Caries Research最新文献

Introduction: The aim of this systematic review was to assess the available evidence related to the effectiveness of stepwise excavation (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.

Methods: 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. A total of 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).

Results: 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.

Conclusion: 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 are still required to provide concrete evidence.

Introduction: The prevalence of caries experience among 5-year-old children in Colombia remains high (62%). The National Health System supports the use of NaF varnish (FV) from age one. Considering the inclusion of SDF solution (SDF) by the WHO and the FDI to control caries burden by 2030, the aim of this non-inferiority randomised controlled trial (RCT) was to compare after 1 year the effectiveness and feasibility of biannual applications of SDF or FV for the control of cavities in young children from Bogotá and Cartagena, Colombia.

Methods: This non-inferiority RCT included seven hundred fifty-two 3- to 4-year-old medically healthy children from Bogotá and Cartagena. Participants in each city were randomised to receive either SDF (38%) or FV (5%) biannually.

Primary outcome: cavity (d) prevention effect.

Secondary outcomes: active cavity (active d) arresting effect, feasibility (study adherence, received treatment fidelity), dental care parental satisfaction/acceptance, child procedure behaviour and pain, and adverse effects. Data were analysed using t tests, χ2 tests, and generalised estimating equation (0.05 statistical significance).

Results: A total of 611 children (75.1%) completed the 1-year follow-up. At baseline, overall prevalence of caries experience (dmf) was of 32% (prevalence of d: 27%), increasing to over 75% when including initial and moderate caries lesions (assessed without air-drying, Epi) (ICDAS-merged Epi dmf). Corresponding mean number of tooth surfaces with ICDAS-merged Epi dmf was >5.9, of which cavities/d >1.1. Most reported a high daily intake of free sugars (FV: 82.8%; SDF: 79.9%), and use of fluoridated toothpaste was not generalised (FV: 60.3%; SDF: 57.8%). After 1 year, mean number of new cavity tooth surfaces showed no inferiority for SDF versus FV (FV: 0.61 ± 1.86; SDF: 0.40 ± 1.13, p = 0.22). Arresting active cavities was achieved in 49.4% (FV) and 72.2% (SDF) of children (p > 0.05). Feasibility was high: study adherence (FV: 76.1%; SDF: 74.0%); received treatment fidelity (FV: 92.9%; SDF: 91.4%) (p > 0.05). Most parents were satisfied-very satisfied (FV: 93.2%; SDF: 96.0%) (p > 0.05). Only one case of adverse effects appeared after the first fluoride application (SDF) and resolved uneventfully.

Conclusion: After 1 year, a biannual application of SDF versus FV was not inferior in preventing new cavities, with high feasibility in community settings. This study supports the use of these fluoride therapies for young children in similar socio-economic contexts, recommending increasing fluoridated toothpaste affordability and including behaviour change strategies to improve oral health practices.

In the abstract by Nunes et al. entitled "In situ Remineralization of Initial Caries Lesions Using Fluoride, CPP-ACP, and TMP-Enhanced Toothpaste" [Caries Res. 2025;59(4):315-383; https://doi.org/10.1159/000546564, abstract No. 100], there is an error in the name of one of the authors, which should read Christian Hannig.The original abstract has been updated.

Introduction: Caries experience in primary teeth has been highlighted as the most important single risk factor for caries development in the subsequent permanent teeth, but at cavitated stages. This 10-year cohort study aimed to evaluate whether children with only initial caries lesions in the primary teeth could also have a higher risk for caries incidence in permanent teeth.

