Initial Caries Lesions Research Articles

The Remineralization of Enamel from Saliva: A Chemical Perspective

The natural remineralization of enamel is of major importance for oral health. In principle, early erosions (demineralization) induced by acidic beverages and foods as well as initial caries lesions can be covered and remineralized by the deposition of calcium phosphate, i.e., tooth mineral. This remineralization effect is characterized by the presence of calcium and phosphate ions in saliva that form hydroxyapatite on the enamel surface. Although it is apparently a simple crystallization, it turns out that remineralization under in vivo conditions is actually a very complex process. Calcium phosphate can form a number of solid phases of which hydroxyapatite is only one. Precipitation involves the formation of metastable phases like amorphous calcium phosphate that convert into biological apatite in a number of steps. Nanoscopic clusters of calcium phosphate that can attach on the enamel surface are also present in saliva. Thus, remineralization under strictly controlled in vitro conditions (e.g., pH, ion concentrations, no additives) is already complex, but it becomes even more complicated under the actual conditions in the oral cavity. Here, biomolecules are present in saliva, which interact with the forming calcium phosphate mineral. For instance, there are salivary proteins which have the function of inhibiting crystallization to avoid overshooting remineralization. Finally, the presence of bacteria and an extracellular matrix in plaque and the presence of proteins in the pellicle have strong influences on the precipitation on the enamel surface. The current knowledge on the remineralization of the enamel is reviewed from a chemical perspective with a special focus on the underlying crystallization phenomena and the effects of biological compounds that are present in saliva, pellicle, and plaque. Basically, the remineralization of enamel follows the same principles as calculus formation. Notably, both processes are far too complex to be understood on a microscopic basis under in vivo conditions, given the complicated process of mineral formation in the presence of a plethora of foreign ions and biomolecules.

Biomimetic Regeneration Of Enamel Using SelfAssembling Peptides: A Systematized Review

Background: Noninvasive methods of treating initial caries lesions have been a widely researched topic in this scientific era. Various biomimetic materials are available on the market. Self-assembling peptides focus on the biomimetic regeneration of enamel and stand out from the others due to their ability to restore the enamel matrix Data: This systematized review was conducted on articles with the remineralization effects of SAP on initial enamel lesions published between 2019 January to 2024 September. Sources: The search of this review was carried out in the electronic databases PUBMED, COCHRANE, EMBASE, and Google Scholar. Only primary researches were included Results: Out of 122 articles obtained, 28 articles were included in this review after screening. The studies demonstrate the effect of SAP on reversing WSLs and its efficacy in comparing and combining with other remineralizing agents such as fluorides, and CPP-ACP. Conclusion: With the limited evidence, SAP can be used as a promising solution for WSLs in permanent as well as primary teeth

Impact of resin infiltration in controlling proximal initial carious lesion: A randomized controlled trial

: Dental caries is a major public health concern commonly affecting all age groups. Early detection and treatment of such lesions will limit the need for invasive treatment in the future. Resin infiltration is proposed as an encouraging non-invasive approach that can be used as an option in addition to non-operative and operative approaches to treatment.: To assesses the efficacy of micro-invasive interventions (resin infiltration or sealing) for controlling caries progression on proximal surfaces.The randomized clinical trial was carried out among 30 proximal caries lesion patients. After randomization participants were equally allocated in three groups; infiltration, sealant and placebo. DMFT & DMFS index and ICDAS were recorded at baseline, 3 months, 6months and 9 months. The ANOVA and chi square tests were used to determine significant differences between groups. In all tests, p-values less than 0.05 were considered significant. : There is a significant difference in the mean DMFT and DMFS value of infiltration and resin group as compared to control group p value 0.023 and 0.007 respectively. Also infiltration group had lower score as compared to resin group. Also, Infiltration group had the lowest mean ICDAS score at all time points, indicating the lowest severity of tooth decay, followed by the sealant group and then the Control group. : Our randomized controlled trial provides valuable insights into the effectiveness of resin infiltration, sealant, and placebo groups in preventing the progression of early enamel lesions. Resin infiltration was found to be the most effective method.

