Caries Activity Assessment Research Articles

Impact of Microbial Intake for Gums and Periodontal Health in Children Receiving Chemotherapy

Probiotics comprised of living microorganisms and are devoid of any detrimental impacts on health. When consumed in sufficient amounts, they provide nutritional advantages. The prevalent oral infections primarily target the periodontal and dental tissues inside the mouth cavity. This study aims to investigate the effectiveness of oral probiotics in combating bacteria associated with periodontal and dental diseases. Moreover, it aims to evaluate the gum and periodontal well-being of children receiving chemotherapy following the intake of oral probiotics. Seventy children, aged 4 to 16 years and undergoing chemotherapy, were randomly assigned to either the control or test group, which received probiotics, over a period of ninety days. Various evaluations, including the examination of gum and teeth-supporting structures, oral cleanliness, and testing for caries activity, were conducted at different intervals. SPSS 19.0 was utilized for statistical analysis. Among participants in the treatment group, the administration of oral probiotics resulted in a noteworthy reduction in biofilm accumulation over the observation period (P < 0.05). The test group exhibited an improvement in the condition of the gums and supporting structures of the teeth (P < 0.05). A caries activity assessment was conducted using the Snyder test. Among the children in the research group, 10 were found to have a score of 1, while eight exhibited a score of 2. None of the children in the research group displayed a score of 3. The findings indicated that consistent intake of oral probiotics leads to a significant decrease in the build-up of biofilm, the production of tartar, and the occurrence of tooth decay within the experimental group.

Minimally invasive dentistry: history, theory and perspectives

The article is a literature review concerning certain aspects of the history of Russian dentistry. In this regard, minimally invasive methods are discussed, including air-abrasive, laser, sonic and ultrasonic preparation, as well as atraumatic restorative treatment without mechanical preparation. Indications for minimally invasive methods, assessment of caries activity and prognosis, causes and mechanisms of the accelerated restoration cycle are discussed. The need to preserve dental tissues has been undervalued in the past. Non-selective preparation to hard dentin is currently considered hypertherapy. The concept of minimally invasive dentistry is also applied in endodontics and periodontology. In patients with gingival recession, it is important to protect atrophic tissues from further damage. After a tooth extraction, excessive socket curettage should be avoided. The research in dentistry should be protected from conflicts of interest. Patients should be objectively informed about treatment options, given recommendations based on clinical indications, wishes and possibilities. It is also necessary to develop economic measures in order to reorient private dental clinics to receive patients with compulsory medical insurance and the use of minimally invasive methods.

Microcomputed Tomography Mineral Density Profile as Reference Standard for Early Carious Lesion Activity Assessment

Early caries diagnosis is crucial to treatment decisions in dentistry and requires identification of lesion activity: whether a carious lesion is active (progressively demineralizing) or arrested (progressively remineralizing). This study aimed to identify microtomographic (micro-CT) differences between active and arrested smooth surface enamel lesions, to quantify those micro-CT differences by creating thresholds for ex vivo caries activity assessment to serve as a future reference standard, and to validate those thresholds against the remaining sample. Extracted human permanent teeth (n = 59) were selected for sound surfaces and non-cavitated smooth surface carious lesions. Each surface was then examined for caries activity by calibrated individuals via visual-tactile examination using the International Caries Classification and Management System (ICCMS) activity criteria. Each tooth was scanned via micro-CT and the mineral density was plotted against lesion depth. The area under the curve (AUC) was calculated and represented the loss of density for the outermost 96 μm of enamel. AUC thresholds obtained from micro-CT were established to classify sound, remineralized, and demineralized surfaces against the gold standard examiner’s lesion assessment of sound, inactive, and active lesions, respectively. The established AUC thresholds demonstrated moderate agreement with the assessment in identifying demineralized lesions (k = 0.45), with high sensitivity (0.73) and specificity (0.77). This study demonstrated quantifiable differences among demineralized lesions, remineralized lesions, and sound surfaces, which contributes to the establishment of micro-CT as a reference standard for caries activity that may be used to improve clinical and laboratorial dental caries evaluations.

