Caries Research最新文献

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.

Introduction: While fluoride exposure is a well-established factor in the development of dental fluorosis (DF), individual variability in susceptibility suggests that additional factors may also contribute to its manifestation. The etiology of molar incisor hypomineralization (MIH), in turn, is multifactorial and remains not fully understood. The aim of this study was to investigate the association between MIH, DF, caries, and polymorphisms in the AQP5, MMP2, and COMT genes in children exposed to high fluoride levels in drinking water.

Methods: A total of 268 schoolchildren aged 6-12 years from an area endemic for fluorosis were included. The EAPD, Thylstrup and Fejerskov, and WHO criteria were used for the diagnosis of MIH, DF, and caries, respectively. Saliva samples from participants were collected for genomic DNA extraction and subsequent genotyping, using the TaqMan method, focusing on markers in AQP5, MMP2, and COMT genes. For statistical analysis, chi-square and Fisher's exact tests, along with binary logistic regression, were used, considering a 5% significance level. Additionally, genetic assessments were conducted using PLINK software.

Results: DF was negatively associated with MIH in both crude (OR = 0.3; p = 0.003) and adjusted analyses (OR = 0.3; p = 0.002). AQP5 rs3736309 was significantly associated with an increased risk of DF under a dominant model, with the G allele being more prevalent in affected individuals, while its association with MIH followed a recessive pattern, requiring two copies of the G allele for increased risk. MMP2 rs9923304 was associated with DF under a recessive model, while rs2287074 and rs9923304 were related to dental caries in individuals with DF or MIH.

Conclusions: The marker in the AQP5 gene was significantly associated with both DF and MIH, presenting different risk patterns depending on the genetic model analyzed (dominant vs. recessive). DF appears to have a protective effect against MIH, highlighting the complex interplay between genetic and environmental factors in dental conditions.

Introduction: This study aimed to investigate risk indicators associated with root caries in older adults aged 65 years and above in Norway. A secondary aim was to explore whether root caries was associated with oral health-related quality of life (OHRQoL).

Methods: This cross-sectional study included 1,075 participants aged ≥65 from the population-based Tromsø Study (Tromsø7) conducted in Northern Norway in 2015-2016. All inhabitants aged 40 years and older in Tromsø municipality (32,591) were invited, of whom 21,083 participated. The participants underwent clinical and radiographic examinations and answered extensive questionnaires. Root caries was registered on four surfaces per tooth and graded D_3-5. For analysis, prevalence of root caries was dichotomised into (1) no (if the participants had no root caries) and (2) yes (if root caries was registered on at least one surface). Characteristics of the study population were described with percentages and frequencies for the categorical variables and mean and standard deviation (SD) for continuous variables for the whole cohort and stratified on presence of root caries and OHRQoL impact. The statistical significance of differences was assessed with the Pearson χ2 test and independent sample T test. Factors associated with root caries and OHRQoL were explored using logistic regression. The significance level was set to p < 0.05 for all analysis.

Results: Men had higher odds of root caries than women (OR: 1.70, 95% CI [1.08, 2.70]) and those who were smokers had a higher odds of root caries than those who had never smoked (OR: 1.83, 95% CI [1.13, 2.94]). Participants with root caries had 1.67 times higher odds of having reduced OHRQoL than those without root caries (95% CI: 1.02, 2.72).

Conclusion: This study found that being male and smoking were risk indicators of root caries. Additionally, root caries had a negative impact on OHRQoL. The results could be useful for oral health professionals to guide individual and targeted root caries preventive measures in older adults.

Introduction: Silver diammine fluoride (SDF; often incorrectly referred to as silver diamine fluoride in the literature) is an effective, minimally invasive treatment for dental caries; however, its widespread adoption is hindered by significant black discoloration of treated dentin. Zinc, known for its antimicrobial properties and potential interactions with silver compounds, may offer a novel approach to reducing SDF-induced staining while preserving its cariostatic effects. This laboratory study investigated the impact of a zinc pretreatment followed by SDF application on dentin discoloration, surface properties, and antimicrobial activity using an artificial caries model.

Methods: Artificial caries lesion was induced in human dentin blocks using a Streptococcus mutans microbial biofilm model. After caries formation, the specimens were treated with 38% SDF alone or in combination with 15 m or 20 m zinc nitrate solution. Antimicrobial challenges were then further assessed using a duo species (S. mutans and Candida albicans) biofilm model. Color changes over 14 days were assessed using grayscale image analysis. Surface roughness was measured using profilometry. Antimicrobial effects were evaluated through assessing culture media pH, viable S. mutans and C. albicans cell counts, biofilm biomass, and biofilm microstructure via multiphoton confocal imaging. Data were analyzed using simple linear regression, two-sample t tests, and Wilcoxon rank-sum tests to evaluate differences among treatment groups.

Results: Zinc incorporation significantly mitigated SDF-induced dentin discoloration. The application of 20 m Zn with SDF significantly improved dentin whiteness compared to the SDF-only group (p = 0.0228). No significant differences in the surface roughness were observed between the zinc-treated and SDF-only groups. Both SDF alone and SDF + zinc groups demonstrated significant reductions in S. mutans and C. albicans viability compared to the untreated controls (p ≤ 0.005). Zinc pretreatment preserved the antimicrobial effects of SDF and supported biofilm disruption and live-dead cell proportions.

Conclusion: The study findings suggest that zinc-enhanced SDF regimen may offer an improved aesthetic profile while maintaining antimicrobial properties, potentially increasing clinical acceptability. Future studies should explore the long-term stability and clinical performance of zinc-enhanced SDF and assess various zinc delivery regimens.

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.