Caries Research最新文献

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.

Introduction: Parental awareness of oral hygiene plays a crucial role in safeguarding children's oral health. This study sought to evaluate the oral health status, habits, and dietary patterns of primary schoolchildren in rural Armenia while investigating the influence of parental oral health knowledge on their children's oral health, as assessed by child's dental plaque index.

Methods: The study involved primary schoolchildren and their parents from two rural communities in Armavir province. It was composed of two key components: (1) a cross-sectional telephone survey conducted with parents to evaluate their knowledge of oral health, their children's oral hygiene practices, dietary habits, and sociodemographic background, and (2) a clinical assessment of the children's oral health, which included measuring plaque index and recording the Decayed, Missing, and Filled Teeth (DMFT/dmft) index. To determine the relationship between parental oral health knowledge and children's plaque index, a multivariable linear regression analysis was performed.

Results: A total of 400 parents participated. Children had a mean plaque index of 3.1 (SD 0.7) and a mean DMFT/dmft index of 7.3 (SD 3.3). The score indicating oral health behavior averaged 3.0 out of 6.0. The mean dietary habits score was 4.5 out of 9.0. The mean score indicating oral health knowledge of parents was 6.9 out of 9.0. After adjusting for potential confounders, each one-point increase in parental oral health knowledge score was associated with a 0.05-point reduction in the child's dental plaque index (95% CI: -0.10; -0.002).

Conclusions: The findings emphasize the need for comprehensive strategies to improve children's oral health, including parental education, behavioral support, caries-prevention efforts, and better access to dental care.

Introduction: Global trends in early childhood caries (ECC) remain unclear, with previous studies reporting either stable or declining rates over the past three decades. Given the short functional lifespan of the primary dentition and the urgency of targeted public health policies, the absence of focused investigation into the most recent decade constitutes a critical gap. This study, therefore, aimed to analyze temporal trends in the global prevalence of caries in deciduous teeth across 204 countries and seven super-regions from 2010 to 2021.

Methods: Prevalence rates (/100,000 population) of dental caries in deciduous teeth among children under 5 years of age were obtained from the Global Burden of Disease Study 2021. Temporal trends were assessed using Prais-Winsten linear regression, and annual percentage change (APC) was calculated.

Results: Over the past decade, the global prevalence of caries in deciduous teeth has exhibited an increasing trend (APC = 0.73%; p < 0.001), with the most marked increases observed in High-Income countries (APC = 6.51%; p = 0.005) and in Latin America and the Caribbean (APC = 2.17%; p < 0.001). The USA (APC = 19.32%; p = 0.002) and Brazil (APC = 5.27%; p < 0.001) recorded the highest increases within their respective super-regions.

Conclusion: Focusing on the last decade underscores in ECC prevalence that may not be evident the aggregated data over the last three decades. The upward trend underscores the urgent need for policies that address both commercial and social determinants, promote reductions in sugar consumption, and ensure equitable access to fluoride for effective caries control.

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: Our previous metagenomic analysis revealed higher frequencies of biotin-related genes (i.e., bioY, bioM, bccP) in caries-active children, indicating a potential role of biotin in caries pathogenesis. This study investigated a biotin limitation strategy against the primary cariogenic bacterium Streptococcus mutans (S. mutans), including its effects on cariogenic phenotypes, gene expression, and metabolomics.

Methods: S. mutans UA159 was cultured in biotin-free medium supplemented with different biotin concentrations. The cariogenic phenotypes of the strain, including growth kinetics, biofilm formation, exopolysaccharide production, lactate synthesis, acid/oxidative tolerance, and membrane fluidity, were measured and compared across biotin concentrations. Biofilm architecture was visualized via confocal laser-scanning microscopy and scanning electron microscopy. Quantitative real-time polymerase chain reaction was employed to analyze the expression of genes associated with virulence and biotin metabolism. Metabolomic analysis was performed to characterize metabolic perturbations induced by biotin limitation in S. mutans.

Results: Under biotin limitation, S. mutans exhibited significantly reduced cariogenic phenotypes, accompanied by cell elongation and reduced membrane fluidity. At the molecular level, biotin limitation suppressed the expression of key virulence-associated genes and induced a compensatory upregulation of genes involved in biotin uptake and biotin-dependent carboxylases. Metabolomic analysis under biotin-limited conditions in S. mutans revealed perturbed pathways in central carbon metabolism and nucleotide metabolism.

Conclusion: Biotin limitation significantly reduced the cariogenic potential of S. mutans by disrupting metabolic flux and virulence gene expression, highlighting biotin uptake and metabolism as potential targets for anticaries therapies.