Prevalence and Association of Caries and Enamel Hypomineralisation/Molar-Incisor Hypomineralisation in 8- to 10-Year-Old Children from Bavaria, Germany

Introduction: The aim of this cross-sectional epidemiological study was to record caries and enamel hypomineralisation (EH), including molar-incisor hypomineralisation (MIH), and assess associations between both entities in 8- to 10-year-olds from Bavaria, Germany. Methods: A total of 5,418 children (mean age 9.8 years; 2,726 females, 2,692 males) were examined using the dmft/DMFT index with additional inclusion of initial or non-cavitated carious lesions (it/IT). EHs were recorded in the primary (eh) and permanent dentition (EH), and individuals with different EH phenotypes were determined as follows: at least one EH, at least one hypomineralised second primary molar (HSPM), at least one hypomineralised first permanent molar (MIH), and at least one hypomineralised first permanent molar and incisor (M+IH). Multiple logistic regression models were constructed to assess association between caries and EH. Results: The percentage of children without caries in the permanent dentition (DMF = 0) was 88.9%. When data regarding initial carious lesions were included (IDMF = 0), the prevalence decreased to 75.7%. The caries experience was idmf/t = 1.6 and the IDMF/T = 0.6. The mean number of carious teeth in subjects with no eh/EH was higher than that in subjects with HSPM, MIH, or M+IH. The presence of HSPM, MIH, and M+IH was associated with a significantly lower probability of caries in the permanent dentition; the corresponding adjusted odds ratios were 0.55 (95% CI: 0.41−0.75), 0.67 (95% CI: 0.56−0.81), and 0.54 (95% CI: 0.41−0.72), respectively. Conclusions: Caries and EH are prevalent conditions in 8- to 10-year-old Bavarian schoolchildren; both dental diseases were negatively associated with each other.

Evaluation of REFIX Technology on the Remineralization of Artificial Early Enamel Caries Lesion by Laser Speckle Tracking Analysis.

To assess the effectiveness of the REFIX technology in the remineralization process of initial caries simulated on bovine enamel. The assessment involved the analysis of backscatter intensity, which was determined from laser speckle images. Twenty-one bovine teeth were divided into three groups: G1 and G7 were submitted to treatment with the REFIX technology for 1 and 7 days, respectively. The control group was treated with deionized water. A significant difference in backscatter was found between the carious and sound areas in all groups (p = 0.0038, p < 0.0001, and p = 0.0002 for the control group, G1, and G7, respectively). The intergroup comparison revealed no significant difference among the groups studied. REFIX technology did not alter the optical properties of the samples of bovine teeth with simulated initial caries lesions after 1 and 7 days of treatment.

Does orthodontic treatment using fixed appliances cause initial caries lesions?

Systematic review and meta-analysis of randomized clinical trials (RCTs), non-randomized studies of intervention (NRSIs), cohort and cross-sectional studies. The systematic review was registered in advance on PROSPERO, and was conducted following the Cochrane Handbook of Systematic Reviews of Interventions and PRISMA checklist. An electronic search in three databases (PubMed, Scopus, and Embase) was conducted by two authors to evaluate studies published from 1990 until May 2023. The review question was defined in PICOS format as follows: Population (P), subjects with permanent dentition who having/had orthodontic therapy; Exposure (E), orthodontic therapy with fixed orthodontic appliance; Comparison/Control (C), no orthodontic treatment or intervention; Outcome (O), assessing incidence and/or prevalence of initial caries lesions (ICLs) at subject and teeth levels was the primary outcome, whereas evaluating the influence of demographics and treatment-related variables were secondary outcomes; studies (S), randomized clinical trials, non-randomized clinical studies, cohort and cross-sectional studies. Meta-analysis was conducted of three or more included studies had comparable findings. The following factors were calculated for each study; sample size, number of patients with ICLs, number of teeth with ICLs, number of teeth affected per patient, and number of surfaces affected. Statistical heterogeneity of effects among studies was assessed by means of the Cochran's test was used to evaluate the statistical heterogeneity of effects in the included studies. Funnel plot approach was used to assess publication bias, whereas Begg's and Egger's correlation test were used to identify asymmetry. Meta-analysis was conducted using a random effects model owing to high methodological and clinical heterogeneity. A descriptive analysis was presented when the meta-analyses appeared inappropriate. Statistical significance level was set at p < 0.05 for all statistical analyses. 21 studies were included in the qualitative synthesis (systematic review); 11 RCTs; 7 NRSIs, and 3 observation studies. Of the included studies, 19 studies were analyzed in the quantitative synthesis (meta-analysis). In regard to the prevalence rate of ICLs; 57% of patients had ICLs, with a mean of 2.24 lesions per patient and 22% of surfaces were affected. In regard to the incidence rate; 48% of patients developed new ICLs, with a mean of 2.29 new lesions per patient, and 15% of surfaces became affected. Both prevalence and incidence rates were positively associated with the duration of the orthodontic therapy (P = 0.01 and P < 0.01, respectively), illustrating an elevation in the ICLs numbers as the treatment duration (number of months) increases. There was no association between patients' age and ICLs numbers. Orthodontic therapy using fixed appliances can increase the risk of accumulating plaque and developing caries lesion. However, other risk factors may play a role in developing ICLs; thus, controlling for these factors is paramount to better evaluate the true influence of orthodontic therapy on the ICLs development. Implementing caries preventive measures during orthodontic treatment may be needed to minimize the potential risks.

