Caries Research最新文献

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.

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: 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: 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: 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.