History Of Caries Research Articles

Hypokalemic paralysis in a girl with dental and renal calculi: Questions

A 15-year-old Chinese girl presented to the emergency department with muscle paralysis of bilateral lower extremities over the course of 1 day. She had a 2-year history of polyuria, nocturia, and rampant dental caries and calculi. She denied vomiting, diarrhea, or use of alcohol, laxatives, or diuretics, and her family history was unremarkable. Her pulse rate was 90/min, blood pressure 112/72 mmHg, and body temperature 36.4 °C. Physical examination revealed severe dental caries and calculi (Fig. 1a) with dry oral mucosa. Her thyroid gland was not enlarged. Neurologic examination disclosed symmetric flaccid paralysis with areflexia of both lower extremities. The remainder of the physical examination was unremarkable. The most striking biochemical abnormalities were profound hypokalemia (1.8 mEq/l) and hyperchloremic metabolic acidosis (pH 7.28, HCO3 – 16.6, Na 141 and Cl 114 mEq/l). Her renal, liver, and thyroid function were all normal (creatinine 0.9 mg/dl). Urinalysis revealed proteinuria (1+), low urine specific gravity (1.010), high K excretion (transtubular K gradient 5, 24-h urine K 38 mEq/day), positive urine anion gap (Na 43, K 16 and Cl 39 mEq/l) and persistent alkaline urine (pH 7–7.5). Electrocardiogram revealed prolonged PR interval with flattened T wave. Abdominal ultrasonography showed bilaterally medullary nephrocalcinosis (Fig. 1b). Questions:

A longitudinal study of occlusal caries in Newark New Jersey school children: Relationship between initial dental finding and the development of new lesions

ObjectiveDental caries is a significant public health problem especially amongst children from low-income backgrounds. This longitudinal study examined the development of new occlusal caries in 227 Newark, NJ children ages 10–18. The role of previous caries experience and the presence of occlusal white and dark lesions in predicting the development of new lesions were examined. DesignAt each visit, the patient's teeth were given a visual-tactile examination and the subject's decayed, missing and filled (DMFS) score was determined. Next, molars lacking probeable caries or restorations were examined using transillumination for occlusal white and dark spots. This examination was repeated periodically. A Cox proportional hazard was used to analyse data concerning the development of new occusal caries in molars. ResultsThe longitudinal data indicates that patients who were caries free at visit-1 developed significantly fewer occlusal caries during the longitudinal study. The hazard ratio for subjects who had first-visit caries was 2.27 compared to caries free subjects. Intact molars with occlusal white or dark lesions had caries hazard ratios of 0.78 and 1.49 respectively, compared to molars lacking initial colour changes. ConclusionHaving a prior caries history places the subject at increased risk of developing future caries. Teeth with dark lesions but not white lesions are at significantly increased risk for developing decay. White lesions may represent remineralizing or slowly progressing lesions. The results of this study can help identify patients and tooth surfaces at risk for future occlusal decay.

The Natural History of Dental Caries Lesions

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.

Prevalence and severity of dental caries among American Indian and Alaska Native preschool children

To describe the Indian Health Service (IHS) oral health surveillance system and the oral health status of American Indian and Alaska Native (AI/AN) children aged 1-5 years. A stratified probability sample of IHS/tribal sites was selected. Children were screened by trained examiners at community-based locations including medical clinics, Head Start, preschools, kindergarten, and Women, Infants, and Children (WIC). Data collection was limited to the primary dentition and included number of teeth present plus number of teeth with cavitated lesions, restorations, and extracted because of decay. Number of molars with sealants and urgency of need for dental care data were also obtained. Statistical analyses were performed with SAS (SAS Institute Inc., Cary, NC, USA). Sample weights were used to produce population estimates based on selection probabilities. A total of 8,461 AI/AN children 12-71 months of age were screened at 63 IHS/tribal sites, approximately 7 percent of the estimated IHS user population of the same age. Overall, 54 percent of the children had decay experience, 39 percent had untreated decay, 7 percent had primary molar sealants, 36 percent needed early or urgent dental care, and 6 percent needed urgent dental care. The mean of decayed, missing, or filled teeth was 3.5 (95 percent confidence interval, 3.1-3.9). The prevalence of decay experience increased with age; 21 percent of 1-year-olds and 75 percent of 5-year-olds had a history of caries. When stratified by IHS area, there were substantial differences in the oral health of preschool children. The results confirm that in the United States, AI/AN children served by IHS/tribal programs are one of the racial/ethnic groups at highest risk of caries.

