Enamel Caries Research Articles

Association between developmental defects of enamel and early childhood caries in children under 6 years old: A systematic review and meta-analysis.

Early childhood caries (ECC) are an oral health problem worldwide in children under 6 years of age. This disease of rapid development has a multifactorial etiology, and one of the possible risk factors is developmental defects of enamel (DDE), such as hypoplasia and opacities. The aim of this systematic review was to evaluate the association between DDE and ECC in children under 6 years of age. An electronic search was conducted until March 2022 using Medline (PubMed), Scopus, Science-Direct, LILACS, Web of Science, Cochrane Library, EBSCO-Host, EMBASE, and Google Scholar and complemented with a manual search, with no restrictions on language or date of publication. Longitudinal studies of children under 6 years of age with primary dentition were included. A total of 1158 studies were found, of which 651 records were reviewed by title and abstract, and 24 articles were selected for full-text evaluation. Finally, nine studies that met the selection criteria were included in the qualitative synthesis. Study quality and certainty were assessed using the Newcastle-Ottawa scale and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Three cohort studies of good quality were included in the meta-analysis. A risk associated with DDE (RR = 1.94; 95% CI: 1.52–2.49) and a risk associated with enamel hypoplasia (RR = 5.45; 95% CI: 1.84–16.14) were found. The results for diffuse opacity (RR = 1.21; 95% CI: 0.18–8.15) and demarcated opacity (RR = 1.26; 95% CI: 0.43–3.65) were not significant. GRADE analysis presented low and very low certainty of evidence. It was concluded that there is an association between DDE and ECC. However, the results should be interpreted with caution because of the limitations of the study.The protocol for this study has been registered in PROSPERO under identification number CRD42021238919.

Evaluation of Incipient Enamel Caries at Smooth Tooth Surfaces Using SS-OCT.

(1) Background: Dental caries, if diagnosed at the initial stage, can be arrested and remineralized by a non-operative therapeutic approach preserving tooth structure. Accurate and reproducible diagnostic procedure is required for the successful management of incipient caries. The aim of this study was to evaluate the diagnostic accuracy of 3D swept-source optical coherence tomography (3D SS-OCT) for enamel caries at smooth tooth surface if the lesion was with remineralization. (2) Methods: Forty-seven tooth surfaces of 24 extracted human teeth visibly with/without enamel caries (ICDAS code 0–3) were selected and used in this study. The tooth surfaces of investigation site were cleaned and visually examined by four dentists. After the visual inspection, SS-OCT scanning was performed onto the enamel surfaces to construct a 3D image. The 2D tomographic images of the investigation site were chosen from the 3D dataset and dynamically displayed in video and evaluated by the examiners. A five-rank scale was used to score the level of enamel caries according to the following; 1: Intact enamel. 2: Noncavitated lesion with remineralization. 3: Superficial noncavitated lesion without remineralization. 4: Deep nonvacitated lesion without remineralization. 5: Enamel lesion with cavitation. Sensitivity and specificity for 3D OCT image and visual inspection were calculated. Diagnostic accuracy of each diagnostic method was calculated using weighted kappa. Statistical significance was defined at p = 0.05. (3) Results: 3D SS-OCT could clearly depict enamel caries at smooth tooth surface as a bright zone, based on the increased backscattering signal. It was noted that 3D SS-OCT showed higher sensitivity for the diagnosis of remineralized lesions and deep enamel lesions without cavitation, as well as cavitated enamel lesions (p < 0.05). No significant difference of specificity was observed between the two diagnostic methods (p > 0.05). Furthermore, 3D SS-OCT showed higher diagnostic accuracy than visual inspection (p < 0.05). (4) Conclusions: Within the limitations of this in vitro study, 3D SS-OCT showed higher diagnostic capacity for smooth surface enamel caries than visual inspection and could also discriminate lesion remineralization of enamel caries.

