Caries Research最新文献

Background: The WHO's Global Oral Health Action Plan towards 2030 suggests prioritizing cost-effective preventive and minimally invasive (MI) dental caries interventions as essential oral health care services. Given the high prevalence of dental caries among children, raising awareness of the limitations and research gaps of the existing economic evaluations assessing preventive and MI procedures is crucial. Therefore, this scoping review aimed to identify and map the relevant literature on economic evaluations for preventive and MI dental caries procedures among children under 12 years of age.

Summary: We conducted a systematic literature search using Medline, Embase, Scopus, Web of Science, Cochrane, LILACS, and PEDE up to December 31st, 2023. Two independent reviewers performed the screening and data extraction using the Covidence software. A third reviewer resolved disagreements. Inclusion criteria comprised full economic evaluations and full-text original articles published in peer-reviewed journals, in English, Spanish, or Portuguese, without any date restrictions. Data extraction included methodological characteristics items. We appraised the content reported using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist.

Key messages: Among 1,285 studies screened, 62 were selected for data extraction. Most studies conducted a cost-effectiveness analysis (98%, n = 61), and only 10% (n = 6) and 3% (n = 2) conducted a cost-benefit and cost-utility analysis, respectively. The majority of studies evaluated sealants (32%, n = 20) and fluoride varnish (24%, n = 15), and only three assessed the cost-effectiveness of silver diamine fluoride. None of the included studies reported the CHEERS item related to community engagement. Moreover, there is a lack of studies among populations from the African region, most low- and lower-middle-income countries, and Indigenous communities. In conclusion, economic evaluations of preventive and MI dental caries procedures among children have increased over the last decade. Nonetheless, these are mostly cost-effectiveness analyses using clinically oriented outcomes, as opposed to patient-centred outcomes. We recommend collaboration with community partners while conducting economic evaluations for mutual capacity building.

Introduction: Gastroesophageal reflux disease (GERD) and bile reflux disease (BRD) are two distinct conditions that may affect oral health through different mechanisms. This study investigated whether these reflux types lead to differing oral and dental outcomes in pediatric patients, aiming to inform clinical practice and promote interdisciplinary care.

Methods: Patients diagnosed with BRD or GERD between 2017 and 2020 were included. Clinical oral examinations, salivary analyses, and questionnaires on potential etiological factors for erosive tooth wear (ETW) were conducted. Oral health was assessed using the Basic Erosive Wear Examination (BEWE), dental caries experience (DMFT), Silness and Löe plaque index (PI), and gingival index (GI). Salivary pH and flow rates were recorded.

Results: Sixty-six patients (33 with BRD, 33 with GERD; 75.8% female; mean age: 14.9 ± 3.1) were included. BEWE scores were significantly higher in GERD patients (median: 6 vs. 4) (p < 0.001), though both groups were classified as low risk for ETW. GERD patients had higher PI (p = 0.018) and GI scores (p < 0.001), while DMFT scores were similar (p = 0.639). BRD patients exhibited significantly higher median values for unstimulated and stimulated salivary pH (7 vs. 6 and 8 vs. 7, respectively) and flow rates (0.6 vs. 0.36 mL/min and 1.7 vs. 1.22 mL/min, respectively) (all p < 0.001), although stimulated flow in GERD patients remained within normal limits (≥1 mL/min).

Conclusion: GERD was associated with poorer oral health, particularly ETW and gingival status. Early, multidisciplinary intervention may help prevent erosion and promote remineralization.

Background: The risk factors for early life sugar consumption in different countries have not been thoroughly mapped, making it difficult to plan interventions.

