Incipient Caries Research Articles

臨床実習における総括的評価としての保存科新規課題 ｢永久歯初期齲蝕に対するフッ化物塗布｣ の評価

臨床実習における総括的評価としての保存科新規課題 ｢永久歯初期齲蝕に対するフッ化物塗布｣ の評価

Clinical Evaluation of Two Different Prevention Programs in Adults Depending on Their Caries Risk Profile: One-year Results.

The aim of this study was to investigate the management of incipient caries lesions in adults with two preventive protocols. A total of 44 adult patients with high, moderate and low caries risk with 516 incipient caries took part in the study. These patients were assessed for caries with International Caries Detection and Assessment System (ICDAS) criteria and were then divided into three groups depending on their caries risk profile: a high-risk group (group A), a moderate-risk group (group B), and a low-risk group (group C). Participants in each group were further divided randomly into two subgroups. In subgroups A1, B1, and C1, an intensive preventive protocol was applied, while in subgroups A2, B2, and C2, the protocol consisted only of instructions in oral hygiene. The invasive-intensive protocol included the topical application of fluoride, brushing with 5000-ppm fluoride toothpaste, use of amorphous calcium phosphate-casein phosphopeptide, applications of sealants for occlusal lesions (ICDAS code 2), and minimal resin restorations for occlusal lesions (ICDAS code 3). There was no statistically significant difference in the number of lesions (baseline and after one year) in the high-risk and moderate-risk groups that received the intensive protocol (groups A1 and B1), while the control groups were statistically significant different (groups A2 and B2). In the low-risk group, there was no statistically significant difference in the number of lesions (groups C1 and C2). The two different preventive protocols in the high- and moderate-risk groups presented differences in effectiveness, while in the low-risk group, no significant difference was demonstrated.

Remineralización de lesiones cariosas activas incipientes después de la aplicación de un barniz fluorado, medida a través de un láser de diagnóstico

Remineralization of incipient caries lesion after using a fluoride varnish therapy detected by a diagnosis laser

In Vitro morphological, optical and microbiological evaluation of nanosilver fluoride in the remineralization of deciduous teeth enamel

Abstract Background Nanosilver fluoride (NSF) was developed as an alternative in the prevention of dental caries. Purpose The aim of this study was to test the remineralizing action of NSF on incipient enamel caries and its antimicrobial action on the acid production and adhesion of Streptococcus mutans. Methods Deciduous enamel fragments were treated with sodium fluoride (NaF), NSF and deionized water. Microhardness, fluorescence spectroscopy and optical coherence tomography imaging were performed on each specimen before chemical caries induction, after caries induction and after 14 days of pH cycling. The treated enamel fragments were also placed into test tubes containing bacterial suspension and saliva. The pH readings and quantification of the adhered microorganisms to the dental enamel were determined. Analysis of variance, Kruskal-Wallis, Mann-Whitney, Tukey and mixed linear regression model were applied. Results NSF and NaF were effective in enamel remineralization, with a statistically significant difference (p<0.001) to deionized water, and they had no statistically significant difference between themselves (p>0.005). NSF had greater effectiveness compared to NaF in preventing decreases of pH and adhesion of S. mutans to the enamel surface, with statistically significant (p<0.001) differences. Conclusion NSF may be more effective than conventional fluorides in treating incipient caries lesions due to its remineralization and antibacterial actions.

A comparative study on early childhood caries detection by using international caries detection and assessment system-Ⅱ and WHO criteria

Objective: To investigate and compare the sensitivities of early childhood caries detection by using international caries detection and assessment system (ICDAS)-Ⅱ and WHO criteria. Methods: A total of 449 3-year-old children from four day care kindergartens in Beijing were enrolled in this study. Both ICDAS-Ⅱ and WHO criteria were used to assess the prevalence of caries in the given subjects. The decayed, missing, and filled teeth (dmft) index scores were calculated. In ICDAS-Ⅱ system, four cut-off points (D1, D2, D3 and D4) were employed to differentiate sound and decayed teeth: D1 (score 0 as sound, scores 1-6 as caries); D2 (0-1 sound, 2-6 caries); D3 (0-2 sound, 3-6 caries) and D4 (0-3 sound, 4-6 caries). SPSS software was used to analyze the data to decide the significance of differences. Results: The caries prevalence using ICDAS-Ⅱ were 76.6% (344/449), 71.3% (320/449), 52.8% (237/449) and 46.1% (207/449) for D1 to D4, respectively; the corresponding mean dmft scores were 4.95±4.85, 4.41±4.77, 2.54±3.69 and 1.97±3.10. The sites with highest caries prevalence were occlusal surface of mandibular molars in groups of D1 and D2 and proximal surface of maxillary anterior teeth in groups D3 and D4. In contrast, the caries prevalence was 48.8% (219/449) and the mean dmft was 2.27±3.54 when using WHO criteria, significantly lower than the detection rates by using ICDAS-Ⅱ (D1-D2) (P=0.00). This suggested that ICDAS-Ⅱ system was a more sensitive method in detecting early childhood caries. Conclusions: ICDAS-Ⅱ system might be superior in detection of incipient caries and be of specific value in prevention of early childhood caries.

