High Caries Risk Research Articles

What is the influence of the operator on the long-term survival of posterior partial lithium disilicate restorations in an undergraduate setting?

To evaluate the influence of the (undergraduate) operator on the survival and success rate of posterior partial lithium disilicate restorations. Patients who received at least one posterior partial lithium disilicate restoration between 2009-2019 by undergraduates at the Center for Dentistry and Oral Hygiene in Groningen were included. Operator- (academic year (4th, 5th, 6th year)), patient- (presence of a nightguard, caries risk, age), tooth- (endodontic status, inlay/onlay, position of the restoration outline) and technique-related factors (cement type, rubber dam use, Immediate Dentin Sealing) on the survival and success rate were analyzed using multilevel Cox regression (p < 0.05). In total, 637 restorations were placed in 373 patients. On the level of survival, 100 restorations failed during the observation period (median follow-up: 70 months, interquartile range 48-99 months): 26 extractions, 61 restoration replacements and 13 biological complications. The overall 5- and 10-year cumulative survival rates were 89.1% (95% CI: 86.5%-91.7%) and 77.6% (95% CI: 73.1%-82.5%) respectively. Multilevel Cox regression showed a medium to high caries risk (HR: 1.57; 95% CI: 1.21-2.04) and an approximal outline located within 3 mm of the bone (HR: 1.52; 95% CI: 1.05-2.22) as significant risk factors for failure. The academic year had no statistically significant effect. The 10-year survival and success of lithium disilicate posterior partial indirect restorations placed by undergraduates was not significantly affected by the academic year of the operator. When a clear treatment protocol is followed, patient and tooth related factors rather than academic year of the operator appear to have a significant influence on the quality of posterior partial lithium disilicate restorations.

Rehabilitación oral integral en paciente pediátrico de 6 años con alto riesgo de caries dental. Reporte de caso

Objective: To document and analyze the comprehensive oral rehabilitation process carried out in a 6-year-old pediatric patient at high cariogenic risk, using minimal intervention techniques to restore dental function and esthetics, improve general oral health and prevent future carious lesions. Case report: 6 year old male patient with no relevant medical-pathological history, with multiple carious lesions, a complete oral rehabilitation was performed, eight treatment sessions were carried out including prophylaxis, restoration with celluloid crowns, application of sealants and pulpotomy with Biodentine, resulting in the return of dental function and esthetics, the sealants prevented new carious lesions in the molars and when performing oral hygiene controls and plaque indexes showed significant improvement in the patient. Conclusion: Comprehensive oral rehabilitation using minimal intervention techniques such as sealants, plaque controls, celluloid crowns, showed good clinical performance in a 6-year-old pediatric patient with high risk of dental caries.

The clinical performance of high-viscosity glass ionomer-based and bulk-fill resin-based restorations in permanent teeth with occlusal or proximal cavities: a systematic review and meta-analysis.

To summarize and analyze existing evidence regarding the clinical performance of high-viscosity glass-ionomer-based materials (HVGIs) and bulk-fill resin-based composites (BFs) in patients with occlusal or proximal cavities in permanent teeth. A literature search was conducted using PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Scopus, and Web of Science (WOS) (last update: April 19th, 2024). Randomized control trials (RCTs), retrospective and prospective comparative cohorts were included. Manual searching was performed for twelve relevant dental journals. The primary outcome was the retention of the restoration. The evaluation of included studies, data extraction, and study selection were completed by two independent reviewers. The Cochrane risk-of-bias tool (RoB 2) and the Newcastle-Ottawa scale were used to assess the quality of included studies. A quantitative meta-analysis was conducted, and the overall quality of the evidence was evaluated. Five RCTs and one retrospective study were included, of which one had a high risk of bias and the others had an unclear risk of bias. In meta-analyses, HVGIs were associated with a less favorable outcome on retention both at one (p = 0.013) and two-year follow-ups (p < 0.0001) compared with BFs. The quality of the evidence was very low. Very low certainty evidence suggested that BFs presented favorable clinical performance on retention and marginal adaptation in Class I and II restorations in permanent teeth comparing HVGIs. Nevertheless, HVGIs with a resin-based coating showed acceptable clinical behavior. For patients with a high caries risk, HVGIs serve as a direct restorative alternative for the posterior permanent teeth; however, they should be carefully considered as bulk-fill composite resin alternatives for long-term restoration. PROSPERO (CRD42024535999).

