Caries Research最新文献

The efficacy of fissure sealants (FS) in controlling occlusal caries is well documented. However, several factors can potentially modify the caries-preventive effect of FS and their failure rate in real life might be higher than in controlled experimental settings. The aim of this study was to prospectively examine failures and risk factors in sealed first permanent molars (FPMs) with sound occlusal surfaces or initial caries lesions of children in a practice-based setting in public dental service (PDS) in Norway.

Methods: Children aged 6 to 10 years considered at high caries risk (D3MFT/d3mft > 0) were recruited by dentists and dental hygienists during routine examination at local dental clinics in PDS. After the application, resin-based FS were maintained according to clinicians' conventional procedures. Occlusal surface/FS status and the following treatment were registered at 6- , 12-, 24- and 36-months. The outcome was categorized into success, minor failure, and failure of sealed FPM based on a combination of diagnosis of occlusal surface/FS status and the following treatment at each follow-up. Univariable and multivariable Cox survival analyses were used to investigate potential risk factors for failure.

Results: Out of 409 participants, 4% (16) were lost to follow-up. Of 393 FPMs, 72% (284) were evaluated as success, 9% (34) as minor failure, and 19% (75) failed during the 36-months of this study period: 13% (51) received FS reapplication and 6% developed dentine caries or were restored. One third of FS were additionally treated with fluoride varnish (FV) at least once during the follow-up. Occlusal surface with caries grade 1-2 (vs intact) increased (adHR 1.9, 95% CI 1.1-3.1), while FV application over FS decreased hazards (adHR 0.4, 95% CI 0.3-0.7) for failure. The clinic's county was associated with failure.

Conclusion: After 3-year follow-up, nearly one out of five sealed FPMs failed, i.e., had to be resealed, developed dentine caries, or were restored. Initial caries lesion on occlusal surface increased while FV application over FS reduced risk for failure. Moreover, regional differences in sealed FPM failures were observed.

Introduction: Dental caries is a non-communicable disease caused by dysbiosis of dental biofilm. S. mutans is considered the major pathogen. The orphan response regulator GcrR negatively regulates exopolysaccharides (EPSs) synthesis in S. mutans. We aimed to investigate the effect of GcrR on the cariogenicity of oral biofilms. A multispecies biofilm model was constructed, including S. mutans, S. sanguinis, and S. gordonii.

Methods: The morphology of multispecies biofilms was detected through scanning electron microscopy (SEM), and the structure was observed using confocal laser scanning microscopy (CLSM). The microbial composition was measured by fluorescence in situ hybridization (FISH) and qPCR. The expression of genes was detected by quantitative RT-PCR (qRT-PCR). A specific pathogen-free (SPF) rat model was used to assess the cariogenicity of the multispecies biofilms.

Results: The architecture of the biofilm was significantly impaired when gcrR-overexpressed S. mutans incubated with S. sanguinis, and S. gordonii (SmugcrR++S.s+S.g). The biofilm exhibited a decrease in the production of water-insoluble glucans (WIGs) and water-soluble glucans (WSGs), consistent with a decreased expression of EPS synthesis-related genes. The SmugcrR++S.s+S.g biofilm exhibited an increase in non-cariogenic species with lower lactic acid production. Furthermore, SmugcrR++S.s+S.g biofilm exhibited reduced cariogenicity.

Conclusion: The biofilm cariogeneicity could be shifted to a less cariogenic state by increased expression of the GcrR regulator.

Introduction: The study sought to assess the cost-effectiveness of silver diamine fluoride (SDF) relative to sodium fluoride varnish (NaF), and direct restorations placed chairside or under general anaesthesia (GA), accounting for caries activity.

Methods: An analytical decision tree model was developed with clinical data from multiple centres to evaluate the four treatment options among all children aged 1 to 6 years in Singapore (N=231,880) over a 12-month time horizon. Base-case scenarios consisted of children with low- (1 carious tooth) and high- (7 carious teeth) caries activity. Incremental cost-effectiveness ratios (ICER) and net monetary benefits (NMB) were tabulated with the outcomes set to be the control of active caries and avoidance of tooth extractions. Deterministic and probabilistic sensitivity analyses were conducted.

