Caries Research最新文献

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: Despite evidence supporting the clinical and cost-effectiveness of minimally invasive dentistry (MID), its adoption by the dental profession has been slow. A systematic review in 2016 found the majority of dentists intervene invasively earlier than necessary. The aim was to update this review of the assessment of dental practitioners' thresholds for providing restorative treatment for carious lesions given changes in evidence, teaching, and guidelines since 2016. The primary outcome was dental practitioners' restorative thresholds (the extent of the lesion when they would decide to intervene restoratively). Secondary outcomes were changes over time, caries risk, regional differences, and primary/permanent dentition.

Methods: This updated review replicated the methodology for the initial review, following the PRISMA 2020 guidelines (PROSPERO; CRD42023431906). Embase, MEDLINE (via PubMed), and Web of Science databases were searched (2016-2023) for observational studies reporting on dental clinicians' thresholds for restorative interventions in adults and children without language, time, or quality restrictions. Screening, data extraction, and risk of bias assessment (Modified Newcastle-Ottawa Scale) were carried out independently and in duplicate. Meta-analyses were performed using a random-effects model. No funding sought.

Results: Overall, 47 publications (30 from original publication and 17 from updated search) met the inclusion criteria and 65 datasets were included in the meta-analyses: 19 for occlusal lesions (16 pre-2016 and 3 post-2016; n = 11,946) and 46 for proximal lesions (38 pre-2016 and 8 post 2016; n = 20,428). The meta-analyses found that for occlusal lesions confined to enamel, there were fewer practitioners intervening invasively: 5% (95% confidence interval [CI]; 1-20%) post-2016, compared with 15% (95% CI; 9-23%) pre-2016. The opposite was found for proximal lesions with increased intervention levels, 27% (95% CI; 18-40%) for lesions confined to enamel post-2016, compared with 19% (95% CI; 12-29%) pre-2016, and for lesions extending up to the enamel-dentine junction 61% (95% CI; 36-81%) post-2016, compared with 39% (95% CI; 29-51%) pre-2016. There was variance between regions but too few studies to draw conclusions on individual regions.

Conclusion: There was a suggestion of less invasive treatment of occlusal lesions over time; however, this was not evident for proximal lesions.

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: 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.

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: There is little discussion in the literature on the pathway linking oral health problems and academic performance (AP) in children. This study investigated the hypothesis that the influence of dental caries on academic performance is mediated through toothache and impacted sleep and study activities.

Methods: This cross-sectional study on children aged 12-14 years collected data on the exposure (decayed tooth index), outcome (school examination results), and mediator (school absence due to toothache, and oral health impact on sleep and study performances using the Child-Oral Impact on Daily Performance instrument) variables. It used mediation analysis to examine the indirect effects of a single and two serial mediators using model 4 (caries → mediator → AP) and model 6 (caries → mediator 1 → mediator 2 → AP), respectively, in PROCESS macro add-on software in IBM SPSS v24. Analyses were carried out separately for boys and girls at a 5% significance level.

Results: In model 4, school absence due to toothache (boys: 95% CI: 0.42, 1.01; girls: 95% CI: 0.58, 0.98), and impacted sleep (95% CI: 0.13, 0.41; 95% CI: 2.17, 13.03), and study (95% CI: 0.05, 0.42; 95% CI: 0.54, 0.94) performance were significant single mediators in both sexes. In model 6, school absence due to toothache and impacted sleep activity (boys: 95% CI: 0.02, 0.29 and girls: 95% CI: 1.37, 12.81), and school absence due to toothache and impacted study activity (girls: 95% CI: 1.37, 12.81) were significant two serial-mediators.

Conclusion: This study provides empirical evidence showing that dental caries and toothache can impact academic performance as they disrupt sleep and study performances to influence the learning and cognition process. The finding bridges the understanding of the mechanism underpinning the relationship and thus, further emphasizes the importance of caries prevention in children with high caries risk for improving their health outcomes and educational experience.

Introduction: This study examined the association between cardiovascular disease (CVD) history and their dental caries experience status.

Methods: Conducted from January 2021 to June 2023, this cross-sectional cohort study involved 7,138 participants who underwent oral examinations. Data on demographic background, oral health-related behaviors, and smoking status were collected using a structured questionnaire. Dental caries was diagnosed at the cavitation level according to the World Health Organization criteria and calculated into caries experience indices including decayed, missing, and filled teeth (DMFT), decayed teeth, missing teeth and filled teeth. Information on CVD history was obtained from the Taiwan National Health Insurance Research Database, including acute myocardial infarction, ischemic stroke, and coronary artery disease. Multivariate linear regression models were used to assess the association between CVD history and its dental caries experience status.

