Early Caries Lesions Research Articles

Remineralisation effect of 1,500 ppm fluoride-containing toothpaste in enamel early caries lesion

Remineralisation effect of 1,500 ppm fluoride-containing toothpaste in enamel early caries lesion

Can the Application of Fluoride Iontophoresis Improve Remineralisation of Early Caries Lesions?

To determine the optimal electric current intensity of fluoride iontophoresis (FI) for remineralisation of early caries lesions in vitro. Sixty specimens were made from bovine incisors and immersed in a demineralising gel for 96 h. Specimens were divided into control (conventional fluoride application) and experimental (FI) groups. All of the specimens were covered with fluoride for 4 min every day. Different electric current intensities (100, 200, 300 and 400 μA) were applied in the FI groups using the FI device. The concentration of KOH-soluble fluoride was determined to evaluate the amount of CaF2 formed on the tooth surface. The reduction in lesion depth was measured by polarised light microscopy. The concentration of KOH-soluble fluoride was the highest in the specimens of the 300 μA FI group. However, there was no significant difference in the reduction of lesion depth between the experimental groups and the control group. Variations in the electric current intensity influenced the amount of CaF2 formed on the enamel surface, with the greatest amount found for 300 μA.

The effect of fluoride varnishes on caries lesions: an in vitro investigation.

The purpose of this study was to investigate the effect of five commercially available fluoride varnishes (FV) on caries lesions. Ninety bovine enamel specimens were assigned to five varnish groups (n = 18). Early caries lesions were created in the specimens and characterized using Vickers surface microhardness number (VHN). FV was applied to each group of specimens. Immediately afterwards, 7.5ml of artificial saliva (AS) were pipetted over each group of specimens, collected and renewed every 15min for 6h. AS samples were analyzed for fluoride using an ion-specific electrode. Enamel fluoride uptake (EFU) was determined using the acid etch technique. Each group was then subjected to a pH cycling regimen for 5days after which VHN was determined again. One-way analysis of variance (ANOVA) was used for data analysis. FVs differed in their rehardening capability (highest mean value was for Enamel Pro = 32.3 ± 5.8 and lowest mean value was for Vanish = 18.9 ± 11.3). No significant difference in EFU was found among groups. Total fluoride release over 6h was in the order of MI Varnish (303μg/ml) > Enamel Pro (217μg/ml) > Flor-Opal (153μg/ml) > PreviDent(84μg/ml) > Vanish(28μg/ml). ΔVHN and fluoride release characteristics differ among FV products. These differences may be attributed to the different compositions and physical properties of the tested FV. Fundamental, comparable research on FV and how different formulations affect early caries lesion rehardening, fluoride release into saliva, and uptake by teeth is scarce.

Detection and monitoring of early caries lesions: a review.

To review the current evidence base of detecting and monitoring early carious lesions in children and adolescents and a rationale proposed to ensure that such lesions are identified and appropriately managed. The systematic literature search identified initially a review by Gomez and co-workers from 2013 and this still represents the current state of the science in relation to caries detection and monitoring. The review described among others, visible detection systems, image-based detection systems and point-measurement approaches. The current evidence base suggests that while there are numerous devices or technology-enabled detection systems, the use of a careful, methodical visual inspection of clean, dry teeth, supplemented where indicated by radiographic views, remains the standard of care in caries detection and diagnostics. Further, it is possible by means of existing visible and radiographical systems to monitor lesions over time. Using low-cost intra-oral cameras facilitates the recording of lesion appearance in the patient record and may be of significant benefit in monitoring early lesions over time following their detection. This benefit extends to the clinician and the patient for whom it may be a useful educational and motivational tool. Recommendations are presented that can be adopted and adapted to local circumstances and that are both substantiated by evidence and promote a clear, simple and consistent approach to caries detection, diagnosis and monitoring in children and adolescents. The diagnoses (initial, active; moderate, active and extensive, active) are linked to appropriate management options within primary care.

Detection and proportion of very early dental caries in independent living older adults.