X-Ray Free Techniques Used for Detection of Dental Caries

Modern dentistry focused on prevention, and the idea of “extension for prevention” must be replace with the procedures for a minimal invasive cavity preperation techniques. For this new approach for dentistry. Conventional or the traditional methods have failed to detect early incipient caries effectively. New diagnostic methods are still under research and seems to be very effective for early detection of caries in the near future. Advanced detection methods based on optical properties (fluorescence and transillumination) are seems to be the most potent methods for the detection of early carious lesions.

One-step phosphorylated poly(amide-amine) dendrimer loaded with apigenin for simultaneous remineralization and antibacterial of dentine.

Dental caries, starting from demineralization of enamel and dentine, is closely related with acid-producing bacteria in oral cavity, for example, Streptococcus mutans. Remineralization is an efficient way to prevent the disease progression and facilitate the therapy of incipient caries. Therefore, for the purpose of effective dentine repair, remineralization and antibacterial should be combined simultaneously. However, most of the literatures only focus on one single aspect, while combing remineralization and antibacteria for dentine repair in one system is rarely reported. Here in this work, phosphoryl-terminated poly(amide-amine) dendrimers were loaded with apigenin, a water-nonsoluble drug antibacterial agains Streptococcus mutans. The apigenin-loaded dendrimers bind strongly with dentine, which further induce dentine tubules occlusion through mineralization in artificial saliva, and the release of apigenin can prevent further erosion of dentine by bacteria. Meanwhile, the phosphorylated dendrimers are easily prepared by one-step modification of poly(amide-amine) and exhibit good cytocompatibility. This strategy developed here can provide reference for the design of effective anti-caries materials.

Beam hardening correction tool improves the diagnosis of incipient caries lesions in Micro-CT images.

To evaluate the effect of Beam Hardening Correction tool (BHC) on Micro-CT images used in the diagnosis of incipient caries lesions. Six posterior teeth, with 6 sound proximal surfaces and 6 natural white spot lesions, were scanned using a SkyScan1174 device. Each tooth was imaged 16 times in various acquisition parameters, and reconstructed 3 times applying different levels of BHC (0, 15 and 30%). The 288 datasets were analyzed by three examiners. Gold-standard was obtained by microscopic analyses under polarized light. Area under the ROC curve was obtained for each protocol and the BHC parameter was isolated to individually observe the influence of such parameters of reconstruction. Microtomographic images were accurate for the diagnosis of incipient caries lesions even when the BHC tool was not applied. Accuracy was perfect in 50 % of the protocols without BHC. When adding the artefact correction, the number of protocols that reached perfect accuracy increased to 81.25%. No difference was found between the protocols that used 15 or 30% BHC. Statistically significant differences were found only in four comparisons, and on those the images that had BHC were more accurate. Two non-BHC protocols reached accuracy scores of 0.653 and 0.881, and were improved to perfect accuracy with BHC application. The use of the BHC tool should be encouraged when using Micro-CT to detect incipient caries lesions, especially when low-quality parameters aiming less acquisition and processing time are used.

Impact of toothbrushing frequency and toothpaste fluoride/abrasivity levels on incipient artificial caries lesion abrasion

ObjectivesTo investigate the interplay among brushing frequency, dentifrice slurry abrasivity, and fluoride content on the surface loss (SL) of incipient enamel caries-like lesions. MethodsLesions were created in 96 bovine enamel specimens (5 × 5 mm) using methylcellulose acid gel. Specimens were randomly allocated to 12 groups (n = 8), resulting from the association of three experimental factors: (1) slurry abrasive level [low: REA = 4/RDA = 69 and high: REA = 7/RDA = 208], (2) fluoride concentration [275 and 1250 ppm F as NaF], and (3) brushing frequency [1, 2 and 3× daily]. Specimens were kept in artificial saliva in between brushings and overnight. SL was determined by optical profilometry after lesion creation, 1, 3, 5, and 7 days. Data was analyzed with repeated measures ANOVA and Tukey’s tests (α = 0.05). ResultsHigh abrasive slurry caused significantly more SL than low with 275 ppm (p < 0.001) but not with 1250 ppm fluoride (p = 0.34). Fluoride at 275 ppm had significantly more SL than 1250 ppm with high abrasive slurry after 7 days (p = 0.008). Brushing 1×/day had significantly less SL than 3×/day after 7 days with high abrasive slurry (p = 0.016), especially in the 275 ppm fluoride groups. ConclusionsHigher fluoride concentration increased protection against the deleterious effect of high abrasive slurry. SL was higher if brushing was performed more than twice daily especially in low fluoride groups. Clinical significanceHighly abrasive toothpaste formulations might cause more surface wear to incipient caries lesions, especially at higher brushing frequencies. Increasing the fluoride content may be beneficial at these circumstances.