Knowledge of Dental Caries Status in Diabetes Mellitus Patients

Background: Diabetes mellitus is a chronic disease that has a significant impact on dental and oral health, including a high risk of dental caries. The level of individual knowledge about oral health care is considered to have an important role in preventing caries in patients with diabetes mellitus. This study aims to analyze the relationship between the level of knowledge and the status of dental caries in patients with diabetes mellitus. Methods: This study used a cross-sectional design involving 61 diabetes mellitus selected by purposive sampling from the Dentica Pondok Labu clinic, South Jakarta. Knowledge data were obtained through a validated questionnaire, while caries status was measured using the DMFT (Decayed, Missing, Filled Teeth) index. Data analysis was performed using the chi-square test. Results: The average knowledge score of respondents was 75.14 ± 12.16 (scale 0-100). The average DMFT index was 7.38 ± 3.707. Chi-square analysis showed a significant relationship between the level of knowledge and the DMFT index (p &lt; 0.000). Conclusion: This study shows that the level of knowledge has a significant relationship with the status of dental caries in patients with diabetes mellitus. More intensive educational efforts about dental and oral health are needed to reduce the risk of caries in patients with diabetes mellitus.

Evaluation of parents' attitudes and behaviors towards products and practices containing fluoride

Aims: The aim of this study was to evaluate parents’ attitudes and behaviors about fluoride-containing products and practices. Methods: The study was conducted between April 2023 and February 2024. Parents of children who applied to Dicle University Faculty of Dentistry, Department of Pediatric Dentistry voluntarily participated in the study and a total of 350 parents participated. A face-to-face questionnaire consisting of 2 sections and a total of 26 questions was administered to the parents. Results: Among the parents who participated in our study, 56.86% stated that they had never heard of fluoride before. Those who had heard of fluoride stated that they had heard about it from school screenings and dentists. 16.86% of the parents stated that fluoride is harmful, but 68% of them did not have any information about it. 78.8% of the parents stated that they did not know the effect of brushing teeth with fluoride toothpaste on the prevention of dental caries and 76.57% stated that they did not look at the fluoride content when choosing toothpaste. 84% of the parents stated that they did not know the fluoride applications made by the physician and 74.57% stated that they would not have their children do it. The vast majority of those who would not have their children fluoridated (73.95%) stated that they would not do so because they did not have information about fluoride. We found that 92% of the parents did not know systemic fluoride applications, 90% did not know whether the drinking water they used contained fluoride, and 93.43% did not know whether fluoride in drinking water helps prevent dental caries formation. Conclusion: Considering the high caries risk and oral hygiene deficiencies in our country, the need to use fluoride in dental treatments is increasing. Therefore, the public’s lack of knowledge and concerns about fluoride should be addressed and the use of preventive treatments such as fluoride should be increased.

Analyzing the Effectiveness of Different Delivery Methods for Remineralization Agents in Pediatric Dental Health: A Systematic Review.

Pediatric dental health is critically impacted by enamel demineralization and early-stage caries, with remineralization therapies playing a vital role in preventing progression. This systematic review evaluates the effectiveness of various delivery methods for remineralization agents in pediatric patients aged 3-15 years, focusing on varnishes, gels, foams, and sprays. Studies were included if they were randomized controlled trials (RCTs), cohort studies, or case-control studies involving pediatric patients with early-stage caries or enamel demineralization, while studies with non-pediatric populations, unrelated treatments, or significant methodological flaws were excluded. A comprehensive search across PubMed, Cochrane, Google Scholar, and Web of Science using keywords like "pediatric," "fluoride varnish," "CPP-ACP," and "enamel remineralization" identified 10 RCTs with 743 participants from countries such as Germany, Italy, Turkey, China, Thailand, Iran, and Brazil. Data extraction followed a standardized protocol, and quality was assessed using the Cochrane Risk of Bias 2 tool. Results showed that fluoride varnishes were the most effective delivery method for high-risk caries populations due to their prolonged retention and sustained fluoride release, while sprays and foams emerged as promising alternatives for behaviorally challenging patients because of their ease of application and better compliance. Gels demonstrated mixed results, indicating that their efficacy might depend on application frequency and patient adherence. The findings also underscore the importance of cultural and regional factors in the acceptance of certain treatment methods. Additionally, long-term studies are needed to evaluate the sustained effects of sprays and foams in pediatric populations. This review highlights the critical role of delivery methods in the success of remineralization therapies, emphasizing that fluoride varnishes remain the gold standard, while sprays and foams are viable alternatives for specific patient needs. Tailoring treatments to individual patient requirements is essential for optimizing outcomes in pediatric dental health, particularly in addressing diverse patient behaviors and treatment environments.