Summary: This scoping review aims to map evidence on the risk factors for introduction of sugar in the first 2 years of life and to characterize the methodological features of the studies included. Population, Concept, and Context strategy (PCC) was adopted to identify relevant studies published up to February 2025 using PubMed, Scopus, Dentistry and Oral Sciences Source, and Web of Science databases. Any interventional or observational study investigating associated or risk factors for the early introduction of sugar in the first 2 years of age was eligible. The study had no funding, and the protocol was not registered. In total, 348 articles were suitable for initial screening of title and abstracts; 118 were submitted to full-text analysis, identifying 19 papers involving 43,622 children from Europe (n = 6), North America (n = 5), South America (n = 3), Asia (n = 3), and Oceania (n = 2). Considerable methodological variation was found between studies, particularly in study design, data collection instruments, and types of sugar investigated. The introduction of sugar was earlier among children from regions with greater socioeconomic inequalities and from mothers with lower level of education, younger age, single mothers, and higher number of siblings. Additionally, behavioral risk factors identified included higher parental sugar consumption, maternal smoking, and shorter breastfeeding duration.

Key messages: The risk factors identified in this scoping review can inform the planning of future strategies to prevent sugar consumption in the first 2 years of life. Furthermore, substantial methodological variations identified across studies may guide researchers in developing future research in this field.

Introduction: Asthma and dental caries may be linked through frequent mouth breathing and the use of inhaled asthma medication. However, the current literature is inconclusive on whether asthma or asthma medications increase the risk of dental caries in permanent dentition. This study aimed to investigate whether asthma, the age of asthma onset, and the use of asthma medications are associated with the caries experience of 13-year-old adolescents.

Methods: This study was embedded in the Generation R Study, a population-based prospective cohort. Data on asthma, asthma medication use, and potential confounders were collected through parental questionnaires. Dental caries in the permanent dentition was defined by the Decayed, Missing, and Filled Teeth (DMFT) index. Hurdle-negative binomial regression models were used to examine the associations between asthma variables and dental caries.

Results: In the study population (n = 3,356, 13.6 ± 0.34 years, 48.8% male), the prevalence of dental caries was 35.2% and the prevalence of ever diagnosed with asthma 15.3%. The results showed no associations between (current) asthma, age at asthma onset, or asthma medication use at 13 years and risk of dental caries (OR [95% CI] ranging from 0.64 [0.41-1.02] to 1.27 [0.79-2.05]).

Conclusion: As the largest study conducted to date in adolescents, no associations were found between asthma or asthma medication and dental caries, consistent with findings across multiple large, population-based cohort studies, underscoring the strength of these findings.

Introduction: Clinical plaque indices are well-established methods for quantifying the effects of plaque control, for example, with different toothbrush types. However, effect sizes observed in such studies depend on the index used. Therefore, this study aimed to evaluate how Turesky-modified Quigley-Hein Plaque Index (T-QHPI), Rustogi-modified Navy Plaque Index (RMNPI), and RMNPI modified by Bretz (RMNPI-Bretz) scores correspond to actual plaque amounts.

Methods: Thirty participants, 24.0 ± 4.1 years old, were included. Following 72 h without oral hygiene and after subsequent habitual toothbrushing, disclosed plaque (Mira-2-Ton®) was captured using intraoral scans (Carestream 3800). Scoring grids corresponding to the indices were projected onto standardised images on the oral and vestibular sides of the Ramfjord teeth (16, 21, 24, 36, 41, and 44) and scored. Afterwards, actual plaque coverage was quantified planimetrically (P%).

Results: All methods yield significant plaque reduction after brushing (P%: 42.1 ± 14.0%, T-QHPI: 32.7 ± 9.5%, RMNPI: 19.7 ± 9.5%, RMNPI-Bretz: 30.2 ± 9.9; p ≤ 0.001 each). However, Bland-Altman analysis revealed distinct systematic and proportional biases in relation to P%. As P% was not linearly related to the index values, equations were derived, enabling the conversion into actual plaque coverage. Those were applied to T-QHPI and RMNPI data from the literature to allow a deeper understanding of effect sizes.