Results: Overall, SDF was less effective than direct restorations placed chairside but was less costly. For children with low-caries activity, the ICER for SDF was $9 per caries-controlled tooth, and $68 per extraction avoided. For children with high-caries activity, the ICERs were $267 and $1 909 respectively. At a willingness-to-pay threshold of $30, the NMB was negative (favours restorations) for caries control in children with low-caries activity and positive (favours SDF) for all other situations. In the low-caries activity group, SDF had a 41.5% probability of being cost-effective for caries control and 49.2% probability of being cost-effective for the avoidance of extraction. The corresponding probabilities for the high-caries activity group were 99.8% and 100%. The NMB of SDF increases proportionally with caries activity, suggesting utilisation of SDF should depend on caries activity. Results were most sensitive to changes in relative cost, and effectiveness of SDF/direct restorations.

Conclusion: SDF was cost-effective in most situations except for caries control in children with low-caries activity. Direct restorations were more effective and should be considered in low-caries activity children.

Introduction: Professional fluorides form reaction products on tooth substrates which once dissolved interfere with the caries process. However, the persistence of these reservoirs before the need of a new application is unknown. We investigated in situ the effect of various cariogenic challenges and exposure to fluoride toothpaste on the retention of enamel fluoride reservoirs.

Methods: In a blind, 4 period crossover study, 12 participants wore palatal devices containing human enamel slabs previously treated with one application of acidulated phosphate fluoride gel. No biofilm or biofilm accumulation and exposure to 20% sucrose 0, 2 or 8 times/day were tested. Participants used non-fluoridated or fluoridated toothpastes (1,100 mg F/kg) throughout the experimental periods. Slabs were collected after 2, 7, or 14 days to assess remaining alkali-soluble fluoride reservoir concentrations.

Results: The loss of the enamel fluoride reservoirs was accelerated either in the absence of biofilm or under biofilms exposed to sucrose 8 times/day (p<0.05). The loss of these reservoirs was reduced by fluoride toothpaste use (p<0.05).

Conclusion: The results support a personalized recommendation of the frequency of professional fluoride application based on patients' caries activity, since the cariogenic challenge and exposure to fluoride influence the retention of fluoride reservoirs formed on enamel by professional fluoride application.

Introduction: This study examined the association between cardiovascular disease (CVD) history and their dental caries experience status.

Methods: Conducted from January 2021 to June 2023, this cross-sectional cohort study involved 7,138 participants who underwent oral examinations. Data on demographic background, oral health-related behaviors, and smoking status were collected using a structured questionnaire. Dental caries was diagnosed at the cavitation level according to the World Health Organization criteria and calculated into caries experience indices including DMFT, DT, MT and FT. Information on CVD history was obtained from the Taiwan National Health Insurance Research Database, including acute myocardial infarction, ischemic stroke, and coronary artery disease. Multivariate linear regression models were used to assess the association between CVD history and their dental caries experience status.

Results: Of the participants, 158 (2.2%) had a prior diagnosis of CVD. Participants with CVD history had a significantly higher mean decayed, missing, and filled teeth (DMFT) index (21.21 ± 8.37) than did those without CVD history (13.4 ± 7.82; P < 0.0001). After adjusting for confounding factors, participants with CVD history had a mean DMFT index that was 2.11 higher (95% CI = 0.99, 3.24, P < 0.01) and 2.21 more missing teeth (95% CI = 1.42, 3.00, P < 0.0001) than did those without CVD history. Subgroup analyses indicated that participants aged ≥ 65 years were predominantly affected.

Conclusion: Older participants with CVD history were associated with increased number of missing teeth. The present study design could not conclude a positive association between CVD history and their DMFT status, partly due to the lack of data on the reason of missing teeth.

Introduction: Children with early childhood caries (ECC) show different caries severities and susceptibility in different tooth types and location in the oral cavity. The study aimed to investigate differences in the oral microbiome in ECC subjects stratified according to the severity of caries and between more and less caries-prone teeth within the same subjects.