A REVIEW OF CONTEMPORARY METHODS FOR CARIES RISK ASSESSMENT

Introduction. Modern dentistry offers various risk assessment tools, such as CAMBRA, Cariogram, and the ADA Risk Assessment Tool. These tools help dentists create personalized treatment plans. However, their effectiveness is still debated. Materials and Methods. An electronic search was conducted using the Cochrane Library, PubMed, and Scopus databases without any regional or temporal restrictions. The following keywords were used: CAMBRA, Cariogram, ADA Risk Assessment Tool, caries risk assessment, ECAT. This comprehensive search strategy ensured a broad and unbiased collection of relevant studies. Results. Quantitative methods include CAMBRA (Caries Management by Risk Assessment), Cariogram, the ADA Risk Assessment Tool, OHIS (Oral Health Impact Profile), and ECAT (Early Childhood Caries Assessment Tool). Qualitative methods, on the other hand, rely on clinical examination, saliva analysis, and genetic testing. Discussion. The key similarities among the aforementioned methods are evident. First, all of these methods employ a comprehensive approach, considering multiple factors that contribute to caries risk, such as oral hygiene, diet, dental history, saliva composition, fluoride exposure, and other relevant risk factors. Second, each method supports an individualized approach, allowing for the development of personalized treatment and prevention plans based on the patient's specific risk profile. Finally, all of these methods are designed to identify patients at high risk for caries, facilitating early intervention and preventive measures. Conclusion. Contemporary quantitative methods for assessing caries risk, such as CAMBRA, the ADA Risk Assessment Tool, Cariogram, and ECAT, prove to be effective in evaluating individual risks for tooth decay. Each method has its strengths and limitations, and the optimal choice for a particular dental practice may depend on factors like the dentist’s preferences, available resources, and patient demographics.

Persistent oral health inequality in children—repeated cross-sectional studies in 2010 and 2019

Background and aimChildren growing up in vulnerable circumstances have a higher risk of caries experience. Tracking the development of caries in relation to socioeconomic variables over time is essential for fair resource distribution to groups with higher caries risk and to even out inequalities in oral health. The aim was therefore to analyse the association between 6-year-olds´ caries prevalence and socioeconomic variables at family and residential area levels in 2010 and 2019 as well as potential differences in the association between 2010 and 2019.MethodsThe study design is an epidemiological registry-based, repeated cross-sectional study based on caries data (grouped as 0, 1–3 and > 3 dmft) for the population of 6-year-olds in 2010 (n = 4,408, 95% coverage) and 2019 (n = 5,199, 94% coverage) in a Swedish region. Multiple socioeconomic variables for the children’s families and residential areas were retrieved from official registries. Multinomial logistic regression was performed at both levels to produce models for each level and studied year.ResultsThe variables that explained most of the association between caries and socioeconomic variables were mainly the same over the years at both levels. At the family level, these were: maternal age when having their first child (explained most of the association in both years, at 30 and 35%, respectively); maternal age when having the child in the study group; parental employment; parental and child’s migration background; maternal educational level; form of housing; and financial assistance (only 2010). At the residential area level, these were: migration background (explained most of the association both years; 82 and 52%, respectively), educational level and number of persons per household. The association between socioeconomic variables and caries was consistently stronger for severe caries (dmft > 3) than moderate (dmft 1–3). Multiple socioeconomic risk variables meant an even greater likelihood of caries.ConclusionOver the studied years, variables related to socioeconomic vulnerability continued to be associated with caries in young children growing up under socially disadvantaged circumstances. Effective efforts for families living in socially vulnerable contexts are needed to achieve good and equal oral health, as is continued follow-up to evaluate whether the goal is reached.