Dental caries is an important healthcare challenge in adults over 65 years of age. Integration of oral health screening into non-dental primary care practice may improve access to preventive dental care for vulnerable populations such as the elderly. Such integration would require easy, fast, and accurate early caries detection tools. Primary goal of this study was to evaluate the diagnostic performance of optical coherence tomography (OCT) imaging for detecting very early caries in the elderly living in community-based settings. The International Caries Detection and Assessment System (ICDAS) served as gold standard. Secondary goal of this study was to provide baseline prevalence data of very early caries lesions in independent living adults aged 65+ years. Seventy-two subjects were recruited from three sites in Southern California: a retirement community, a senior health fair, and a convalescent hospital. Clinical examination was performed using the ICDAS visual criteria and this was followed by OCT imaging. The two-dimensional OCT images (B-scan) were analyzed with simple software. Locations with a log of back-scattered light intensity (BSLI) below 2.9 were scored as sound, and areas equaling or exceeding 2.9 BSLI were considered carious. Diagnostic performance of OCT imaging was compared with ICDAS score. OCT-based diagnosis demonstrated very good sensitivity (95.1%) and good specificity (85.8%). 54.7% of dentate subjects had at least one tooth with very early coronal caries. Early coronal decay is prevalent in the unrestored pits and fissures of coronal surfaces of teeth in independent living adults aged 65+ years. Though OCT imaging coupled with a simple diagnostic algorithm can accurately detect areas of very early caries in community-based settings, existing devices are expensive and not well-suited for use by non-dental health care providers. Simple, inexpensive, fast, and accurate tools for early caries detection by field health care providers working in non-traditional settings are urgently needed to support inter-professional dental health management.

Is there a place for Tooth Mousse in the prevention and treatment of early dental caries? A systematic review.

BackgroundIt is important for Dental Professionals to consider the evidence for the effectiveness of the preventive strategies used to maintain good oral health and reduce the risk of caries in their patients. Whilst many of the traditional preventive activities, including the recommendation and use of fluoride products and the placement of fissure sealants have a wealth of clinical evidence to support their use, some of the newer preventive agents have a more limited evidence base. In order to investigate the level of scientific support behind one such technology, a systematic literature review was carried out to assess the effectiveness of Tooth Mousse® (MI Paste®) and Tooth Mousse Plus® (MI Paste Plus®) in the prevention and treatment of early dental caries.MethodsA broad search strategy using Medline via OvidSP and EMBASE was performed in order to capture all published studies to related Casein Phosphopeptide-Amorphous Calcium Phosphate. In addition to the above searches the terms “CPP ACP” and “casein phosphopeptide amorphous calcium phosphate” were searched using PREMEDLINE and the Cochrane Central Register of Controlled Trials. Inclusion criteria were clinical trials of participants of any age, comparing the use of Tooth Mousse® (MI Paste®) or Tooth Mousse Plus® (MI Paste Plus®) to a routine oral care regimen and reporting recognised clinical outcome measures for early caries lesions. Only research studies in English were selected.Results7576 articles were identified, but the majority were duplicates. Once these were removed 172 articles were inspected and the focus on ‘CPP-ACP formulations of Tooth Mousse® (MI Paste®) and Tooth Mousse Plus® (MI Paste Plus®) resulted in 29 articles being selected, and of these 12 studies met the inclusion criteria and were considered acceptable for the systematic review.DiscussionThe overall findings of this review did not show any significant benefits of using Tooth Mousse® (MI Paste®) products over brushing with a fluoride toothpaste for the prevention of early dental caries. With regard to the regression of white spot lesions in orthodontic patients there is a tendency towards a benefit for the use of Tooth Mousse® (MI Paste®) but the quality of evidence is limited. There is a lack of evidence to support the use of Tooth Mousse Plus® (MI Paste Plus®) over Tooth Mousse® (MI Paste®) at this time.ConclusionThis review suggests that further well-designed randomized controlled trials are required prior to the widespread recommendation of Tooth Mousse® products for the prevention and treatment of early dental caries in the general population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12903-015-0095-6) contains supplementary material, which is available to authorized users.

