Assessment Of Carious Lesions Research Articles

Study of Dental Caries and PTH Gene

Parathyroid hormone (PTH) is essential for calcium and phosphate homeostasis in odontogenesis-related cells. Therefore, the present study aimed to investigate the association between single nucleotide polymorphisms in the gene encoding PTH, and dental caries in Brazilian children. Three hundred and fifty-three children (170 boys and 183 girls, age ranging from 8 to 11 years old) were included in this study. The International System for Detection and Assessment of Carious Lesions (ICDAS) was used for diagnosis of dental caries. Visible biofilm was also evaluated during the clinical examination. Genomic DNA was extracted from saliva for real-time PCR to evaluate the single nucleotide polymorphisms rs6256, rs307247 and rs694 in PTH gene. Dental caries was classified in ICDAS0 vs. ICDAS1−6 or ICDAS1−2 vs. ICDAS3−6. Chi-square test, binary logistic regression adjusted by biofilm and haplotype analyses were performed (p < 0.05). Biofilm was associated with dental caries (p < 0.05). There were no associations between dental caries and rs6256, rs307247, rs694 in none of the analyses performed (p > 0.05). In conclusion, the present study supports that the single nucleotide polymorphisms rs6256, rs307247, and rs694 in the PTH-encoding gene are not associated with dental caries in Brazilian children.

The effect of two clinical criteria in the assessment of caries lesions around restorations in children (CARDEC-03): study protocol for a diagnostic randomized clinical trial

Introduction: The detection of caries lesions around restoration can be challenging. Therefore, the use of some criteria has been proposed in order to give more objectivity to the diagnosis process. Two of them are the International Dental Federation (FDI) and the Caries Associated with Restorations and Sealants (CARS) criteria. Both methods have a different approach to caries, and it is not possible to know which one of them is the best to use in clinical practice to assess restorations in children. Thus, the present protocol aims to evaluate the effect of the use of the FDI and CARS criteria in the assessment of caries lesions around restorations in primary teeth on outcomes related to oral health in children and costs resulting from the assessments. Methods and analysis: A total of 626 restorations of children from three to 10 years were randomly assessed and are being treated following the FDI criteria (FDI group) or CARS criteria (CARS group). Participants will be followed-up after six, 12, 18, and 24 months. The primary outcome will be the need for a new intervention in the evaluated restorations. This outcome consists of several components, and each of these events will be analyzed separately as secondary outcomes. The changes in children’s oral health-related quality of life and the cost of the restoration dental treatments will also be analyzed as secondary outcomes. The methods will be compared using the Cox regression model with shared frailty. A significance level of 5% will be adopted for all statistical analyses. Discussion: This will be the first randomized clinical study carried out regarding the detection of caries lesions around restorations in primary teeth. Trial registration: The study underwent registration in Clinicaltrials.gov (NCT03520309) on 9 May 2018.

Assessing the Association Between Nutritional Status, Caries, and Gingivitis in Schoolchildren: A Cross-Sectional Study

Objective. To evaluate if nutritional status is associated with caries and gingivitis in Brazilian schoolchildren. Material and methods. Children of both genders, age ranging from 8 to 11 years old, were included in this study. Caries was diagnosed using ICDAS (International System for Detection and Assessment of Carious Lesions) and gingivitis was diagnosed using the Community Periodontal Index. The nutritional status of each child was defined by BMI Z-score calculation. Data on oral health behavior and dietary habit were collected through parent’s questionnaires. Parametric analyzes were performed to compare the groups. The established alpha was 5%. Results. The sample consisted of 353 schoolchildren: 16 underweight children, 247 eutrophic children, 64 overweight children, and 26 were obese children. Overweight, Obese and Overweight + Obese children presented less cavitated caries lesion than Eutrophic children (P < .05). Gingivitis was not associated with nutritional status (P > .05). Conclusion. Caries was associated with overweight and obesity in Brazilian schoolchildren.