Oral Hygiene, Dietary Habits, and Saliva Properties in Relation to the Decayed, Missing, and Filled Teeth Index of Dental Students: A Pilot Study

Background and Objectives: Caries development is associated with poor oral hygiene, inadequate dietary habits, quantitative and qualitative food content, and a high level of bacterial plaque. Physical and chemical changes in saliva composition and particularly changes in its buffering capability play a significant role in caries development. This study aimed to determine the predictors of poor oral health among a sample of second-year dental students. Materials and Methods: The oral health of students was estimated with clinical examination and the DMFT index. The interview included questions about demographics status (gender, age), a dietary habits questionnaire, questions about oral hygiene, and a demonstration of tooth brushing technique. Unstimulated saliva samples were collected to measure buffering capacity and pH. Results: Almost half of the students have a low level of caries experience (46.7%), followed by a slightly smaller number having a medium level (41.3%), while one in eight students (12.0%) demonstrates a high level of caries experience. Male students have a statistically higher DMFT index 5.7 ± 1.2 than female participants 4.5 ± 0.5 (p = 0.036). Significant predictors for the DMFT index score in students were milk [β-coefficient = −0.338, p = 0.011] and yoghurt [β-coefficient = 0.284, p = 0.040] consumption. All students brushed their teeth two or more times during the day, usually after waking up before breakfast and before bedtime. Most students (85.3%) apply the proper tooth brushing technique, with female students applying it more frequently (p = 0.038). The mean salivary pH was 6.9, while the mean buffer capacity was 5.8. Female respondents have a statistically lower buffer capacity (5.8 ± 0.5) than male respondents (6.1 ± 0.4) (p = 0.047). Conclusions: Dentistry students are introduced to good oral hygiene habits, especially female students, while dietary habits should be improved. However, one in eight dental students is at high caries risk. By assessing the level of caries experience, targeted strategies can be developed to promote, maintain, and enhance oral health among dental students.

Dental Health in Children with Congenital Heart Defects: A Systematic Review and Meta-Analysis.

Background: Oral health outcomes in children with Congenital Heart Defects (CHD) have significant implications. The aim of this systematic review and meta-analysis is to update the current understanding of oral health outcomes in children with CHD and compare caries prevalence between CHD children and healthy controls. Methods: All studies between 2014 and 2024 comparing oral health status between children with and without CHD were considered for inclusion. Studies had to use the DMF/dmf index (Decayed, Missing, Filled Teeth or Surface index), in permanent and deciduous teeth. Two separate meta-analyses were conducted: one analyzing DMFS scores and another focusing on dmft scores. Medline, Central, and Embase databases were screened. Twelve articles were included in the qualitative synthesis, and two studies were finally included in each quantitative synthesis. Results: Several studies identified significant differences in oral health outcomes, suggesting that children with CHD are at a higher risk of dental caries compared with healthy controls, particularly as they become older. However, the differences were not uniformly observed across all studies and age groups. Based on the meta-analysis, there was no statistically significant difference in either DMFS scores (MD: 0.07 [95% CI: -0.13, 0.27]; p = 0.48) or in dmft scores (MD: 1.39 [95% CI: -1.05, 3.83]; p = 0.26). Conclusions: This systematic review and meta-analysis highlight a possible increased risk of dental caries in children with CHD, although results were not statistically significant and varied across studies. More standardized and rigorous studies are required to provide clearer insights into oral health outcomes for this population.

