Caries Research最新文献

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.

Introduction: Adverse childhood experiences (ACEs) are negative events occurring before age 18 that may impact health. Children exposed to ACEs often receive inadequate preventive care and have a higher prevalence of diseases like dental caries. However, research on this topic remains limited. This study evaluated the association between ACEs and dental caries in adolescents.

Methods: This is a cross-sectional study nested in a cohort performed with a representative sample of preschools from Santa Maria, southern Brazil. This study used data from the last follow-up, with individuals aged between 14 and 18. Data collection was performed through structured questionnaires administered face-to-face and oral clinical examinations. All research team was previously trained and calibrated. Dental caries was measured by International Caries Detection and Assessment System (ICDAS). ACE was evaluated by questions of the Brazilian version of the Adverse Childhood Experiences-International Questionnaire (ACE-IQ), considering alcohol and drug use, suicidal intent, imprisonment, divorce, or death of family members. The co-occurrence of ACEs was also evaluated. Sociodemographic and behavioral variables were used as covariables. Poisson regression models were used to investigate the associations with results present in rate ratio (RR) and 95% confidence interval (CI).

Results: A total of 406 adolescents were examined. The mean of teeth with dental caries was 1.45 (standard deviation 3.6). The rate of dental caries was 56% higher in adolescents who lived with someone who has been sent to prison (RR: 1.56; 95% CI: 1.02-1.90) and 22% higher in adolescents who witnessed their parents' divorce (RR: 1.22; 95% CI: 1.02-1.45) compared to those counterparts. The other ACEs separately were not associated with dental caries. Adolescents exposed to one, two, or more ACEs concomitantly had significantly higher caries rates compared to those with no exposure.

Conclusion: Individuals who witnessed parental divorce or imprisonment exhibited higher rates of dental caries. Moreover, exposure to one, two, or more concurrent ACEs was associated with higher dental caries rates compared to no exposure. These findings underscore the importance of considering specific ACEs within the family environment when assessing their impact on dental caries.

Introduction: Leveraging data from a cohort study of Quebec youth with a family history of obesity, this study aimed to (i) identify neighbourhood socio-environmental typologies in childhood and (ii) estimate their associations with the incidence of dental caries in adolescence.

Methods: We used baseline (2005-2008) and second follow-up (2012-2015) data from the ongoing QUALITY cohort study in Montreal, Canada, which included 512 children aged 8-10 years with ≥1 biological parent with obesity at baseline. Based on prior literature and data availability, we selected three key neighbourhood-level indicators - social disorder, social deprivation, and material deprivation - measured in both school and residential settings. Latent class analysis was used to derive the socio-environmental typologies by combining social disorder, social deprivation, and material deprivation of the social environment in school and residential neighbourhoods. The outcome was dental caries incidence, assessed as the change in the Decayed, Missing, Filled Surface index. Negative binomial regression was performed to estimate incidence ratios (IRs) and corresponding 95% confidence intervals (CIs).

Results: Only three neighbourhood socio-environmental typologies were identified. Type 1 neighbourhoods: high social disorder, high social deprivation, and low material deprivation; type 2 neighbourhoods: median social disorder, median social deprivation, and median material deprivation; type 3 neighbourhoods: low social disorder, low social deprivation, and high material deprivation. Compared to type 1, the IRs (95% CIs) were 0.9 (0.6-1.2) for type 2 and 0.8 (0.6-1.1) for type 3.

Conclusion: Neighbourhoods with lower social disorder and social deprivation may offer a protective effect against dental caries in youth.

Introduction: Dental caries in childhood remains a major global public health issue. In response to persistently high caries levels among children, Chile implemented a national programme (Sembrando Sonrisas) including daily supervised toothbrushing and biannual fluoride varnish applications in nurseries. This study aimed to examine the association between these interventions and caries experience in preschool children, and to assess related socioeconomic inequalities.

Methods: We analysed aggregated municipality-level data (n = 346) on dental caries outcomes in 5-year-olds, coverage of fluoride varnish applications, delivery of toothbrushing materials (toothbrushes and 1,000 ppm fluoride toothpaste), exposure to community water fluoridation (CWF), rurality, and socioeconomic deprivation. The primary outcome was the caries experience of children covered by the programme since its national rollout in 2015. Univariate and multivariate weighted linear regression models assessed associations between programme interventions and caries experience, adjusting for deprivation and CWF. Socioeconomic inequalities in caries experience were evaluated using the Slope Index of Inequality (SII) and Relative Index of Inequality (RII). The distribution of programme delivery across socioeconomic deciles was assessed using weighted regression models.