Study protocol for a diagnostic randomized clinical trial to evaluate the effect of the use of two clinical criteria in the assessment of caries lesions around restorations in adults: the Caries Cognition and Identification in Adults (CaCIA) trial

BackgroundThe assessment of restored teeth in dentistry remains a challenge, mainly related to the detection of caries around restorations. There is a diversity of clinical criteria available to assess the caries lesions, resulting in differences in the dentists’ diagnosis and treatment decisions. In addition, there is a lack of evidence regarding the best criteria to detect caries lesions around the restorations. Thus, the present protocol aims to evaluate the effect of using 2 visual criteria to assess restored teeth on the outcomes related to oral health in adults.MethodsThe design protocol of the Caries Cognition and Identification in Adults trial correspond to a triple-blind randomized, controlled clinical trial with parallel-groups. Two groups will be compared: patients who will receive the diagnosis and treatment decision according to FDI (World Dental Federation) criteria—FDI group; and patients who will receive diagnosis and treatment decision according to the “Caries Associated with Restorations or Sealants” criteria defined by the International Caries Classification and Management System (ICCMS group). The participants will be followed up after 6, 12, 18, 24, and 60 months, and the restoration failure will be the primary outcome. The analysis will be conducted through Cox regression with shared frailty. The impact of oral health on quality of life and the cost-effectiveness of the methods used will be the secondary outcomes. Two-tailed analyzes will be used, considering a level of significance of 5%.DiscussionThis is the first clinical trial to assess the effect of using two visual methods to detect caries lesions around restorations on the outcomes related to oral health in adults. The findings of this study will define what is the best diagnostic strategy for the assessment of caries around restorations in permanent teeth.Trial registration NCT03108586 (registered 11 April 2017).

The effect of two clinical criteria in the assessment of caries lesions around restorations in children (CARDEC-03): study protocol for a diagnostic randomized clinical trial

Introduction: The detection of caries lesions around restoration can be challenging. Therefore, the use of some criteria has been proposed in order to give more objectivity to the diagnosis process. Two of them are the International Dental Federation (FDI) and the Caries Associated with Restorations and Sealants (CARS) criteria. Both methods have a different approach to caries, and it is not possible to know which one of them is the best to use in clinical practice to assess restorations in children. Thus, the present protocol aims to evaluate the effect of the use of the FDI and CARS criteria in the assessment of caries lesions around restorations in primary teeth on outcomes related to oral health in children and costs resulting from the assessments. Methods and analysis: A total of 626 restorations of children from three to 10 years were randomly assessed and are being treated following the FDI criteria (FDI group) or CARS criteria (CARS group). Participants will be followed-up after six, 12, 18, and 24 months. The primary outcome will be the need for a new intervention in the evaluated restorations. This outcome consists of several components, and each of these events will be analyzed separately as secondary outcomes. The changes in children’s oral health-related quality of life and the cost of the restoration dental treatments will also be analyzed as secondary outcomes. The methods will be compared using the Cox regression model with shared frailty. A significance level of 5% will be adopted for all statistical analyses. Discussion: This will be the first randomized clinical study carried out regarding the detection of caries lesions around restorations in primary teeth. Trial registration: The study underwent registration in Clinicaltrials.gov (NCT03520309) on 9 May 2018.

The effect of two clinical criteria in the assessment of caries lesions around restorations in children (CARDEC-03): study protocol for a diagnostic randomized clinical trial

Introduction: The detection of caries lesions around restoration can be challenging. Therefore, the use of some criteria has been proposed in order to give more objectivity to the diagnosis process. Two of them are the International Dental Federation (FDI) and the Caries Associated with Restorations and Sealants (CARS) criteria. Both methods have a different approach to caries, and it is not possible to know which one of them is the best to use in clinical practice to assess restorations in children. Thus, the present protocol aims to evaluate the effect of the use of the FDI and CARS criteria in the assessment of caries lesions around restorations in primary teeth on outcomes related to oral health in children and costs resulting from the assessments. Methods and analysis: A total of 626 restorations of children from three to 10 years were randomly assessed and are being treated following the FDI criteria (FDI group) or CARS criteria (CARS group). Participants will be followed-up after six, 12, 18, and 24 months. The primary outcome will be the need for a new intervention in the evaluated restorations. This outcome consists of several components, and each of these events will be analyzed separately as secondary outcomes. The changes in children’s oral health-related quality of life and the cost of the restoration dental treatments will also be analyzed as secondary outcomes. The methods will be compared using the Cox regression model with shared frailty. A significance level of 5% will be adopted for all statistical analyses. Discussion: This will be the first randomized clinical study carried out regarding the detection of caries lesions around restorations in primary teeth. Trial registration: The study underwent registration in Clinicaltrials.gov ( NCT03520309) on 9 May 2018.