Biomimetic Tooth Repair: Amelogenin-Derived Peptide Enables in Vitro Remineralization of Human Enamel.

White spot lesions (WSL) and incipient caries on enamel surfaces are the earliest clinical outcomes for demineralization and caries. If left untreated, the caries can progress and may cause complex restorative procedures or even tooth extraction which destroys soft and hard tissue architecture as a consequence of connective tissue and bone loss. Current clinical practices are insufficient in treating dental caries. A long-standing practical challenge associated with demineralization related to dental diseases is incorporating a functional mineral microlayer which is fully integrated into the molecular structure of the tooth in repairing damaged enamel. This study demonstrates that small peptide domains derived from native protein amelogenin can be utilized to construct a mineral layer on damaged human enamel in vitro. Six groups were prepared to carry out remineralization on artificially created lesions on enamel: (1) no treatment, (2) Ca2+ and PO43- only, (3) 1100 ppm fluoride (F), (4) 20 000 ppm F, (5) 1100 ppm F and peptide, and (6) peptide alone. While the 1100 ppm F sample (indicative of common F content of toothpaste for homecare) did not deliver F to the thinly deposited mineral layer, high F test sample (indicative of clinical varnish treatment) formed mainly CaF2 nanoparticles on the surface. Fluoride, however, was deposited in the presence of the peptide, which also formed a thin mineral layer which was partially crystallized as fluorapatite. Among the test groups, only the peptide-alone sample resulted in remineralization of fairly thick (10 μm) dense mineralized layer containing HAp mineral, resembling the structure of the healthy enamel. The newly formed mineralized layer exhibited integration with the underlying enamel as evident by cross-sectional imaging. The peptide-guided remineralization approach sets the foundation for future development of biomimetic products and treatments for dental health care.

Performance of Preventive Methods Applied to the Occlusal Surface of Primary Teeth: A Randomized Clinical Study

Objective: To evaluate the clinical performance of three preventive materials on the occlusal surfaces of primary molars over a 36-month period. Material and Methods: The study was conducted with a split-mouth design involving four experimental groups: G1 – resin-modified glass ionomer cement (Vitremer ® ); G2 - resin sealant (Alpha Seal Light ® ); G3 - silver diamine fluoride (Cariostatic ® ); and G4 - control group without material. Thirty-two children aged 36 to 60 months, attending a pediatric clinic, with a deft index ≥ 1 and four primary second molars participated in the study. The material retention was evaluated in G1 and G2, and the presence of incipient caries was evaluated in all groups. Data were submitted to the Wilcoxon test and survival test (α = 5%). Results: At three, six, 12, 24 and 36 months, G2 exhibited greater material loss (maximum loss: 44%) in comparison to G1 (maximum loss: 35%), but this difference did not achieve statistical significance (p = 0.214). The highest incidence of incipient caries occurred in G3 (20%), but no significant differences were found between groups at any evaluation time (p = 0.154). Conclusion: There were no statistically significant differences between the evaluated products regarding material retention and dental caries, although there was more material loss in teeth that received the Alpha Seal ® sealant resin, and a greater number of carious lesions in the Cariostatic® group (silver diamine fluoride).

Low Viscosity Resin Penetration Degree in Incipient Caries Lesions

Resin infiltration is considered a treatment option for initial caries lesions. To prevent enamel lesion s from further demineralization a complete and homogeneous penetration of low-viscosity resins should be accomplished. The aim of this study was to compare the penetration abilities of 3 commercial products: Icon (DMG, Germany), Fluorodose (Centrix Inc. USA) and Tetric flow (IvoclarVivadent, Schaan, Liechtenstein).Artificial white spot lesions were produced in 60 orthodontic extracted human premolars. The samples were randomly divided into 3 groups: F - weeklyapplication of 5%fluoride gel; IC � resin infiltration (Icon1-DMG) and T - treatment with composite resins (Tetric flow). Specimens were studied using confocal microscopy and penetration depths were determined. A good correlation between PC and penetration depth was thereby observed (Pearson correlation coefficient, r=0.820).

