Caries Research最新文献

Introduction: Intraoral scanners with fluorescence technology (IOSFT) include a caries detection feature in addition to their standard scanning function. The aim of this study was to determine the diagnostic performance of the caries detection tool of the IOSFT Trios 4® on permanent premolar and molar surfaces when compared to visual and radiographic International Caries Detection and Assessment System (ICDAS).

Methods: Participants (n = 71, age 6-88 years) were examined under standardised conditions using ICDAS criteria for visual caries detection of occlusal and smooth surfaces. Bitewing (BW) radiographs were used to examine proximal surfaces using ICDAS radiographic criteria. Finally, participants underwent an intraoral scan of both the maxilla and the mandible according to the manufacturer's instructions. The automated caries detection (ACD) output on the IOSFT software was compared to the visual ICDAS scores obtained clinically for occlusal and free smooth (buccal and lingual) surfaces; the IOSFT caries detection output was compared to radiographic ICDAS scores from BW radiographs for interproximal (mesial and distal) surfaces. Sensitivity, specificity, and accuracy values for each tooth surface were calculated.

Results: Out of 3,684 permanent tooth surfaces examined, 461 surfaces with dental caries were included in the analysis. 392 were initial lesions (ICDAS 1-2), while 69 were moderate/severe (ICDAS 3-6). There was a moderate positive correlation (r = 0.4, p < 0.001) when comparing all ICDAS scores to IOSFT ACD categories for unrestored permanent occlusal surfaces. IOSFT ACD accuracy was higher for moderate/advanced lesions (ICDAS 3-6) lesions when compared to initial (ICDAS 1-2) ones (81% vs. 37.7%). For unrestored smooth surfaces, weak positive correlations were found when comparing all ICDAS scores to IOSFT ACD categories (r = 0.19, p < 0.001). Accuracy results for smooth surfaces were 93.5% for moderate/advanced and 77.1% for initial lesions. Correlations between BW ICDAS scores and IOSFT ACD scores for proximal surfaces were weak (r = 0.07, p = 0.019). Diagnostic accuracy was higher for moderate/advanced lesions when compared to initial ones (83.5% vs. 40.4%). There was a weak correlation between IOSFT ACD categories and ICDAS/visual categories for restored occlusal surfaces (r = 0.029, p = 0.68).

Conclusion: IOSFT cannot currently replace visual and radiographic exams for caries detection.

Introduction: This cohort study evaluated the clinical behavior of dental caries lesions classified as inactive on the occlusal surfaces of permanent molars, defining their risk for progression after 13 years, in comparison with sound occlusal surfaces.

Methods: Clinical assessments were undertaken at baseline (n=258), after 1 year (n=200), 4-5 years (n=193), and 13 years (n=102). Plaque and dental caries were recorded on the occlusal surfaces, as well as the eruption stage of permanent molars. Outcomes were progression by activity (active lesion, filling or extraction in the follow-up exam) and progression by severity (dentin cavity, filling or extraction in the follow-up exam). Predictors were occlusal site status, plaque accumulation on occlusal surfaces, eruption stage, type of molar, and dental arch, all of them collected at baseline. Logistic regression models were fitted using generalized estimating equations due to data clustering.

Results: A total of 601 occlusal surfaces were reexamined. For the activity criterion, progression rates were 8.7% for sound sites and 18.8% for caries lesions initially classified as inactive (p<0.05). For the severity criterion, the respective rates were 5.8% and 13.4% (p<0.001). Inactive occlusal caries lesions had about twice the risk for caries progression than sound surfaces, for both the activity criterion (adjusted OR=2.09, 95% CI=1.23-3.52) and the severity criterion (adjusted OR=2.49, 95% CI =1.42-4.35).

Conclusion: The vast majority (>80%) of lesions initially classified as inactive did not progress after 13 years. However, they showed higher risk for progression than sound occlusal surfaces of the same patients.

Introduction: The main cause of failure in restorations is the development of caries around restorations (CARs). Therefore, the aim of this study was to assess the evidence related to the development of CAR with fluoride-releasing restorative materials compared to non-fluoride releasing in deciduous and permanent teeth.

