Caries Research最新文献

Introduction: Dental caries is highly prevalent among pregnant women, and investigating potential modifying factors is particularly relevant for this population. This study aimed to evaluate the moderating effect of oral health literacy (OHL) on the relationship between socioeconomic conditions and dental caries in pregnant women.

Methods: This cross-sectional study was performed with pregnant women attending the public health service in Santa Maria, a municipality in Southern Brazil. The Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) instrument was used to evaluate OHL. The presence of dental caries was measured using the decayed, missing, or filled teeth (DMFT) index. Socioeconomic conditions were assessed based on family income and education level. The moderating effect of OHL on the relationship between income, education, and caries (D component of DMFT) was tested using multilevel Poisson regression analyses. The results are presented as prevalence ratio.

Results: A total of 520 pregnant women were examined (response rate of 93%). Pregnant women with low educational level and low OHL exhibited a 69% higher prevalence of dental caries compared to those with higher education and high OHL. Similarly, among those with high income, pregnant with low OHL had a 57% higher prevalence of untreated dental caries than their counterparts with both high income and high OHL.

Conclusion: Our findings indicate that low OHL modifies the association between socioeconomic conditions and dental caries among pregnant women. Low OHL appears to function as an aggravating factor, potentially exacerbating oral health outcomes in this population.

Introduction: Determinants of oral health are formed early and influenced by variations in socioeconomic status (SES). It is unclear whether early life SES influences child oral health directly or indirectly through determinants such as intake of free sugars. This study applied the marginal structural modelling approach to household income at birth and free sugar intake to investigate pathways those determinants influence child oral health.

Methods: We used data collected in SMILE, a population-based birth cohort study of Australian mother/newborn dyads, who have been followed-up prospectively since birth with questionnaires and clinical assessment. Area- and individual-level factors collected at childbirth were background confounders. Household income at childbirth (low/medium/high) and free sugar intake at age 2 years (low/medium/high) were used as primary exposure and mediator to investigate pathways through which SES at childbirth influences oral health. By applying the causal inference approach and using marginal structural modelling, we estimated the controlled direct effect of household income and the direct effect and mediating effect of intake of free sugars on dental caries experience. We developed a causal directed acyclic graph to guide the analysis. The baseline confounders were balanced using a stabilised inverse probabilities of treatment weight, mimicking randomisation.

Results: Low household income at childbirth was associated with 1.65 (95% confidence intervals [CI]: 1.01, 3.02) times higher accumulated dental caries experience by age 5 years than in children born to high-income households. High intake of free sugars had strong direct effects on both the prevalence (1.55 [95% CI: 1.03, 2.32]) and cumulative experience (2.64 [95% CI: 1.36, 5.15]) of dental caries by age 5 years. Proportions of effects of income were mediated by intake of free sugars.

Conclusion: Socioeconomic variations at birth and immediate determinants such as intake of sugars, directly and indirectly, influence oral health. Timely and appropriate addressing of those variations may limit inequity in oral health.

Introduction: Dental caries is a biofilm-mediated, multifactorial disease of the dental hard tissues. Maternal psychosocial and behavioral factors can affect a child's risk for many chronic childhood conditions including dental caries. We examined the relationship between maternal psychological well-being during and after pregnancy on caries experience in 3-year-old offspring.

Methods: Using data from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study (N = 667), maternal psychological well-being including depressive symptoms (Edinburg Postnatal Depression scale [EPDS]), anxiety symptoms (State Trait Anxiety Inventory [STAI]), and sleep quality were measured. Offspring dental caries experience was defined as having at least one decayed, missing, and filled teeth or surface (dmft ≥1 vs. 0/dmfs ≥1 vs. 0). We estimated associations between maternal psychological well-being in the pre- and postnatal periods with offspring dental caries experience using logistic regression models adjusted for several maternal and child demographic and socioeconomic factors.

Results: The mean maternal age at delivery was 31 (SD: 5.1) years with ethnic distribution of 55% Chinese, 28% Malay, and 17% Indian; 8.6% of mothers had a prenatal EPDS score ≥15 indicating probable depression and 44% of the children had dmft ≥1. Children of mothers with high prenatal EPDS scores (≥15) had 1.57 times (95% CI: 0.85-2.93) the adjusted odds of dental caries experience as compared to children of mothers with prenatal EPDS score <15, although this association was not statistically significant. Moreover, children of mothers with consistently high/changing EPDS and STAI scores in the pre- and postnatal periods had adjusted odds of caries experience of 1.65 (95% CI: 1.01-2.72) and 1.24 (95% CI: 0.89-1.74), respectively, when compared to children whose mothers had consistently low EPDS and STAI scores, though only EPDS association was statistically significant. Associations with poor sleep quality followed a similar direction, although not statistically significant.

Conclusion: While the current findings did not consistently demonstrate statistically significant associations, they suggest a potential role of maternal psychological well-being during and after pregnancy on children's oral health status.

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.