Effects of dental anxiety on dental caries and salivary alkaline phosphatase in children with different nutritional status

Objectives: Dental anxiety among children is a familiar problem. The study (cross sectional) was conducted to evaluate dental anxiety precedes the first dental examination in relation to dental caries experience according to nutritional status of children and to measure salivary alkaline phosphatase in relation to dental anxiety. Material and Methods: A total of 82 children aged six to eight years old, selected from public clinics in Baghdad city were divided into two groups: anxious and non-anxious group according physiological measures (heart rate and oxygen saturation) before first dental treatment. Weight and height for each child were measured to determine the nutritional status (normal weight, overweight and obese). Dental caries (experience and severity) in children with different nutritional status were recorded by using DMF, dmf and Manjie et al indices. Saliva was collected to analyze salivary alkaline phosphatase. Results: No statistical significant differences were observed between anxious and non-anxious children in means of dmf and DMF indices for primary and permanent teeth (p&gt;0.05). Higher mean of D1 (initial enamel caries) was found in non-anxious children than anxious with statistical significant difference (P&lt;0.05) in normal weight children only. Salivary alkaline phosphatase was not significantly different between the two groups.

Is Silver Diamine Fluoride Effective in Arresting Enamel Caries? A Randomized Clinical Trial.

Background: There is limited information on the effectiveness of 38% silver diamine fluoride (SDF) in managing enamel caries. Objective: This study aimed to compare effectiveness of 38% SDF and 5% Sodium fluoride (NaF) varnish in arresting enamel caries in young children when applied semiannually over 18 months. Methods: A randomized controlled trial was conducted on children aged 1–3 years who had at least one active carious surface. They were allocated into two groups: Group 1 (38% SDF) and Group 2 (5% NaF varnish). Visual-tactile examination was used to assess extent of carious lesions. Enamel caries that did not progress to dentin were classified as having caries arrest. Intention-to-treat analysis was performed. Results: At baseline, 290 children with 1974 tooth surfaces with enamel caries were recruited. Caries arrest rates at the tooth surface level in Group 1 and Group 2 were 59.1% and 58.8%, respectively (p = 0.873), at 18 months. The multilevel logistic regression analysis revealed that tooth position, tooth surface, extent of enamel caries at baseline, caries experience, and brushing with fluoride toothpaste influenced caries arrest (p < 0.05). Conclusion: The semiannual application of 38% SDF and 5% NaF varnish had comparable effectiveness in arresting enamel caries in primary teeth.

Fissure sealing and caries development in Norwegian children

PurposeTo explore the use of fissure sealing as a caries preventive method by describing characteristics of children who had received sealants and to study associations between sealing and caries prevalence at 12 years of age.MethodsThe study included 3075 children examined at 5 and 12 years of age. Data were collected by clinical examination and questionnaire to parents. The questionnaire provided information on child characteristics and oral health behaviour in children at 5 years of age. Data on sealing and caries prevalence were obtained from dental records. Bi- and multivariate logistic regressions were performed. The Regional Committee for Medical Research Ethics approved the study (2.200.54 and 2013/1881).ResultsOf the children, 12% had received sealants on permanent teeth before 12 years of age. Children with dentin caries at 5 years of age (OR 2.0, CI 1.5–2.7) had a higher probability of having received sealants than children without caries. Having sealants (OR 2.8, CI 2.2–3.6), enamel caries (OR 1.5, CI 1.2–1.9), dentin caries (OR 2.9, CI 2.3–3.6) and using fluoride lozenges less than daily (OR 1.5, CI 1.3–1.8) at 5 years of age were associated with having dentin caries prevalence at 12 years of age.ConclusionFew children had received fissure sealing. Although sealing was used as a caries preventive method in children who had experienced caries in primary teeth, these children continued developing caries in their permanent teeth.