Evaluation Of The Effect Of Current Remineralization Agents On Enamel By Different Methods

Objectives: In this study, it was aimed to quantitatively evaluate the remineralization capacity of natural medicaments such as ginger, grape seed extract and rosemary, and materials containing casein and hydroxyapatite of initial caries lesions in vitro.. Materials and Methods: 42 enamel samples obtained from human teeth; were divided into six group as; Group-I (10% Casein Phosphopeptide Amorphous Calcium Phosphate [CPP-ACP], GC Tooth Mousse, Group-II (Rosemary Oil), Group-III (ginger+honey), Group-IV (ginger+honey+cocoa), Group-V (grape seed extract) and Group-VI (control group; remineralization solution). After enamel samples were kept in demineralization solution for 72 hours to create initial caries lesion, grouped remineralization agents were applied to enamel samples with caries lesion during the six-day pH cycle. Measurements were made using surface microhardness and DIAGNOdent at three different stages. The data obtained in the research were analyzed using the SPSS 25.0 program. The results were evaluated at the p ginger+honey+cocoa&gt;ginger+honey&gt; rosemary oil &gt; GC tooth mousse. Conclusions: : It is thought that rosemary, ginger + honey + cocoa, grape seed extract materials can be used for remineralization in these working conditions where the initial caries lesions can be remineralized after six days.

Effect of tablets containing a paraprobiotic strain and the cranberry extract on caries incidence in preschool children: A randomized controlled trial.

Preand probiotics may help restore a dysbiotic oral ecosystem. The first years of life provide a window of opportunity to modulate the composition of the oral microbiota and prevent disease. The aim of the present study was to investigate the effect of a tablet containing inactivated Ligilactobacillus salivarius CECT 5317 and the cranberry extract on the development of caries in cariesactive preschool children. The study employed a randomized, placebo-controlled, double-blind design. Preschool children (N = 73) with at least one active carious lesion were enrolled and randomly assigned to the test group or the placebo group. The intervention period was 3 months. Caries was assessed according to the International Caries Detection and Assessment System (ICDAS) II criteria at baseline and after 9 months, and oral hygiene was evaluated with the simplified oral hygiene index (OHI-S). The salivary counts of Streptococcus mutans and Lactobacillus spp. were determined at baseline, and then after 3 and 9 months through the conventional cultivation on TYCSB and MRS agar, respectively. Sixty children completed the trial (a dropout rate of 19%). The baseline caries prevalence was high in both groups (~71%) and there were no major differences between the groups with regard to background variables. The 9-month incidence of initial carious lesions (ICDAS 1+2) was significantly lower in the test group as compared to the placebo group (p < 0.05). The plaque levels, and the salivary counts of S. mutans and Lactobacillus spp. remained unchanged in both groups throughout the study. A daily intake of a tablet containing a paraprobiotic and the cranberry extract reduced the 9-month incidence of initial non-cavitated carious lesions in caries-active preschool children. The present study is one of the first to show the impact of synbiotics on the development of caries in children.

Evaluation of Oral Health Status and Treatment Needs of Children with Congenital and Acquired Heart Disease.