Methods: Supragingival plaque from the upper and lower anterior regions in the oral cavity of subjects were collected in 3 groups of increasing caries severity: G1 - molar (M) caries only; G2 - molar and upper anterior (UA) caries; and G3 - M + UA + lower anterior (LA) caries followed by microbiome analysis.

Results: Alpha-diversity analyses showed inter- but no intra-individual statistically significant differences between the UA and LA (p < 0.001, LA > UA) and a significant difference between the microbiome of the three caries groups (p < 0.001). There were significant beta-diversity differences between G1 and G2 (p < 0.05) and in the composition and diversity among the three groups (p < 0.001). Actinomyces, Saccharibacteria_genera_inserta_sedis, and Eikenella had increased differential abundance in G1 versus G3 and Fusobacterium was less abundant in G2 compared to the other groups.

Conclusions: There were clear distinct differences in tooth-site-specific and caries-severity microbiome diversity patterns and bacterial abundance profiles in S-ECC children.

Introduction: The association between breastfeeding status and early childhood caries (ECC) remains inconclusive. Few studies evaluate the breastfeeding status including both duration and exclusivity according to the WHO recommendations on breastfeeding. This study aimed to investigate the association between breastfeeding status and ECC.

Methods: This prospective cohort study comprised 3,666 children whose breastfeeding status was precisely evaluated. Poisson regression models and multivariable linear regression models were employed to analyze the associations of breastfeeding status with risk of ECC, and mean decayed, missing, and filled primary tooth surfaces (dmfs) in 3-year-old children, respectively. The data were collected from 2014 to 2020, and the analysis was conducted in 2023.

Results: The prevalences of ECC in offspring breastfed for <6 months, 6-11 months, 12-24 months, and >24 months were 9%, 12%, 17%, and 23%, respectively. Offspring breastfed for 12-24 months and over 24 months had a 1.82 times (95% CI, 1.40-2.37; p < 0.001) and 2.48 times (95% CI, 1.63-3.75; p < 0.001) higher risk of ECC, compared to those breastfed for less than 6 months. Offspring breastfed for 12-24 months showed a mean dmfs increase of 0.32 (95% CI, 0.21-0.44; p < 0.001), while those breastfed for over 24 months had a mean dmfs increase of 0.51 (95% CI, 0.27-0.74; p < 0.001), compared to those breastfed for less than 6 months. Among offspring breastfed for over 24 months, those exclusively breastfed for at least 6 months had significantly lower mean dmfs compared to those exclusively breastfed for less than 6 months (p for heterogeneity = 0.003). A significant interaction was observed between breastfeeding duration and exclusive breastfeeding duration on the association with mean dmfs (p for interaction <0.001).

Conclusion: Our findings suggest that breastfeeding for over 12 months was associated with increased risk of ECC. Preventive interventions for dental caries should be implemented as early as possible, as breastfeeding is beneficial to children's health. The associations between breastfeeding duration and exclusivity with ECC should be investigated more thoroughly, particularly with adjustments for accurately measured sugar consumption.

Introduction: There is little discussion in the literature on the pathway linking oral health problems and academic performance (AP) in children. This study investigated the hypothesis that the influence of dental caries on academic performance is mediated through toothache and impacted sleep and study activities.

Methods: This cross-sectional study on children aged 12-14 years collected data on the exposure (decayed tooth index), outcome (school examination results), and mediator (school absence due to toothache, and oral health impact on sleep and study performances using the Child-Oral Impact on Daily Performance instrument) variables. It used mediation analysis to examine the indirect effects of a single and two serial mediators using model 4 (caries → mediator → AP) and model 6 (caries → mediator 1 → mediator 2 → AP), respectively, in PROCESS macro add-on software in IBM SPSS v24. Analyses were carried out separately for boys and girls at a 5% significance level.

Results: In model 4, school absence due to toothache (boys: 95% CI: 0.42, 1.01; girls: 95% CI: 0.58, 0.98), and impacted sleep (95% CI: 0.13, 0.41; 95% CI: 2.17, 13.03), and study (95% CI: 0.05, 0.42; 95% CI: 0.54, 0.94) performance were significant single mediators in both sexes. In model 6, school absence due to toothache and impacted sleep activity (boys: 95% CI: 0.02, 0.29 and girls: 95% CI: 1.37, 12.81), and school absence due to toothache and impacted study activity (girls: 95% CI: 1.37, 12.81) were significant two serial-mediators.

