Fluoridated milk is effective in prevention of enamel caries in adolescents: a randomised trial

Dental caries is one of the most prevalent chronic non-communicable diseases worldwide. There is a lack of evidence, especially in adult populations, documenting caries disease progression considering lesion severity, activity and tooth surface-level characteristics. The study aimed to investigate the extent to which primary active caries lesions in adults affect caries lesions progression compared with inactive caries lesions over a 2-year follow-up period, considering their severity, surface and tooth type. A prospective study data set from a cohort of workers in a factory in Belarus were used. Participants aged 18-64 years with 20 or more natural teeth were included in the study. The participants were clinically examined twice within an interval of 2 years and completed a self-reported questionnaire. One calibrated examiner evaluated caries lesions using the International Caries Detection and Assessment System (ICDAS) and the Nyvad system. The primary outcome was caries lesions' progression. The lesion was classified as 'progressed' if it turned to a more advanced severity stage, was restored or missing/extracted due to caries. A multilevel Poisson regression was used to estimate the association between baseline caries lesions' characteristics and caries lesion progression. Out of 495 participants, 322 people completed clinical examinations at baseline and 2 years later, with an attrition rate of 35%. The prevalence of active DS1-6 and DS5-6 lesions at the baseline was 83.8% and 64.8%, respectively. In 2 years, 24% of active non-cavitated and 31% of active micro-cavitated/shadowed caries lesions progressed, while 15% of inactive caries lesions, non- or micro-cavitated/shadowed, progressed. The adjusted rate ratio (RR) for ICDAS3 + 4 caries lesions progression was 1.41 (CI 95% 1.16, 1.70) than ICDAS1 + 2 lesions. The RR for ICDAS1 + 2, active and ICDAS3 + 4, active lesions was 1.78 (CI 95%, 1.40, 2.27) and 1.97 (CI 95%, 1.53, 2.55), respectively than ICDAS1 + 2, inactive lesions. The RR for caries lesions progression on proximal surfaces and on pits and fissures was 1.57 (CI 95%, 1.30, 1.89) and 1.37 (CI 95%, 1.11, 1.67), respectively than smooth surface lesions. In caries active adults over 2 years, most non- and micro-cavitated/shadowed active and inactive caries lesions did not progress. Among caries lesions that showed progression, more severe lesions were more likely to progress than less severe lesions; active lesions were more likely to progress than inactive lesions. Pit and fissure caries lesions and proximal lesions were more likely to progress than smooth surface lesions.

The aims of this study were: (1) to evaluate the overall reproducibility and accuracy of the International Caries Detection and Assessment System (ICDAS) for assessing coronal caries lesions, and (2) to investigate the use of systems associated with the ICDAS for activity assessment of coronal caries lesions. Specific search strategies were adopted to identify studies published up to 2016. For the first objective, we selected studies that assessed primary coronal caries lesions using the ICDAS as a reference standard. A total of 54 studies were included. Meta-analyses summarized the results concerning reproducibility and accuracy (correlation with histology, summary ROC curves [SROC], and diagnostic odds ratio [DOR]). The latter 2 were expressed at D1/D3 levels. The heterogeneity of the studies was also assessed. Reproducibility values (pooled) were > 0.65. The ICDAS mostly presented a good overall performance as most areas under SROC were > 0.75 at D1 and > 0.90 at D3; DOR ≥6. For the second objective, we selected studies investigating activity assessment associated with the ICDAS. The meta-analyses pooled results based on the same methodology and parameters as above. Longitudinal findings regarding caries progression were described to estimate the validity of these systems. On average, the systems for activity assessment of caries lesions showed moderate values concerning reproducibility and overall performance. Active caries lesions were more prone to progress than inactive ones after 2 years. In conclusion, the ICDAS presented a substantial level of reproducibility and accuracy for assessing primary coronal caries lesions. Additional systems associated with the ICDAS that classify caries lesion activity can be useful as they are moderately reproducible and accurate.