Caries Assessment by ORATEST in school going children: A cross sectional study

Aim: To determine caries activity among school going children using an uncomplicated oral rinse test (Oratest) Method: A Cross-sectional study was conducted in the Paediatrics Dentistry department of Bahria University Dental College Karachi, Pakistan from July 2019 to October 2019. Out of total 300 children visiting paediatrics dental clinic of private dental college, Karachi, Pakistan between July 2019-Oct 2019, 200 children were excluded who did not meet the inclusion criteria. Out of remaining 100 children, randomly selected 25 children were allocated to test group and separate 25 healthy children without caries were allocated to control group. On the basis of number of decayed teeth, the test group was divided into three subgroups: Group-I had 1-2 carious teeth, individuals with 3-5 carious lesions were included in Group-II, while 7-9 were included in Group-III. Microbial status was evaluated using Oratest. The time observed for the change colour represents the microbial activity, it was documented in planned proforma. Results: A total of 50 children, 26 were female and 24 were male with a mean age of 6.74 ±2.20 yrs. were included. The result showed significant relationship between control and test group in term of mean time for Colour modification and number of carious lesion. The Oratest colour change time was higher in patients with less number of carious teeth, showing an inverse relationship between Oratest and presence of caries lesions. The result also showed a significant relationship between age and eruption status of molar with caries activity. Conclusion: Caries activity can be assessed using Oratest as it is an uncomplicated, economical, chairside and time efficient test. It can be of immense service in aiding caries activity assessment in paediatric dental setups as it is gladly accepted by children. The Oratest can be used as a teaching tool to improve the oral health literacy of the children and their families, by viewing the activity of their bacteria. Keywords: Caries detector, dental caries, microbial colonies, oratest

The Calcivis story - enamel caries activity assessment from technology to practice

The Calcivis story is one of innovation and collaboration to deliver new technology capable of helping dentists improve patient care through solving an unmet clinical need in assessing the activity of caries lesions in enamel. Presently, there is no system routinely used in dental practice that can, in a single visit, determine whether a non-cavitated caries lesion is active or not. Calcivis has evolved since 2005, when a potential link between basic science in luminescence and differentiating initial-stage caries lesions that are actively demineralising and likely to progress, from other lesions which are inactive and currently do not need interventive care, was recognised. The 16-year journey has involved clinical academic dentists, scientists and entrepreneurs, general practitioners and their patients, together with serial investors and a core team working to patent, refine, assess and develop products to submit to regulatory approval and take to the international dental market. This journey has been made possible through effective long-term collaborations between disparate groups all sharing a common vision for the possibilities of harnessing new technology to help dental professionals provide better care for their patients.

In vivo effectiveness of visual inspection and laser fluorescence in the diagnosis of early pit-and-fissure carious lesions: A cross-sectional study in a group of Romanian children.

General practitioners are still facing great challenges in the management of occlusal caries. Therefore, the development of better diagnostic protocols and assessment of caries activity might improve the results of nonoperative treatment. This study aimed to evaluate the effectiveness of visual inspection based on ICDAS-II (International Caries Detection and Assessment System) and DiagnoDent pen in the detection of pit-and-fissure early lesions in young permanent molars. The evaluation of 237 occlusal surfaces and caries risk assessment were performed in 96 children aged 7 to 15 years. The presence of pit-and-fissure noncavitated lesions was recorded using ICDAS-II scoring system and laser fluorescence. Statistical analysis was performed using McNemar test, with a level of significance of P < .05. The caries risk was measured for all participants. In 109 occlusal surfaces both methods identified enamel changes (46%) and in 62 cases both methods excluded the carious lesion (26.2%). The statistical analysis showed a significant moderate agreement between ICDAS-II code and DiagnoDent pen measurements (McNemar chi-squared statistic 9.5, P = .002 and Cohen kappa coefficient = 0.427). The majority of children (69.8%) had moderate caries risk and the most frequent risk factors recorded were sugar intake between meals, lack of regular dental control and poor oral hygiene. We concluded that ICDAS-II is a valuable and reliable diagnostic tool for early pit-and-fissure lesions and could be used alone during dental examination in children. The evaluation of caries risk should become clinical routine, as parameters belonging to high risk were frequently recorded in our study group.