Дослідження активності каріозного процесу у осіб різного віку, за допомогою індексної оцінки КПВ та ICDAS

The purpose of the work was to study the activity of the carious process in people of different ages using the assessment of the Decayed, Missing, and Filled Teeth and the International Caries Detection and Assessment System index. Materials and methods. The study involved 53 people who were divided into groups: group 1 – 16 people aged 18 to 25 years, group 2 – 20 people aged 26 to 35 years and group 3 – 17 people aged 36 to 45 years. The intensity of caries was determined using the Decayed, Missing, and Filled Teeth index. The International Caries Detection and Assessment System index was used to assess the activity of carious lesions. Results. The indicators of the Decayed, Missing, and Filled Teeth index in the group of people aged 18-25 years significantly differed (p &lt;0.05) from the indicators in the group of people aged 26-45 years. In the group of people aged 36-45 years the indicators were higher than in the group of people aged 26-45 years, but no significant difference (p˃0.05) was found. In the group of people aged 18-25 years the share of filled teeth was 61.5%, teeth affected by caries were found in 29.4%, and removed teeth – in 9.1%. In the group of people aged 26-45 years, the rate of filled teeth was lower compared to people of the 1st group, the share of carious teeth increased up to 35.0%, and the number of removed teeth increased up to 16.4%. In the group of people aged 36-45 years the share of teeth affected by caries was lower than in the 1st and 2nd groups and was equal to 27.3%, the share of filled teeth was 46.2%, which is lower than in other groups, but the share of removed teeth was the highest of the groups which were examined and was 26.5%. The results indicate a rapid increase in the intensity of caries in patients of main working age, namely persons of the 2nd and 3rd groups compared with persons of young working age of the 1st group. The study of the depth of caries in enamel and dentin according to the International Caries Detection and Assessment System showed that in patients aged 18-25 years, from all teeth which are affected by caries in 71.4% enamel caries was found, which averaged 1.81 ± 0.2 teeth and in 28.6% – dentin lesions, which was an average of 0.68 ± 0.2. In patients aged 26-35 years, codes 1-3 accounted for 41.0% of affected teeth (mean 2.05 ± 0.1 teeth) and code 4-6 accounted for 59.0% of affected teeth (average 2.95 ± 0.2 teeth). In patients of the oldest age group, the number of teeth affected by caries with a code of 1-3 was 27.9% (average of 1.12 ± 0.1 teeth) and with a code of 4-6 was 72.1% (average of 2.88 ± 0.2 teeth). Conclusion. As the age of patients increases, the proportion of filled teeth decreases, but the proportion of removed teeth increases. The highest percentage of teeth affected by caries was found in the 3rd group. As the age of patients increases, both the average number of carious teeth and the number of teeth with damage dentin increase

Remineralization and Antibacterial Efficacy of Different Concentrations of Aqueous Stevia extract and green tea Solutions in Comparison with Fluoride-based Mouthwash on Initial Enamel Carious Lesion- An Invitro Study

Remineralization and Antibacterial Efficacy of Different Concentrations of Aqueous Stevia extract and green tea Solutions in Comparison with Fluoride-based Mouthwash on Initial Enamel Carious Lesion- An Invitro Study

Changes in Knowledge After Education with Demonstration and Actions for Email Carries Treatment with Autraumatic Restrorative Treatment

ABSTRACT Education is a learning process from not knowing to knowing. The provision of education is a very important need for human life so that the goals of the learning process or health education lead to the achievement of goals. Education, namely for behavior change, can be done by several methods, including lectures, discussions, demonstrations, simulations and others. There is also the provision of dental caries treatment with the Autraumatic Restorative Treatment technique as a form of early rescue effort that is carried out to prevent tooth decay from getting worse. This study aims to determine changes in knowledge and attitudes after being given education with demonstrations and actions for treating enamel caries with the Autraumatic Restorative Treatment technique. This research uses the type of research in the form of a cross sectional study. The population in this study consisted of grade 4.5 and 6 elementary school students. Sampling in this research using purposive sampling technique, namely sampling based on the researcher's assessment of who is eligible to meet the requirements as a sample. The results of this study indicate that there are changes in students' knowledge and attitudes after conducting education and before conducting education and there are differences in students' knowledge and attitudes before and after counseling. This study can be concluded that educational counseling about knowledge and attitudes of dental caries treatment can affect students' knowledge of gogo treatment in Autraumatic Restorative Treatment.Keyword : Knowledge,Attitude,Education,Autraumatic Restrorative Treatment