The purpose of this study was to evaluate the in vivo performance of the International Caries Detection and Assessment System (ICDAS), Lesion Activity Assessment (LAA), and bitewing radiographs (BW) in detecting carious lesions on approximal surfaces of primary teeth and determine their association with treatment decisions (TDs). Eighty-nine primary molars (166 approximal surfaces) in 56 eight- to 12-year-old children were clinically evaluated by a single examiner before and after temporary tooth separation. After exfoliation/ extraction, the teeth were histologically analyzed for caries depth and activity. Sensitivities for ICDAS and ICDAS-LAA were higher after tooth separation, while specificities were lower (P<0.05). The sensitivity and specificity values for BW were 0.49 and 0.79, respectively. The strongest correlations were found between ICDAS and BW before and after tooth separation, and between ICDAS and ICDAS-LAA and ICDAS and TDs before tooth separation (P<0.05). The International Caries Detection and Assessment System assessment after tooth separation presented better clinical performance than bitewing radiography for the detection of approximal carious lesions in primary molars. There was a high correlation between treatment decisions based on ICDAS, ICDAS-Lesion Activity Assessment, and bitewing radiography, highlighting the functional similarity of these tools in the clinical decision-making process.

Evaluate the prevalence and severity of caries in permanent teeth and their association with the treatment needs of 8-12-year-old Mexican schoolchildren. The cross-sectional study was conducted on 1139 8-12-year-old schoolchildren attending two public primary schools in State of Mexico. The study used the International Caries Detection and Assessment System (ICDAS) to examine the prevalence of caries and identify treatment needs in schoolchildren. Other variables considered were age, gender, oral hygiene, dental visits ≤6 months, toothbrushing frequency, and the mother's years of education. A logistic regression model was used to identify the association between independent variables and treatment needs. In all analyses, two-tailed p values ≤ 0.05 were considered statistically significant. The prevalence of caries lesions was 82.1% (82.2% boys vs. 81.9% girls) considering all lesion categories (ICDAS 1-6), while the distribution of the severity of caries was 17.9% (ICDAS 0), 13.9% (ICDAS 1-2), 28.3% (ICDAS 3-4) and 39.9% (ICDAS 5-6). The treatment needs index was 77.3%. The logistic regression model showed that the schoolchildren with moderate (ICDAS 3-4) and extensive carious (ICDAS 5-6) lesions were, respectively, 61% Odds Ratio ((OR) = 1.61; p = 0.036) and 77% (OR = 1.77; p = 0.013) more likely to present treatment needs. Other variables, such as poor oral hygiene (OR = 1.52; p = 0.009), the mother's low level of education (OR = 1.53; p = 0.007), and a lack of dental visits (OR = 1.42; p = 0.030) were associated with dental treatment needs. The results obtained show that the 8-12-year-old Mexican schoolchildren presented a high level of treatment needs for moderate and extensive carious lesions (ICDAS 3-6). These findings reiterate the importance of implementing oral health prevention, promotion, and intervention programs to help protect the oral health of school-age children.

A total 302 teeth (148 molars and 154 premolars) corresponding to 152 patients aged ≥18 years were evaluated for caries using the ICDAS (International Caries Detection and Assessment System), fluorescence (DD, DIAGNOdent) and electrical impedance (IMS, CarieScan PRO) systems. Fissurotomy and intraoral radiographs were used as the gold standard. Accordingly, 27.5% (n=84) of the teeth were classified as sound, while 26.9% (n=81) had enamel involvement and 45.6% (n=138) presented carious lesions reaching the dentin. Sensitivity (Se), specificity (Sp), and the area under the curve (AUC) were, respectively, 90.7%, 87.8%, and 0.954 (IMS); 92.4%, 92.7%, and 0.954 (DD); and 79.0%, 72.3%, and 0.756 (ICDAS). With regard to Se and Sp, there were significant differences between ICDAS and DD (p<0.001) and between ICDAS and IMS (p=0.01), but not between IMS and DD (p=0.07). In relation to AUC, there were significant differences between ICDAS and DD (p<0.001), and between ICDAS and IMS (p<0.001), but not between IMS and DD (p>0.05). The correlations between fissurotomy and each method were 88.7% (IMS), 89.7% (DD), and 77.1% (ICDAS). Within the limitations of this study, clinically, the electrical system is not useful for differentiating between sound teeth and truly incipient caries lesions by itself. The fluorescence or electrical systems are recommended with the ICDAS to detect carious lesions in their early stages.