Use of alaser fluorescence device for the in vitro activity assessment of incipient caries lesions.

To evaluate the progression of demineralization during orthodontic treatment, the assessment of lesion activity is important in addition to the detection of lesion extent. This study aimed to evaluate the ability of laser fluorescence measurements to differentiate between active and inactive initial lesions in vitro. In all, 63extracted, permanent human teeth were available for the study. On each occlusal investigation site, surface extent and activity of caries lesions were classified visually using ICDAS/ICCMS (International Caries Detection and Assessment System/International Caries Classification and Management System) criteria, following laser fluorescence measurements. Teeth were hemisected and assessed for lesion depth. Methyl red dye was applied to validate lesion activity on the sections. AMann-WhitneyU-test was performed to evaluate differences between laser fluorescence measurements for active and inactive lesions. For visual and laser fluorescence findings, diagnostic accuracy (Az, sensitivity and specificity) were calculated. A total of 19sound surfaces and 44surfaces with ICDAS codes 1/2 were classified visually. The differences in laser fluorescence measurements between active and inactive lesions were not significant for the initial lesions (p > 0.05). Sensitivity/specificity for lesion depth was 90.5/92.3% (Az = 0.894), respectively, for visual assessment and 69.1/76.9% (Az = 0.745), respectively, for laser fluorescence. Sensitivity/specificity for activity assessment was 68.6/85.0% (Az = 0.768) for the visual method. For laser fluorescence measurements, no diagnostic accuracy values could be calculated for caries activity assessment. The visual detection and activity assessment of initial lesions was more suitable than the laser fluorescence method. Based on the results of this in vitro study, use of laser fluorescence cannot be recommended for distinguishing between active and inactive initial caries lesions on occlusal surfaces.

Do undergraduate dental students perform well detecting and staging caries and assessing activity by visual examination? A systematic review and meta-analysis.

To assess the undergraduate students' performance in detecting and staging caries and assessing activity using visual inspection. Two independent reviewers searched the literature through PubMed/MEDLINE, Scopus, Lilacs databases, and OpenSINGLE. Meta-analyses summarized the results concerning reproducibility and accuracy at D1 (considering all lesions) and D3 (including only cavitated lesions or lesions into dentin) levels. For activity, we considered sound surfaces plus inactive caries lesions vs active lesions. Meta-regression assessed the effect of methodological variables on the outcomes. Fourteen studies were included. The mean reproducibility values were ≥0.52, except for interexaminer agreement when assessing caries activity (0.39; 95% CI 0.10-0.67). The intra-examiner reproducibility tended to be higher than the interexaminer reproducibility. Overall, undergraduate students' performance in staging caries lesions using visual examination was good (AUC>0.85 and DOR>25). The sensitivity values were moderate; however, these were associated with excellent specificity values. Despite few pooled studies, caries activity assessment revealed moderate overall performance, with lower pooled sensitivity than pooled specificity. Students' education level and background clinical experience had no influence on the accuracy and reproducibility of the visual inspection. Undergraduate students' performance in detecting and staging caries using visual inspection was good, although caries activity assessment still requires improvement.

Multidisciplinary management of adult rampant dental caries - A rare case report.