Methods: We evaluated Brazilian preschoolers aged 1-5 years in 2010 (T1) and re-evaluated them 2 (T2), 7 (T3), and 10 (T4) years later. Dental caries in primary and permanent teeth was assessed through the International Caries Detection and Assessment System (ICDAS). For the primary dentition (T1 and T2), the participants were categorised according to caries severity in the first two assessments into children with (i) no caries, (ii) only initial caries lesions (ICDAS scores 1 and 2), (iii) at least one moderate lesion (ICDAS scores 3 and 4), and (iv) extensive caries lesions (ICDAS scores 5 and 6). We also created a dichotomous variable considering only extensive lesions. Demographic and socio-economic data were also collected. For the permanent dentition (T3 and T4), the participants were re-evaluated for extensive caries lesions after 7 and 10 years of follow-up. The outcome variables were the number of decayed, extracted, and filled surfaces of permanent teeth and the occurrence of any extensive lesion (caries incidence) after 10 years. Associations were evaluated through negative binomial and Poisson regression analyses, respectively. Incidence rate ratios (IRRs) and relative risks, along with 95% confidence intervals (95% CIs), were derived.

Results: At the baseline, 639 children were included, and 429 were reassessed after 10 years (67.2% retention rate). Children with only initial or moderate caries lesions did not have a higher risk of caries in permanent teeth. By contrast, children with extensive caries lesions were more likely to develop caries in the permanent dentition than children without caries (IRR, 95% CI = 2.90, 1.98-4.23). This higher risk was more clearly demonstrated when the caries experience was used as a dichotomous variable (IRR, 95% CI = 4.02, 2.38-6.78).

Conclusion: Children with only initial caries lesions do not have a higher risk of developing dental caries in the permanent dentition by adolescence.

Introduction: This study aimed to assess the sensitivity, specificity, and accuracy of a digital-based method for caries assessment in a rodent model, compared to a conventional modified-Keyes method.

Methods: One hundred and eight mandible molars of Sprague-Dawley rats were collected from a cariogenic caries rodent model, including both caries-free and carious teeth. Smooth surfaces were evaluated using digital photography, whereas sulcal lesions and volumetric quantification were assessed with micro-CT and the Amira software. In the conventional assessment, smooth surfaces were examined under a stereomicroscope with tactile probing, and sulcal surfaces were evaluated on stained, sectioned teeth. Sensitivity, specificity, and accuracy of the digital approaches were calculated, with the conventional method serving as the gold standard. Spearman correlation analysis was conducted between conventional enamel caries scores, combined digital (photography and micro-CT) enamel caries scores, and micro-CT quantified remaining enamel volume.

Results: A total of 107 m were available for smooth surfaces evaluation, and 98 m were included for sulcal surfaces, tooth-level caries detection and enamel lesion assessments. For smooth surfaces, the digital photographic method demonstrated an accuracy of 88.0%, with a sensitivity of 88.8% and a specificity of 85.7%. In the evaluation of sulcal caries, Micro-CT analysis achieved an accuracy of 96.9%, with 100% sensitivity and 87.0% specificity. For tooth-level caries detection, the combined digital approaches of smooth surface photography and sulcal micro-CT slicing achieved 96.9% accuracy, 97.6% sensitivity, and 92.9% specificity.

Conclusions: This study demonstrates the efficacy of digital photography and micro-CT in the caries assessment of rodent models. The findings support the establishment of a standardized, nondestructive imaging protocol to enhance consistency in caries research.

Introduction: The study objective was to assess and compare the use of diagnostic methods, clinical decision-making, treatment strategies, and attitudes of general dentists, pediatric dentists, and endodontists regarding deep carious lesions (DCL) in Egypt and Saudi Arabia.

Methods: A cross-sectional multinational study was conducted in Egypt and Saudi Arabia (January 2023-June 2024). A validated online questionnaire was distributed to 1,000 dentists (734 Egypt; 266 Saudi Arabia), including general practitioners, pediatric dentists, and endodontists. The survey covered demographics, diagnostics, clinical scenarios, treatment strategies, and influencing factors. Data were analyzed using SPSS v26 with descriptive statistics, chi-square tests, and logistic regression (p < 0.05).