A split-mouth randomized clinical trial was carried out to assess the effectiveness of sealants in preventing carious ICDAS (International Caries Detection and Assessment System) 3–6 lesions within a 2-year follow-up. We evaluated the effectiveness of 2 types of resin-based sealants, with and without fluoride, their retention rates, and the caries risk factors related to their outcomes. The study included 663 tooth pairs in 400 children (aged 5–15 years) considered to be at high individual caries risk (ICR) and presenting permanent molars free of caries or affected by ICDAS 1–2 lesions. In the first randomization, molars were either randomized to the treatment group receiving a dental sealant or the control group (nontreatment), and in the second randomization the sealant material to be used in the intervention group was selected. Uni- and multivariate Cox proportional hazard models were employed. At the 2-year follow-up, 483 tooth pairs were assessed: sealed molars had 83% (adjusted HR = 0.17; 95% CI: 0.15–0.20) less risk of developing ICDAS 3–6 lesions than molars without sealant. The magnitude of the protective effect was lower among teeth with ICDAS 1–2 lesions or with occlusal deep fissures than without. If the total retention rate of sealants was 70% at 2 years, sealant loss was not associated with the risk of caries (HR = 1.29, 95% CI: 0.92–1.79, p = 0.14). Sealants allow the prevention of new ICDAS 3–6 lesions or progression of noncavitated carious lesions in children at high ICR, and the effect of the sealant was similar regardless of whether it contained fluoride or not.

Although there is strong evidence for the effectiveness of sealants, one major barrier in sealant utilization is the concern of sealing over active caries lesions. This study evaluated detection and monitoring of caries lesions through a clear sealant over 44 mo. Sixty-four 7- to 10-year-old children with at least 2 permanent molars with International Caries Detection and Assessment System (ICDAS) scores 0-4 (and caries less than halfway through the dentin, radiographically) were examined with ICDAS, DIAGNOdent, and quantitative light-induced fluorescence (QLF) before sealant placement and 1, 12, 24, and 44 mo (except QLF) after. Bitewing radiographs were taken yearly. DIAGNOdent and QLF were able to distinguish between baseline ICDAS before and after sealant placement. There was no significant evidence of ICDAS progression at 12 mo, but there was small evidence of minor increases at 24 and 44 mo (14% and 14%, respectively) with only 2% ICDAS ≥ 5. Additionally, there was little evidence of radiographic progression (at 12 mo = 1%, 24 mo = 3%, and 44 mo = 9%). Sealant retention rates were excellent at 12 mo = 89%, 24 mo = 78%, and 44 mo = 70%. The small risk of sealant repair increased significantly as baseline ICDAS, DIAGNOdent, and QLF values increased. However, regardless of lesion severity, sealants were 100% effective at 12 mo and 98% effective over 44 mo in managing occlusal surfaces at ICDAS 0-4 (i.e., only 4 of 228 teeth progressed to ICDAS ≥ 5 associated with sealants in need of repair and none to halfway or more through the dentin, radiographically). This study suggests that occlusal surfaces without frank cavitation (ICDAS 0-4) that are sealed with a clear sealant can be monitored with ICDAS, QLF, or DIAGNOdent, which may aid in predicting the need for sealant repair.

The aim of this in vivo study was to validate the DIAGNOdent laser fluorescence method and the International Caries Detection and Assessment System (ICDAS) for caries classification against the gold standard, histological examination, for detecting occlusal caries on permanent molars; the thresholds used were the outer enamel (D1), the inner enamel and outer third of the dentine (D2), and the inner two-thirds of the dentine (D3). Patients with non-impacted third molars (n = 43) were recruited from a university clinic. A trained examiner performed the examinations. After the teeth were extracted, the histological criterion was used to determine the severity of the lesions. Intra-examiner agreement (weighted kappa) for ICDAS was 0.60 and reliability (intraclass correlation coefficient) for DIAGNOdent was 0.968. The correlations with the histological reference were weak for DIAGNOdent (rs = 0.369) and moderate for ICDAS (rs = 0.515). The areas under the receiver-operating characteristics (ROC) curve at D1, D2, and D3 were 0.60, 0.69, and 0.91, respectively, for ICDAS and 0.55, 0.65, and 0.92, respectively, for DIAGNOdent. ICDAS and DIAGNOdent proved to be reproducible methods with similar performance in the detection of occlusal carious lesions in dentine. The ability of DIAGNOdent to detect initial enamel lesions was higher than that of ICDAS, but with low specificity. The usefulness of DIAGNOdent as an adjunct method for assessment of initial occlusal caries in permanent molars is questionable.