The National Health and Nutrition Examination Survey for 1999-2002 recorded that 21% of children and 23% of adults had untreated dental caries in the permanent dentition. Ten percent of adults had untreated root caries. Though considerable literature exists on rampant caries in children, because of the lack of strict diagnostic criteria, there is little published data on the incidence and prevalence of adult rampant dental caries. Diagnosis requires assessment of caries activity, oral dryness, dietary risks and medical risks. Management of this condition requires a disease control phase involving Caries risk assessment and evaluation, with reassessment throughout the program. Restoration of all cavitated lesions and use of fluoride releasing materials followed by preventive and therapeutic control strategies, including diet modification. This is followed by extensive multidisciplinary corrective phase involving endodontic, periodontal and prosthetic rehabilitation. The maintenance phase involves preventive and therapeutic agents employed from several different fronts simultaneously, tailored to the source of the caries risk. This case report highlights the importance of proper diagnosis, treatment planning and comprehensive multidisciplinary approach to achieve the function, esthetics and to regain self confidence of the patient in a rare case of adult rampant dental caries.

Diagnostic Accuracy of a Bioluminescence System for the Assessment of Caries Activity on Occlusal Surfaces

Objective: Assessment of caries lesion activity is usually performed using visual-tactile criteria. A new approach is to use a system consisting of a photoprotein, which is specific for free calcium ions, along with an integrated camera that visualizes the elevated calcium ions on the lesion as a light signal (bioluminescence). This study aimed to evaluate the reproducibility and diagnostic accuracy of a newly developed bioluminescence system to assess caries lesion activity on occlusal surfaces in vitro. Materials and Methods: Ninety-four extracted permanent teeth with sound surfaces and both active and inactive caries lesions were included. The extent and activity of the investigation sites were classified visually according to the International Caries Detection and Assessment System. Digital images of the teeth were produced by the bioluminescence system and the images were analyzed for the presence of caries activity (the bioluminescent areas at the investigation sites). The images were reanalyzed after 4 weeks. Teeth were hemisected and methyl red dye was applied on the sections to validate lesion activity histologically. Results: Agreement between the bioluminescence readings was shown by κ values of 0.802–0.917. A significant positive correlation (p < 0.001) was found across all methods (r_s 0.618–0.811). Sensitivity and specificity for activity assessment using histology as the gold standard (cut-off: active/inactive) were, respectively, 83.6 and 85.0% for the visual assessment, and 92.5 and 90.0% for the bioluminescence method. Comparison of areas under the receiver-operating characteristic curves showed no significant difference between the visual and bioluminescence systems (p = 0.094). Conclusion: The bioluminescence system demonstrated high in vitro reproducibility and good diagnostic accuracy for activity assessment of caries lesions on occlusal surfaces which were not significantly different from the values obtained in the visual assessment.

Cariology Education in Canadian Dental Schools: Where Are We? Where Do We Need to Go?

The aim of this study was to document cariology education across Canadian dental schools. Ten faculty members who supervise cariology education at each of the ten Canadian dental schools were invited to participate in the study in 2016. An adapted version of the European Organization for Caries Research-Association for Dental Education in Europe cariology curriculum group questionnaire was used. Representatives of all ten dental schools completed the questionnaire, for a 100% response rate. In four schools, cariology and restorative dentistry were taught by the same department. Five schools had didactic/laboratory courses focusing primarily on cariology as well as a specific written curriculum. Six schools provided cariology-related hands-on workshops/laboratories before students started working with patients. In teaching cariology, seven institutions included dental hard tissues defects. The following caries detection methods were addressed didactically in cariology education: visual (10/10 total schools), tactile (9/10), International Caries Detection and Assessment System criteria (6/10), caries activity assessment (9/10), radiographic (10/10), and other detection tools (8/10). Seven schools charted activity of carious lesions in clinic. Only one school used the concept of caries risk assessment regularly in clinic. Clinical cariology teaching was carried out mostly by private dentists hired as clinical instructors (7/10) and faculty members involved in didactic cariology education (9/10). Calibration of faculty members for caries detection criteria was reported by only one school. The main concern reported by all institutions was the difficulty of implementing didactic instruction on cariology into clinical training. This study found that contemporary cariology concepts are in the process of being implemented in didactic education across Canadian dental schools, but all schools lacked appropriate integration of cariology education into clinical training. These findings suggest a need for harmonization of evidence-based cariology education in Canada.