Effect of a 1.1% NaF toothpaste containing Sr/F-doped bioactive glass on irradiated demineralized dentin: an in vitro study

ObjectivePatients receiving head and neck radiation are at high risk for radiation caries. This study aimed to evaluate the remineralizing effects of an experimental 1.1% NaF (5000 ppmF) toothpaste containing Sr/F-doped bioactive glass nanoparticles (BAG or B) on demineralized irradiated dentin.Materials and methodsFluoride concentration and pH stability of materials upon mixing with water were assessed using a fluoride-specific electrode (n = 3) for up to 3 months. Elemental release of materials in water was determined using ICP-OES (n = 3). Fourteen extracted molars were irradiated with a cumulative dose of 70 Gy. Each tooth was sectioned into 4 specimens (n = 14/group), demineralized, and subjected to pH cycling for 14 days. Groups were treated with Prevident (PV), E5000, E5000B, and deionized water twice daily. Remineralization was assessed using ATR-FTIR (mineral-to-collagen ratio) (n = 14). Mineral precipitation was additionally examined with SEM-EDX. The in vitro cytotoxicity of the materials on L929 mouse fibrosarcoma was evaluated with the MTT test (n = 3). Kruskal-Wallis test, followed by Dunn’s procedure, was used to compare the data between groups.ResultPV demonstrated greater pH and fluoride release stability than the experimental materials. E5000B exhibited a slight reduction of fluoride release (p < 0.01, R²=0.656) and an increase in pH with time (p = 0.006, R²=0.233). The highest increase in mineral-to-collagen ratio at 14 days was detected with PV (p < 0.05). E5000B also showed a significantly higher ratio than E5000 (p = 0.014). SEM-EDX detected mineral precipitation on dentin treated with PV and E5000B but not in E5000 and DI. The cell viability of PV (56%) was significantly lower than that of E5000 (94%) and E5000B (89%) (p < 0.05).ConclusionThe use of 5000 ppm fluoride toothpaste enhanced the remineralization of irradiated demineralized dentin, highlighting a potentially valuable strategy for preventing radiation caries. Adding bioactive glass further promoted remineralization but may require formulation adjustments to maintain toothpaste stability for clinical use.

Comparing the Antibacterial Efficacy of Nanosilver vs Traditional Fluoride Varnishes in Caries Prevention

ABSTRACT Background: Dental caries remains a prevalent chronic condition affecting individuals worldwide, particularly children. Traditional fluoride varnishes have long been employed in caries prevention due to their ability to enhance enamel remineralization and reduce demineralization. Materials and Methods: A randomized controlled trial was conducted involving 120 participants aged 6–12 years with a high risk of dental caries. The participants were divided into two groups: one receiving nanosilver varnish and the other receiving traditional fluoride varnish. Each varnish was applied bi-weekly for six months. Salivary samples were collected at baseline, three months, and six months to measure bacterial counts, focusing on Streptococcus mutans. The data were analyzed using ANOVA to assess differences between the groups over time. Results: At baseline, both groups exhibited similar levels of Streptococcus mutans (P &gt; 0.05). After three months, the nanosilver group showed a significant reduction in bacterial counts (mean reduction of 45%, P &lt; 0.01), compared to a 30% reduction in the fluoride varnish group (P &lt; 0.05). At six months, the nanosilver group maintained a 55% reduction, whereas the fluoride group showed a 40% reduction. The difference between the groups at six months was statistically significant (P &lt; 0.01). Conclusion: Nanosilver varnish demonstrated superior antibacterial efficacy compared to traditional fluoride varnish in reducing Streptococcus mutans levels over six months. These findings suggest that nanosilver could serve as a valuable alternative or adjunct to fluoride varnish in caries prevention strategies.

Is Poor Self-Rated Health Associated with Higher Caries Experience in Adults? The HUNT4 Oral Health Study