Genetic polymorphisms in interleukin-6 and interleukin-1-beta were associated with dental caries and gingivitis

Objective Evaluate the association between single nucleotide polymorphisms (SNPs) in Interleukin-6 (IL-6) gene (rs1800795) and in Interleukin-1-beta (IL-1β) gene (rs1143627 and rs1143629) with dental caries and gingivitis in Brazilian children. Material and methods Three hundred and fifty-three children aged 8–11 years were included. Visible biofilm and gingival bleeding were evaluated by Community Periodontal Index. The International System for Detection and Assessment of Carious Lesions (ICDAS) was used to investigate dental caries. Real-time PCR evaluated SNPs in the DNA. Chi-square test, haplotype analysis and logistic regression were applied (alpha of 5%). Results The GG genotype in rs1800795 (IL-6) decreases the risk of gingivitis in a co-dominant model (p = .05; OR = 0.64). The GG genotype in rs1143627 (IL-1β) reduces the risk of dental caries (Co-dominant model: ICDAS0 versus ICDAS1-6: p = .05; OR = 0.55. ICDAS0-2 versus ICDAS3-6: p = .02; OR = 0.49. Recessive model: ICDAS0 versus ICDAS1-6: p = .005; OR = 0.48. ICDAS0-2 versus ICDAS3-6: p = .004; OR = 0.45. Logistic regression: ICDAS0-2 versus ICDAS3-6: p = .05; OR = 0.24; CI 95%= 0.05–1.00). The GG genotype in rs1143629 was more frequent in ICDAS0 (p = .05; OR: 0.60). In the haplotype analysis, IL-1β was associated with gingivitis. Conclusion The rs1800795 in IL-6 gene was associated with gingivitis. The rs1143627 and rs1143629 in IL-1β were associated with dental caries and gingivitis.

Vitamin D receptor FokI and BglI genetic polymorphisms, dental caries, and gingivitis.

To investigate the association between the genetic polymorphisms FokI (rs2228570) and BglI (rs739837) in vitamin D receptor (VDR) with dental caries and gingivitis susceptibility. This study included 353 Brazilian children (8 to 11years old). Dental caries was assessed using ICDAS (International System for Detection and Assessment of Carious Lesions) and gingival bleeding using Community Periodontal Index (CPI). The presence of visible biofilm was also evaluated. DNA was extracted from saliva, and real-time PCR was used to evaluate genetic polymorphisms in VDR: rs2228570 (FokI, A>G/Met>Thr) and rs739837 (BglI, G>T). Dental caries was evaluated as a continuous data (mean and standard deviation-SD) and was also categorized (ICDAS0 versus ICDAS1-6 or ICDAS1-2 versus ICDAS3-6). Gingivitis was categorized in with and without. One-way ANOVA was used for comparisons of caries among genotypes. Chi-square test, logistic regression, and haplotype analysis were performed (P<.05). Biofilm was associated with dental caries susceptibility and gingivitis (P<.05). The mean distribution of the caries lesions and cavitated caries lesions among FokI and BgII genotypes were not statistically significant (P>.05). Genotype distributions among caries groups (in the two different cut-offs) and among gingivitis and non-gingivitis groups were not statistically significant (P>.05). The polymorphisms FokI and BglI in VDR were not associated with dental caries or gingivitis.

Cross-sectional and en-face depolarization imaging for the assessment of dental lesions

Abstract Dental caries is one of the most widespread diseases and the early and non-invasive detection of carious lesions remains an ongoing topic in biomedical research. In contrast, optical coherence tomography (OCT) is an emerging, non-invasive imaging technique for near-surface structures, that has already proved its capability for manifold biomedical applications and can be extended by several modalities such as polarization sensitivity. We have recently shown that polarization sensitive OCT combined with an algorithm for depolarization imaging, visualizing the degree of polarization uniformity (DOPU), is a promising tool for the detection and assessment of carious lesions. In this paper, we evaluate different visualization approaches based on both the intensity and DOPU data with cross-sectional and en-face representations and discuss limitations and the potential of the proposed method for the assessment of dental lesions on the example of a molar tooth with a brown spot.

Influence of brightness and contrast adjustments on the diagnosis of proximal caries lesions.