Results: Data on 309,360 5-year-olds were included. Complete delivery of toothbrushing materials was associated with lower caries experience (50.1% vs. 55.0%), a 4.9% difference (95% CI: 2.5%, 7.2%) after adjustment. CWF exposure was associated with a 7.5% lower caries experience (95% CI: 4.2%, 10.9%). The combination of both interventions showed the lowest caries levels, with a 13.4% difference compared to areas with neither intervention (95% CI: 7.5%, 19.3%). Fluoride varnish application was not significantly associated with caries experience. Delivery of interventions was equitable across socioeconomic groups. However, caries experience was significantly higher in the most deprived municipalities (SII = 14.7%, 95% CI: 11.7%, 17.7%; RII = 0.283, p < 0.001).

Conclusion: Lower caries experience was associated with supervised daily toothbrushing and CWF exposure, but not with fluoride varnish application. Despite equitable programme coverage, substantial socioeconomic inequalities persist. As this ecological study cannot establish causality, further research is needed to evaluate long-term trends and the role of broader determinants in improving child oral health.

Introduction: This study compared the diagnostic accuracy of interproximal caries detection using intraoral bitewing radiographs, assessed by both human operators and an artificial intelligence (AI) program, a near-infrared reflectance imaging (NIRI) system with operator-conducted assessment, and histological evaluation as the reference.

Methods: 100 posterior teeth with or without caries were mounted on 10 typodonts. Initially, 180 surfaces were examined, but eight were excluded for different reasons. Therefore, 171 proximal surfaces were analyzed. NIRI imaging was performed using the iTero Element 5D®, and radiographs were analyzed by operators and an AI program, Denti.AI. Results were compared with histology, assessing sensitivity (Se), specificity (Sp), positive (PPV) and negative (NPV) predictive values, F1-score, areas under receiver operating characteristic curves (AUCs), and the Fleiss Kappa coefficient (k).

Results: The statistical analysis results for each diagnostic test were as follows: examiner radiographic assessment (Se = 52%, Sp = 84.6%, PPV = 71.6%, NPV = 70.3%, F1-score = 60%, AUC = 0.684, k = 0.459); NIRI (Se = 37%, Sp = 98.9%, PPV = 96.4%, NPV = 67.8%, F1-score = 52%, AUC = 0.673, k = 0.475); AI-guided radiographic assessment (Se = 13.7%, Sp = 95.9%, PPV = 71%, NPV = 59.8%, F1-score = 23%, AUC = 0.548). McNemar's test showed a p < 0.05 for all diagnostic tests.

Conclusion: Both the operator-conducted NIRI system and examiner radiographic assessment demonstrated superior detection capabilities compared to the AI program. Among these methods, the examiner radiographic assessment yielded the best results, followed by the NIRI system, demonstrating its potential for clinical use.

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: This study aimed to describe the prevalence of untreated dental caries in early childhood based on intergenerational socioeconomic data and to evaluate the association between intragenerational socioeconomic mobility data and untreated dental caries in children aged 4.

Methods: This is a longitudinal study. Data from three birth cohorts in Pelotas (1982, 1993, and 2015) were used. Data from three generations participating in these cohorts were evaluated. Untreated dental caries in childhood (2015 cohort) was considered the dependent variable. Family income and schooling were independent variables. The social mobility variable was categorized considering income and level of schooling data in the mothers' generation. Poisson regression was performed to estimate prevalence ratios (PRs) and 95% confidence intervals (95% CIs).

Results: A total of 286 pairs of children and mothers/grandmothers were evaluated for the intergenerational sample (1982 and 1993 cohorts), and 3,633 mothers and children for the intragenerational sample (2015 cohort). In the intergenerational analysis, there was a reduction of about 10 percentage points in the prevalence of untreated caries in children from families that experienced upward/downward income mobility compared to children whose generations remained with lower income. In the intragenerational analysis, children belonging to the ascending/descending economic mobility groups had twice the prevalence of untreated dental caries compared to those always with higher salaries (PR 2.04; 95% CI 1.52-2.71 and PR 2.07; 95% CI 1.56-2.74, respectively).

Conclusion: Findings demonstrate an association between untreated dental caries in children and family socioeconomic status, including their mothers' income/education mobility. Thus, intervening in early childhood socioeconomic conditions is needed to improve children's oral health.

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.