Introduction: The association between lower socioeconomic status and a higher risk of dental caries is well established, but the independent association between general health status and dental caries on a population level is less investigated. The aim of this study was to assess the association between self-rated general health and caries experience in an adult Norwegian population and to assess if the associations were modified by age and sex. Methods: Data were collected as part of the Trøndelag Health Study (HUNT4) conducted 2017–2019 and a randomly selected subsample (20%) were invited for the HUNT4 Oral Health Study. This cross-sectional study included 4,880 dentate participants aged 19–94 years (response rate 67%). Participants underwent clinical and radiographic oral examinations and caries experience was measured by numbers of decayed (DT), missing (MT), and filled teeth (FT), DMFT index. The DT component consisted of primary and secondary caries in dentine, cavitated root caries, and remaining roots. Questionnaires were used to assess self-rated general health and socioeconomic position, denoted by education, household income, and employment status. Associations between self-rated health and caries experience (DMFT) and components (DT, MT, and FT) were assessed using negative binomial regression models. Ratios of means (RMs) with 95% confidence intervals (CI) for the associations were estimated, adjusting for socioeconomic position. Results: Individuals with poor self-rated general health had a 29% higher mean number of MT (RM: 1.29 [95% CI: 1.13–1.46]), a 22% higher mean number of DT (RM: 1.22 [95% CI: 1.07–1.39]), and a 7% higher mean number of DMFT (RM: 1.07 [95% CI: 1.04–1.11]) than individuals reporting very good health. Age-stratified analyses presented a more pronounced association between self-rated health and caries experience for individuals below the age of 55 years than for those 55 years or older. Similarly, the association was more evident in women, with significantly higher mean values for DMFT, MT, and FT among women reporting poor health. Conclusions: The present study demonstrated an independent association between poor self-rated health and a higher burden of caries experience, adjusted for education, income, and employment status. The association was stronger in women and individuals below the age of 55 years. These findings add new evidence in understanding caries inequalities through self-rated health.

PREVALENCE OF DENTAL CARIES AMONG SMOKERS OF A TERTIARY CARE HOSPITAL OF LAHORE

Dental caries is a common chronic oral health condition globally, with an increased prevalence among smokers. Smoking contributes to caries risk by affecting saliva production, oral microbiota, and oral hygiene practices. In Pakistan, where smoking is prevalent. Objective: This study aims to assess the prevalence of dental caries among smokers attending a tertiary care hospital in Lahore. Methods: A cross-sectional study was conducted at Jinnah Hospital, Lahore, from January to July 2024. The sample included 100 adult smokers aged 18 years and above. Data on demographics, smoking frequency, oral hygiene practices, and dental caries were collected using structured interviews and clinical examinations. Caries severity was assessed using the Decayed, Missing, and Filled Teeth (DMFT) index. Statistical analyses, including chi-square tests, were conducted to explore associations between smoking habits and caries prevalence. Results: The majority of participants were aged 26-35 (30%), with 35% smoking 6-10 cigarettes daily. Oral hygiene practices were suboptimal, with only 25% brushing twice daily, and 15% reporting no regular hygiene routine. The prevalence of dental caries was strongly correlated with smoking frequency and duration. Participants smoking more than 21 cigarettes daily had an 80% caries prevalence, while those with a smoking history of over 16 years had a mean DMFT score of 7.6. These results align with previous studies linking smoking with higher caries risk and severity. Conclusion: The study highlights a high prevalence of dental caries among smokers, with significant associations between smoking frequency, duration, and caries severity. These findings underscore the need for preventive dental health interventions, including smoking cessation programs and targeted oral hygiene education, to mitigate the burden of dental caries in this high-risk population.

Clinical Decision-Making of Repair vs. Replacement of Defective Direct Dental Restorations: A Multinational Cross-Sectional Study With Meta-Analysis.

This web-based survey, conducted across multiple countries, sought to explore the factors that impact the decision-making of clinicians when it comes to managing defective direct restorations. A survey consisting of 14 questions was sent out to dentists in 21 countries through various online platforms. The survey consisted of two sections. The first contained five questions about demographic information, while the second involved eight clinical scenarios. In the second part, participants were tasked with deciding whether to repair or replace defective composite and amalgam restorations. Three thousand six hundred eighty dental practitioners completed the survey. For composite restorations, repair was preferred in scenarios like partial loss or fracture (RR:0.72; 95% CI: 0.58, 0.89; p = 0.002), whereas replacement was favored for secondary caries (RR:2.43; 95% CI: 1.87, 3.16; p < 0.001) and open/defective margins (RR:3.93; 95% CI: 2.68, 5.76;p < 0.001). Amalgam restorations were mostly replaced across all scenarios. The main factors influencing decision-making were caries risk, restoration size, and patient oral hygiene. Substantial heterogeneity was observed across countries. This study underscores the complexity of the decision-making process and the need for evidence-based guidelines to inform clinicians' decisions regarding restoration management. Patient-level factors predominantly influence decision-making, emphasizing the need for individualized approaches. The study reveals that the material type in the original restoration is a critical determinant, with composite restorations being repaired in specific scenarios, while amalgam restorations are consistently replaced across different countries. Key patient and tooth-level factors, such as high caries risk, poor oral hygiene, and restoration size, significantly impact clinicians' decisions, often favoring replacement over repair. These findings underscore the necessity for evidence-based guidelines to assist clinicians in making informed choices, ultimately enhancing the quality of patient care.