Objective: To evaluate the oral health status and treatment needs of children with congenital and acquired heart disease. Methods: This descriptive study included 301 children aged 5-14 from June 2022 to June 2023. Heart conditions were classified by congenital/acquired status and severity. The children's sociodemographic characteristics, medical and dental history, tooth brushing habits, and non-nutritional habits (bruxism, nail-biting, thumb-sucking, etc.) were evaluated. Oral health assessments including caries, oral hygiene, enamel defects, and dental treatment needs-related indices were recorded. Results: The mean age was 8.95 ± 2.91 years, and 271 (90%) of the children had congenital heart disease. The children with moderate and severe heart disease had significantly higher decayed/missing/filled surfaces (dmfs) (p = 0.038) and pulp exposure (p = 0.015) compared to the children with mild heart disease. According to the International Caries Detection and Assessment System II (ICDAS II) index, which included initial caries lesions, there were no caries-free children and 75.7% had extensive caries. The mean plaque index and gingival index were found to be 1.18 ± 0.38 and 0.69 ± 0.53, respectively. Enamel defects were observed in 15.9%. The Treatment Needs Index (TNI) was 85.8% for the primary teeth and 88.9% for the permanent teeth. The Care Index (CI) was 12.4% for the primary teeth and 10.8% for the permanent teeth. Conclusions: Children with congenital and acquired heart disease exhibit a high prevalence of untreated dental caries, gingivitis, and plaque accumulation, with a high need for dental treatments. Dentists should prioritize addressing these issues to prevent the risk of infective endocarditis (IE) and improve oral health outcomes in this population.

Synthesis of novel silver-loaded clay AgF@Hec for the prevention of dental caries in vitro

Dental caries, a chronic infectious disease characterized by tooth mineral loss caused by plaque, is one of the major global public health problems. Silver diamine fluoride (SDF) has been proven to be a highly effective anti-caries drug due to its high bacterial inhibition and remineralization ability. However, the SDF solution is unstable, which immensely limits its clinical application. Therefore, new silver-load clay named AgF@Hec was designed by replacing the NH3 with hectorite in this study. Fourier transform infrared spectroscopy and x-ray diffraction spectroscopy were employed to confirm the structure of AgF@Hec. Dynamic light scattering analysis was used to reveal the effect of different hectorite concentrations on the stability of AgF@Hec. Moreover, AgF@Hec exhibits significant remineralization and hardness recovery of the initial carious lesions. Bacteriostatic experiments also proved that it has a significant inhibitory effect on A. Viscosus, S. mutans, S. sanguinis, S. salivarius, Lactobacillus sp. and both gram-positive and gram-negative bacteria. We therefore believed that AgF@Hec should be a promising biomaterial that can be applied in the prevention of dental caries.

High Anticholinergic Burden and Dental Caries: Findings from Northern Finland Birth Cohort 1966.

Anticholinergic drugs propose a threat for oral health by causing dry mouth. The aim of this cross-sectional study was to investigate whether a high anticholinergic burden was associated with the presence of initial caries lesions, manifested caries lesions, dental fillings, or tooth loss among 46-y-old people. The study population consisted of 1,906 participants from the Northern Finland Birth Cohort 1966 who underwent an oral health examination in 2012-2013. Socioeconomic and medical data were collected from questionnaires, medical records, and national registers. Nine previously published anticholinergic scales were combined and used to measure the high anticholinergic burden from the participants' medication data. Cariological status was determined according to the International Caries Detection and Assessment System, and the number of missing teeth (excluding third molars) was used as an indicator for tooth loss. The decayed, missing, and filled surfaces index was used to depict caries experience. Negative binominal regression models were used to estimate prevalence rate ratios (PRRs) and confidence intervals (CIs). Fourteen percent of the participants (n = 276) used at least 1 anticholinergic drug and about 3% had a high anticholinergic burden (n = 61). After adjusting for confounding factors, participants with a high anticholinergic burden had a higher likelihood of having manifested carious lesions needing restorative treatment (PRR, 1.60; CI, 1.11-2.29) and more missing teeth (PRR, 1.59; CI, 1.13-2.24) when compared to participants without any or with a lower anticholinergic burden. High anticholinergic burden was associated with a present caries experience and with tooth loss among the general middle-aged population. The findings of this study suggest that middle-aged patients with a high anticholinergic burden may have a heightened risk of dental caries. These patients may benefit from targeted caries preventive regimes.