Silver diamine fluoride and glass ionomer differentially remineralize early caries lesions, in situ.

The aim of the present study was to evaluate the percent mean mineral density (MD) change of early caries lesions after the application of silver diamine fluoride (SDF) or glass ionomer cement (GIC). This double-blind, crossover study involved two experimental phases of 28days each. Thirty-two pairs of enamel slabs were created from the proximal surfaces of 16 premolars. Each pair of artificial carious slabs was randomly divided into the control or test group (38% SDF or GIC). The slabs were attached to orthodontic brackets and bonded to the maxillary first permanent molars of 16 subjects for 28days. After a 7-day washout period between phases, the subjects received the other material for the second phase. The mean MD of the lesions was measured by microcomputed tomography. SDF yielded a percent mean MD increase at a depth of 0-84μm, although increase in the GIC group was observed at a depth of 24-108μm. The percent mean MD changes of the SDF and GIC groups were similar (p = 0.100) and significantly higher than in control (p < 0.001, p = 0.003, respectively). The two materials increased the percent mean MD change of early proximal caries lesions to a similar extent, but with different spatial patterns. Due to deeper level of GIC remineralization, the refractive index of the GIC applied enamel might be closer to sound enamel. Hence, GIC is recommended for remineralization of anterior teeth. SDF staining makes it unsuitable for use in anterior teeth; thus, it is reserved for use in posterior teeth.

Detection and diagnosis of the early caries lesion.

The purpose of this manuscript is to discuss the current available methods to detect early lesions amenable to prevention. The current evidenced-based caries understanding, based on biological concepts, involves new approaches in caries detection, assessment, and management that should include non-cavitated lesions. Even though the importance of management of non-cavitated (NC) lesions has been recognized since the early 1900 s, dental caries has been traditionally detected at the cavitation stage, and its management has focused strongly on operative treatment. Methods of detection of early carious lesions have received significant research attention over the last 20 years. The most common method of caries detection is visual-tactile. Other non-invasive techniques for detection of early caries have been developed and investigated such as Quantitative Light-induced Fluorescence (QLF), DIAGNOdent (DD), Fibre-optic Transillumination (FOTI) and Electrical Conductance (EC). Based on previous systematic reviews, the diagnosis of NCCLs might be more accurately achieved in combination of the visual method and the use of other methods such as electrical methods and QLF for monitoring purposes.

Diagnosis of Early Dental Caries with Dye-Enhancing Quantitative Light-Induced Fluorescence (QLF)

This study used sodium fluorescein to improve imaging diagnostic ability by increasing the fluorescence difference between sound enamel and caries lesions. It also made it easier to discriminate between stain and caries lesions using quantitative light-induced fluorescence (QLF). Half of the specimen surface was covered with nail varnish as a control. Specimens were divided randomly in six decalcification groups and decalcified for different lengths of time. Then, ΔF was measured using QLF-D. After applying 0.075% sodium fluorescein, we measured ΔF again and compared it with the initial value. After cutting the central portion of the specimen, we measured the lesion depth using scanning electron microscopy. The lesion surfaces observed with QLF were darker than normal enamel, whereas they were lighter than normal enamel after applying fluorescein. Longer decalcification time was associated with greater fluorescent dye penetration. The ΔF measured after applying fluorescein was higher than the initial value ( p < 0.05). Due to QLF measurement using fluorescein being more sensitive for diagnosing early decalcification, this approach will enable early diagnosis of dental caries before the cavity formation stage, allowing the treatment of early caries lesions. With QLF and sodium fluorescein, we can easily discriminate between stain and caries lesions.

Selective removal of demineralized enamel using a CO2 laser coupled with near-IR reflectance imaging.

