Caries Research最新文献

Introduction: Dental caries with pulp involvement potentially impacts the oral health-related quality of life (OHRQoL). This meta-analysis aimed to evaluate whether clinical consequences of pulp involvement due to dental caries impacts OHRQoL of children and adolescents.

Methods: Observational studies evaluating whether children/adolescents (population) with pulp involvement due to caries (exposition) compared with those without it (comparison) have more negative impact on their OHRQoL (outcome) were included. A systematic search was undertaken in August 2022 in seven databases. Alerts were set until August 2023. JBI Critical Appraisal tool for cross-sectional studies was used for methodological quality assessment. Random-effects meta-analyses were performed to calculate mean differences (MD) or standardized mean differences (SMD) of impact on OHRQoL. For studies with dichotomous outcome, meta-analysis calculated the odds ratio (OR). Robustness, heterogeneity, certainty of evidence, and publication bias were evaluated.

Results: From 29 included studies, 14 assessed preschoolers, nine assessed schoolchildren, four assessed adolescents, and two assessed children/adolescents. PUFA was the main index used to assess the exposure. ECOHIS (preschoolers) and CPQ (children/adolescents) were the main tools used to assess the outcome. Only five articles fully adhered to the quality criteria. The meta-analyses found the following main results: (a) preschoolers: MD -10.79 (-16.50; -5.09); (b) schoolchildren: MD -5.12 (-7.51; -2.72); (c) adolescents: MD -1.86 (-4.59; 0.87); (d) overall impact: SMD -2.18; (CI: -3.21;-1.15) and OR 0.52 (CI: 0.30; 0.90).

Conclusion: Pulp involvement impacted OHRQoL of children negatively. In adolescents, this impact was not observed. Results must be interpreted with caution due to very low certainty of evidence.

Introduction: This in vitro study evaluated the validity and reliability of spectral-domain optical coherence tomography (SD-OCT) to detect approximal carious lesions compared to bitewing radiography.

Methods: Forty extracted human premolars and molars with fifty-four unrestored approximal surfaces (ICDAS ll score 0-3) were mounted in a patient-equivalent simulator and imaged by digital radiography (DR) and the prototype of an intraoral OCT probe. The lesion status of the tooth surfaces was validated histologically and by microtomography (µCT). Five calibrated raters with low to high level of clinical expertise analyzed the DR and OCT images at intervals of 2-4 weeks each. Intra- and interrater agreement (weighted Cohen's kappa κ, Fleiss' kappa), sensitivity, and specificity were calculated.

Results: The sensitivity of OCT (0.66-0.91) was higher than that of DR (0.46-0.82), as was the specificity (OCT: 0.67-0.92; DR: 0.33-0.58). Intrarater agreement with OCT was moderate to substantial (κ: 0.53-0.77; p < 0.001) and fair to substantial for DR (κ: 0.36-0.78; p < 0.05). The DR interpersonal agreement ranged from slight to substantial (κ: 0.1-0.74, Fleiss' κ: 0.23/0.24; p < 0.001) toward fair to substantial with OCT (κ: 0.27-0.62; Fleiss' κ: 0.23/0.18; p < 0.001). Agreement between histology and µCT was almost perfect (κ: 0.82; p < 0.001).

Conclusions: In a clinically oriented simulation, OCT was more sensitive in detecting early approximal carious lesions than DR without impairing specificity or reproducibility. Clinical studies will have to show whether OCT can confirm these promising results.

Introduction: This study aimed to examine the effects of age, period (historical events), and cohort (generational impact) (APC) on caries prevalence and mean DMFT among Singapore schoolchildren from 2007 to 2019.

Methods: Anonymised records of all 6-year-old primary 1 (P1), 11-year-old primary 6 (P6), and 14-year-old secondary 3 (S3) students before the start of each school year between 2007 and 2019 were extracted from the Integrated Dental Electronic Assessment System (IDEAS), categorised by school level, ethnicity, and sex. Poisson regression and partial least squares regressions were applied to estimate APC effects.