Evaluation of various remineralizing agents containing calcium and phosphate on caries by using Raman spectroscopy

AbstractThe remineralization process of dental caries is dependent on the Ca and PO4−3ions that are lost during demineralization back to the tooth tissue. The aim of this study was to determine the PO4−3changes of enamel surfaces by using Raman analysis, as a result of applying three different remineralization agents containing Ca‐PO4−3in in vitro conditions. Enamel specimens obtained from 80 human third molar teeth were randomly divided into four groups (n = 20) each according to surface treatment: no treatment (control), casein phosphopeptide‐amorphous calcium phosphate, tricalcium phosphate, and amorphous calcium phosphate. The effects of remineralization agents were evaluated according to PO4−3changes by using Raman analysis. Statistical analyses were performed by using one‐way analysis of variance (ANOVA) and Tamhane's T2 tests. There was a statistically significant difference between the study group surfaces subjected to the pH cycling process and remineralization and the control group surfaces only subjected to pH cycling (p &lt; 0.05). However, the intragroup evaluation showed no statistically significant difference between the mean PO4−3changes of intact and remineralized surfaces (p &gt; 0.05). Remineralizing agents have positive effects on the phosphate concentration of initial enamel caries at the level of intact tooth tissue.

A unified convolution neural network for dental caries classification

Dental caries is one of the most common chronic diseases in the oral cavity. The early detection of initial dental caries is needed for treatment. It is problematic to diagnose the initial carious lesion, as known as enamel caries, due to the similarity of a tiny hole to human perception error. In this paper, we propose a unified convolution neural network to improve the diagnostic and treatment performance for dentists using classification from bitewing radiographs. We adapt the AlexNet and ResNet models to properly classify the dental caries dataset. The modified ResNet successfully achieves excellent binary-classification performance with accuracy of 86.67%, 87.78% and 82.78% of teeth with all conditions, teeth without dental restoration, and only teeth with dental restorations, respectively. For multilevel classification, our model has good performance with 5-class average accuracy of 80%. Remarkably, our adapted ResNet-18 has good performance with enamel caries and secondary caries with accuracy of 86.67% and 77.78%, respectively. Conversely, our ResNet-50 and ResNet-101 have contradictory low performance with enamel and secondary caries but high performance with sound teeth, dentin caries and teeth with restoration of 90%, 78.89% and 88.89%, respectively. The accuracies of our model are good enough that our model could support dentists to enhance diagnostic performance.

Diagnostic Validity in Occlusal Caries Detection of ICDAS II, DIAGNOdent, Radiography and a Combination of the Three Methods: An In Vitro Study.

In this study, we compare the efficacy and diagnostic concordance of the ICDAS, the radiographic criterion and the instrument known as the DIAGNOdent fluorescence laser pen on occlusal caries lesions using a histological section as the gold standard. Of 100 teeth that did not present cavitated occlusal lesions or occlusal fillings, 80 were chosen through a randomization program and examined by two previously trained and calibrated researchers. Subsequently, the teeth were sectioned with a diamond disk and observed under an optical microscope. The results were studied for caries with a limit established in enamel and caries with extension to dentin. The intra-examiner (0.821–0.933) and inter-examiner (0.817–0.924) reproducibility obtained for both ICDAS and DIAGNOdent for the diagnosis of borderline enamel caries was high. Similarly, intra-examiner (0.686–1.000) and inter-examiner (0.809–0.944) reproducibility for diagnosis of caries with dentin extension was also high for both methods. The sensitivity obtained was 0.76 (ICDAS), 0.87 (DIAGNOdent) and 0.58 (Rx), whereas the specificity obtained was 0.66 (ICDAS), 0.4 (DIAGNOdent) and 0.77 (Rx) for lesions limited to enamel. For lesions with extension to dentin, the sensitivity obtained was 0.73 (ICDAS), 0.82 (DIAGNOdent) and 0.09 (Rx), and the specificity obtained was 0.79 (ICDAS), 0.52 (DIAGNOdent) and 0.97 (Rx). Sensitivity increases in both cases by combining diagnostic methods. In conclusion, ICDAS and DIAGNOdent are better diagnostic methods than Rx for the detection of occlusal caries, and the combination of these methods helps to obtain a better diagnosis.