Detection and diagnosis of early dental caries lesions can be difficult due to variable tooth coloration, staining of the teeth and poor contrast between sound and demineralized enamel. These problems can be overcome by using near-infrared (NIR) imaging. Previous studies have demonstrated that lasers can be integrated with NIR imaging devices, allowing image-guided ablation. The aim of this study was to demonstrate that NIR light at 1500 - 1700 nm can be used to guide a 9.3-μm CO2 laser for the selective ablation of early demineralization on tooth occlusal surfaces. The occlusal surfaces of ten sound human molars were used in this in-vitro study. Shallow simulated caries lesions of varying depth and position were produced on tooth occlusal surfaces using a demineralization solution. Sequential NIR reflectance images at 1500 - 1700 nm were used to guide the laser for selective ablation of the lesion areas. Digital microscopy and polarization sensitive optical coherence tomography (PS-OCT) were used to assess the selectivity of removal. This study demonstrates that high contrast NIR reflectance images can be used for the image-guided laser ablation of early demineralization from tooth occlusal surfaces.

ORTODONTİK TEDAVİYLE OLUŞAN BEYAZ NOKTA LEZYONLARI, TEŞHİS YÖNTEMLERİ VE KANTİTATİF IŞIK ETKİLİ FLORESANS (QLF)

The fixed appliances used in orthodontic treatment cause the patient to hardly maintain oral hygiene procedures. This is the reason that demineralization is more common in orthodontic patients than normal population. White spot lesions are early caries lesions that indicate demineralization. White spot lesions are non cavitated areas of decalsification that occur as a result of the reduction in the mineral density by prolonged plaque accumulation on the affected surface and are limited to enamel but have a more porous surface than the sound enamel. White spot lesions are the first phase of caries formation and they can remineralize and have a normal or at least acceptable appereance after the orthodontic treatment. However, some of the lesions don’t remineralize and look aesthetically undesirable or can form cavities when left untreated. Thus, it is important to diagnose white spot lesions early, prevent their development and choose the proper treatment. There are various methods for the diagnosis of white spot lesions. Altough the visual method, radiographic method are the most widely known ones, there are current methods like direct digital radiography, electrical conductivity measurement, fiber optic transillumination, ultrasound, alternating current impedance spectroscopy, laser fluorescence, quantitative light induced fluorescence (QLF). This review gives information about white spot lesions, the effect of the orthodontic treatment in white spot formation, diagnostic methods and Quantitative lightinduced fluorescence (QLF)

The dynamic behavior of the early dental caries lesion in caries-active adults and implications.

To describe the full range of behavior of the visible, noncavitated, early caries lesion in caries-active adults with substantial fluoride exposure, and to consider implications. The data were from the Xylitol for Adult Caries Trial (X-ACT) collected annually for 33 months using condensed ICDAS caries threshold criteria. Individual tooth surfaces having a noncavitated caries lesion were included, and the patterns of transition to each subsequent annual clinical examination to sound, noncavitated or cavitated, filled or crowned were determined. The resulting sets of patterns for an individual tooth surface, looking forward from its first appearance as a noncavitated lesion, were combined into one of four behavior profiles classified as reversing, stable, oscillating, or continuously progressing, or were excluded if not part of the caries continuum. The distributions of profile types were assessed using the Rao-Scott chi-square test, which adjusts for clustering of tooth surfaces within teeth. Inter- and intra-examiner kappa scores demonstrated acceptable calibration at baseline and annually. 8084 tooth surfaces from 543 subjects were included. The distribution of profile types differed significantly between coronal and root surfaces. Overall, two-thirds of all coronal noncavitated lesions were first seen at baseline, half reversed, over a fifth were stable, 15% oscillated, and only 8.3% progressed to cavitation, filled, or crowned in 33 months or less (6.3% consistently Progressed plus 2.0% inconsistently, a subset of oscillating, which oscillated before progressing to cavitation). Approximal, smooth, and occlusal coronal surfaces each were significantly different in their individual distributions of profile types. Xylitol showed no significant and consistent effect on this distribution by tooth surface type. This was in keeping with the X-ACT's lack of effect of xylitol at the noncavitated plus cavitated lesion thresholds combined. This study demonstrated the full dynamic range of early caries lesion behavior. The great majority were not progressive, and few (8.3%) became cavitated over 33 months in caries-active adults using fluorides. Important caries management implications favoring recorded longitudinal monitoring, prevention of active risks, and minimal restoration only after direct visual determination of cavitation are discussed.