Results: In total, 502,339 P1, 535,579 P6, and 496,725 S3 records were included from 2007 to 2019, with 1,058,589 (69.0%) Chinese, 187,948 (12.2%) Malay, and 152,618 (9.9%) Indian students; 245,447 (48.8%) P1, 259,389 (48.4%) P6, and 243,941 (49.1%) S3 students were girls. Overall, the APC effects on caries prevalence and mean DMFT showed a strong age effect, with the lowest prevalence in the youngest P1 group and the highest in the oldest S3 group. Period and cohort effects were identified, with the prevalence decreasing among those born after 1995 and the lowest prevalence rate in 2013. Similarly, period and cohort effects on mean DMFT were also detected, with decreased mean DMFT after period 2009 and the highest mean DMFT (0.72 in P6 and 1.13 in S3) in cohort 1995.

Conclusion: Caries prevalence and DMFT increased with age. While both decreased in individuals born after 1995, mean DMFT began to rise again in those born after 2003.

Introduction: Erosive tooth wear (ETW) is a multifactorial condition of increasing prevalence in the younger population. This study aimed to explore the association between different ETW phenotypes with MMP2 and COMT single-nucleotide variants and selected environmental factors.

Methods: Saliva samples, erosive wear, and dental caries experience data and dietary/behavioral information from 16- to 18-year-old patients (n = 747) were used. Genotypes were obtained, and phenotypes were further analyzed considering diet and behavioral data, using logistic regression as implemented in PLINK, with an alpha of 0.05.

Results: When comparing individuals' ETW-free with those with mild ETW, an association was found with COMT rs6269 (p = 0.02). The comparison between ETW-free individuals with individuals with severe ETW also showed an association with COMT rs6269 under the recessive model (p = 0.03). Logistic regression showed that in the presence of less common alleles of MMP2 rs9923304 and COMT rs6269, ETW was more likely to occur when individuals drank wine. The GG genotype of COMT rs6269 was associated with the presence of lower (p = 0.02) and higher (p = 0.02) caries experience when individuals with ETW only in enamel were compared with individuals with ETW involving dentin.

Conclusion: The results support a role of genes in ETW, with wine consumption being identified as a significant modulator, suggesting that gene-environment interactions may contribute to the development of ETW.

Introduction: The association between lower socioeconomic status and a higher risk of dental caries is well established, but the independent association between general health status and dental caries on a population level is less investigated. The aim of this study was to assess the association between self-rated general health and caries experience in an adult Norwegian population and to assess if the associations were modified by age and sex.

Methods: Data were collected as part of the Trøndelag Health Study (HUNT4) conducted 2017-2019 and a randomly selected subsample (20%) were invited for the HUNT4 Oral Health Study. This cross-sectional study included 4,880 dentate participants aged 19-94 years (response rate 67%). Participants underwent clinical and radiographic oral examinations and caries experience was measured by numbers of decayed (DT), missing (MT), and filled teeth (FT), DMFT index. The DT component consisted of primary and secondary caries in dentine, cavitated root caries, and remaining roots. Questionnaires were used to assess self-rated general health and socioeconomic position, denoted by education, household income, and employment status. Associations between self-rated health and caries experience (DMFT) and components (DT, MT, and FT) were assessed using negative binomial regression models. Ratios of means (RMs) with 95% confidence intervals (CI) for the associations were estimated, adjusting for socioeconomic position.

Results: Individuals with poor self-rated general health had a 29% higher mean number of MT (RM: 1.29 [95% CI: 1.13-1.46]), a 22% higher mean number of DT (RM: 1.22 [95% CI: 1.07-1.39]), and a 7% higher mean number of DMFT (RM: 1.07 [95% CI: 1.04-1.11]) than individuals reporting very good health. Age-stratified analyses presented a more pronounced association between self-rated health and caries experience for individuals below the age of 55 years than for those 55 years or older. Similarly, the association was more evident in women, with significantly higher mean values for DMFT, MT, and FT among women reporting poor health.

Conclusions: The present study demonstrated an independent association between poor self-rated health and a higher burden of caries experience, adjusted for education, income, and employment status. The association was stronger in women and individuals below the age of 55 years. These findings add new evidence in understanding caries inequalities through self-rated health.