Objective: The objective of this study was to identify risk factors for enamel and dentin caries in adolescents.Method: This 1-year longitudinal study was conducted in 2018 and 2019; 13- to 14-year-old adolescents were recruited. The merged International Caries Detection and Assessment System (ICDAS) was used to identify caries. The relationships between the caries increment and variables were analyzed with a zero-inflated negative binomial (ZINB) regression model.Results: A total of 1,016 participants completed the assessment. The ZINB analysis found that individuals with caries at baseline were more likely to develop new dentin caries. Females, or individuals who had a high cariostat score had an increased likelihood of having a high ΔD4-6MFT score. Among the caries-free adolescents at baseline, females, or individuals who consumed snacks once or more than once a day were more likely to develop caries. Individuals from one-child families, who used fluoride toothpaste, and who had a high saliva buffering capability (pH≥4.25) had an increased likelihood of a low ΔD1-6MFT score.Conclusion: The results suggest that there are some specific risk factors of initiating of enamel caries in adolescents, including the frequency of snack consumption, sex, saliva buffering capability, fluoride toothpaste usage and belonging to a one-child family. In all adolescents, most of whom have enamel caries, the dentin caries risk factors were past caries experience, cariostat score and sex.

Diagnostic agreement between visual examination and an automated scanner system with fluorescence for detecting and classifying occlusal carious lesions in primary teeth

Objective: We investigated the precision and accuracy of methods to detect caries lesions on the occlusal surface in vitro using ICDAS and radiological image. Methodology: Human third molars (n=14) were placed in an acrylic resin base and maintained wet during the study. The occlusal surfaces were visually inspected by three examiners using the International Caries Detection and Assessment System (ICDAS) method. The condition of each tooth was registered by images obtained with Digital Radiography (DR), Microcomputed Tomography (µ-CT) and Histologic Specimen (HS). For each tooth and method utilized in the study, an image was selected based on the largest extension of caries found, wherein the three examiners attributed a score to the lesion in accordance with the visual description of each method. The Kappa index, Fisher’s exact test and the Spearman´s correlation coefficient were used for evaluating reliability and accuracy, with a significance level of 5%. Results: Considerable interobserver reliability values were found for ICDAS (k = 0.701), almost perfect for µ-CT (k = 0.855) and HS (k = 0.920), and reasonable for DR (k = 0.221). Significant statistical difference was observed for ICDAS (p &lt; 0.05), and for DR and µ-CT methods (p &lt; 0.01). The correlation was moderate for ICDAS (r = 0.597), high for DR (r = 0.764) and perfect for µ-CT (1.000). Conclusions: the most reliability method for detecting caries lesions on occlusal surfaces in vitro was µ-CT, followed by ICDAS and DR. The most accurate method was µ-CT, followed by DR and ICDAS.

Bioactive materials that are capable of releasing remineralizing ions may be an interesting alternative treatment to prevent the development of carious lesions. The purpose of this study is to evaluate the effectiveness of the association of 45S5 with resin-modified glass ionomer cement (GIC-MR) for conservation and prevention of the progression of initial carious lesions in permanent molars. A total of 36 patients, aged 8 to 14 years, with at least two permanent molars homologous with ICDAS (International Caries Detection and Assessment System) 3 or 4 will be selected to participate in a clinical study of the split-mouth type. The DLF-T (Decayed, Lost and Filled Teeth index), ICDAS, BOP (Bleeding on probing), and VPI (Visible Plaque Index) will be analyzed. A complementary radiographic exam will be performed to assess the dentin underlying lesion. The selected teeth will be randomly assigned into two groups: GIC-MR and GIC-MR + 45S5. Parameters such as retention, the clinical performance of materials, and caries evolution will be evaluated into the two studied groups. Two calibrated evaluators will perform clinical, radiographic, and microscopic evaluations at one, six, 12, and 24 months of follow-up. The results obtained will be evaluated using a Chi-square test. The intention-to-treat protocol will be followed. The results of this study will help to assess the behavior of a bioactive glass ionomer in lesions with enamel microcavities. Innovative research projects, such as the one described here, are needed to determine whether new materials can be used as a treatment alternative.