Critical appraisal. Evidence for sealing versus restoration of early caries lesions.

Resin-based pit and fissure sealants are established tools for prevention of dental caries. Conversely, the role of sealants for management of existing early dental caries lesions has been disputed despite the recommendation from the American Dental Association Council on Scientific Affairs. The development of more sensitive caries detection technologies has revealed that many sealants have likely been placed over incipient lesions inadvertently over the years. However, the issue remains whether sealing overt incipient occlusal caries lesions leads to a worse outcome versus restoring the surface. Certainly, there are diverse opinions regarding this topic. But what does the science say? This Critical Appraisal presents evidence from several clinical trials for sealing incipient occlusal caries lesions.

Remineralisation Effect of Fluoride on Early Caries Lesions using a Quantitative Light-Induced Fluorescence-Digital (QLF-D)

The aim of this study was to evaluate the remineralisation effect after fluoride application onto an early caries lesion using a Quantitative Light-induced Fluorescence-Digital (QLF-D). Specimens were prepared by human posterior teeth and were embedded into a plaster cast to exposure the crown part. Specimens were divided randomly into the following three groups; (1) control group, (2) 2% NaF solution, (3) 1.23% APF gel. Artificial enamel caries were formed in specimens (demineralised area) with a 1.0% Carbopol 2050 (pH 4.8). Topical fluoride solution and gel were applied to the specimens of experimental group for 4 minutes and they were immersed in human saliva for 1 hour. Mineral loss of artificial caries lesion was evaluated by fluorescence loss (⊿F) values using QLF-D. Differences between baseline and post-treatment values in the three groups were assessed one-way ANOVA and post-hoc test was performed with the Tukey's test (SPSS 18.0). The average ⊿F values of baseline were -6.56 in three groups. ⊿F of APF gel group (1.90) is greatly decreased compared to the baseline and was statistically significant difference compared with two groups (0.12) (p < 0.05). Therefore, the 1.23% APF gel is the most effective in the treatment of remineralisation of artificial caries lesions. Also, the QLF-D could be useful for the evaluation of the remineralisation effect in early caries.

The dynamic behavior of the early dental caries lesion in caries-active adults and implications

The dynamic behavior of the early dental caries lesion in caries-active adults and implications

Remineralizing Agents: Effective Method for Restoring Tooth Minerals

Minimial intervention is a key phrase in today's dental practice. Concentrating mainly on the prevention and early intervention of dental caries, remineralizing agents plays an important role in controlling the demineralization/remineralization cycle. This article has emphasized on the non-invasive treatment of early caries lesions by various remineraling agents that enhances and promotes remineralization with their clinical implementation.

Effect of tablets containing probiotic bacteria (Lactobacillus reuteri) on early caries lesions in adolescents: a pilot study.

The objective of the study was to investigate the effect of tablets containing probiotic lactobacilli on early caries lesions in adolescents with quantitative light-induced fluorescence (QLF). 36 healthy adolescents of both sexes (12-17 years of age) were enrolled and randomly allocated to a placebo-controlled trial with two parallel groups. The test group received two tablets daily containing two strains of Lactobacillus reuteri (DSM 17938 and ATCC PTA 5289) for a period of three months, while the control group got identical placebo tablets without live bacteria. The primary outcome was QLF-readings (change in fluorescence, ΔF and lesion area, mm2) at baseline and after 3 months, conducted at two buccal sites of each individual, pre-selected with clearly visible clinical signs of enamel demineralisation (white spots). Significantly more premolars were allocated to the placebo group, while the test group had more incisors (P<0.05). There were no statistically significant differences in fluorescence values between the groups, neither at baseline, nor at the follow-up. There was however a significant decrease in fluorescence over time in the test group, but not in the placebo group (P<0.05). No alterations of the lesion area (ΔA) were found in any group. The inter-examiner intra-class correlation coefficient-value for QLF-readings was excellent. No side- or adverse effects were reported during the intervention period. This pilot study found a significant decrease over time in the test group. However, no statistically significant differences in fluorescence values between the groups were found. Hence, the null hypothesis could not be rejected.