Introduction: Selective outcome reporting (SOR) is a bias that can occur in randomized controlled trials (RCTs), defined as the alteration or omission of primary outcome in the publication compared to the original protocol. Researchers may modify outcomes to highlight statistically significant results. This study aimed to assess the prevalence of SOR in RCTs related to dental caries in children and adolescents.

Methods: We conducted a search on ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP), using a comprehensive search strategy with terms related to pediatric dentistry and dental caries, up to February 2023. Two independent reviewers included trials with two or more arms focusing on dental caries in pediatric dentistry. Registrations that did not result in at least one published article were excluded. Data on the characteristics and outcomes from the protocols and corresponding publications were extracted. The primary outcome was the prevalence of SOR in the included RCTs. A chi-square test, with a significance level of 5%, was used to assess the association between SOR and pre-specified variables, which was the secondary outcome.

Results: A total of 175 protocols and their corresponding publications were included. SOR was identified in 58.9% (n = 103) of the studies, with 41.1% (n = 72) showing discrepancies in the primary outcome's time frame. Retrospective registrations accounted for 73.7% of the studies. SOR was significantly associated with discrepancies in the follow-up period (p < 0.001) and with study design type (parallel assignment, split-mouth, cluster RCT, and no information) (p = 0.048).

Conclusions: The high prevalence of SOR in dental caries RCTs in pediatric dentistry highlights the need for attention to this issue. Ensuring transparency in the research process requires implementing an appropriate pre-registered protocol, disclosing deviations from it, and enabling stakeholders to compare the protocol with the published outcomes which can help reduce research waste.

Introduction: The efficacy of fissure sealants (FS) in controlling occlusal caries is well documented. However, several factors can potentially modify the caries-preventive effect of FS and their failure rate in real life might be higher than in controlled experimental settings. The aim of this study was to prospectively examine failures and risk factors in sealed first permanent molars (FPMs) with sound occlusal surfaces or initial caries lesions of children in a practice-based setting in public dental service (PDS) in Norway.

Methods: Children aged 6-10 years considered at high caries risk (D₃MFT/d₃mft >0) were recruited by dentists and dental hygienists during routine examination at local dental clinics in PDS. After the application, resin-based FS were maintained according to clinicians' conventional procedures. Occlusal surface/FS status and the following treatment were registered at 6, 12, 24, and 36 months. The outcome was categorized into success, minor failure, and failure of sealed FPM based on a combination of diagnosis of occlusal surface/FS status and the following treatment at each follow-up. Univariable and multivariable Cox survival analyses were used to investigate potential risk factors for failure.

Results: Out of 409 participants, 4% (16) were lost to follow-up. Of 393 FPMs, 72% (284) were evaluated as success, 9% (34) as minor failure, and 19% (75) failed during the 36 months of this study period: 13% (51) received FS reapplication and 6% developed dentine caries or were restored. One third of FS were additionally treated with fluoride varnish (FV) at least once during the follow-up. Occlusal surface with caries grade 1-2 (vs. intact) increased (adjusted HR [adHR]: 1.9, 95% CI: 1.1-3.1), while FV application over FS decreased hazards (adHR 0.4, 95% CI: 0.3-0.7) for failure. The clinic's county was associated with failure.

Conclusion: After 3-year follow-up, nearly one out of five sealed FPMs failed, i.e., they had to be resealed, developed dentine caries, or were restored. Initial caries lesion on occlusal surface increased, while FV application over FS reduced risk for failure. Moreover, regional differences in sealed FPM failures were observed.

Introduction: Sealing of occlusal dentin caries has shown promise in studies, but long-term outcomes remain inconclusive. This RCT aimed to investigate the potential of postponing restorative interventions of manifest occlusal caries by sealing.

Methods: After randomization (ratio 2:1), 341 resin sealings and 152 composite restorations in 493 patients (6-17 years) were performed by 66 dentists in nine Danish municipalities. All lesions were predesignated to require restorative treatment by the treating dentists. The treatments were controlled annually both clinically and radiographically. The primary objectives, assessed at different observation intervals, were to analyze the survival of sealing until replacement by restoration, the survival of sealing and restoration until retreatment, caries progression beneath sealing and restoration, and the longevity of repaired versus unrepaired sealing until replacement by restoration. The secondary objectives identified factors influencing survival of sealings and restorations. χ2/Kaplan-Meier/Cox-regression tests were used for statistical analyses.