BackgroundAlthough dental caries is a globally widespread disease, there is no consensus regarding the method that should be used for their detection. In recent decades, a variety of new methods have been proposed for measuring caries in a population. Three caries detection methods, the decayed, missing and filled (DMF) index, the International Caries Detection and Assessment System (ICDAS) and the Caries Assessment Spectrum and Treatment (CAST), were compared to provide information to guide future method choices.MethodsThis was a descriptive, cross-sectional study in which three methods were used to measure caries in students, staff and their dependents at UNEB (State University of Bahia), Salvador, Brazil. We compared the mean application time of each method and the frequencies obtained by each method using the following indicators: the most severe caries lesion per individual; the mean number of missing, filled and decayed teeth; and the disease extent.ResultsThe mean time taken to apply the DMF was 3.8 min; for ICDAS, it took 8.9 min, and for CAST, 4.7 min. When calculating the indicator the most severe caries lesion per individual, the prevalence rates were as follows: 28.1% for DMF, 84.0% for ICDAS and 75.0% for CAST. The mean numbers of decayed, missing and filled teeth were 6.0 according to the DMF, 6.2 according to ICDAS and 5.9 according to CAST. When the disease extension indicator was used, the following percentages of teeth were affected by caries: DMF 22.12%, ICDAS 49.11% and CAST 33.2%.ConclusionsThe DMF underestimated the occurrence of caries lesions in individuals but was the fastest method to apply. ICDAS obtained detailed information regarding lesion severity, but it was a time-consuming method and difficult to analyse. CAST described disease distributions very well and identified lesion severities and preventive and curative needs in the examined group, and the time required to apply CAST was similar to that of the DMF.

Dental caries is a ubiquitous disease affecting all age groups and segments of the population. It is known that not all caries lesions progress to cavitation, but little is known regarding the progression pattern of caries lesions. This study’s purpose was to evaluate the natural history of dental caries using a standardized, visually based system, the International Caries Detection and Assessment System (ICDAS). The study population consisted of 565 consenting children, who were enrolled and examined at baseline and at regular intervals over 48 months with ICDAS and yearly bitewing radiographs. Of these, 338 children completed all examinations. Not all lesions cavitated at the same rate, differing by surface type and baseline ICDAS severity score and activity status. With increasing severity, the percentage of lesions progressing to cavitation increased: 19%, 32%, 68%, and 66% for ICDAS scores 1, 2, 3, and 4, respectively. Lesions on occlusal surfaces were more likely to cavitate, followed by buccal pits, lingual grooves, proximal surfaces, and buccal and lingual surfaces. Cavitation was more likely on molars, followed by pre-molars and anterior teeth. Predictors of cavitation included age, gender, surfaces and tooth types, and ICDAS severity/activity at baseline. In conclusion, characterization of lesion severity with ICDAS can be a strong predictor of lesion progression to cavitation.

Introduction: Caries experience in primary teeth has been highlighted as the most important single risk factor for caries development in the subsequent permanent teeth, but at cavitated stages. This 10-year cohort study aimed to evaluate whether children with only initial caries lesions in the primary teeth could also have a higher risk for caries incidence in permanent teeth. Methods: We evaluated Brazilian preschoolers aged 1–5 years in 2010 (T1) and re-evaluated them 2 (T2), 7 (T3), and 10 (T4) years later. Dental caries in primary and permanent teeth was assessed through the International Caries Detection and Assessment System (ICDAS). For the primary dentition (T1 and T2), the participants were categorised according to caries severity in the first two assessments into children with (i) no caries, (ii) only initial caries lesions (ICDAS scores 1 and 2), (iii) at least one moderate lesion (ICDAS scores 3 and 4), and (iv) extensive caries lesions (ICDAS scores 5 and 6). We also created a dichotomous variable considering only extensive lesions. Demographic and socio-economic data were also collected. For the permanent dentition (T3 and T4), the participants were re-evaluated for extensive caries lesions after 7 and 10 years of follow-up. The outcome variables were the number of decayed, extracted, and filled surfaces of permanent teeth and the occurrence of any extensive lesion (caries incidence) after 10 years. Associations were evaluated through negative binomial and Poisson regression analyses, respectively. Incidence rate ratios (IRRs) and relative risks, along with 95% confidence intervals (95% CIs), were derived. Results: At the baseline, 639 children were included, and 429 were reassessed after 10 years (67.2% retention rate). Children with only initial or moderate caries lesions did not have a higher risk of caries in permanent teeth. By contrast, children with extensive caries lesions were more likely to develop caries in the permanent dentition than children without caries (IRR, 95% CI = 2.90, 1.98–4.23). This higher risk was more clearly demonstrated when the caries experience was used as a dichotomous variable (IRR, 95% CI = 4.02, 2.38–6.78). Conclusion: Children with only initial caries lesions do not have a higher risk of developing dental caries in the permanent dentition by adolescence.