Caries Research最新文献

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: 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.

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: The aim of the study was to investigate the caries-preventive effect of fluoride-free toothpastes, containing either herbal agents or (nano-)hydroxyapatite.

Methods: Bovine dentin specimens each having a sound (ST) and a demineralized area (DT) were prepared and randomly allocated to eleven groups (n = 187). Treatments during pH cycling (28 days; 6 × 120 min demineralization/day) were brushing 2×/day with 0 ppm F- [NaF₀], 500 ppm F- [NaF₅₀₀], 1,100 ppm F- [NaF₁₁₀₀], grape seed extract [GSE], (nano-)hydroxyapatite, melaleuca oil [MO₁, MO₂, MO-CU], and propolis + myrrh [PM₁, PM₂] containing dentifrices. Dentifrice slurries were prepared with deionized water (1:3 w/w). Differences in integrated mineral loss (∆∆Z) and lesion depth (∆LD) were evaluated before and after pH cycling using transversal microradiography.

Results: The correlation between ΔΔZ/ΔLD and F- concentration (NaF₀, NaF₅₀₀, NaF₁₁₀₀) was strong for the DT (r_{ΔΔZ, DT} = 0.681; p < 0.001) and very strong for ST (r_{ΔΔZ, ST} = 0.861; p < 0.001), indicating a fluoride dose-response for both baseline substrate conditions. For ΔΔZ_DT and ΔLD_DT, only NaF₁₁₀₀ and GSE revealed significant differences compared with NaF₀ (p < 0.001; ANOVA). For ΔΔZ_ST and ΔLD_ST, significant differences could be found for NaF₁₁₀₀ and NaF₅₀₀ compared to all fluoride-free groups (p ≤ 0.002; ANOVA), without significant difference between fluoride-free groups (p = 1.000; ANOVA). For DT and ST, a hypermineralized surface layer and no surface loss could only be observed when fluoride was present.

Conclusion: A dose-response for fluoride concentrations was observed in this mild demineralization pH-cycling model. Fluoride-free dentifrices containing GSE or melaleuca oil showed certain preventive effect against further progression of root caries lesions. However, surface loss was observed for all fluoride-free dentifrices.

Introduction: Root caries (RC) remains a global health problem leading to negative impacts on an elderly person's well-being causing oral health-related quality of life issues, such as inadequate nutrition and detrimental oral functionality. The present systematic review with meta-analysis is designed to synthesize existing research findings on the prevalence and experience of root caries globally over the past 30 years. It aims to describe its distribution by country and explore its links with various socioeconomic indicators.

Methods: Selection criteria: Three electronic databases (PubMed, Embase, and Scopus) were screened for observational epidemiological studies (cross-sectional and cohort studies) reporting the prevalence of RC and/or mean RC experience between 1990 and 2023. No languages were applied. Study selection, data extraction, and quality assessment were done in duplicate. Risk of bias was graded with customized quality assessment tools (Study Quality Assessment Tools NHLBI, NIH).

Data collection and analysis: studies reporting on (1) root-caries experience (mean and SD) and (2) root-caries prevalence (%) were used to synthesize the results. It was assessed as decayed, missing, and filled teeth (RDMFT).

Results: A total of 91 publications were included in the descriptive analysis; the estimated overall pooled mean RC was 2.87 teeth and the global estimated random-effects pooled RC prevalence was 41%. Low gross national income (GNI) countries reported a low mean number of RC (1.35 GNI

Conclusion: This study highlights the high caries burden among adult population globally by estimating overall trends and comparing against factors including area, GNI, and Gini index. The large magnitude of these inequities indicates that oral health equity can only be achieved taking into account socioeconomic factors on a global scale. The lack of uniform data collecting among studies as well as knowledge gap regarding the incidence and experience of RC in different countries.

Introduction: The study sought to assess the cost-effectiveness of silver diamine fluoride (SDF) relative to sodium fluoride (NaF) varnish and direct restorations placed chairside or under general anaesthesia, accounting for caries activity.

Methods: An analytical decision-tree model was developed with clinical data from multiple centres to evaluate the four treatment options among all children aged 1-6 years in Singapore (N = 231,880) over a 12-month time horizon. Base-case scenarios consisted of children with low (1 carious tooth)- and high (7 carious teeth)-caries activity. Incremental cost-effectiveness ratios (ICERs) and net monetary benefits (NMBs) were tabulated with the outcomes set to be the control of active caries and avoidance of tooth extractions. Deterministic and probabilistic sensitivity analyses were conducted.