Buonocore Memorial Lecture 2023: Longevity of Dental Restorations or Longevity of Teeth: What Matters?

This paper aims to raise a discussion from the perspective of maintaining long-term oral health, posing a critical question: What holds greater significance for maintaining oral health, the longevity of restorations or teeth? This question explores the aspects that truly matter in ensuring sustained oral health throughout an individual's life. Restoration longevity is well-researched, and evidence shows several risk factors influencing longevity. The dentist's decision-making factor may be of utmost importance, and further studies are needed to investigate its relevance. The critical risk factors for restoration longevity are active pathology (high caries risk), less prominent parafunction, and extensive defects such as endodontic treatment. However, tooth longevity and the main risk factors for tooth loss are not well-researched. The evidence shows dental caries, and its sequelae, are the principal reasons for tooth loss. Patient-related risk factors, especially those associated with lifestyle and health choices, play a major role in the longevity of restorations and, more importantly, tooth longevity. To provide personalized dental care with maximum patient benefit, clinicians should identify and record potential risk factors, promoting a healthy lifestyle to ensure tooth and dentition longevity. Moreover, the evidence suggests that decision-making frameworks based on minimal intervention principles offer the best standard for clinical practice, promoting a longstanding healthy oral environment.

Effect of BMI on Caries Assessed by Structural Equation Modelling in an Adult Brazilian Population.

Compare different behavioural, environmental and socioeconomic factors for caries with transversal data to decompose the direct and indirect effects of body mass index (BMI) in relation to coronal and root caries. This cross-sectional study used a representative sample of 1002 individuals aged ≥ 35 years living in Porto Alegre. Questionnaires recorded age, sex, educational level, tooth brushing frequency and access to dental services. Oral examination assessed gingival bleeding and recession, coronal and root caries. Height and weight were collected to calculate the BMI. The structural equation modelling approach was used, and standardised coefficients (SC) to direct, indirect and total effects were calculated. The prevalence of excessive body weight was 71.17%, of which 40.09% were overweight and 31.07% were obese. The overall prevalence of coronal and root caries was 99.83 and 36.95, respectively. No direct link between BMI and coronal or root caries was observed. For coronal caries, positive SC was found for age (0.56; p < 0.01) and sex (female) (0.14; p < 0.01). For root caries, positive SC was detected for age (0.34; p < 0.01), smoking exposure (0.17; p < 0.01) and gingivitis (0.08; p < 0.01). Overweight and obese adults should not be regarded at higher risk for dental caries.

Optimizing Treatment for Severe-Early Childhood Caries: The Role of Groper’s Appliance

Severe-Early Childhood Caries (S-ECC), often leading to serious health issues if left untreated, possesses a great restorative challenge to the pediatric dentist. This case report discusses a comprehensive management of S-ECC in a 5-year-old female patient with high dental caries risk. The patient presented with multiple carious lesions, root stumps, and fenestrated roots, necessitating a staged intervention. Treatment involved restorations with glass ionomer cement, pulpectomy followed by omega loop post build-up on anterior tooth and stainless-steel crowns on posterior teeth. Additionally, extractions were performed and Groper’s appliance was inserted for esthetic rehabilitation and space maintenance on maxillary anterior and posterior regions, respectively. Following completion of the planned treatment, overall risk assessment measured low. This case report emphasizes the importance of rehabilitative interventions in S-ECC, showcasing Groper's appliance as a viable and effective treatment option.

