Caries Research最新文献

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: 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: 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: 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.

Introduction: The present study evaluated the association between drug use and erosive tooth wear (ETW) in prisoners.

Methods: This is a cross-sectional, descriptive, and analytical research carried out in Southern Brazil. Data collection took place through the application of questionnaires and clinical examination. ETW was assessed using the BEWE index and the use of illicit substances using the Screening Test for Involvement with Alcohol, Smoking and Other Substances (WHO). Data were tabulated and statistics were performed using the STATA 14.0 software.

Results: A total of 653 volunteers participated in the research, and prisoners were mostly male (94.0%), self-declared as black (53.5%), with average age of 34 years (SD = 10.17). It was possible to identify that 81.3% of prisoners have used some type of drug during their lives, the most prevalent being alcohol (74.2%) followed by cocaine (46.0%). Through clinical examination, it was detected that 49.6% of prisoners evaluated showed some degree of erosive wear (BEWE >0). In the univariate analysis, prisoners with higher schooling (≥8 years) and age between 18 and 29 years had statistical association with ETW index ≥3, respectively (p = 0.010) and (p = 0.015). In the multivariate analysis, there was no association between dental wear and drug use.

Conclusion: It was possible to observe high consumption of drugs by prisoners and the prevalence of ETW; however, the hypothesis that drug consumption would be associated with the presence of ETW in the prison population was rejected.

Introduction: Research on the impact of physical activity (PA) and physical fitness on oral health has been limited in scope. The aim of this report was to assess the impact of PA and physical fitness as modifiable factors in dental caries and erosive tooth wear (ETW) among middle-aged individuals in Finland.

Methods: Data were gathered from the North Finland Birth Cohort 1966 (NFBC1966) 46-year follow-up, which included dental clinical examinations conducted by seven calibrated dentists, physical fitness tests, measurements of PA, and measurements of height and weight administered between 2012 and 2014. PA was measured over a 2-week period with a wrist-worn accelerometer and reported as average daily duration of PA (min/day). Physical fitness was assessed by measuring cardiorespiratory fitness via heart rate recovery in a step test using a heart rate monitor and chest belt, and by evaluating back strength with the Biering-Sorensen test. Of the whole cohort, 1,964 cohort members participated in the oral clinical examination, and the regression models were conducted with 1,590 participants. The prevalence of dental caries (ICDAS), DMFT score, and ETW (BEWE), and the results of the PA test and physical fitness tests were categorized and analyzed using cross-tabulations and multivariable logistic regression models. SPSS version 29.0.0.0 was used to calculate 95% confidence intervals (CI), odds ratios (ORs), χ2, and p values.

Results: Poor (OR 1.60, 95% CI: 1.15-2.23) and moderate (OR 1.48, 95% CI: 1.14-1.93) cardiorespiratory fitness and low PA (OR 1.48, 95% CI: 1.07-2.05) were associated with dentine caries in the regression model. The same model indicated that tooth brushing frequency (OR 1.97, 95% CI: 1.21-3.20), ETW (OR 1.30, 95% CI: 1.12-1.49), and male gender (OR 1.22, 95% CI: 1.05-1.43) were associated with increased dentine caries. No statistically significant association was found between PA or physical fitness and ETW.

Conclusion: In the middle-aged Finnish population, high PA and good physical fitness are associated with a lower prevalence of dentine caries. No association between PA or physical fitness and ETW was found. Further research is needed to explore the potential oral health benefits of PA and physical fitness as modifiable factors.

Introduction: In vitro studies show that fluoride varnishes (FVs) differ significantly in their ability to remineralize and fluoridate enamel caries lesions, as, respectively, measured by percent surface microhardness recovery (%SMHr) and enamel fluoride uptake (EFU). However, there is a need to confirm these findings in clinically relevant conditions.

Methods: This in situ study adopted a five-leg crossover design. In each leg, 28 subjects wore their mandibular partial denture with two previously demineralized enamel slabs treated with one of the following FV (selected based on our previous in vitro data): Vanish™ (high-%SMHr, low-EFU), Flor-Opal® (low-%SMHr, high-EFU), Enamel-Pro® (high-%SMHr, high-EFU), PreviDent® (generic, commercial reference), or negative control (no varnish). After 3 days, specimens were wrapped in gauze to allow plaque accumulation on the enamel. Toothbrushing of natural teeth was performed twice/day with F-free toothpaste. After 14 days, enamel specimens were collected and analyzed (%SMHr and EFU). Data were analyzed by ANOVA models suitable for crossover (alpha = 0.05).

Results: Vanish™ had a significantly higher %SMHr; other varnishes did not differ from each other and had higher %SMHr than the control. EFU was significantly lower for the control than for all other treatments; Flor-Opal® had significantly lower EFU than Vanish™ and PreviDent®. Neither %SMHr nor EFU in vitro data could predict in situ results, although better approximation was observed for %SMHr.

Conclusion: All tested FV could remineralize enamel; however, they presented different efficacies. Comparative clinical trials are warranted to confirm these results. Adequate in vitro tests are necessary to predict the clinical efficacy of FVs.

Introduction: Despite efforts to reduce sugar consumption, Italy continues to experience high levels of caries, particularly among 12-year-old children. The introduction of a sugar tax is one strategy that gained traction as a mean of curbing excessive sugar intake. This study aimed to assess the potential impact of a sugar tax on reducing caries prevalence through the analysis of two scenarios: a hypothetical implementation of the tax in 2008 (Scen₁), compared against actual 2017 data, and a projection of the effects of the planned 2025 tax extending to 2034 (Scen₂).

Methods: The evaluation utilizes a Markov model to evaluate the health and economic outcomes of a 20% ad valorem tax on sugar-sweetened beverages. Outcomes included the caries experience, as DMFT index and QALYs (Quality-Adjusted Life Year/s), direct dental costs, and indirect costs as forgone earnings due to care, assuming a 100% pass-through to consumers. A 3% annual discount rate was applied to all costs. Sub-analysis also included geographical macro-areas of Italy (North-West, North-East, Centre, South, Islands), based on main socioeconomic determinants. A probabilistic sensitivity analysis, involving a Monte Carlo simulation with 1,000 iterations, was conducted to assess the robustness of the model, generating estimates of mean values and 95% uncertainty intervals.

Results: In Scen₁, the simulation suggested that a 20% ad valorem tax would have resulted in a 0.05 reduction of the DMFT, yielded a cost saving of EUR 18.5 million, and EUR 24,520 per QALY gained. The projected 2025-2034 implementation estimated to decrease the DMFT by 0.07, save EUR 38.6 million, and EUR 31,933 per QALY gained. Significant benefits were observed in southern Italy, an area with higher caries rates and lower dental care utilization, where the impact was pronounced in both scenarios.

Conclusion: Integrating a sugar tax into a broader public health strategy can significantly reduce caries and healthcare costs, especially in disadvantaged settings. These findings highlight the need for policymakers to pair sugar taxes with additional preventive measures for optimal public health outcomes.