Caries Research最新文献

Introduction: Despite the notable progress in developing artificial intelligence-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 15-88 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: The Caries Impacts and Experiences Questionnaire for Children (CARIES-QC) is a disease-specific questionnaire that assesses the impact of caries on the oral health-related quality of life of children. This study aimed to establish a baseline for caries-specific impact on schoolchildren in Saudi Arabia and to examine its association with dental care utilization.

Methods: This cross-sectional study used random stratified cluster sampling among 4th-6th graders in Jeddah. Two surveys were administered: (1) a general parental survey and (2) CARIES-QC, a self-reported survey for children. Clinical examinations were conducted using the decayed, missing due to caries, and filled teeth (DMFT/dmft) index. Descriptive statistics provided CARIES-QC baseline estimates, and multilevel linear regression was performed to examine the relationships between CARIES-QC scores, DMFT/dmft index, and care utilization.

Results: A total of 805 children aged 8-13 years participated. The overall median CARIES-QC score was six (interquartile range, 3-11). A higher DMFT/dmft index was associated with a higher CARIES-QC score (p < 0.05). Children who had never visited a dentist had lower CARIES-QC scores (β = -1.18, 95% confidence interval: -2.33; -0.02, p = 0.045) than those who had visited a dentist in the past 12 months. After adjusting for reasons for dental visits, the CARIES-QC scores were not associated with prior dental visits (p = 0.086).

Conclusion: A higher DMFT/dmft index was associated with higher CARIES-QC scores, but prior dental care utilization was not significantly associated with improved CARIES-QC scores. Future research should explore other factors that influence the relationship between care utilization and caries-specific quality of life.

Introduction: The aim of this in vitro study was to evaluate the accuracy of near-infrared imaging (NIRI) generated by the iTero Element 5D scanner for detecting proximal caries lesions in deciduous molars, compared with visual inspection (VI), bitewing (BW) radiography, and histological examination (reference standard).

Methods: Sound deciduous molars and those with caries lesions (ICDAS 0 to 5) on the proximal surface were included, while teeth with marginal crest breakdown, restoration on the mentioned surfaces, or extensive dentin resorption were excluded. A total of 182 deciduous molars, divided into 91 pairs of first and second molars, were evaluated by two blinded examiners. Two distinct thresholds were considered for the assessment of caries detection methods: enamel lesion (D1) and dentin lesion (D3). Specificity, sensitivity, accuracy, and area under the ROC curve (AUC) were calculated for each method in the statistical analysis.

Results: All evaluated methods demonstrated high specificity at D1, with 1.00 for VI and 0.95 for NIRI and BW, and at D3, 0.99 for BW and 0.98 for NIRI and VI, without statistical differences. The sensitivity and accuracy of NIRI at D1 were 0.44 and 0.55, while those of VI were 0.46 and 0.58, and of BW were 0.60 and 0.68, respectively. And sensitivity and accuracy of NIRI at D3 were 0.14 and 0.69, while those of VI were 0.37 and 0.77, and of BW were 0.51 and 0.82, respectively. No difference in sensitivity and accuracy was observed between NIRI and VI at D1 (p = 0.589); however, NIRI presented the lowest accuracy at D3. At D1, no statistical difference was observed between the AUC of BW and VI (p = 0.1124), nor between NIRI and VI (p = 0.2523). However, at D3, statistical differences were observed between the AUCs of the three evaluated methods: VI versus NIRI (p = 0.0005), VI versus BW (p = 0.0281), and NIRI versus BW (p < 0.0001).

Conclusion: NIRI showed accuracy comparable to VI at the D1 threshold but was less effective than BW radiography at both D1 and D3 thresholds.

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.

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

Methods: The morphology of triple-species biofilms was detected through scanning electron microscopy, and the structure was observed using confocal laser scanning microscopy. The microbial composition was measured by fluorescence in situ hybridization and qPCR. The expression of genes was detected by quantitative reverse transcription-PCR. A specific pathogen-free rat model was used to assess the cariogenicity of the triple-species biofilms.

Results: The architecture of the biofilm was significantly impaired when gcrR-overexpressed S. mutans were incubated with S. sanguinis and S. gordonii (SmugcrR++S.s+S.g). The biofilm exhibited a decrease in the production of water-insoluble glucans and water-soluble glucans, 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, the SmugcrR++S.s+S.g biofilm exhibited reduced cariogenicity.

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

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 randomized 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: 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: Caries lesions that are difficult to detect through visual inspection pose risks to dental health. To address this, we propose a detection method using the split-spectrum optical attenuation coefficient (OAC), capitalizing on the wavelength-dependent properties of carious dental structures.

Methods: The complete OCT spectrum is divided into four spectral segments, each independently reconstructed and analyzed for OAC. OAC values are then compared across segments to differentiate between healthy and carious tissue. Experiments were conducted on ex vivo human teeth, with carious areas marked by dental professionals. The accuracy of the proposed method was evaluated and compared with the full-spectrum OAC method.

Results: For healthy enamel, OAC values ranged from 0.2 to 0.4 mm-1, remaining consistent across spectral bands. In carious enamel, OAC increased significantly (0.5-2.5 mm-1), with a 60% rise in short-wave versus long-wave OAC. Healthy dentin showed OAC values from 0.3 to 0.7 mm-1, whereas carious dentin reached 0.8-1.2 mm-1, with a 50% increase in short-wave OAC compared to long wave. The average false-positive rate of the method proposed in this paper is 0.9%, significantly lower than the 1.8% of the traditional OAC method (t test, n = 16, p = 0.013). The average false-negative rates of both methods are around 1%, with no significant difference.

Conclusion: Findings indicate that the split-spectrum OAC method can effectively identify caries lesions, with higher accuracy and specificity compared to the traditional OAC method.

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.