Caries Research最新文献

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.

Introduction: The association between breastfeeding status and early childhood caries (ECC) remains inconclusive. Few studies evaluate the breastfeeding status including both duration and exclusivity according to the WHO recommendations on breastfeeding. This study aimed to investigate the association between breastfeeding status and ECC.

Methods: This prospective cohort study comprised 3,666 children whose breastfeeding status was precisely evaluated. Poisson regression models and multivariable linear regression models were employed to analyze the associations of breastfeeding status with risk of ECC, and mean decayed, missing, and filled primary tooth surfaces (dmfs) in 3-year-old children, respectively. The data were collected from 2014 to 2020, and the analysis was conducted in 2023.

Results: The prevalences of ECC in offspring breastfed for <6 months, 6-11 months, 12-24 months, and >24 months were 9%, 12%, 17%, and 23%, respectively. Offspring breastfed for 12-24 months and over 24 months had a 1.82 times (95% CI, 1.40-2.37; p < 0.001) and 2.48 times (95% CI, 1.63-3.75; p < 0.001) higher risk of ECC, compared to those breastfed for less than 6 months. Offspring breastfed for 12-24 months showed a mean dmfs increase of 0.32 (95% CI, 0.21-0.44; p < 0.001), while those breastfed for over 24 months had a mean dmfs increase of 0.51 (95% CI, 0.27-0.74; p < 0.001), compared to those breastfed for less than 6 months. Among offspring breastfed for over 24 months, those exclusively breastfed for at least 6 months had significantly lower mean dmfs compared to those exclusively breastfed for less than 6 months (p for heterogeneity = 0.003). A significant interaction was observed between breastfeeding duration and exclusive breastfeeding duration on the association with mean dmfs (p for interaction <0.001).

Conclusion: Our findings suggest that breastfeeding for over 12 months was associated with increased risk of ECC. Preventive interventions for dental caries should be implemented as early as possible, as breastfeeding is beneficial to children's health. The associations between breastfeeding duration and exclusivity with ECC should be investigated more thoroughly, particularly with adjustments for accurately measured sugar consumption.

Introduction: This study aimed to investigate the effectiveness of a nutritional counseling program for mothers of newborns to prevent sugar consumption in the first year of life on the occurrence of early childhood caries (ECC).

Methods: A multicentric randomized clinical trial (ClinicalTrials.gov - NCT03841123) was conducted in three state capitals of Brazil (n = 516). Mothers were randomly assigned to the intervention group (IG) or control group (CG) after delivery. The IG received face-to-face nutritional counseling based on UNICEF dietary guidelines after delivery, followed by monthly phone calls. The CG received standard counseling. Dietary intake was measured through structured questionnaires and 24-h recalls at 6 and 12 months. Dental clinical examination for ECC diagnosis was performed by calibrated dentists after the children completed the first year of life.

Results: The prevalence of ECC was 17.4% in the overall sample (49/290). The number of affected teeth ranged from 0 to 6 (mean 0.43). The IG had a 2.4 times probability of not consuming sugar in the first 6 months of life (RR 2.44; 95% CI: 1.18-5.00) and a significantly lower mean number of sweet items consumed at 12 months (p = 0.016). However, no significant differences between groups were found with regard to the occurrence of ECC (RR 1.33; 95% CI: 0.79-2.25) or the number of teeth affected by caries (p = 0.273).

Conclusion: The intervention to prevent and reduce sugar intake in the first year of life was not effective at reducing the occurrence of ECC or the number of teeth with carious lesions.

Introduction: Caries is the most widespread noncommunicable disease (NCD) globally and can predict fatality NCDs in the future, such as diabetes and cardiovascular diseases. Therefore, we hypothesized that the behavioral risk factors for those NCDs may be present in adolescents with caries. The objective was analyzing the association of unhealthy diet, tabagism, and alcohol with caries in adolescents.

Methods: This population-based study with a cross-sectional design used data from 2,515 adolescents aged 18-19 years, born in São Luís-MA, Brazil, and part of the RPS Cohort Consortium. The exposures were the latent variables of the unhealthy diet pattern (sugars, fast foods, and salty snacks) and addictive behaviors (tabagism and risk of alcohol dependence). The outcome was the number of decayed teeth. The model adjustment considered the socioeconomic status (head of household education, adolescent education, economic class, and monthly family income) as a distal determinant and the oral biofilm as a mediator between the exposures and the outcome, analyzed by structural equation modeling, using the Mplus 8.0 software.

Results: Unhealthy diet pattern was associated with a higher number of decayed teeth directly (SC = 0.092, p ≤ 0.001) and indirectly via dental biofilm (SC = 0.020, p ≤ 0.001). Addictive behaviors were associated with a higher number of decayed teeth indirectly via dental biofilm (SC = 0.019, p = 0.013). The unhealthy diet pattern and addictive behaviors were associated with each other (CP = 0.199, p < 0.001).

Conclusion: Besides sugars, other behavioral risk factors for NCDs underlie caries, emphasizing the importance of comprehensive adolescent health care.

Introduction: Finnish conscripts have proven to be an excellent study group for epidemiological research in oral health in recent decades. The aim of this cross-sectional study was to determine the geographical distribution of dental caries prevalence in young healthy males in Finland at the beginning of the 2020s. Associated dental caries risk factors were of interest as well.