Caries and obesity in 6 year-old schoolchildren from the Metropolitan region (MR) of Santiago, Chile

PURPOSE: Dental caries and obesity are multifactorial diseases of high prevalence in Chilean child population, and both are preventable from early age. They share association with diet habits and socio-cultural determinants. The objective of this study was to determine the coexistence between caries and obesity in 6 year-old schoolchildren from the Metropolitan Region of Santiago, Chile. METHODS: A sample was composed by 571 6 year-old schoolchildren from the fluoridated communes of the Metropolitan Region of Santiago, Chile, in 2004-2005. Caries diagnosis was performed by using the WHO criteria for epidemiological studies. Nutritional diagnosis was carried out according to BMI/age and sex in relation to CDC-NCHS curves, considering obese children with a ≥95 percentile. Socioeconomic level (SEL) and sex were recorded. RESULTS: No statistically significant difference was found between caries history and nutritional status (NS) (P=0.837), in both primary and permanent dentition (P=0.306).There was no risk association (OR 0.88; IC 0.60-1.28; 95%). Overweight children had less caries prevalence and history than normal weight and obese children. No relationship was found at the multivariate analysis between NS, SEL and caries occurrence. CONCLUSION: Obesity is not related to dental caries in this sample. Overweight children had less caries prevalence and severity.

Parental Perspectives of Early Childhood Caries

BACKGROUND. Parental perspectives of children with early childhood caries may help inform the development and improvement of caries prevention strategies. OBJECTIVES. This study aimed to explore parents' experiences, perceptions, and expectations regarding prevention and management of early childhood caries. Methods. The authors conducted semistructured interviews with 25 parents of children aged 2 to 5 years, with a known history of caries. All interviews were transcribed and coded, and iterative analyses were conducted to identify key emergent themes within the data. RESULTS. Parents had limited knowledge of behaviors contributing to early childhood caries and when to first seek regular dental care. Parents expected pediatricians to provide education on how to prevent childhood caries, conduct preliminary oral health assessments, and help establish early linkages between medical and dental care. CONCLUSION. The findings make a strong case for pediatricians to take responsibility for engaging and educating parents on fostering optimal oral health and helping to access early childhood dental care.

Al and Fe levels in mixed saliva of children related to elution behavior from teeth and restorations

Objectives The levels of trace elements in mixed saliva were not well-defined. This study was performed to determine Al and Fe concentrations in mixed saliva of children and to investigate the relationship between these levels and dental caries. Methods Among 562 collected mixed saliva specimens, 514 and 548 samples for analyses of Al and Fe levels were obtained, respectively. The Al and Fe concentrations were determined using flameless atomic absorption spectrometry. Results The Al and Fe concentrations in children without a history of caries were 0.093 ± 0.136 and 0.121 ± 0.128 μg/mL, respectively. The Fe level depended on sex. The Fe level in girls who experienced caries was significantly higher than that without caries history. The Al and Fe levels were significantly higher in children with treated caries than children without caries history. The Fe concentrations were affected by restoration type. Composite resin increased the Fe level significantly especially in girls, and the Fe level was also higher in boys treated with both composite resin and metal restorations. In children without caries history, the Al level was inversely proportional to the number of deciduous teeth and increased with the number of permanent teeth. In contrast, the Fe level showed the reverse tendency. Conclusions The Fe level in mixed saliva of children was influenced by the restoration type. It was suggested that Al was eluted more from sound permanent teeth than sound deciduous teeth, while Fe was eluted in the opposite manner.