Attenuation of near-ultraviolet, visible and near-infrared light in sound and carious human enamel and dentin

ObjectivesThis in vitro study aimed to investigate the optical attenuation of light at 405, 660 and 780 nm sent through sound and carious human enamel and dentin, including respective individual caries zones, as well as microscopically sound-appearing tissue close to a carious lesion.Materials and methodsCollimated light transmission through sections of 1000–125-µm thickness was measured and used to calculate the attenuation coefficient (AC). The data were statistically analysed with a MANOVA and Tukey’s HSD. Precise definition of measurement points enabled separate analysis within the microstructure of lesions: the outer and inner halves of enamel (D1, D2), the translucent zone (TZ) within dentin lesions and its adjacent layers, the enamel side of the translucent zone (ESTZ) and the pulpal side of the translucent zone (PSTZ).ResultsThe TZ could be distinguished from its adjacent layers and from caries-free dentin at 125 µm. Sound-appearing dentin close to caries lesions significantly differed from caries-free dentin at 125 µm. While sound and carious enamel exhibited a significant difference (p < 0.05), this result was not found for D1 and D2 enamel lesions (p > 0.05). At 405 nm, no difference was found between sound and carious dentin (p > 0.05).ConclusionsLight optical means enable the distinction between sound and carious tissue and to identify the microstructure of dentin caries partially as well as the presence of tertiary dentin formation. Information on sample thickness is indispensable when interpreting the AC.Clinical relevanceNon-ionising light sources may be suitable to detect lesion progression and tertiary dentin.

Combined Effects of Topical Fluorides and Semiconductor Lasers on Prevention of Enamel Caries: A Systematic Review and Meta-Analysis.

Objective: To compare the effects of combined treatment of topical fluoride and semiconductor laser (F&L) with topically using fluoride (F) on remineralization and prevention of enamel caries. Background: There is no agreement on whether semiconductor lasers can promote the effect of topical fluoride on the remineralization and prevention of dental caries. This study is the first systematic review and meta-analysis to investigate the pooled effect of data from studies that compared the combined use of semiconductor lasers and topical fluorides with the single use of fluoride on remineralization and prevention of caries. Methods: We performed literature search on Scopus, Web of Science, and PubMed. The keywords were as follows: ((diode lasers) OR (diode laser) OR (quantum cascade laser) OR (quantum cascade lasers) OR (Gallium Aluminum Arsenide lasers) OR (Gallium Aluminum Arsenide laser) OR (GaAlAs lasers) OR (GaAlAs Laser) OR (semiconductor laser) OR (semiconductor lasers)) AND ((caries) OR (dental caries) OR (remineralisation) OR (remineralization) OR (demineralization) OR (demineralisation)) AND fluoride. We carried out meta-analysis to compare the microhardness of demineralized enamel, lesion depth (LD), and percent reduction of calcium (Ca%) of sound enamel receiving F&L with F. Results: The search identified nine laboratory studies, which used 445 to 980 nm semiconductor lasers with various fluorides. The standard mean difference of microhardness of demineralized enamel between F&L and F was 1.06 [95% confidence interval (CI): 0.12 to 2.00, p = 0.03]. No difference was found in LD (95% CI: -1.63 to 0.10, p = 0.08) and Ca% (95% CI: -0.52 to 1.28, p = 0.40) on sound enamel between the two groups. Conclusions: Semiconductor lasers enhance the effect of fluoride on remineralizing but not on preventing enamel caries. Moreover, substantial heterogeneity was found among the studies, and the results should be interpreted cautiously.