Results: A total of 500 dentists responded (response rate of 46.0% for Egypt [338/734] and 60.9% for Saudi Arabia [162/266]). Most participants were general practitioners (60.4%) and female (57.8%), with an average of 9 years of clinical experience. Selective caries removal was preferred by 23.2% of general practitioners, 34.2% of pediatric dentists, and 21.8% of endodontists. Multivariable regression analysis showed that selective caries removal was more likely to be chosen by pediatric dentists (adjusted odds ratio [AOR] = 1.38, p = 0.04), dentists practicing in Egypt (AOR = 2.70, p < 0.001), and those who had attended MID courses (AOR = 1.75, p < 0.001). Endodontists demonstrated greater adherence to evidence-based guidelines (AOR = 3.35, p < 0.001), whereas practicing in Egypt (AOR = 0.43, p = 0.002), having more years of experience (AOR = 0.94, p = 0.001), and attending MID courses (AOR = 0.57, p = 0.03) were associated with lower odds of adherence.

Conclusions: Pediatric dentists, practitioners in Egypt, and those with training in minimally invasive dentistry were more likely to favor selective caries removal, whereas endodontists demonstrated the highest adherence to AAE guidelines and tended to prefer more invasive treatment strategies. Despite strong evidence supporting conservative approaches for managing DCLs in vital teeth, invasive strategies were still commonly reported among respondents. Greater implementation of evidence-based, patient-centered treatment strategies is needed among dentists in Egypt and Saudi Arabia.

Introduction: The aim of this study was to simultaneously assess three alternative models to animal caries testing - an in situ remineralization model, an in vivo salivary fluoride clearance model, and a modified in vitro pH cycling model - for measuring the anticaries efficacy of dentifrices containing monofluorophosphate (MFP) up to 2,800 ppm F.

Methods: A series of MFP dentifrices were prepared at 250, 1,100, and 2,800 ppm F as MFP in a silica abrasive base with a placebo toothpaste (fluoride-free). Model #1: in a randomized crossover trial, in situ remineralization (% surface microhardness recovery of partially demineralized enamel) and enamel fluoride uptake (microbiopsy) were assessed over 7, 14, and 21 days in 15 participants. Model #2: in vivo salivary fluoride clearance was evaluated in 26 participants using a randomized, crossover design by measuring salivary fluoride concentration over 30 min following 2 min of brushing. Model #3: a modified in vitro pH cycling model with pre-hydrolyzed (2N HCl) MFP dentifrice supernatants was used to evaluate lesion progression over 19 days with 6 h demineralization and 17 h remineralization daily (Monday-Friday with weekend remineralization) and twice daily morning and afternoon 2-min dentifrice slurry treatments on 10 teeth per dentifrice.

Results: There was a statistically significant impact of dose (p < 0.001) observed in all three models, and the three models are highly correlated with one another and with animal caries testing results (Spearman's ρ > 0.77, p < 0.0001). In situ hardening, fluoride uptake, and fluoride area under the curve clearance showed linear relationships with MFP dose. Acid hydrolysis successfully liberated ionic fluoride and lesion progression in pH cycling was exponentially suppressed with fluoride dose.

Conclusion: The in situ, in vivo, and modified in vitro models each provided dose-responsive and sensitive measures of MFP activity. Importantly, the modification of pH cycling for MFP hydrolysis enabled a well-developed laboratory protocol to be adapted to an important fluoride source. These approaches appear to offer viable alternatives to animal caries models for evaluating the efficacy of MFP-containing dentifrices and each could be chosen in different settings to understand the impact of MFP-containing dentifrices on caries prevention.

Introduction: Automated methods for caries detection among children can help triage children with greater need for treatment and assist clinicians in achieving a more accurate diagnosis of caries lesions. Therefore, we aimed to develop artificial intelligence algorithms based on various object detectors for detecting and staging caries lesions in primary molars using bitewing radiographs.

Methods: We used a dataset of 1,023 bitewing radiographs of primary molars from children aged 3-10 years. The radiographs were annotated by two examiners using a dedicated annotation platform to draw bounding boxes corresponding to four different primary caries severity stages. Five popular deep learning object detection algorithms were trained to detect the annotated caries and evaluated with various performance metrics, considering three different thresholds: all lesions, dentine caries lesions, and dentine caries lesions requiring operative treatment.