Methods: Randomized clinical trials were included. Literature searches were conducted without language/data restrictions in 6 databases and in the grey literature in June 2024. ROB2 tool assessed the risk of bias. Through meta-analyses, expressed by the risk difference (RD) with a 95% confidence interval, the outcome was evaluated considering the follow-up period (12, 18-24, and ≥36 months), type of dentition and fluoride-releasing restorative materials, number of surfaces treated, and the type of dental isolation performed. Meta-regression models were applied with the above variables as moderators. The certainty of the evidence was assessed by GRADE.

Results: Forty-six studies were selected. Among them, 29 presented some concerns and 9 showed high risk of bias. The type of dentition and dental materials, number of surfaces, and dental isolation did not influence the outcome (p > 0.05). Although after 36 months of follow-up, deciduous and permanent teeth restored with fluoride-releasing materials had a lower risk of CAR (RD -0.015 [-0.024, -0.006], p = 0.002, I2 = 0%), the moderators did not influence this effect by meta-regression models. The certainty of the evidence ranged from low to moderate.

Conclusion: Fluoride-releasing restorative materials were more effective in preventing CAR after 36 months of follow-up. However, this result should be interpreted with caution, considering the low to moderate certainty of the evidence, the included studies' risk of bias, and the small RD.

Introduction: Salivary matrix metalloproteinase-8 (MMP-8) concentration is considered a biomarker of oral health in adults, but studies in pediatric populations, especially with longitudinal data, are scarce.

Methods: We examined the associations of caries experience (DFT index) and gingivitis/calculus (CPITN) retrieved from public dental records with repeated salivary MMP-8 concentrations. Salivary MMP-8 were measured from 403 Finnish adolescents (50.1% girls) at the mean (SD) age of 11.4 (0.4) and 13.8 (0.5) years, using an ELISA kit. Oral health was determined on average 42 (27) days after saliva collection at baseline. The DFT index was categorized into no caries experience (DFT = 0) and having caries experience (DFT >0), and CPITN into no gingivitis/calculus (CPITN = 0) or having gingivitis/calculus (CPITN >0).

Results: Of the participants, 19.1% presented with caries experience, and 69.5% had gingivitis/calculus. The mean MMP-8 increased during follow-up by 0.125 ng/mL (95% CI: 0.05; 0.20, p = 0.006). MMP-8 at the two time points correlated weakly in all participants (r = 0.137, p = 0.006), especially in girls (r = 0.204, p = 0.004). The change in MMP-8 was not associated with caries experience or gingivitis/calculus in all participants or in gender-specific analyses (repeated measures ANOVA p > 0.05). Puberty status and medication use were not related to MMP-8 concentration.

Conclusions: Oral health indices retrieved from public health records were not associated with changes in MMP-8 concentrations in early adolescents over a 2-year follow-up. Salivary MMP-8 may not be a suitable biomarker of oral health in pediatric populations.

Introduction: This study aimed to investigate the association between online social capital and dental caries among adolescents.

Methods: A cross-sectional study was nested within a cohort and conducted with adolescents from Santa Maria, southern Brazil. Dental caries was assessed using the International Caries Detection and Assessment System (ICDAS), considering the number of teeth with cavitated lesions (scores 3, 5, and 6). Online social capital was measured using self-reported items on social media use, perceived digital support, and sense of digital belonging. Poisson regression models were used to estimate associations, adjusting for sociodemographic, behavioural, and psychosocial variables. Results are presented as rate ratios with 95% confidence intervals.

Results: A total of 406 adolescents were included. The mean number of teeth with cavitated caries was 1.45 (SD: 3.48). Adolescents who reported infrequent use of social media had a higher mean number of cavitated lesions compared to those who used social media daily. Higher levels of dental caries were also observed among those who reported low trust in online interactions. Similarly, a lack of perceived belonging in the digital environment was associated with a greater number of cavitated caries.

Conclusion: Infrequent social media use, low trust in online relationships, and a diminished sense of digital belonging were associated with higher levels of dental caries among adolescents.

Introduction: Potential dental health benefits, including pH buffering, have been demonstrated for nitrate in placebo-controlled studies when consumed one or several hours before sugar intake. However, its immediate local effect when co-administered with sugar is unclear. Our aim was to test the local effect of adding nitrate to a sugar rinse on human saliva acidification.