Methods: The data were randomly collected from the eight biggest garrisons in Finland in July of 2021 by ten calibrated dentists. The study population consisted of 2077 male conscripts born between 2000 and 2002. Dental caries was recorded according to the ICDAS system. Wisdom teeth were excluded. Mean DMFT and mean DT values were calculated, and geomaps were constructed to visualize the geographical distribution. Generalized linear mixed models with logit link were conducted for the associated risk factors.

Results: The mean DMFT value of all conscripts was 3.29 (SD 3.91), while the mean DT value was 1.19 (SD 2.33). Living in areas with endemic fluoride levels in drinking water ≥0.3 mg/L decreased the odds for restorative treatment need.

Conclusion: While geographical distribution of dental caries prevalence has remained nearly the same as before, the overall restorative treatment need and treatment history have decreased countrywide.

Introduction: To prevent caries with targeted strategies and to act conservatively, it is essential oral healthcare providers perform an individual caries risk assessment (CRA). This study aimed to explore knowledge and application regarding CRA by Dutch fifth-year dental students (D5DSs) and practitioners (DDPs).

Methods: A survey was conducted through a questionnaire sent at random to a group of 1,500 members of the Royal Dutch Dental Association (KNMT) and to 213 D5DSs from all three dental schools in the Netherlands.

Results: Of the 374 DDP respondents (25%), 79% reported to perform CRA in routine practice. Female dentists reported using CRA in their daily practice more often than males (p = 0.008). The questionnaire was completed by 118 D5DSs (55%). All D5DS respondents reported using CRA and most students were familiar with Dutch prevention-oriented methods. Eighteen percent of them did not make an individual treatment plan based on caries risk. The familiarity of DDPs regarding Dutch prevention-oriented methods was lower than that of students (p < 0.001). In both groups of respondents, oral hygiene and diet were the two most important factors considered when assessing caries risk in patients, whatever their age.

Conclusion: CRA is applied less frequently in the general practice compared to student clinics at university. Our results suggest that dentists in the Netherlands could improve their knowledge about cariology by continuing education. Dental schools should emphasize implementation of the knowledge in clinical practice. In addition, a uniform and evidence-based method to perform CRA in the dental practice is needed.

Introduction: The present study aimed to identify the 100 most-cited articles concerning atraumatic restorative treatment (ART) through a bibliometric analysis.

Methods: The search was conducted in the Web of Science database in December 2023. Scopus and Google Scholar were used to compare the number of citations. The following data were extracted from the articles: title, authors, number of citations, access type, institution, country, continent, year of publication, journal, keywords, study design, and theme. Collaborative networks were generated using the VOSviewer software. Google Trends was used to investigate the global popularity of "atraumatic restorative treatment" research.

Results: The 100 selected articles, published between 1996 and 2019, were cited 5,092 times, ranging from 21 to 239 citations. CariesResearch (12%) and Community Dentistry and Oral Epidemiology (12%) published the highest number of articles. Clinical study (52%) was the most prevalent study design. The main theme addressed was restoration longevity (43%). Conventional high-viscosity glass ionomer was the most used restorative material (69%). The country with the highest number of articles was The Netherlands (33%) and Europe was the continent with most publications (38%). The Radboud University of Nijmegen had the highest number of articles (25%). Frencken was the most prominent author (38%). The most common keyword was "atraumatic restorative treatment" (n = 60). According to Google Trends, Tanzania was the country that searched the most about ART.

Conclusion: The 100 most-cited articles on ART were mainly composed of clinical studies focusing on the longevity of restorations and originated in Europe.

Introduction: Despite the notable progress in developing artificial intelligence-based tools for caries detection in bitewings, limited research has addressed the detection and staging of secondary caries. Therefore, we aimed to develop a convolutional neural network (CNN)-based algorithm for these purposes using a novel approach for determining lesion severity.

Methods: We used a dataset from a Dutch dental practice-based research network containing 2,612 restored teeth in 413 bitewings from 383 patients aged 15-88 years and trained the Mask R-CNN architecture with a Swin Transformer backbone. Two-stage training fine-tuned caries detection accuracy and severity assessment. Annotations of caries around restorations were made by two evaluators and checked by two other experts. Aggregated accuracy metrics (mean ± standard deviation - SD) in detecting teeth with secondary caries were calculated considering two thresholds: detecting all lesions and dentine lesions. The correlation between the lesion severity scores obtained with the algorithm and the annotators' consensus was determined using the Pearson correlation coefficient and Bland-Altman plots.

Results: Our refined algorithm showed high specificity in detecting all lesions (0.966 ± 0.025) and dentine lesions (0.964 ± 0.019). Sensitivity values were lower: 0.737 ± 0.079 for all lesions and 0.808 ± 0.083 for dentine lesions. The areas under ROC curves (SD) were 0.940 (0.025) for all lesions and 0.946 (0.023) for dentine lesions. The correlation coefficient for severity scores was 0.802.

Conclusion: We developed an improved algorithm to support clinicians in detecting and staging secondary caries in bitewing, incorporating an innovative approach for annotation, considering the lesion severity as a continuous outcome.