Conclusions: Plaque indices only partially reflect actual plaque coverage. Compared to RMNPI, T-QHPI and RMNPI-Bretz gave closer agreement with the planimetric measurements. These findings highlight the limitations of traditional plaque indices in accurately representing plaque reduction, while offering a new approach to enhance the interpretability of oral hygiene studies.

Introduction: Early childhood caries (ECC) is a significant public health issue, affecting nearly half of children worldwide. Severe ECC (S-ECC) is characterized by smooth-surface caries in children under 3 years old. Early dental eruption has been linked to a higher risk of ECC, as teeth are exposed to cariogenic environments longer. This study analyzes the association between the number of teeth at 12 and 24 months and the presence of S-ECC at 4 years of age.

Methods: Data were obtained from the 2015 Pelotas Birth Cohort, which included all children born in Pelotas, Brazil, in 2015. The number of teeth at 12 and 24 months, reported by mothers, was the primary exposure, and S-ECC at 4 years was the outcome. Sugar consumption was analyzed as a potential mediator. Confounders included maternal education, family income, and child sex. Mediation analysis was conducted using PARAMED, and Poisson regression with robust variance estimated prevalence ratios, adjusting for confounders. A significance level of 0.05 was used.

Results: The number of teeth at 12 and 24 months was positively associated with S-ECC at 4 years. However, the sugar consumption trajectory did not mediate these relationships.

Conclusion: This study highlights a significant association between the number of teeth in early life and S-ECC development, independent of sugar consumption.

Introduction: This study evaluates the reliability of an artificial intelligence (AI) software for detecting approximal caries lesions of different depth on bitewing radiographs.

Methods: A total of 40 bitewing radiographs consisting of 288 teeth (576 approximal surfaces) were selected for analysis. Utilising the International Caries Detection and Assessment System radiographic scoring system, five dentists established a consensus on the assessment of all radiographs, serving as the gold standard of this study. These radiographs were later analysed using an AI software (Nostic software®), and the detection results were compared to the established ground truth.

Results: The area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive values, negative predictive values, and F1 scores were computed. A total of 246 surfaces were included for the detection of enamel lesions (D _1-2) while 341 surfaces were assed for dentinal lesions (D _3-4) and for both enamel and dentinal lesions (D _1-4). The accuracy (95% confidence interval) for detecting enamel lesions (D _1-2) was 0.78 (0.72-0.83), for dentinal lesions (D _3-4) was 0.85 (0.80-0.88) and for both enamel and dentinal lesions (D _1-4) was 0.77 (0.73-0.81). Correspondingly, the AUC (95% confidence interval) values for detecting enamel lesions (D _1-2), dentinal lesion (D _3-4) and both enamel and dentinal lesions (D _1-4) were 0.70 (0.65-0.76), 0.81 (0.75-0.87), 0.75 (0.71-0.80), respectively.

Conclusion: In conclusion, the performance of the AI software in detecting proximal caries lesions of varying depths on bitewing radiographs was found to be decent when compared to the gold standard. This AI software has the potential to serve as an effective tool to support diagnosing initial caries in bitewing images for dental practitioners.

Introduction: Deep learning techniques have emerged as promising tools for enhancing the radiographic diagnosis of caries, particularly when utilizing bitewing radiographs.

Methods: Following the PRISMA guidelines, a systematic review was conducted to assess the use of deep learning for caries diagnosis in bitewing radiographs. Literature searches were performed across Web of Science and PubMed databases for studies published before March 2025 that utilized deep learning for caries detection, segmentation, and classification using bitewing radiographs. Data extraction focused on model architectures, dataset characteristics, annotation processes, diagnostic performance metrics, and potential biases, as assessed by the QUADAS-2.

Results: Twenty-three studies met the inclusion criteria, encompassing caries detection, segmentation, and severity classification. The most frequently applied deep learning models were classification models, such as ResNet and detection models, such as YOLO architectures. Dataset sizes varied widely, ranging from 112 to 8,539 images. Most studies reported high diagnostic performance, with accuracies ranging from 70% to 99%. Some AI models outperformed or matched the performance of human experts, particularly in detecting advanced carious lesions. However, considerable variability was observed in model architectures, dataset characteristics, the applied diagnostic performance metrics, and reporting standards. The risk of bias assessment revealed concerns in patient selection, index test interpretation, and reference standards, with all studies rated as having a high risk of bias in at least one domain.