Longitudinal In Vitro Effects of Silver Diamine Fluoride on Early Enamel Caries Lesions.

This laboratory study evaluated the longitudinal surface microhardness changes in early, incipient, noncavitated, white-spot, enamel caries lesions treated with silver diamine fluoride (SDF). Five intervention groups (SDF, AgNO3, KF, 5% sodium fluoride varnish (FV), deionized water (DI)) × two-time intervals after intervention (immediate & delayed pH-cycling) resulted in 10 groups (n=18). Silver nitrate (AgNO3) and potassium fluoride (KF) groups served as controls to assist in evaluating if remineralization effects were due to the silver or fluoride component in SDF. Early, incipient, noncavitated, white-spot, enamel caries lesions were created in bovine enamel, the extent of demineralization was determined using Vickers surface microhardness (VHNlesion). Intervention treatments were applied. Half the specimens from each group underwent immediate 5-day pH-cycling, and half were stored in an incubator with artificial saliva for 2 weeks before undergoing 5-day pH-cycling. After pH-cycling, lesion hardness was evaluated using VHNpost. Specimens were then exposed to a second demineralization challenge, and lesion softening was evaluated (VHNsecdem). Hardness variables were calculated: ΔVHN = VHNpost - VHNlesion; ΔVHNsecdem = VHNsecdem - VHNpost. Data were analyzed using two-way ANOVA (α=0.05). Immediately cycled, SDF had significantly (p<0.0001) greater remineralization than DI, AgNO3, and FV. All delayed cycling groups had significantly greater remineralization than FV (p<0.0001). Significantly greater remineralization was noted in delayed AgNO3 (p≤0.0001), DI (p=0.0003), and FV (p=0.0006) compared to immediately cycled. After the second demineralization challenge, FV had significantly less surface softening than AgNO3 (p=0.0002), DI (p=0.0003), KF (p=0.0225), and SDF (p=0.0388) intervention groups. No significant difference was found between the pH-cycle timings (p=0.2710). Based the present findings, FV may be better suited than SDF to treat early, incipient, noncavitated, white-spot, enamel caries lesions.

Detecting Proximal Caries on Periapical Radiographs Using Convolutional Neural Networks with Different Training Strategies on Small Datasets.

The present study aimed to evaluate the performance of convolutional neural networks (CNNs) that were trained with small datasets using different strategies in the detection of proximal caries at different levels of severity on periapical radiographs. Small datasets containing 800 periapical radiographs were randomly categorized into a training and validation dataset (n = 600) and a test dataset (n = 200). A pretrained Cifar-10Net CNN was used in the present study. Different training strategies were used to train the CNN model independently; these strategies were defined as image recognition (IR), edge extraction (EE), and image segmentation (IS). Different metrics, such as sensitivity and area under the receiver operating characteristic curve (AUC), for the trained CNN and human observers were analysed to evaluate the performance in detecting proximal caries. IR, EE, and IS recognition modes and human eyes achieved AUCs of 0.805, 0.860, 0.549, and 0.767, respectively, with the EE recognition mode having the highest values (p all < 0.05). The EE recognition mode was significantly more sensitive in detecting both enamel and dentin caries than human eyes (p all < 0.05). The CNN trained with the EE strategy, the best performer in the present study, showed potential utility in detecting proximal caries on periapical radiographs when using small datasets.

Molar Incisor Hypomineralization-Influence on Dental Caries Experience Indexes: A Cross-sectional Study.