치아우식증 탐지 및 평가의 기준 체계, ICDAS에 대한 고찰

Objectives : In most developed countries there has been a substantial decrease in the prevalence of dental caries in children of 12 years old over the past 40 years. This change in epidemiology highlights the importance of preventive management in dentistry. For successful management of early caries lesions, it is essential to detect and assess the pathological changes of dental caries. Therefore, the purpose of this study was to investigate the overview of International Caries Detection and Assessment System(ICDAS) criteria for the detection and assessment of early caries lesions by literature reviews. Methods : The author reviewed the MEDLINE search by the key words of 'caries assessment', 'caries detection', 'caries measurement', and 'ICDAS'. Results : This literature review provided an overview of International Caries Detection and Assessment System(ICDAS) criteria for the detection and assessment of early caries lesions. This article showed the principles, concept, and primary caries detection criteria of the ICDAS. The ICDAS can macroscopically measure the enamel surface changes and potential histological depth of caries lesions by the surface characteristics of the teeth. The ICDAS criteria allow researchers and clinicians to choose the stage of dental caries and characteristics for assessment. Conclusions : ICDAS can be an adjunct method to clinical decision making and preventive treatment planning.

Biomimetic remineralization of demineralized enamel with nano-complexes of phosphorylated chitosan and amorphous calcium phosphate.

Remineralization of enamel plays a crucial role in the progression of carious process and the management of early caries lesion. Based on the influence of phosphorylated proteins in biomineralization, the objective of this study was to synthesize nano-complexes of phosphorylated chitosan and amorphous calcium phosphate (Pchi-ACP), and evaluate their ability to remineralize enamel subsurface lesions invitro. Pchi was synthesized using a previously established chemical method. The biomimetic remineralizing solution containing nano-complexes of Pchi-ACP was prepared by adding CaCl2 and K2HPO4 into Pchi-ACP solution (0.5% w/v) in sequence. The final concentrations of calcium and phosphate ions were 10 and 6mM, respectively. The nano-complexes of Pchi-ACP were characterized by Fourier-transform infrared (FTIR), X-ray diffraction (XRD), transmission electron microscopy (TEM), and selected area electron diffraction (SAED). During testing the enamel lesions were treated with Pchi-ACP and fluoridated remineralizing solutions, respectively. The remineralizing of enamel lesions was examined with field emission electron microscope (FE-SEM) and Micro-CT. ACP was stabilized by Pchi to form nano-complexes that were soluble in water. The size of Pchi-ACP nano-complexes particles was determined to be less than 50nm. XRD and SAED results confirmed their amorphous phases. FE-SEM and Micro-CT results showed that the remineralizing effect of Pchi-ACP on enamel lesions was similar to that of fluoride. However, the remineralizing rate of Pchi-ACP treatment was significantly higher than that of fluoride treatment (P<0.05). This study highlighted the potential of nanoparticles functionalized with a natural analogue involved in biomineralization, to remineralize early enamel caries.

Near-infrared imaging of demineralization under sealants.

Previous studies have shown that near-infrared (NIR) reflectance and transillumination imaging can be used to acquire high contrast images of early caries lesions and composite restorative materials. The aim of the study was to determine the optimum NIR wavelengths for imaging demineralized areas under dental sealants. Fifteen natural human premolars and molars with occlusal lesions were used in this in vitro study. Images before and after application of sealants were acquired using NIR reflectance and NIR transillumination at wavelengths of 1300, 1460, and 1500 to 1700 nm. Images were also acquired using polarization sensitive optical coherence tomography (OCT) for comparison. The highest contrast for NIR reflectance was at 1460 nm and 1500 to 1700 nm. These NIR wavelengths are coincident with higher water absorption. The clear Delton sealant investigated was not visible in either copolarization or cross-polarization OCT images. The wavelength region between 1500 and 1700 nm yielded the highest contrast of lesions under sealants for NIR reflectance measurements.