAU.

Conclusion: TOHI, added to usual care at WBCs, modestly reduced ECC incidence and severity at 48 months. Further research is needed to assess long-term impacts and cost-effectiveness.

Introduction: In vitro studies show that fluoride varnishes (FV) differ significantly in their ability to remineralize and fluoridate enamel caries lesions, as respectively measured by surface microhardness recovery (%SMHr) and enamel fluoride-uptake (EFU). However, there is a need to confirm these findings in clinically relevant conditions.

Methods: This in situ study adopted a five-leg cross-over design. In each leg, 28 subjects wore their mandibular partial denture with two previously demineralized enamel slabs treated with one of the following FV (selected based on our previous in vitro data): Vanish™ (high-%SMHr, low-EFU), Flor-Opal® (low-%SMHr, high-EFU), Enamel-Pro® (high-%SMHr, high-EFU), PreviDent® (generic, commercial reference) or Negative control (no varnish). After three days, specimens were wrapped in gauze to allow plaque accumulation on the enamel. Toothbrushing of natural teeth was performed twice/day with F-free toothpaste. After 14 days, enamel specimens were collected and analyzed (%SMHr and EFU). Data were analyzed by ANOVA models suitable for cross-over (alpha=0.05).

Results: Vanish™ had a significantly higher %SMHr; other varnishes did not differ from each other and had higher %SMHr than the control. EFU was significantly lower for the control than for all other treatments; Flor-Opal® had significantly lower EFU than Vanish™ and PreviDent®. Neither %SMHr nor EFU in vitro data could predict in situ results, although better approximation was observed for %SMHr.

Conclusion: All tested FV could remineralize enamel; however, they presented different efficacies. Comparative clinical trials are warranted to confirm these results. Adequate in vitro tests are necessary to predict the clinical efficacy of FVs.

Introduction: To prevent caries with targeted strategies and to act conservatively, it is essential oral healthcare providers perform an individual caries risk assessment (CRA). This study aimed to explore knowledge and application regarding CRA by Dutch fifth-year dental students (D5DSs) and practitioners (DDPs).

Methods: A survey was conducted through a questionnaire sent at random to a group of 1,500 members of the Royal Dutch Dental Association (KNMT) and to 213 D5DSs from all three dental schools in the Netherlands.

Results: Of the 374 DDP respondents (25%), 79% reported to perform CRA in routine practice. Female dentists reported using CRA in their daily practice more often than males (p = 0.008). The questionnaire was completed by 118 D5DSs (55%). All D5DS respondents reported using CRA and most students were familiar with Dutch prevention-oriented methods. Eighteen percent of them did not make an individual treatment plan based on caries risk. The familiarity of DDPs regarding Dutch prevention-oriented methods was lower than that of students (p < 0.001). In both groups of respondents, oral hygiene and diet were the two most important factors considered when assessing caries risk in patients, whatever their age.

Conclusion: CRA is applied less frequently in the general practice compared to student clinics at university. Our results suggest that dentists in the Netherlands could improve their knowledge about cariology by continuing education. Dental schools should emphasize implementation of the knowledge in clinical practice. In addition, a uniform and evidence-based method to perform CRA in the dental practice is needed.

Introduction: Research on the impact of physical activity (PA) and physical fitness on oral health has been limited in scope. The aim of this report was to assess the impact of PA and physical fitness as modifiable factors in dental caries and erosive tooth wear (ETW) among middle-aged individuals in Finland.

Methods: Data were gathered from the North Finland Birth Cohort 1966 (NFBC1966) 46-year follow-up, which included dental clinical examinations conducted by seven calibrated dentists, physical fitness tests, measurements of PA, and measurements of height and weight administered between 2012 and 2014. PA was measured over a 2-week period with a wrist-worn accelerometer and reported as average daily duration of PA (min/day). Physical fitness was assessed by measuring cardiorespiratory fitness via heart rate recovery in a step test using a heart rate monitor and chest belt, and by evaluating back strength with the Biering-Sorensen test. Of the whole cohort, 1,964 cohort members participated in the oral clinical examination, and the regression models were conducted with 1,590 participants. The prevalence of dental caries (ICDAS), DMFT score, and ETW (BEWE), and the results of the PA test and physical fitness tests were categorized and analyzed using cross-tabulations and multivariable logistic regression models. SPSS version 29.0.0.0 was used to calculate 95% confidence intervals (CI), odds ratios (ORs), χ2, and p values.