Silver diamine fluoride remineralized artificial incipient caries in permanent teeth after bacterial pH-cycling in-vitro

ObjectivesTo investigate the remineralizing effect of 38% silver diamine fluoride (SDF) application on enamel artificial caries in adjunct to 1000ppm fluoride toothpaste compared with fluoride toothpaste alone by analyzing the mineral density, depth of remineralization, and remineralization percentage of the lesions. MethodsEighteen artificial caries slabs were created from the proximal surfaces of nine chemically demineralized premolars. The slabs were scanned by Micro-Computed Tomography (Micro-CT) to determine the baseline mineral density of the initial lesions and randomly allocated into 2 groups. The test group was applied with 38% SDF in adjunct to fluoride toothpaste and the control group was treated with fluoride toothpaste alone. The specimens underwent bacterial pH-cycling for 5 d and were re-evaluated using Micro-CT. The pre-treatment and post-treatment mineral densities were plotted and the areas under the curves were used to calculate the remineralization percentage of both groups. ResultsMineral density significantly increased in both groups after pH-cycling (p<0.05) although to different depths (control group=260μm, test group=300μm). The test group demonstrated a significantly higher mineral density to a depth of 120μm and higher remineralization percentage (p<0.05) compared with the control group. ConclusionThe adjunctive use of 38% SDF enhances the remineralization of initial carious lesions based on mineral density, depth, and remineralization percentage compared with the use of 1000ppm fluoride toothpaste alone. SDF might be used as an adjunct to fluoride toothpaste to remineralize incipient caries lesions on smooth tooth surfaces. Clinical significanceIn non-compliant patients, the application of 38% SDF might be used as an adjunct to fluoride toothpaste, to remineralize incipient caries lesions of permanent teeth where esthetics is not a concern.

Preventive and Therapeutic Proximal Sealing: A 3.5-Year Randomized Controlled Clinical Trial Follow-Up

Objective: The aim of this split-mouth, randomized controlled clinical trial was to evaluate the efficacy of proximal sealing for avoiding the development of new caries lesions or arresting incipient caries lesions on the mesial surface of first permanent molars (6m) abutting lesions on the distal surface of second primary molars (05d) in children at high caries risk. Methods: A total of 61 children 8-10 years old were selected based on the caries status of the proximal sites of 05d and 6m. Children with caries on 05d and caries-free 6m were placed in the preventive sealing group and children with caries on both 05d and 6m in the therapeutic group. The children in each group had one 6m surface pair and in each pair one 6m surface was randomly allocated to receive a preventive or therapeutic sealing. Using a split-mouth design, the other 6m surface in the pair served as control. Results: After 3.5 years, standardized follow-up radiographs were obtained for the 45 children who remained. In the preventive sealing group, 4 out of 30 (13.3%) sealed and 16 out of 30 (53.3%) unsealed sound 6m surfaces had developed new caries lesions (p = 0.004, McNemar test). In the therapeutic sealing group, the progression of the carious lesions on 6m was observed in 3 out of 15 sealed (20.0%) and 8 out of 15 (53.3%) unsealed caries control surfaces (p = 0.06). Conclusions: Preventive sealing on sound 6m surfaces abutting 05d lesions in children at high caries risk efficaciously prevents the development of caries lesions. Therapeutically sealing active non-cavitated caries lesions reduces the progression.

Diagnosis of occlusal caries lesions in deciduous molars by coherent light scattering pattern speckle

BackgroundThis study presents the correlation between laser speckle images and detection of incipient caries lesions from changs in the microstructure of the surface of tooth enamel. MethodsWe used 30 healthy deciduous molar teeth collected from the Biobank Human Teeth, Faculty of Dentistry, University of São Paulo who had carious lesions induced by the pH cycling method. The samples were evaluated for the diagnosis of caries by two methods ICDAS and speckle pattern of coherent light scattering after 5, 10 and 15days and the results were statistically analyzed using α=0.05 significance level. ResultsA significant difference was observed between the image of the speckle scattering of healthy and injured areas within the 3 study groups, but not when comparing the three groups, showing us that it is an innovative technique that needs further study, but can be used as a diagnostic method for the detection of early caries lesions. ConclusionIt can be concluded that the analysis of scattering speckle pattern is a diagnostic technique that provides information on the microstructure of the surface of tooth enamel which has sensitivity for detection of incipient caries lesions.