Aim and and objectiveTo evaluate the influence of the clinical characteristics inherent to Molar Incisor Hypomineralization on the values ​​and scores of the DMF-T and ICDAS indexes.Materials and methodsEight hundred and eight seven teeth were examined, from 39 individuals aged 3-14 years (8.95 ± 3.26), who had at least one first permanent molar (FPM) or second primary molar with signs of hypomineralization, according to the criteria of the European Academy of Paediatric Dentistry. Hypomineralized teeth were evaluated for the presence of restorations, post-eruptive breakdowns (PEB), and dental caries, being considered sound for the DMF-T when there was the presence of PEB without caries lesion. Chi-square and Kruskal Wallis tests (p ≤ 0.05) were used to detect differences.ResultsTwo hundred and five teeth showed signs of hypomineralization. The average number of opacities was influenced by the period of dentition, with more opacities when the primary dentition and the eruption of FPM and permanent incisors were complete (p ≥ 0.05). Hypomineralized teeth showed a higher DMF-T value, mainly of the decayed component (12%), in contrast to 2.5% of nonhypomineralized teeth. It was not possible to associate ICDAS scores 1 and 2 to hypomineralized surfaces, due to the overlap with the diagnosis of early enamel caries. The values ​​of this index changed in the presence of cavitation by caries (scores 3,4,5,6), but not in the presence of PEB.ConclusionDue to the impossibility of differential diagnosis with caries lesion, PEB, and opacities present in hypomineralized teeth tend to overestimate the values ​​and scores of the DMF-T and ICDAS, respectively.Clinical significanceMake future suggestions for epidemiological studies in the area.How to cite this articleVieira FG, Pintor AV, Silva FD, et al. Molar Incisor Hypomineralization—Influence on Dental Caries Experience Indexes: A Cross-sectional Study. Int J Clin Pediatr Dent 2022;15(1):65-68.

In Vitro Effect of Strontium-Doped 45S5 Bioglass and Nd:YAG Laser on Microhardness of Demineralized Enamel

Background: This study aimed to assess the effect of strontium-doped 45S5 bioglass (BG) and Nd:YAG laser on the microhardness of demineralized enamel. Materials and Methods: In this in vitro, experimental study, 65 sound enamel samples were prepared of human premolars and polished, and then immersed in a demineralizing solution for 10 weeks. The samples were randomly divided into 5 groups of control, BG, laser, laser plus BG, and BG plus laser. Two samples of each group underwent assessment of surface morphology under a scanning electron microscope. Finally, the microhardness of samples was measured using a Vickers hardness tester, and data were analyzed by ANOVA. Results: The mean microhardness of the BG group was significantly higher than that of other groups (P&lt;0.05). The lowest microhardness was noted in the control group. The difference in microhardness was significant between laser and laser plus BG groups (P&lt;0.05). Further, the BG plus laser group had a significant difference in microhardness with BG and control groups (P&lt;0.05). The difference between laser plus BG and control groups was also significant in this respect (P&lt;0.05). Eventually, maximum morphological changes were observed in the BG group. Conclusions: Overall, BG seems to be effective for the treatment of incipient enamel caries. It effectively increases enamel microhardness and decreases mineral loss while preserving the integrity of the enamel surface.

The Effect of Toothpastes Containing Natural Extracts on Bacterial Species of a Microcosm Biofilm and on Enamel Caries Development.

This study investigated the effects of herbal toothpaste on bacterial counts and enamel demineralization. Thirty-six bovine enamel samples were exposed to a microcosm biofilm using human saliva and McBain saliva (0.2% sucrose) for 5 days at 37 °C and first incubated anaerobically, then aerobically–capnophilically. The following experimental toothpaste slurries (2 × 2 min/day) were applied: (1) Vochysia tucanorum (10 mg/g); (2) Myrcia bella (5 mg/g); (3) Matricaria chamomilla (80 mg/g); (4) Myrrha and propolis toothpaste (commercial); (5) fluoride (F) and triclosan (1450 ppm F), 0.3% triclosan and sorbitol (Colgate®, positive control); (6) placebo (negative control). The pH of the medium was measured, bacteria were analyzed using quantitative polymerase chain reaction, and enamel demineralization was quantified using transverse microradiography. The total bacterial count was reduced by toothpaste containing Myrcia bella, Matricaria chamomilla, fluoride, and triclosan (commercial) compared to the placebo. As far as assessable, Myrcia bella, Matricaria chamomilla, and Myrrha and propolis (commercial) inhibited the outgrowth of S. mutans, while Lactobacillus spp. were reduced/eliminated by all toothpastes except Vochysia tucanorum. Mineral loss and lesion depth were significantly reduced by all toothpastes (total: 1423.6 ± 115.2 vol% × μm; 57.3 ± 9.8 μm) compared to the placebo (2420.0 ± 626.0 vol% × μm; 108.9 ± 21.17 μm). Herbal toothpastes were able to reduce enamel demineralization.