Delivery of Oral Health Services at Medical Visits through 3 Medical Dental Integration Models.

The Rocky Mountain Network of Oral Health is 1 of 3 regional projects funded by the Health Resources and Services Administration (2019 to 2024) focusing on caries prevention through medical-dental integration (MDI) in community health centers (CHCs). MDI models included provision of preventive oral health services (POHS) at medical visits by the medical team (model 1), by integrated dental hygienists (DHs; model 2), or a hybrid of these models (model 3). The overarching aim is to evaluate the effectiveness of these models on 3 objectives: (1) ≥50% receive POHS, (2) ≥75% with high caries risk receives dental referral, and (3) ≥30% of parents/caregivers set an oral health goal for the child. Primary care association practice facilitators (PFs) recruited 22 CHCs to participate from Arizona, Colorado, Montana, and Wyoming. CHCs completed oral health needs assessments prior to participating. PFs coached CHCs using an MDI change package. CHCs submitted monthly and 6-mo, aggregated, deidentified population metrics for children aged 0 to 40 mo receiving well-child care visits. Monthly CHC-specific reports were used by PFs with teams in continuous quality improvement activities. POHS delivery trends over time were assessed using a linear mixed model, adjusting for number of eligible patients during each 6-mo reporting period. Participating CHCs were urban (55%), rural (36%), and frontier (8%). Twelve (55%) had co-located dental clinics. Ten CHCs implemented model 1, 5 implemented model 2, and 7 implemented model 3. From September 2020 to August 2023, CHCs reported providing 91,604 POHS to eligible children. After adjustment, there was significant improvement over time for all objectives: objective 1: F(5, 90) = 4.66, P = 0.0008; objective 2: F(5, 90) = 2.99, P = 0.0151; objective 3: F(5, 90) = 4.56, P = 0.0009. The implementation of 3 MDI models across 22 CHCs in 4 states resulted in a meaningful increase in POHS delivery. POHS delivery by both medical and embedded DHs was associated with the most substantial increase in POHS delivery. The results of this study can be used by medical and dental providers when deciding which approach they wish to use when planning the delivery of preventive oral health services at medical visits.

Tap water filtration and purification usage and their impact on the concentrations of fluoride and other minerals – A community-based study

ObjectiveThis study investigated the prevalence of water filtration and purification system (WFPS) use among residents of central Indiana (USA) and determined the effects of WFPS on the concentrations of fluoride, calcium, magnesium, potassium, and sodium in tap water. MethodsA census-based questionnaire collected data on demographics, water use, and water sources. Participants were also asked to provide water samples from their tap water or the WFPS they used. Water samples were analyzed using ion-specific electrodes (fluoride) and atomic absorption spectrometry (metals). Mineral concentration comparisons between water sources used nonparametric tests; questionnaire associations were testing using correlations, chi-square tests, and nonparametric tests. ResultsOne hundred and one participants completed the study, of which 71 % used some type of WFPS. Blacks were less likely to use WFPS than Asian or White participants (p = 0.045). Those with bachelor's degrees or higher were more likely to use WFPS (p = 0.003). The most used WFPS were pitcher filters (31 %), water softeners (21 %), reverse osmosis systems (11 %), faucet-mounted filters (4 %), and whole-house carbon filters (1 %). Reverse osmosis systems resulted in the lowest mineral concentrations (median, ppm; F-0.08, Ca-2.30, Mg-0.46, Na-4.60, P-0.35). Pitcher filters were largely comparable to unfiltered tap water. Water softeners resulted in the highest sodium concentrations (78.40 ppm). ConclusionA large proportion of study participants use WFPS, with pitcher filters being the most common. Reverse osmosis systems had the most significant impact on reducing mineral levels in tap water, while pitcher filters do not adversely affect mineral concentrations. Clinical SignificanceUnderstanding how different WFPS affect the various minerals in tap water is essential for helping consumers in choosing the right system and for oral care providers to guide patients on water consumption and the need for fluoride supplementation, especially for those at high risk of dental caries.