Pulmonary resection for lung cancer with impaired pulmonary function due to severe spinal deformity: Report of a case

A 58-year-old man underwent surgery for the treatment of lung adenocarcinoma at our hospital. He had a history of spinal caries at the age of 3 and frequent recurrent asthma-like symptoms thereafter. Chest plain radiography revealed an irregularly shaped mass in the left hilum and a thoracic cage severely deformed by kyphosis. A pulmonary function test demonstrated a severe restrictive ventilation pattern. He underwent a left upper lobectomy without mediastinal dissection. His asthma-like symptoms were exacerbated by difficulty in expectoration of sputum for several days after surgery, but the symptoms disappeared without any medical care. Dyspnea, hemoptysis, and intrathoracic hemorrhage were observed on the 8th postoperative day. Computed tomography revealed torsion of the residual left lower lobe, but the symptoms spontaneously disappeared in a week. The patient had complained of frequent coughing and mild dyspnea on exertion for years, but his quality of life was unchanged after the lobectomy. Bone metastasis was detected 3 years after the surgery, and the patient then underwent chemotherapy. However, he died of the disease 4 years 2 months after the surgery.

The Monitor Practice Programme: is non‐invasive management of dental caries in private practice cost‐effective?

The objective of this research was to assess the efficacy and cost-effectiveness of a non-invasive approach to dental caries management in private dental practice. Private dental practices from a variety of locations in New South Wales were randomly allocated to either non-invasive management of caries, or continue with usual care. Patients were followed for three years and caries incidence assessed. A patient-level decision analytic model was constructed to assess the cost-effectiveness of the intervention at two years, three years, and hypothetical lifetime. Twenty-two dental practices and 920 patients were recruited. Within the clinical trial there was a significant difference in caries increment favouring non-invasive therapy at both two and three years. Efficacy was independent of age, gender, medical concerns, fluoride history, or previous history of dental caries, in a population of patients attending for treatment in private dental practices, in a variety of locations both urban and rural. Cost per DMFT avoided estimate was A$1287.07 (two years), A$1148.91 (three years) decreasing to A$702.52 in (medium) and A$545.93 (high) risk patients (three years). A joint preventive and non-invasive therapeutic approach appears to be cost-effective in patients at medium and high risk of developing dental caries when compared to the standard care provided by private dental practice.

Discriminant ability for caries risk of modified colorimetric tests

The aim of this study was to evaluate the relationship between the caries risk in children over a two-year period and their baseline caries status, salivary levels of mutans streptococci and lactobacilli, and results of the Alban test and modifications thereof using different substrates. Ninety-five children aged 6-7 were examined in Granada (southern Spain) for dental caries at baseline and every six months. Stimulated saliva was sampled and inoculated in 7 colorimetric tests based on Snyder's medium with different sugars and polyalcohols. A mutans streptococci and lactobacilli count was performed (Dentocult SM strip® and Dentocult LB®). Caries risk proportions were contrasted against the potential predictor variables, i.e., basal caries history and salivary tests, by means of the Mantel Haenszel test for linear association, based on a chi-square distribution with 1 degree of freedom (df). Caries index, lactobacillus count and colorimetric tests showed significant, but limited, and non-different discriminant abilities. Increasing values of all predictor variables, except for Dentocult SM®, were related to increasing caries risk proportions. Colorimetric test results and caries history showed similar correlation values as caries predictors.

Evaluation of the history of caries and associated factors among quilombolas in Southeastern Brazil

Evaluation of the history of caries and associated factors among quilombolas in Southeastern Brazil