Clinical comparison of silver diamine fluoride (SDF) or silver-modified atraumatic restorative technique (SMART) on hypomineralised permanent molars with initial carious lesions: 3-year results of a prospective, randomised trial

ObjectivesThis study aimed to assess the clinical outcomes of utilizing silver diamine fluoride + potassium iodide (SDF + KI) treatment and Silver-Modified Atraumatic Restorative Technique (SMART/SDF + KI + Glass Ionomer Cement) over a three-year period on hypomineralised permanent molars with initial carious lesions. Methods112 hypomineralised permanent molars with ICDAS 1 or 2 lesions were selected in 48 children. The teeth were randomized into SDF + KI and SMART (SDF + KI + GIC) groups (n = 56 teeth/group) in a split-mouth design. Hypersensitivity and caries development were evaluated in both groups. Schiff Cold Air Sensitivity Scale (SCASS) was used for evaluation of hypersensitivity, and the modified USPHS criteria were utilised for clinical assessments of SMART sealants at 1,6,12,18,24 and 36 months. Fisher's Exact test, Kaplan-Meier Survival Curves, Log-rank test, Mann Whitney U test, and Friedman test was performed for the statistical analysis. ResultsThe caries preventive effect was 100 %, 67.9 % and 65.4 % for SDF + KI-treated teeth; and 100 %, 97.6 % and 94.7 % for SMART(SDF + KI + GIC)-treated teeth at 12, 24 and 36 months, respectively. The mean survival probabilities for caries-preventive effect were significantly lower in SDF + KI-treated teeth (31.01 months) than SMART-treated teeth (35.61 months), (p < 0.001). Twenty-six molars with initial hypersensitivity due to hypomineralization demonstrated a significant reduction at all evaluation periods compared to baseline SCASS scores (p < 0.001). Additionally, there was no significant difference in hypersensitivity scores between the groups during the re-call periods, and none of the teeth exhibited hypersensitivity at the 18-month and beyond evaluations. ConclusionsDuring the three-year assessment, both groups demonstrated effectiveness in reducing sensitivity in hypomineralised molars. However, SMART (SDF + KI + GIC) sealants offered better protection against tooth decay over time, despite experiencing gradual retention loss. Clinical significanceBoth SMART (SDF + KI + GIC) sealants and SDF + KI proved effective in alleviating hypersensitivity in hypomineralised molars for up to three years. SMART (SDF + KI + GIC) sealants showed greater caries-preventive effect compared to SDF + KI. However, continuous long-term monitoring is crucial due to the gradual decline in retention of SMART (SDF + KI + GIC) sealants. ClinicalTrials registration numberNCT03862014.

Evaluation of the Effect of Different Remineralizing Agents and Ozone Application on Artificial Carises

ABSTRACT This study aimed to assess the combined and individual effects of different remineralization agents and ozone application on initial caries. Seventy-two premolar teeth were collected. Three different toothpastes (Ipana, ROCS, and Gumgumix) were utilized. The samples were divided into eight groups (n = 8) for experimentation (Distilled water, Ipana+Ozone, Gumgumix+Ozone, ROCS+Ozone, Ipana, Gumgumix, ROCS, Ozone). Microhardness measurements were conducted initially. All samples were then immersed in a demineralization solution for 72 hours to induce initial caries. Then, microhardness measurements were repeated, and pH cycles were carried out for one-week. Finally, microhardness measurements and SEM-EDS analyses were performed. Ipana+Ozone exhibited the highest microhardness value, which was statistically significant compared to other groups except ROCS+Ozone (p < 0.05). Distilled water, Gumgumix+Ozone, and Gumgumix displayed the lowest microhardness values. Ozone application with remineralization agents led to higher precipitation of Ca ions. The demineralized group showed the lowest Ca, P, and F ions. While Ipana+Ozone and ROCS+Ozone had the highest Ca ions, Gumgumix+Ozone had the highest P ions. Within the study’s limitations, it can be concluded that ozone gas positively impacts the remineralization process in initial caries lesions. Additionally, mineral-containing products demonstrated a noteworthy capacity to reverse the demineralization process.