Results: Overall, SDF was less effective than direct restorations placed chairside but was less costly. For children with low-caries activity, the ICER for SDF was SGD 9 per caries-controlled tooth and SGD 68 per extraction avoided. For children with high-caries activity, the ICERs were SGD 267 and SGD 1,909, respectively. At a willingness-to-pay threshold of SGD 30, the NMB was negative (favours restorations) for caries control in children with low-caries activity and positive (favours SDF) for all other situations. In the low-caries activity group, SDF had a 41.5% probability of being cost-effective for caries control and 49.2% probability of being cost-effective for the avoidance of extraction. The corresponding probabilities for the high-caries activity group were 99.8% and 100%. The NMB of SDF increases proportionally with caries activity, suggesting utilization of SDF should depend on caries activity. Results were most sensitive to changes in relative cost and effectiveness of SDF/direct restorations.

Conclusion: SDF was cost-effective in most situations except for caries control in children with low-caries activity. Direct restorations were more effective and should be considered in low-caries activity children.

Introduction: The study aimed to assess the direct and indirect effect of parental locus of control (LoC) on child oral health-related quality of life.

Methods: As part of the Growing Up in Singapore towards Healthy Outcomes (GUSTO) multicenter longitudinal cohort study, sociodemographic characteristics of parents and their children were obtained at recruitment. Oral health status and dental caries outcomes were assessed at the 5th year post-natal visit and administered alongside the LoC questionnaire. Intraoral examinations were carried out by 3 trained calibrated dental professionals using the modified International Caries Detection and Assessment System (ICDAS-II) criteria. At the 6-year post-natal visit, the Early Childhood Oral Health Impact Scale (ECOHIS) was administered to mothers to assess the oral health-related quality of life (OHRQoL) of their child. Statistical analysis of the direct effects of parental LoC on OHRQoL and the causal mediation effects of dental caries were carried out using the potential outcomes approach with 1,000 simulations.

Results: A total of 312 parent-child dyads were included in this prospective cohort study. At the 5th year post-natal visit, the median decayed, missing, and filled surfaces (dmfs) was 2 (IQR 0-5), while the median LoC was 47 (IQR 43-50). The total effect of parental LoC on ECOHIS was -2.05 (95% CI: -4.03 to -0.08), of which the direct effect through dmfs was -1.45 (95% CI: -3.41 to 0.47). The percentage of the total effect of parental LoC on ECOHIS that was mediated by the presence of dental caries was 29.5% for dmfs, including incipient caries (ICDAS 1-6). The proportion mediated was lower if only active decayed surfaces were considered (23.7%) and higher if only cavitated lesions (ICDAS 3-6) (30.1%) were considered.

Conclusion: The effect of parental LoC on child OHRQoL was mediated in part through the development of dental caries.

Introduction: The aim of this cross-sectional study was to explore the degree whereby dentists differentiate between repair versus replacement for failed restorations. A random selection of adult patients from North Norway was chosen from the larger Tromsø 7 study.

Methods: A randomized sample of 3,653 persons (11.5% of the total number of individuals invited to the Tromsø 7 study, 51.5% women, aged 40-93 years) were included. Based on FDI's clinical criteria for the evaluation of restorations - 2010, 17 calibrated dentists evaluated patients by clinical and radiographical pictures in a specially designed software developed for this purpose. The dental practitioners' opinions gave rise to the reported treatment decisions. Descriptive statistics and multivariable multilevel mixed-effect logistic regression models (STATA 17/SE) were performed.

Results: The participants' DMFT values ranged from 0 (0.9%) to 24 (8.8%) (median DMFT 21.3, mean 20.0). A total of 90.062 teeth (24.7 teeth per patient) were assessed. Re-treatment suggestions were made for 3,006 restorations, i.e., an average of 3.3% re-treatments. Of these, 25.3% (n = 814) were suggested for repair and 74.7% (n = 2,192) for replacement. Dental treatment was suggested for 1,597 patients and varying from 1 to 14 suggestions per patient. Secondary caries (37.6%) and restoration fracture (15.2%) were found to be most frequently used indications for re-treatment, surface properties the least. No significant difference was found between assessing dentists based on sex or age. Clustering by dentist level was checked using intra-class correlation coefficients, demonstrating that 16% of the variance in suggestions for restoration re-treatment was explained at the dentist level. Thus, a wide range of treatment suggestions was noted among the dentists.

Conclusion: Need for restoration revision seems low in North Norway. There is a tendency towards larger and more indirect restorations, and the diagnosis of secondary caries is still a matter of uncertainty.