Results: Of the participants, 158 (2.2%) had a prior diagnosis of CVD. Participants with CVD history had a significantly higher mean DMFT index (21.21 ± 8.37) than did those without CVD history (13.4 ± 7.82; p < 0.0001). After adjusting for confounding factors, participants with CVD history had a mean DMFT index that was 2.11 higher (95% CI = 0.99, 3.24, p < 0.01) and 2.21 more missing teeth (95% CI = 1.42, 3.00, p < 0.0001) than did those without CVD history. Subgroup analyses indicated that participants aged ≥65 years were predominantly affected.

Conclusion: Older participants with CVD history were associated with an increased number of missing teeth. The present study design could not conclude a positive association between CVD history and its DMFT status, partly due to the lack of data on the reason for missing teeth.

Introduction: Dental sealants applied to occlusal pit-and-fissure surfaces have been shown to prevent caries and arrest occlusal noncavitated carious lesions (NCCLs). The American Dental Association (ADA) recommends that oral healthcare providers apply sealants on occlusal NCCLs. Though the evidence is clear that sealants are effective, few studies have examined the adoption of the ADA guideline by dentists and the duration of protection provided by sealants in a large real-world setting.

Methods: This study used observational electronic health record (EHR) data from a network of dental clinics to follow teeth over a 2 year time period from when they were diagnosed as having an occlusal NCCL until either they were treated with a restoration or the time period ended with no restoration. The objectives of the study were to determine: (1) the degree to which dentists adopted the guideline, (2) whether the duration of protection was different for teeth that received a sealant from teeth that did not receive a sealant, and (3) whether dentists' experience placing sealants was associated with the duration of protection.

Results: Overall, there were 7,299 teeth in the sample. Of those, dentists restored 591 teeth and applied sealants on 164. The sealant application rate for eligible teeth was 2.2%. Sealant application was associated with provider, with 1.9% of providers placing more than half of the sealants. By the end of the observation period, the proportion of teeth progressing to restorations was 8.2% for teeth that had not received a sealant and 3.0% for teeth that had received one (RR = 0.37; 95% CI: 0.16-0.88; p = 0.02). Multilevel survival analysis showed that teeth that had not received a sealant were restored sooner than teeth that had received a sealant (aHR = 0.11; 95% CI: 0.03-0.36; p < 0.01). Overall, teeth that received a sealant had an 89% reduced hazard of restoration within 2 years compared with teeth that did not receive sealants.

Conclusion: This study found that by arresting decay, the presence of sealants led to fewer restorations and delayed restorations compared with teeth not receiving a sealant or restoration in the 2 years following diagnosis of occlusal NCCL in clinical settings.

Introduction: Streptococcus mutans adherence to the tooth surface and subsequent biofilm development is modulated by the carbohydrate source, but the corresponding effect on bacterial proteome has not been previously studied. This study aimed to assess the effect of different carbohydrates on S. mutans viability and bacterial proteome at 2 time points, early attachment (8 h) and biofilm maturation (24 h).

Methods: Hydroxyapatite (HAp) discs coated with parotid saliva proteins were inoculated with S. mutans UA159 in tryptone soy broth without dextrose supplemented with one of the following carbohydrates (n = 12/treatment/time point): 1% sucrose; 0.525% glucose + 0.525% fructose; 10% xylitol; 10% xylitol + 1% sucrose; or culture medium without supplementation as negative control. Once inoculated, HAp discs were incubated for 8 h or 24 h at 37°C and 10% CO2. After each incubation period, adhered bacteria were quantified using the plate-counting method for 6 HAp discs/group, and the remaining 6 HAp discs/group were used to extract bacterial cell wall proteins. Extracted proteins were analyzed using liquid chromatography coupled with mass spectrometry and then classified by their biological process. The study was conducted in three independent assays, and the number of bacteria adhered to the HAp discs was determined at each time point and analyzed by two-way ANOVA followed by Bonferroni test (α = 5%).

Results: The results suggest that xylitol significantly repressed bacterial adherence and metabolism at 8 h and 24 h; however, bacterial adherence and metabolism were significantly enhanced when xylitol was combined with sucrose, showing no negative effect on S. mutans at both time points. Bacterial proteome was modulated by the carbohydrate source.

Conclusion: The cariogenicity of S. mutans biofilms may be reduced by the alternative sweetener xylitol; however, the combination with fermentable sugars may inhibit such a beneficial effect.