Results: After 11 years, dropout rate was 10%, and 22% of sealings were repaired/renewed. 58% of sealings and 81% of restorations remained sealed/restored until completion due to age 18 or primary caries. Additionally, 33% of sealings were replaced by restorations, and 12% of restorations were repaired/replaced (p values <0.001). No endodontics were performed. The mean annual failure rates were 4-7% for sealings and 1% for restorations. The survival of sealings was affected by various predictor variables across the outcomes and observation intervals. The survival rate of repaired/renewed sealings was comparable to that of new sealings (p = 0.96).

Conclusions: This long-term study provided a comprehensive overview regarding reasons and time for retreatments of occlusal sealings and restorations. The results indicate that sealing is an effective treatment for occlusal enamel and dentin caries.

Introduction: Among the wide variety of commercially oral hygiene products, activated charcoal-based toothpastes have irrupted the market, claiming multiple benefits. Although most are fluoride free, others incorporate fluoride into their formulations, yet the chemical availability and stability of fluoride in these products remain unclear. Our study aimed to assess the chemical availability and stability of fluoride in commercially fluoridated toothpastes formulated with activated charcoal.

Methods: We purchased duplicate samples with different lot numbers of different brands containing fluoride (F) and activated charcoal (n = 20) in the USA and Chile. Three toothpastes, one non-fluoridated, one containing sodium fluoride (NaF), and another with sodium monofluorophosphate (Na2FPO3), were used as controls. All toothpastes were evaluated at the time of purchase (fresh) and after their expiration date (aged). We determined total F and available total soluble F (TSF), using a F-specific ion electrode. Values were expressed in mg F/kg (ppm F, w/w).

Results: Most evaluated toothpaste contained NaF (70%) or Na2FPO3 (30%) as the F salt, and all declared to contain silica. The TSF concentration ranged from 952.6 to 1,438.1 and from 925.7 to 1,493.7 ppm F for fresh and aged toothpaste, respectively. TSF remained close to total F and in agreement with the F concentration reported by the manufacturer. After expiring, the commercial toothpastes did not form insoluble F, except the Na2FPO3-/CaCO3-based control.

Conclusion: The silica-based toothpastes formulated with activated charcoal present fluoride potentially bioavailable and chemically stable to control caries. However, concerns regarding abrasiveness, as raised by other researchers, cast doubt on the suitability of these toothpastes for widespread use.

Introduction: This study assessed the influence of social support, oral health beliefs, and health behaviours on dental caries incidence among children living in underprivileged neighbourhoods.

Methods: Data from a cohort study with 12-year-old schoolchildren (N = 312) selected from public schools in Manaus, Brazil, and their parents or guardians were analysed. Socio-economic characteristics, sex, oral health beliefs, social support (SSA questionnaire), oral health-related behaviours (sugar consumption, frequency of toothbrushing, use of fluoride toothpaste), and dental caries (DMFT index) were assessed at age 12 years. Dental caries incidence over 12-month period was registered according to the number of new cavitated teeth. The hypothesis was that socio-economic disadvantage, lower social support, unfavourable oral health beliefs, and inadequate behaviours would increase the risk of dental caries incidence. Statistical analysis was conducted using confirmatory factor analysis and structural equation modelling.

Results: Unfavourable oral health beliefs indirectly predicted higher dental caries incidence (β = 0.041) via sugar consumption and frequency of toothbrushing. Unfavourable oral health beliefs directly predicted higher sugar consumption (β = 0.148) and lower frequency of toothbrushing (β = -0.218). Lower frequency of toothbrushing directly predicted higher dental caries incidence (β = -0.140). Sex (β = -0.017) and social support (β = -0.016) were indirectly linked to dental caries incidence.

Conclusions: Our findings suggest that incidence of dental caries in socially underprivileged children results from the complex relationships between social support, oral health beliefs, and oral health behaviours.