Conclusion: The review identified challenges in currently developed deep learning models regarding methodological heterogeneity, lack of standardization, limited dataset diversity, insufficient clinical validation, and concerns about bias and data transparency. Nevertheless, all studies concluded that deep learning models are promising as an assistive diagnostic tool in caries diagnostics using bitewing radiography.

Introduction: Dental caries is a disease with high prevalence and concern worldwide, especially among the elderly population. Considering the impact of saliva on the disease development process, protein biomarkers may be potentially useful to monitor the clinical course of the disease.

Methods: This study recorded clinical data and conducted a proteomic analysis of the saliva of eighty elderly individuals (60-84 years). Participants were classified into a no active caries (NC) group and low caries activity (LC) and high caries activity (HC) groups. We hypothesized that the protein profile between the groups would be different and could be used to learn about disease progression and identify potential markers for caries severity in the aged population. All participants had their unstimulated total saliva collected for 5 min. Further correlations were tested to find target proteins strongly linked to clinical variables of caries disease, i.e., the visible dental plaque index, root caries experience, salivary flow, buffering capacity and pH, and percentage of sugar intake. To achieve this, groups with different dental caries statuses were compared.

Results: In total, 1,299 proteins were identified, of which 665 could be quantified in all samples. Of these, 16 proteins had statistically different abundances between the groups with and without dental caries activity (p < 0.05; fold-change [FC] 1.23). Furthermore, 31 proteins differentially regulated in saliva, including 22 downregulated and 9 upregulated proteins, were found in the HC group compared with the LC group (p < 0.05; FC 1.23). When correlated with caries disease-related clinical parameters, 87 candidates were identified and 19 maintained significances from the primary data analysis (p < 0.05). In the gene ontology analysis, most of the regulated proteins were related to innate immunity processes, calcium ions activity, action against bacteria, and cell adhesion.

Conclusion: This study identified potential proteins that may help distinguish different caries activity status on people over 60 years of age. Ultimately, future studies could investigate whether the differential abundance of regulated proteins is a result of the caries process itself or the underlying factors that contribute to its development.

Introduction: This study conducted a molecular dynamics simulation to elucidate the interactions in silico between a sugarcane cystatin (CaneCPI-5) and hydroxyapatite, aiming to deepen the understanding of its potential role in modulating the dental enamel demineralization process.

Methods: The CaneCPI-5 protein structure was modeled using homology with SWISS-MODEL, based on the multicystatin template PDB-ID 4LZI. Molecular dynamics simulations were conducted with the protein positioned randomly in a box containing a hydroxyapatite surface (001 face). Molecular dynamics simulations were then carried out for 500 ns with control of temperature and pressure using the GROMACS package. The free energy of interaction between CaneCPI-5 and the hydroxyapatite surface was calculated using the MM/GBSA method based on trajectory frames.

Results: For several initial orientations, the protein rapidly migrated to anchor to the surface, ensuring minimal distance between its amino acid residues and the surface. Most residues interacting with the surface phosphates were positively charged. Arginine 81, alanine 105 and arginine 107 were found to be key residues. During the simulations, similar values were observed for all orientations in terms of root-mean-square deviation, radius of gyration, and root mean square fluctuation. The free energy calculation showed strong protein-hydroxyapatite interactions, except for one of the initial orientations.

Conclusion: This study demonstrates that CaneCPI-5 has affinity for hydroxyapatite surfaces, with positively charged residues, particularly arginine. The stable binding observed throughout the simulations suggests that this protein may contribute to mechanisms that influence the integrity of dental enamel in demineralizing conditions.