The Impact of Nano-Hydroxyapatite Resin Infiltrant on Enamel Remineralization: An In Vitro Study.

This study assessed the effect of nano-hydroxyapatite incorporation into resin infiltrant on the mineral content, surface tomography, and resin tag penetration of demineralized enamel. Forty specimens were exposed to a demineralized solution to form subsurface caries lesions. The lesions were treated with negative control, a resin infiltrant (ICON), ICON with 5% nano-hydroxyapatite (NHA, Sigma-Aldrich), or ICON with 10% NHA. Mineral density was assessed using microcomputed tomography scans at various stages of the experiment. Specimens were scanned by scanning electron microscope (SEM) for surface analysis and resin tag penetration. Analysis of variance was used to assess the difference among groups. Specimens treated with ICON and 5% or 10% NHA showed the most favorable mineral density regarding the percent change in mineral content (32.4% and 29.7%, respectively), compared to 8.8% in teeth treated with ICON alone and -1.8% in teeth in the control group. SEM showed that teeth treated with ICON or ICON with 5% or 10% NHA had a smooth surface. The resin penetration in all tested groups showed high-quality resin tags, regardless of the treatment protocol. NHA resin infiltrant (ICON with 5% or 10% NHA) effectively enhanced the artificial enamel caries surfaces in terms of smooth surfaces, mineral density, and resin penetration.

An alkasite restorative material effectively remineralized artificial interproximal enamel caries in vitro.

To evaluate the remineralization of artificial interproximal enamel caries (AIEC) adjacent to alkasite, high viscous glass ionomer cement (HVGIC), and resin composite in class II restorations. Human enamel specimens were randomly assigned to 3 groups (n = 22): Filtek™ Z350, EQUIA Forte®, and Cention N®. The baseline hardness was determined using a Knoop microhardness assay. AIEC was formed in the specimens, and they were placed in contact with the proximal restorative materials then subjected to a 7-day pH cycling. Microhardness was determined post-artificial caries formation and post-pH cycling. The differences in the percentage of surface hardness recovery (%SHR) between the groups were compared using the Kruskal-Wallis test. The Dunn's test was used for between-group comparisons (p < 0.05).Specimen surface morphology was evaluated using scanning electron microscopy (SEM), and the calcium, phosphorus, and fluoride contents were analyzed by energy-dispersive spectroscopy (EDS). ANOVA with the post hoc Tukey multiple comparison test was used to evaluate the differences between groups (p < 0.05). The Cention N® %SHR was the highest, followed by EQUIA Forte®, and Filtek™ Z350. There was a significant difference in the %SHR between Cention N® and Filtek™ Z350 (p < 0.05). In contrast, there were no significant difference between Cention N® and EQUIA Forte®. Significantly increased enamel surface fluoride content was observed in the Cention N® compared with Filtek™ Z350 specimens (p < 0.05). The SEM image of the Cention N® specimens demonstrated the greatest mineral deposition. Cention N® markedly increased the surface hardness and fluoride content of adjacent AIEC compared with Filtek™ Z350 restorations. Cention N® is a promising alternative restorative material to remineralize initial enamel lesions in approximal adjacent surfaces, especially in high-risk caries patients.