Improperly Formed Maxillary Teeth

A general dentist referred a 14-year-old boy to an oral surgeon (J.S.S.) because he was missing multiple maxillary left teeth. The patient was otherwise asymptomatic, and the principal concern was the missing teeth. The patient was healthy and had undergone surgery to correct hypospadias (congenital malformation of the penis in which the urethral opening is on the underside) at 3 years of age. The results of an extraoral examination revealed normal facial symmetry. The results of an intraoral clinical examination showed hypoplasia of the left posterior maxillary alveolar process but normal occlusion. The left maxillary premolars were absent (Figure 1). The patient had retained his left maxillary primary canine, which had been extracted two weeks before the oral surgeon examined him. The maxillary lateral incisors had been peg shaped and had received dental veneers. Eruption of tooth no. 27 was delayed. No masses were palpable, and the overlying mucosa and gingiva appeared normal. The involved teeth had no history of caries or trauma. The patient’s oral hygiene was excellent. We obtained a computed tomographic scan of the patient. It revealed segmental deformity or dysplasia of the left maxillary alveolar ridge with associated deformity in the position or development of the maxillary left canine and first and second premolars. We detected no other skeletal abnormalities. We also noted these defective maxillary teeth on the panoramic and periapical radiographs (Figures 2 and 3). The maxillary left first and second molars appear to be normal in position and appearance, and the mandibular teeth were normal in appearance. The oral surgeon surgically removed the defective teeth and submitted them to oral pathologists (I.B., D.M.C.) for microscopic examination. Histopathological examination of the decalcified hard tissue revealed anomalous toothlike structures associated with spherical droplets of cementumlike material. We noted aggregates of calcified abnormal dental hard tissue in the defective teeth (Figure 4).

There are no Clearly Superior Methods for Diagnosing, Predicting, and Noninvasively Treating Dental Caries

To be included in the systematic review, all articles were required to meet predetermined criteria: the results of the studies should be relevant to the questions posed by the project, ie, have appropriate outcome measures and an appropriate follow-up period and study design. With respect to diagnosis, the efficacy of the various methods was compared with reference methods that included studies of extracted teeth. For prediction, the material comprised mainly prospective studies, where the reliability of risk assessment could be evaluated. With respect to treatment of early caries lesions, it was a requirement for inclusion that the study had a control group. For caries detection of accessible surfaces, visual-tactile testing was used. Radiographic diagnosis was used for approximal surfaces. For caries risk prediction, modeling was used to determine the influence of specific variables (eg, sugar intake). For noninvasive treatment assessment, size of lesion growth or shrinkage after treatment was used. Caries detection: Visual-tactile detection for accessible surfaces carried the best, but far from optimal, accuracy. Although specificity tends to be high with this method, sensitivity is low. Caries risk prediction: Streptococcus mutans count, salivary Lactobacillus count, salivary buffering capacity, visible plaque levels, and sugar intake have low accuracy. The best, but still far from optimal, predictor was past caries history. Noninvasive methods of caries treatment: Too few studies exist for meaningful analysis. (1) Past caries is the best predictor of future caries. (2) A combination of visual-tactile and radiographic examination is better than either method alone. (3) There is insufficient evidence to support noninvasive treatment of early caries. STUDY OBJECTIVE AND METHODS: To perform a systematic review of published literature to (1) determine the evidence for the effectiveness of different methods (visual-tactile versus radiographic) for detecting caries; (2) identify the most prescient predictors of dental caries; and (3) evaluate the evidence supporting the use of noninvasive methods for the treatment of caries, particularly early caries. With regard to the questions posed by the study team: (1) Past caries is the best predictor of future caries; (2) a combination of visual- tactile and radiographic examination is better than either method alone; and (3) there is insufficient evidence to support noninvasive treatment of early caries.

The VicGeneration study--a birth cohort to examine the environmental, behavioural and biological predictors of early childhood caries: background, aims and methods.