Results: Poor (OR 1.60, 95% CI: 1.15-2.23) and moderate (OR 1.48, 95% CI: 1.14-1.93) cardiorespiratory fitness and low PA (OR 1.48, 95% CI: 1.07-2.05) were associated with dentine caries in the regression model. The same model indicated that tooth brushing frequency (OR 1.97, 95% CI: 1.21-3.20), ETW (OR 1.30, 95% CI: 1.12-1.49), and male gender (OR 1.22, 95% CI: 1.05-1.43) were associated with increased dentine caries. No statistically significant association was found between PA or physical fitness and ETW.

Conclusion: In the middle-aged Finnish population, high PA and good physical fitness are associated with a lower prevalence of dentine caries. No association between PA or physical fitness and ETW was found. Further research is needed to explore the potential oral health benefits of PA and physical fitness as modifiable factors.

Introduction: This in vitro study evaluated the validity and reliability of spectral-domain optical coherence tomography (SD-OCT) to detect approximal carious lesions compared to bitewing radiography.

Methods: Forty extracted human premolars and molars with fifty-four unrestored approximal surfaces (ICDAS ll score 0-3) were mounted in a patient-equivalent simulator and imaged by digital radiography (DR) and the prototype of an intraoral OCT probe. The lesion status of the tooth surfaces was validated histologically and by microtomography (µCT). Five calibrated raters with low to high level of clinical expertise analyzed the DR and OCT images at intervals of 2-4 weeks each. Intra- and interrater agreement (weighted Cohen's kappa κ, Fleiss' kappa), sensitivity, and specificity were calculated.

Results: The sensitivity of OCT (0.66-0.91) was higher than that of DR (0.46-0.82), as was the specificity (OCT: 0.67-0.92; DR: 0.33-0.58). Intrarater agreement with OCT was moderate to substantial (κ: 0.53-0.77; p < 0.001) and fair to substantial for DR (κ: 0.36-0.78; p < 0.05). The DR interpersonal agreement ranged from slight to substantial (κ: 0.1-0.74, Fleiss' κ: 0.23/0.24; p < 0.001) toward fair to substantial with OCT (κ: 0.27-0.62; Fleiss' κ: 0.23/0.18; p < 0.001). Agreement between histology and µCT was almost perfect (κ: 0.82; p < 0.001).

Conclusions: In a clinically oriented simulation, OCT was more sensitive in detecting early approximal carious lesions than DR without impairing specificity or reproducibility. Clinical studies will have to show whether OCT can confirm these promising results.

Introduction: Caries is the most widespread non-communicable disease (NCD) globally and can predict fatality NCDs in the future, such as diabetes and cardiovascular diseases. Therefore, we hypothesized that the behavioral risk factors for those NCDs may be present in adolescents with caries.

Objective: To analyze the association of unhealthy diet, tabagism, and alcohol with caries in adolescents.

Methods: This population-based study with a cross-sectional design used data from 2515 adolescents aged 18-19 yo, born in São Luís-MA, Brazil, and part of the RPS Cohort Consortium. The exposures were the latent variables of the Unhealthy Diet Pattern (sugars, fast foods, and salty snacks) and Addictive Behaviors (tabagism and risk of alcohol dependence). The outcome was the number of decayed teeth. The model adjustment considered the Socioeconomic Status (head of household education, adolescent education, economic class, and monthly family income) as a distal determinant and the oral biofilm as a mediator between the exposures and the outcome, analyzed by Structural Equation Modeling (SEM), using the Mplus 8.0 software.

Results: Unhealthy Diet Pattern was associated with a higher number of decayed teeth directly (SC=0.092, p≤0.001) and indirectly via dental biofilm (SC=0.020, p≤0.001). Addictive Behaviors were associated with a higher number of decayed teeth indirectly via dental biofilm (SC=0.019, p=0.013). The Unhealthy Diet Pattern and Addictive Behaviors were associated with each other (CP=0,199; p<0,001).

Conclusion: Besides sugars, other behavioral risk factors for NCDs underlie caries, emphasizing the importance of comprehensive adolescent health care.