Do the ball-ended probe cause less damage than sharp explorers?-An ultrastructural analysis.

BackgroundNo evidence about damage caused by ball-ended probes on tooth is available. No study compared probing defects caused by ball-ended probes with sharp explorers during tactile examinations of primary teeth. This exploratory study aimed to compare ultrastructural defects caused by ball-ended probes with sharp explorers during tactile examinations of primary teeth.MethodsForty-nine primary extracted teeth were tactile examined as performed for caries activity assessment. Surfaces were randomly divided into groups based on probe type (ball-ended probe or sharp explorer). Two examiners probed different surfaces using the sharp explorer and the ball-ended probe. The order for examination was randomly determined. Images were captured using environmental scanning electron microscopy (ESEM) before and after probing. Two external examiners evaluated independently the ESEM images and scored them as: 0) no damage, 1) slight marks, 2) distinct marks, 3) marks with discontinuity, 4) enamel break-offs. Multilevel Poisson regression models were used to analyze associations between probing ultrastructural damage and surface type, baseline condition and probe type. Prevalence ratios (PR) were calculated with 95 % confidence interval (CI).ResultsThe most common defects observed on the dental surfaces were probing marks without discontinuity (scores 1 and 2). Ball-ended probes caused significantly less severe damage than sharp explorers (PR: 0.28; CI: 0.11–0.76, p = 0.01).ConclusionBall-ended probes cause less damage than sharp explorers when probing gently dental surfaces of primary teeth.

Assessment of caries activity using the Calcivis Caries Activity Imaging System

Objective: An adequate diagnosis of dental caries means not only assessment of the change and the spread of change in the lesion, but also making a decision concerning its possible activity. Caries activity is primarily assessed using visual-tactile criteria that help estimate the probability of a carious lesion to progress. The aim of the present study was to test the capability of a new approach to ascertain lesion activity by means of bioluminescence (CalcivisⓇ Caries Activity Imaging System, Calcivis) in-vitro. Subjects and Methods: 46 extracted permanent posterior teeth were included in the study (30 occlusal surfaces, 16 smooth surfaces). The investigation sites were classified by two examiners using ICDAS and NYVAD criteria for lesion activity (activity yes/no) and consensus score of each site was determined as reference value. The sites were photographed using a prototype Calcivis System and the images were evaluated by both examiners for the presence of activity (bioluminescence, blue spots at the investigation sites). Correlation of methods was calculated using Spearman's rank correlation coefficient (rs). Agreement between methods was assessed by kappa statistics. ROC curves were created for Calcivis and both visual methods and the areas under the Curve (AUC) were compared (α=0.05). Results: Significant positive correlation was found between Calcivis and the visual detection methods: rs ICDAS=1.0, rs Nyvad criteria=0.776 (p<0.001). Kappa-values were: Calcivis/ICDAS=1.0, Calcivis/Nyvad=0.78. AUC for Calcivis was 1.0 (ICDAS as reference value) and 0.89 (Nyvad criteria as reference value).No significant differences were observed between the AUCs (p=0.30). Conclusion: The in-vitro use of the bioluminescence method showed good agreement with visual findings in assessment of the activity of a carious lesion in the area of occlusal and smooth surfaces.

Icdas II criteria (international caries detection and assessment system).

The International Caries Detection and Assessment System (ICDAS) is a clinical scoring system which allows detection and assessment of caries activity. ICDAS was developed for use in clinical research, clinical practice and for epidemiological purposes. A recent review of caries detection criteria systems found that there were inconsistencies among the research criteria for caries measuring systems. There is a need to an uniform system which allows comparison of data collected in different researches. ICDAS allows detection of caries process at every stage and characterization of the caries activity status of lesion. Later, the criteria were modified and ICDAS II created. The aim of this review is to inform about the ICDAS II and make a comparison between ICDAS II criteria and other caries detection systems.

Noncavitated Active Caries Lesions at Occlusal Surfaces Presented Higher Risk of Progression Than Inactive Ones.