BackgroundDental caries (decay) during childhood is largely preventable however it remains a significant and costly public health concern, identified as the most prevalent chronic disease of childhood. Caries in children aged less than five years (early childhood caries) is a rapid and progressive disease that can be painful and debilitating, and significantly increases the likelihood of poor child growth, development and social outcomes. Early childhood caries may also result in a substantial social burden on families and significant costs to the public health system. A disproportionate burden of disease is also experienced by disadvantaged populations.Methods/DesignThis study involves the establishment of a birth cohort in disadvantaged communities in Victoria, Australia. Children will be followed for at least 18 months and the data gathered will explore longitudinal relationships and generate new evidence on the natural history of early childhood caries, the prevalence of the disease and relative contributions of risk and protective biological, environmental and behavioural factors. Specifically, the study aims to:1. Describe the natural history of early childhood caries (at ages 1, 6, 12 and 18 months), tracking pathways from early bacterial colonisation, through non-cavitated enamel white spot lesions to cavitated lesions extending into dentine.2. Enumerate oral bacterial species in the saliva of infants and their primary care giver.3. Identify the strength of concurrent associations between early childhood caries and putative risk and protective factors, including biological (eg microbiota, saliva), environmental (fluoride exposure) and socio-behavioural factors (proximal factors such as: feeding practices and oral hygiene; and distal factors such as parental health behaviours, physical health, coping and broader socio-economic conditions).4. Quantify the longitudinal relationships between these factors and the development and progression of early childhood caries from age 1-18 months.DiscussionThere is currently a lack of research describing the natural history of early childhood caries in very young children, or exploring the interactions between risk and protective factors that extend to include contemporary measures of socio-behavioural factors. This study will generate knowledge about pathways, prevalence and preventive opportunities for early childhood caries, the most prevalent child health inequality.

Pit and Fissure Sealants: An Unused Caries Prevention Tool

ABSTRACTPit and fissure sealants along with fluoridation and good oral hygiene is an important tool for the prevention of dental caries in children and adolescents.RECOMMENDATIONSThe following recommendations are based on the evidence gathered: 1. Sealants should be placed on all permanent teeth without cavitation (i.e., teeth that are free of caries, teeth that have deep pit and fissure morphology, teeth with “sticky” fissures or teeth with stained grooves) as soon after eruption as isolation can be achieved. 2. Sealants should not be placed on partially erupted teeth or teeth with cavitation or caries of the dentin. 3. Sealants should be placed on the primary molars of children who are susceptible to caries (i.e., those with a history of caries). 4. Sealants should be placed on first and second molars within 4 years after eruption. 5. Resin-based sealants should be preferred, until such time as glass ionomer cements with better retention capacity are developed. 6. Sealants should be placed as part of an overall prevention strategy based on assessment of caries risk. Sealing is a recommended procedure to prevent caries of the occlusal surfaces of permanent molars. Though the effectiveness of sealants is obvious at high caries risk groups there is still some degree of latitudein operators preference for sealant placementand material selection.

Osteomielite de Garré: atualização do tema e relato de dois novos casos clínicos

The present article aimed to update and report two clinical cases of Garre’s osteomyelitis in children. In the first case, there was history of dental caries in the tooth 36 submitted to extraction ten days before. Extraorally it was observed painful tumefaction in left submandibular region. The occlusal radiography showed expansion of the board vestibular bone in concentric layers. The treatment was antibiotics after culture and antibiogram. The second case presented swelling in the left submandibular, metallic restoration in the tooth 36 with periapical radiolucent image. It was applied endodontic treatment and antibiotics. The condition has evolved favourably in both reported cases with signs of relapse after follow-up of 3 months

The utility of dental patterns in forensic dentistry

The comparison of antemortem and postmortem dental patterns, which reflect a combination of dental states, can be quantified for human identification. However, the utility derived from the uniqueness of these patterns is limited by variations in oral health status related to population, age, and birth cohort. We analyzed dental pattern diversity from reference datasets that documented differences in oral health. Our analysis was based on full dentitions and partial dentitions available in forensic situations. To analyze the diversity of dental patterns, data from 3166 adults were extracted from the last 3 contemporary Spanish National Oral Health Examination Surveys, corresponding to the years 1993, 2000, and 2005. Each survey comprised 2 adult age groups (35–44 years and 65–74 years), therefore six datasets were available for our study. Our six samples showed substantial variability in oral health status (caries history) and dental code distribution, not only between age groups within the same survey year, but also between different survey years for the same age group. To test the overall diversity of dental patterns in each datasets, pairwise comparisons were performed and the total number of pattern matches was generated. We calculated total and conditional diversity (excluding individuals in whom all teeth were classified as unrestored or missing) for each forensic situation. To test the homogeneity of diversity estimates among the six datasets we used a random effect model that requires a parameter estimate together with its standard error. Total diversity values were low and heterogeneous. However, conditional diversities were high and homogeneous, which allowed all data to be pooled into a single database. Once data were pooled, high combined diversity values (above 0.99) were obtained for each forensic situation. This indicates their usefulness for forensic purposes. We conclude that the conditional diversity value derived from dental patterns is a potentially valuable tool with broad applicability for human identification.