Methods: A double-blind, crossover study was conducted with three periods. In each period, 18 adults, equally distributed between men and women (n = 9 each), aged 25.4 ± 3.8 (mean ± SD), with normal salivary flow, rinsed for 2 min using 10 mL of one of the following rinses: spinach-only (blended spinach providing 8 mm nitrate), spinach+sucrose (blended spinach providing 8 mm nitrate + 20% sucrose), or sucrose-only (20% sucrose). Unstimulated saliva was collected at baseline and every 3 min up to 24 min. pH, lactate, nitrate, and nitrite were measured using Reflectoquant®. The effect of treatment and time was assessed using a linear mixed model (α = 0.05). Nitrate reduction capacity was determined in vitro using baseline saliva.

Results: All saliva samples demonstrated nitrate reduction activity. The lowest pH values were observed 6 min after rinsing, with all groups differing from each other: sucrose only (6.56 ± 0.38; mean ± SD), spinach+sucrose (6.83 ± 0.37), spinach only (7.15 ± 0.44, no pH drop). The pH returned to baseline values 12 min after the spinach+sucrose rinse, but not after the sucrose-only rinse at any time point. Nitrate and nitrite concentrations increased in saliva after using spinach-containing rinses, returning to their baseline levels after 6 min and 12 min. Lower lactate levels were detected after 12 min, suggesting proton consumption during nitrate metabolism in the spinach+sucrose group.

Conclusion: Adding a low dose of nitrate to a sucrose rinse limited sugar-induced salivary acidification in vivo, supporting the potential for topical nitrate strategies to reduce sugar acidogenicity.

Introduction: Dental caries remains a prevalent condition with significant health and economic repercussions. To address persistent oral health disparities and reduce the burden of dental caries among preschoolers in Sweden, this study aimed to evaluate the clinical and economic impact of implementing a theory-based behavioural intervention delivered by health promoters in clinics serving children at elevated risk for caries.

Methods: A retrospective cohort design was applied, comparing clinics using a theory-based behavioural intervention led by health promoters with clinics using the Recommended Programme for Caries Treatment (RPCT). The cohort were children aged 3-6 years identified as being at increased caries risk in Region Västra Götaland during 2021-2023. Three analytic approaches were employed: (1) budget impact analysis (BIA) to measure net costs and resource shifts; (2) difference-in-differences (DiD) to compare mean decayed, extracted, or filled teeth (deft) in intervention versus control clinics; and (3) cost-effectiveness analysis (CEA) to estimate the incremental cost-effectiveness ratio (ICER).

Results: The BIA showed that the theory-based behavioural intervention led by health promoters incurred higher initial personnel costs than the RPCT but required fewer clinical hours - an opportunity cost that, if redeployed to clinical activity, could partially offset these expenses. The DiD showed that, over 3 years, clinics implementing the intervention achieved a statistically significant reduction of 0.26 deft among 6-year-olds. The CEA estimated the ICER to be 2,142 SEK (199 EUR) per deft prevented, which improved to 513-810 SEK (48-75 EUR) when the economic value of the liberated work hours was included.

Conclusion: A theory-based behavioural intervention led by health promoters reduced caries risk among high-risk preschoolers and may enable improved resource allocation, contingent on the redeployment of freed hours. Despite higher initial personnel costs, the approach demonstrated favourable cost-effectiveness over time, supporting its integration into public dental care systems.

Introduction: The restorative threshold of dentists varies considerably. This retrospective study examined the association between the depth of radiolucency in proximal surfaces on bitewing radiographs and the probability of restorative treatment among Finnish dentists.

Methods: The study population comprised 160 patients aged 18-40 years who underwent routine dental examinations by 16 randomly selected dentists within the Public Dental Services of Kuopio, Finland, in 2022. Data on patient characteristics, caries lesions, radiographic findings, and treatment decisions were manually extracted from the local electronic health record system. The depth of radiolucency was measured for all proximal caries lesions that had been registered by the dentists and were visible on the radiographs. The association between radiolucency depth and treatment decisions was estimated using linear regression analyses with cluster-robust standard errors.

Results: Bitewing radiography had been used for 128 (80%) patients. Most of the 394 caries lesions that had been registered were radiographically confined to the enamel (57%) or outermost third of dentin (27%), whereas 12% were in the middle third of dentin, and 4% extended to the inner third of dentin. Regression analyses revealed that the predicted probability of restorative treatment was 8% for lesions reaching the dentinoenamel junction and 75% for those extending to the border between the outer and middle thirds of dentin.

Conclusions: The probability of restorative treatment increased sharply with the depth of radiolucency and was unexpectedly high for lesions confined to enamel or the outer third of dentin.