Results: For staging caries lesions, the DINO model achieved higher concordance with a weighted kappa score of 0.713 on the test dataset, outperforming other object detectors. The DINO model achieved the highest sensitivity for detecting all caries lesions (0.509) while also attaining the highest sensitivity and accuracy in identifying dentine caries requiring operative treatment, at 0.659 and 0.980, respectively. However, YOLOv7 also achieved good performance, with specificity values exceeding 0.99 and accuracy values exceeding 0.92 across all thresholds.

Conclusions: The DINO and YOLOv7 algorithms perform well at detecting caries on primary molars in bitewings, highlighting their potential for clinical application at aiding clinicians in daily practice.

Introduction: Area-level socioeconomic factors are within the social determinants of health, encompassing conditions in which people are born, grow, live, work, and age, which influence health beyond individual characteristics. This review examined the association between area-level socioeconomic factors and dental caries and tooth loss. The hypothesis was that individuals residing in more socioeconomically deprived areas experience higher odds of dental caries and tooth loss, independent of individual socioeconomic status.

Methods: A systematic search was conducted in PubMed, Scopus, Embase, and Web of Science. Studies reporting clinical or self-reported dental caries or tooth loss and evaluating area-level socioeconomic deprivation or income (neighbourhood, municipality, or region) using multilevel models were included.

Results: Of 4,671 screened records, 44 studies (41 cross-sectional) published from 2006 to 2024 were included. The most common exposures were area socioeconomic deprivation indices (n = 24), area average income (n = 21), and the Human Development Index (HDI) (n = 13). Quantitative synthesis was precluded by heterogeneity of aggregation levels, outcomes (tooth loss, caries experience, and untreated caries), and outcome measurement (dichotomous/continuous). Most studies adjusted for individual-level socioeconomic factors (82%). The hypothesised association was most consistent for tooth loss (e.g., functional dentition or edentulism, 6/6 studies), at a medium level of aggregation (13/15), and for the HDI (10/13). Studies using ordered categories frequently demonstrated clear socioeconomic gradients.

Conclusion: The findings support the hypothesis that residing in more affluent areas is associated with better oral health outcomes, specifically lower levels of tooth loss and, to a lesser extent, dental caries, after adjusting for individual-level socioeconomic factors.

Introduction: The aim of this study was to determine the level of erosive tooth wear (ETW) in young, healthy Finnish men in relation to their sociodemographic background; the number of decayed, missing due to caries, and filled teeth in their permanent dentition (DMFT); and Community Periodontal Index (CPI). Studies on the association between ETW and periodontal health, as well as those related to sociodemographic factors, have so far been inconclusive, indicating a need for further research on these associations.

Methods: The data used in this study were collected from the database of the "Oral Health of Finnish Conscripts 2021" project, including clinical and survey data from healthy Finnish males (n = 1,712) in their early twenties. Basic Erosive Tooth Wear Examination (BEWE) scoring was used to evaluate the ETW level. Distributions and mean BEWE sum score values excluding wisdom teeth were calculated. Cross-tabulation together with a χ2 test and binary logistic regression analysis were used to evaluate increased risk (BEWE sum score ≥3) for ETW. A geomap was used to illustrate the prevalence and severity of ETW across various regions of Finland.

Results: ETW is common among young Finnish men as almost two-thirds (63.0%) of the subjects had signs of erosive lesions. Severe ETW (BEWE sum score ≥9) was rare (3.2%). More severe ETW was associated with poorer overall oral health as the DMFT and CPI values were both higher with an exacerbated level of erosion. Restorative treatment need (D >0) and periodontal treatment need (CPI ≥2) were also associated with ETW. Living in urban areas and older age were associated with a higher prevalence and severity of ETW. A distinct variation in the increased risk for ETW was observed between various regions of Finland.

Conclusion: Poorer dental and periodontal health, as well as place of residence, were associated with higher severity of ETW. The progressive and irreversible nature of the condition underscores the importance of early detection.