To assess the influence of brightness and contrast adjustments of digital radiographs on the diagnosis of proximal caries lesions, and to compare with observers' preferences for subjective image quality. 80 proximal surfaces of posterior teeth were radiographed using an intraoral digital system (Digora Toto, Soredex, Finland). Initial images and four different combinations of brightness and contrast for each radiography were analysed. Five observers scored the images for the presence and extension of caries lesions. Micro-CT images were used as gold standard. In a second stage, the observers were asked which of the radiographs they preferred for the assessment of caries lesions. No differences were found between the original and adjusted radiographic images regarding the area under the receiver operating characteristic curve, sensitivity, and specificity (p > 0.05). There was a significant difference between the micro-CT and the intraoral radiographs (p < 0.0001). Images with high brightness and low contrast presented higher number of true negative cases, but also a decrease in caries detection. On the other hand, there were more cases of overestimation of the presence and extension of caries lesions in images with low brightness and high contrast. The subjective evaluation of image quality showed that radiographs with lower brightness and higher contrast tended to be preferred by observers. Brightness and contrast adjustments in digital intraoral radiographs within the range tested in this study do not significantly influence the diagnosis of proximal caries lesions, although observers tend to prefer lower brightness and higher contrast images.

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.

Ultrashort echo time (UTE) MRI for the assessment of caries lesions

Objective:Direct in vivo MRI of dental hard tissues by applying ultrashort echo time (UTE) MRI techniques has recently been reported. The objective of the presented study is to clinically evaluate the applicability of UTE MRI for the identification of caries lesions.Methods:40 randomly selected patients (mean age 41 ± 15 years) were enrolled in this study. 39 patients underwent a conventional clinical assessment, dental bitewing X-ray and a dental MRI investigation comprising a conventional turbo-spin echo (TSE) and a dedicated UTE scan. One patient had to be excluded owing to claustrophobia. In four patients, the clinical treatment of the lesions was documented by intraoral pictures, and the resulting volume of the cavity after excavation was documented by dental imprints and compared with the MRI findings.Results:In total, 161 lesions were identified. 157 (97%) were visible in the UTE images, 27 (17%) in the conventional TSE images and 137 (85%) in the X-ray images. In total, 14 teeth could not be analysed by MR owing to artefacts caused by dental fillings. All lesions appear significantly larger in the UTE images as compared with the X-ray and TSE images. In situ measurements confirm the accuracy of the lesion dimensions as observed in the UTE images.Conclusion:The presented data provide evidence that UTE MR imaging can be applied for the identification of caries lesions. Although the current data suggest an even higher sensitivity of UTE MRI, some limitations must be expected from dental fillings.

Feasibility of ultra‐short echo time (UTE) magnetic resonance imaging for identification of carious lesions

The objective of this study was to investigate the potential of ultra short echo time imaging for the assessment of caries lesions and early demineralization. 12 patients with suspected caries lesions underwent a dental magnetic resonance imaging investigation comprising ultra short echo time imaging (echo time=50 μs) and spin echo imaging. Before the dental magnetic resonance imaging, all patients underwent a conventional clinical dental investigation including visual assessment of the teeth as well as dental x-ray imaging. All lesions identifiable in the x-ray could be clearly identified in the ultra short echo time images, but only about 19% of the lesions were visible in the spin echo images. In 19% of all lesions, the lesions could be more clearly delineated in the ultra short echo time images than in the x-ray images. This was especially the case for secondary lesions. In direct comparison with the x-ray images, all lesions appeared substantially larger in the dental magnetic resonance imaging data. The presented data provide evidence that caries lesions can be identified in ultra short echo time magnetic resonance imaging with high sensitivity. The apparent larger volume of the lesions in dental magnetic resonance imaging may be attributed to fluid accumulation in demineralized areas without substantial breakdown of mineral structures.

Caries Detection Methods Based on Changes in Optical Properties between Healthy and Carious Tissue.

A conservative, noninvasive or minimally invasive approach to clinical management of dental caries requires diagnostic techniques capable of detecting and quantifying lesions at an early stage, when progression can be arrested or reversed. Objective evidence of initiation of the disease can be detected in the form of distinct changes in the optical properties of the affected tooth structure. Caries detection methods based on changes in a specific optical property are collectively referred to as optically based methods. This paper presents a simple overview of the feasibility of three such technologies for quantitative or semiquantitative assessment of caries lesions. Two of the techniques are well-established: quantitative light-induced fluorescence, which is used primarily in caries research, and laser-induced fluorescence, a commercially available method used in clinical dental practice. The third technique, based on near-infrared transillumination of dental enamel is in the developmental stages.