Validation of visual caries activity assessment: a 2-yr cohort study. Guedes RS, Plovesan C, Ardenghi TM, Emmanuelli B, Braga MM, Ekstrand KR, Mendes FM. J Dent Res 2014;93(7 suppl):101S–107S. Marisol Tellez, BDS, MPH, PhD, Sungwoo Lim, MS, DrPH Would children with a higher number of active lesions present a higher risk for developing new lesions? Would caries lesions classified as active be more prone to progress to higher ICDAS scores when compared to inactive lesions? Government- Conselho Nacional de Desenvolvimento Cientifico e Tecnologico and Fundacao de Amparo a Pesquisa no Estado de Sao Paulo Cohort study Level 2: Limited-quality, patient-oriented evidence Not applicable

Eruption Stage of Permanent Molars and Occlusal Caries Activity/Arrest

This study assessed the association between the eruption stage of permanent second molars and occlusal caries activity among 12-year-old schoolchildren from South Brazil. A cross-sectional study was performed in Porto Alegre using a multistage probability sampling strategy to select a representative sample. Clinical examination was conducted to assess the eruption stage of permanent molars, Gingival Bleeding Index, and, after tooth cleaning and drying, caries experience (noncavitated and cavitated lesions, including caries activity assessment). Data were collected on sex, socioeconomic status, mother’s education, brushing frequency, and consumption of soft drinks. Generalized estimating equations were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Overall, 983 schoolchildren with 3,071 second molars were available for analysis. Whereas active caries was observed in 6.6% of fully erupted permanent second molars, caries affected 26.2%, 29.6%, and 18.2% of erupting molars classified as stages 1, 2, and 3, respectively: stage 1, partially erupted occlusal surface; stage 2, fully erupted occlusal surface, <1/2 crown exposed; and stage 3, fully erupted occlusal surface, >1/2 crown exposed. After adjusting for socioeconomic and behavioral variables, partially erupted molars were significantly more likely to present active caries lesions than molars in full occlusion: stage 1, OR = 4.99 (95% CI = 3.38, 7.38); stage 2, OR = 5.18 (95% CI = 3.14, 8.53); stage 3, OR = 3.20 (95% CI = 2.21, 4.64). Similar results were found when clinical variables were included in the adjusted model. In conclusion, most occlusal caries lesions tend to arrest/revert when teeth reach the occlusal plan; however, an important proportion of these lesions remains active and in need of proper management. Children at risk should be targeted with preventive and minimally invasive strategies.

Validation of Visual Caries Activity Assessment

We evaluated the predictive and construct validity of a caries activity assessment system associated with the International Caries Detection and Assessment System (ICDAS) in primary teeth. A total of 469 children were reexamined: participants of a caries survey performed 2 yr before (follow-up rate of 73.4%). At baseline, children (12-59 mo old) were examined with the ICDAS and a caries activity assessment system. The predictive validity was assessed by evaluating the risk of active caries lesion progression to more severe conditions in the follow-up, compared with inactive lesions. We also assessed if children with a higher number of active caries lesions were more likely to develop new lesions (construct validity). Noncavitated active caries lesions at occlusal surfaces presented higher risk of progression than inactive ones. Children with a higher number of active lesions and with higher caries experience presented higher risk of developing new lesions. In conclusion, the caries activity system associated with the ICDAS presents predictive and construct validity in primary teeth in the assessment of occlusal caries lesions, but predictive validity was not observed in smooth surfaces.