Introduction: Dental caries is a complex, multifactorial pathological disease. Despite advances in dental care, dental caries continues to pose a significant public health challenge. In addition to the behavioural factors (e.g., sugar exposure) and environmental/oral hygiene factors (e.g., fluoride exposure in water and/or toothpaste) on the development of dental caries, potential genetic influence on dental caries susceptibility is possible, but evidence is inconclusive, especially from a candidate gene approach. Over the past 2 decades, a genome-wide association study (GWAS) approach has also been applied to understand the genetic variants associated with dental caries. This study aims to systematically review GWAS on dental caries and identify relevant genetic risk variants of dental caries.

Methods: A systematic search was conducted in five databases (PubMed; ScienceDirect; Embase, Global Health, MEDLINE) and one GWAS registry: GWAS Catalog in March 2024. Studies published after 2005 using GWAS approach were eligible. Q-Genie tool was used for the quality assessment. Study information and single-nucleotide polymorphisms (SNPs) at conventional (5 × 10-8) or suggestive (5 × 10-6) GWAS significance level were extracted and synthesized.

Results: A total of 16 papers were included, identifying 20 risk SNPs associated with dental caries at conventional GWAS significance level and 33 SNPs at suggestive level. No common conventional SNPs or shared gene regions were found between studies. Of these studies, the sample sizes in majority were relatively small and only one study reported all recommended quality control steps. Most studies focused on the white or European-American population and dental caries on permanent teeth. In addition, some data resources were used repeatedly in multiple studies, particularly the Center for Oral Health Research in Appalachia (COHRA) cohorts, which was used in 9 studies.

Conclusion: This study explored the GWAS on dental caries and summarized the heterogeneities of the included studies, leading to inconsistent results. Guideline and more GWAS with larger sample size and multiethnicities are needed to fully understand the genetic basis of dental caries.

Introduction: The aim of the present study was to evaluate the use of vertical bitewing (VBW) radiographs compared to visual examination alone for caries detection and treatment planning of primary molars in children.

Methods: Children aged 5-10 years with high caries risk were examined by trained and calibrated paediatric dentists. Treatment decisions were made based on visual examination alone and after VBW findings and categorised into control treatment (CT), non-restorative treatment (NRT), restorative treatment (RT), and treatment of the necrotic tooth (TNT). Descriptive and statistical analysis was performed using Stata 18.0 (α = 5%).

Results: A total of 1,417 surfaces in 75 children were included in the study (occlusal = 528; proximal = 889). Radiographic dentine caries lesions were detected in 7% of clinically sound surfaces. Radiographic signs of pulp necrosis were observed in almost 20% of teeth that had no clinical signs of pulp necrosis. This led to significant changes from RT to pulpectomy/extraction of primary molars. Treatment changes were required for 221 surfaces (15.60%) after radiographic examination (CT to NRT = 120; CT to RT = 32; NRT to RT = 47; RT to TNT = 22). Changes were significantly more frequent in proximal surfaces when compared to occlusal ones (p < 0.001).

Conclusion: VBW increased the detection of proximal caries lesions in primary molars compared to visual examination; however, most of those lesions were restricted to enamel. The majority of changes in the treatment decision after radiographic examination occurred from CT to NRT. VBWs allowed the determination of the depth of dentine caries, proximity to pulp signs of pulp necrosis, and presence of permanent successors, which are essential for treatment planning for deep caries lesions.

Introduction: Universal coverage for oral healthcare is expected to improve population oral health. However, empirical evidence to substantiate this expectation is scarce and inconsistent. This study investigated the association between municipal oral healthcare coverage and dental caries among 5-year-old children.

Methods: This study pooled together individual-level data from 7,185 5-year-old children who participated in the National Oral Health Survey - SB Brasil 2023 and monthly data on municipal oral healthcare coverage from January 2019 to December 2023. Dental caries was determined at cavity level in clinical examinations and summarised using the numbers of decayed teeth (dt), missing and filled teeth (mft) and decayed, missing, and filled teeth (dmft). Group-based trajectory modelling was used to identify four distinct classes of municipal oral healthcare coverage: always-low, medium-low, medium-high, and always-high. Multilevel negative binomial regression models, with children nested within municipalities, were fitted to test the association between municipal oral healthcare coverage and each caries measure, adjusting for demographic factors, socioeconomic conditions, and oral healthcare-seeking behaviour.

Results: The variance partition coefficient of the empty model (no predictors) indicated that 4.1%, 3.1%, and 4.4% of the variance in the dmft, dt, and mft scores was attributable to differences between municipalities. Greater municipal oral healthcare coverage was not associated with the dmft and dt scores after adjusting for covariates. In contrast, municipal oral healthcare coverage was associated with the mft score after adjustments. Children in municipalities with medium-low (1.09, 95% CI: 0.72-1.66), medium-high (1.45, 95% CI: 0.93-2.26), and always-high coverage (1.50, 95% CI: 0.88, 2.56) had on average higher mft scores compared to those in municipalities with always-low coverage (p value for trend = 0.047).

Conclusion: This study shows that greater oral healthcare coverage was positively associated with more caries treatment experience but not with current untreated disease.