Relationships Between Caregivers' Responses to Oral Health Screening Questions and Early Childhood Caries

This study evaluated relationships between caregiver responses to oral health screening questions and caries in young children. Two samples of caregivers answered identical eight-item screening questionnaires about their oral health. One sample included children enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) who were 24 to 42 months of age; the other sample included 3- to 5-year-old children attending a pediatric dental clinic. Using chi-square and relative risk, questionnaire findings were related to children's caries history based on clinical caries exams. Questions significantly (P < 0.05) related to children's caries in the older sample included caregivers' poorer rating of their oral health, less frequent dental visits, current or recent caries, and history of tooth loss due to caries. However, only questions pertaining to tooth loss were related to caries in the younger sample. Caregivers' reported loss of teeth due to caries was significantly associated with caries development in their children in both samples, and may be a useful means for early identification of children at high risk.

A pilot study of the association between cariogenic oral bacteria and preterm birth*

We examined the associations between preterm birth and low birth weight and maternal caries history, maternal periodontal status, and salivary levels of mutans streptococci and Lactobacilli. This study was a matched case-control study in women during their pregnancy or up to 8 weeks after delivery. Thirty-four women delivering before 37 weeks gestation were recruited along with 73 term controls matched for age and race/ethnicity. Demographic and obstetric information was collected from questionnaires and medical records and oral examinations along with commercial salivary tests were completed within the study groups. The main outcome variables were the preterm birth and low birth weight status. The independent variables measured were the salivary levels of Lactobacilli and mutans streptococci and the caries and periodontal status of the subjects. The odds ratio comparing low levels of bacteria in preterm mothers and controls was statistically significant for Lactobacilli (odds ratio (OR) = 3.45, 95% confidence interval (CI) = 1.27 to 10.00) and almost significant for mutans streptococci (OR = 2.63, 95% CI = 0.95 to 8.33). Clinical caries and periodontal disease measures did not differ significantly between groups. Within the limitation of our study, low levels of Lactobacilli in saliva were found to be associated with preterm birth.

Caries experience in primary molars and its impact on the variability in permanent tooth emergence sequences

Objectives A history of caries in the primary molars is associated with an advanced emergence of their permanent successors. Hence, caries in the primary molars may have an impact on the emergence order of the permanent teeth. The aim of the present study was to fully investigate the variability in permanent tooth emergence, taking into account the (caries) status of the primary molars. Methods For this purpose data available from the Signal Tandmobiel ® project were used. In this prospective longitudinal survey data were collected from a representative sample of 4468 children, examined yearly by trained dentist-examiners. Bayesian statistical analyses taking into account the interval-censored character of the data were performed. Results 56% of all examined primary molars were sound; between 2.5 and 7.2% of the first and second primary molars were extracted due to caries. When both primary molars were sound, the most prevalent emergence order was ‘4–3–5–7’ (first premolar–canine–second premolar–second molar) in the maxilla and ‘3–4–5–7’ in the mandible. When both maxillary primary molars were affected by caries (i.e., decayed, filled or extracted due to caries), the sequence ‘4–5–3–7’ was the most prevalent whereas sequences ‘3–4–5–7’ and ‘4–3–5–7’ were less prevalent. When both mandibular primary molars were affected by caries, the prevalence of sequences ‘4–3–5–7’, ‘4–3–7–5’ and ‘4–5–3–7’ increased whereas the prevalence of sequences ‘3–4–5–7’ and ‘3–4–7–5’ decreased. Conclusions A history of caries in the primary molars is associated with an altered emergence order of canines, premolars and second molars.