Current possibilities in occlusal caries management

Dental caries is a multifactorial disease that affects most populations throughout the world and it is still the primary cause of oral pain and tooth loss. The occlusal surfaces of posterior teeth are the most vulnerable sites for dental caries due to their anatomy. Therefore, the aim of the following article is to summarize current knowledge on occlusal caries development and the possibilities of its prevention. Although the overall caries rate today has fallen for populations in industrialized countries, the rate of occlusal surface caries has not decreased. This may be explained with fact that topically applied fluorides and their mode of action prevent caries better on smooth than on occlusal surfaces. As we know, tooth decay of first permanent molars causes a great deal of different short and long term difficulties for patients. Therefore, there is a continuous need for implementation of programs for caries prevention in permanent teeth. Nowadays, we like to treat our patients by minimally invasive methods. A very important step in our effective preventive treatment is sealing pits and fissures as a cornerstone of occlusal caries management. Reliable assessment of caries activity is also very important for defining treatment needs and plans. A very important decision, which should be made during occlusal caries management, is the selection of restorative material according to the treatment plan. Current possibilities in occlusal caries prevention and management are very effective. Therefore, dentists today do not have any excuse for avoiding the philosophy of Minimally Invasive Dentistry, especially when we talk about caries management of occlusal surfaces in permanent molars.

Activity assessment has little impact on caries parameters reduction in epidemiological surveys with preschool children

This study aimed to evaluate the magnitude of the reduction in caries parameters after inclusion of dental caries activity assessment, in an epidemiological survey of preschool children, involving cavitated and noncavitated caries lesions. The survey was carried out in Santa Maria, Brazil, during the National Children's Vaccination Day, and 639 children aged between 12 months and 59 months were included. Fifteen examiners assessed the children based on the International Caries Detection and Assessment System (ICDAS) and additional lesion activity assessment criteria. The mean of decayed surfaces (d-s), the mean of decayed teeth (d-t), caries prevalence, and 95% confidence intervals were calculated, initially by classifying all lesions using the various thresholds defined by the ICDAS. Caries activity status was then evaluated, and inactive lesions were classified as sound in a secondary analysis; subsequently, the same caries parameters, at the same thresholds, were recalculated. The reduction in caries parameters and the number of children requiring assessment to change their classification from decayed to sound (number needed to be assessed) were also calculated. The majority of lesions were classified as active, mainly at cavitated thresholds. When activity was considered, values of all caries parameters decreased. This decrease was more evident at noncavitated thresholds. The number of children requiring assessment to change their classification from decayed to sound was <20 considering all lesions, but this value increased to approximately 100 when we included only cavitated lesions. The inclusion of activity assessment in caries epidemiological surveys has little impact on the d-s, d-t and prevalence of dental caries considering both noncavitated and cavitated lesions.

Intraoral pH measurement of carious lesions with qPCR of cariogenic bacteria to differentiate caries activity

ObjectivesA low pH environment is created by cariogenic bacteria. This study was aimed to measure pH of carious lesions intraorally using a micro-pH sensor, and assess predominant acid-producing cariogens by qPCR to differentiate caries activities. Methods103 dentine lesions classified as active or arrested caries based on the clinical and radiological examinations were collected from patients after intraoral measurement of the lesion surface pH using a micro-pH sensor. Quantitative detection of genomic DNA copies of target cariogenic bacteria (mutans streptococci and Lactobacillus spp.) in each lesion was performed using real-time PCR. Correlation between the pH ranges and the number of bacterial species was examined by Spearman test. Results50 samples were diagnosed as active and 53 as arrested lesions. Statistically significant difference was observed on average surface pH value between active and arrested lesions (p<0.05). Prevalence of Lactobacillus spp. was higher in active lesions than in arrested lesions (76% vs. 58% of samples, respectively). When the carious lesions were categorised into four different pH ranges (up to 5.5, from 5.6 to 5.8, from 5.9 to 6.1 and 6.2 or above), increased prevalence of Lactobacillus spp. was observed with decrease of pH levels. A significant negative relationship was found between pH value and number of Lactobacillus spp. (r=−0.209, p<0.05) but no such correlation was found for mutans streptococci. ConclusionsIntraoral pH measurement might be clinically useful to determine acidity of the local environment of carious lesions as one aspect of the caries activity assessment. Clinical significanceThe population of certain bacteria may indicate activity of carious lesions. Intraoral pH measurement of the carious lesions using a micro-pH sensor may be a clinically feasible method for assessment of lesion acidity.