Conclusion: This study provides empirical evidence showing that dental caries and toothache can impact academic performance as they disrupt sleep and study performances to influence the learning and cognition process. The finding bridges the understanding of the mechanism underpinning the relationship and thus, further emphasizes the importance of caries prevention in children with high caries risk for improving their health outcomes and educational experience.

Introduction: Dental sealants applied to occlusal pit-and-fissure surfaces have been shown to prevent caries and arrest occlusal noncavitated carious lesions (NCCLs). The American Dental Association (ADA) recommends that oral healthcare providers apply sealants on occlusal NCCLs. Though the evidence is clear that sealants are effective, few studies have examined the adoption of the ADA guideline by dentists and the duration of protection provided by sealants in a large real-world setting.

Methods: This study used observational electronic health record (EHR) data from a network of dental clinics to follow teeth over a 2 year time period from when they were diagnosed as having an occlusal NCCL until either they were treated with a restoration or the time period ended with no restoration. The objectives of the study were to determine: (1) the degree to which dentists adopted the guideline, (2) whether the duration of protection was different for teeth that received a sealant from teeth that did not receive a sealant, and (3) whether dentists' experience placing sealants was associated with the duration of protection.

Results: Overall, there were 7,299 teeth in the sample. Of those, dentists restored 591 teeth and applied sealants on 164. The sealant application rate for eligible teeth was 2.2%. Sealant application was associated with provider, with 1.9% of providers placing more than half of the sealants. By the end of the observation period, the proportion of teeth progressing to restorations was 8.2% for teeth that had not received a sealant and 3.0% for teeth that had received one (RR = 0.37; 95% CI: 0.16-0.88; p = 0.02). Multilevel survival analysis showed that teeth that had not received a sealant were restored sooner than teeth that had received a sealant (aHR = 0.11; 95% CI: 0.03-0.36; p < 0.01). Overall, teeth that received a sealant had an 89% reduced hazard of restoration within 2 years compared with teeth that did not receive sealants.

Conclusion: This study found that by arresting decay, the presence of sealants led to fewer restorations and delayed restorations compared with teeth not receiving a sealant or restoration in the 2 years following diagnosis of occlusal NCCL in clinical settings.

Introduction: Dental caries with pulp involvement potentially impacts the oral health-related quality of life (OHRQoL). This meta-analysis aimed to evaluate whether clinical consequences of pulp involvement due to dental caries impacts OHRQoL of children and adolescents.

Methods: Observational studies evaluating whether children/adolescents (population) with pulp involvement due to caries (exposition) compared with those without it (comparison) have more negative impact on their OHRQoL (outcome) were included. A systematic search was undertaken in August 2022 in seven databases. Alerts were set until August 2023. JBI Critical Appraisal tool for cross-sectional studies was used for methodological quality assessment. Random-effects meta-analyses were performed to calculate mean differences (MD) or standardized mean differences (SMD) of impact on OHRQoL. For studies with dichotomous outcome, meta-analysis calculated the odds ratio (OR). Robustness, heterogeneity, certainty of evidence, and publication bias were evaluated.

Results: From 29 included studies, 14 assessed preschoolers, nine assessed schoolchildren, four assessed adolescents, and two assessed children/adolescents. PUFA was the main index used to assess the exposure. ECOHIS (preschoolers) and CPQ (children/adolescents) were the main tools used to assess the outcome. Only five articles fully adhered to the quality criteria. The meta-analyses found the following main results: (a) preschoolers: MD -10.79 (-16.50; -5.09); (b) schoolchildren: MD -5.12 (-7.51; -2.72); (c) adolescents: MD -1.86 (-4.59; 0.87); (d) overall impact: SMD -2.18; (CI: -3.21;-1.15) and OR 0.52 (CI: 0.30; 0.90).

Conclusion: Pulp involvement impacted OHRQoL of children negatively. In adolescents, this impact was not observed. Results must be interpreted with caution due to very low certainty of evidence.