Comparative remineralization effects of human and artificial saliva compositions on incipient dental caries

Comparative remineralization effects of human and artificial saliva compositions on incipient dental caries

A Neanderthal deciduous human molar with incipient carious infection from the Middle Palaeolithic De Nadale cave, Italy.

The aim of the study is the assessment of Nadale 1, a Neanderthal deciduous tooth recently discovered in Northeastern Italy in the De Nadale cave (Middle Palaeolithic). Together with the clear archaeological context of the site, this study brings new insight on Neanderthal behavior and dental morphological variability. We used microCT data to provide a morphological description and morphometric analysis (diameter measurements and dental tissue volumes) of the Nadale 1 human tooth. Microwear analysis, taphonomical investigation and caries identification were performed using a stereomicroscope and Scanning Electron Microscope. In terms of morphology (i.e., incipient tuberculum molare, marked mesial marginal ridge and well-developed mid-trigonid crest connecting the protoconid and the metaconid, deep anterior fovea) and size, Nadale 1 presents features frequently observed in Neanderthal lower first deciduous molars. Microscope investigations reveal the presence of a small pit which could be correlated to an incipient caries. Nadale 1 expands the Italian Middle Palaeolithic fossil record and provides further information on Neanderthal dm1s in terms of dimensional and morphological variability. Furthermore, the presence of an incipient caries brings further data on Neanderthal diet.

Third Molar Eruption Mechanisms and Patterns

Third molars are highly variable in their presence and form. This report focuses on a horizontally impacted third molar and analyzes the potential etiology of this situation. Upon a clinical and radiographic examination, it was noted that the patient had four third molars present. The patient’s third molars began erupting around the age of 19. Currently, they are asymptomatic with incipient caries on the occlusal surfaces. While three of the third molars erupted in a normal orientation, one of the third molars (mandibular left) erupted in an orientation that would be classified as horizontal and/or mesio-angular. No treatment has been undertaken at the moment, however surgical extraction can be recommended with the prognosis being very good. For the clinician that has to treat dental complications that arise from abnormal tooth eruption, as seen in numerous genetic and acquired disorders, knowledge about the basic molecular mechanisms involved may become extremely important.

Remineralization of early enamel caries lesions using different bioactive elements containing toothpastes: An in vitro study.

Demineralization can be arrested or reversed when remineralization agents are applied to incipient carious or non-cavitated carious lesions. A large number of therapeutic agents including non-fluoridated products have been developed to promote enamel remineralization. This study aims to evaluate the efficacy of different bioactive elements containing toothpastes in remineralization of artificial enamel lesions. Artificial carious lesions were created on 40 human enamel slabs, and were randomly divided into four groups: (1) control group (no treatment), (2) casein phosphopeptide-amorphous calcium phosphate group (CPP-ACP, GC Tooth Mousse), (3) 8% arginine and calcium carbonate group (ACC, Colgate Sensitive Pro-Relief), (4) calcium sodium phosphosilicate group (CSP, NovaMin®). All samples were subjected to 15 days of pH-cycling. Subsequently, a one-hour acid resistance test was carried out. Surface hardness of the samples was assessed using the Knoop hardness test, and surface morphology and roughness were assessed by scanning electron microscopy (SEM) and atomic force microscopy (AFM). Data were analyzed using one-way ANOVA, Tukey's test and paired t test. The three tested toothpastes exhibited a significantly higher remineralization efficacy compared with the control group (P< 0.05 for all). After pH-cycling, the specimens treated with Colgate Sensitive Pro-Relief and NovaMin® showed a significant higher surface hardness (P< 0.001 and P= 0.03, respectively) and lower surface roughness (P< 0.05 for both) compared those treated with GC Tooth Mousse. While after the acid resistance test, all groups showed a significant loss of surface hardness (P< 0.001 for all) and significant increase of surface roughness (P< 0.05). The specimens treated with Colgate Sensitive Pro-Relief and NovaMin® still showed a significant higher surface hardness and lower surface roughness in comparison with those treated with GC Tooth Mousse (P< 0.05 for all). No significant difference was found in surface hardness and roughness between Colgate Sensitive Pro-Relief and NovaMin® during the pH-cycling test and acid resistance test (P= 0.45 and P= 0.83, respectively). Colgate Sensitive Pro-Relief and NovaMin® present an advantage in enhancing remineralization and inhibiting demineralization for early enamel carious lesions in comparison with GC Tooth Mousse.

Repairing human tooth enamel with leucine-rich amelogenin peptide–chitosan hydrogel

Abstract