Do progression rates of initial and moderate caries lesions and sound surfaces of primary teeth increase significantly after 7 years?

Initial caries lesions in primary teeth have presented a low progression rate after 2 years, but it could be higher in longer follow-ups. To evaluate the progression rates of sound surfaces and initial and moderate caries lesions after 7 years. This prospective 7-year cohort study included 639 preschool children aged 1-5 years in 2010. In 2017, 449 children were reassessed (70.3% retention rate). Dental caries was collected using the International Caries Detection and Assessment System (ICDAS) in both assessments. Incidence rate (IR) per 100 surface-years estimated the progression rates of sound surfaces and initial and moderate lesions for worse conditions. Cox regression with shared frailty evaluated the possible risk factors. IR was 1.0% for sound surfaces, 2.8% and 4.2% for ICDAS scores 1 and 2, respectively, and about 17.0% for moderate lesions. The most significant risk factor for the progression was the presence of cavitated lesions in other teeth. The type of surface and tooth also influenced the outcome. The progression rate of initial caries lesions in primary teeth remains low even after 7 years, but cavitated caries lesions in other teeth increase this risk. Moderate lesions demonstrate a higher risk of progression when compared to sound surfaces and initial caries lesions.

Influence of different pre-treatments on the resin infiltration depth into enamel of teeth affected by molar-incisor hypomineralization (MIH)

ObjectivesThis in vitro pilot study aimed to evaluate whether different pre-treatments (demineralization, deproteinization, (chemo-)mechanical reduction of the surface layer) influence the penetration depth of a resin infiltrant into MIH-affected enamel compared to initial carious lesions. MethodsThirty extracted human permanent molars with non-cavitated initial carious lesions (n = 5) or MIH (n = 25) were chosen and randomly assigned to six experimental groups: IC: initial caries; M: MIH; MN: MIH, 5.25% sodium hypochlorite; MM: MIH, microabrasion; MA: MIH, air abrasion; MAN: MIH, air abrasion and 5.25% sodium hypochlorite. A modified indirect dual fluorescence staining method was adopted to assess the penetration depth (PD) of the resin infiltrant and the lesion depth (LD) by confocal laser scanning microscopy (CLSM). Exemplarily, scanning electron microscopic (SEM) images were captured. The relationship between group assignment and penetration/lesion depth was estimated using a linear mixed model incorporating the tooth as random effect (two observations/tooth). The significance level was set at p < 0.05. ResultsFor MIH-affected molars, the mean PD (in µm; median, [minimum-maximum]) were M (178.2 [32.5–748.9]), MN (275.6 [105.3–1131.0]), MM (48.7 [0.0–334.4]), MA (287.7 [239.4–491.7]), and MAN (245.4 [76.1–313.5]). Despite the observed differences in PD between the groups, these could not be statistically verified (Bonferroni, p = 0.322). The percentage penetration was significantly higher for IC than for MIH groups (Bonferroni, p < 0.05). SignificanceCompared to IC, resin infiltration into MIH-affected enamel ist more variable. Different pre-treatments influence the resin penetration into developmentally hypomineralized enamel to a fluctuating level.

Enamel Matrix Derivative, 58S5 Bioactive Glass, and Fluoride Varnish for Enamel Remineralization: A Multi-analysis Approach.

This study aimed to evaluate the enamel remineralization efficacy of enamel matrix derivative (EMD), experimental bioactive glass (BAG), and fluoride varnish in vitro. Artificial initial caries lesions were developed on fifty human enamel specimens using demineralization solution (pH 4.5, 37°C, 96 hours). Specimens were randomly assigned to five groups (n=10): I-5% NaF varnish (Enamelast), II-experimental 58S5 BAG+37% phosphoric acid (PA), III-EMD (Emdogain) + Ethylenediaminetetraacetic Acid (EDTA), IV-EMD+37% PA, V-Control (untreated). All remineralization agents were applied with pH cycling for seven days. The specimens were scanned by spectral domain optical coherence tomography (SD-OCT) at baseline, at demineralization, and after pH cycling. Lesion depths were measured using image analysis software (ImageJ). Lesions were evaluated using surface microhardness (SMH) and two fluorescence methods (FluoreCam and DIAGNOdent Pen [DDPen]). The data were statistically analyzed by Kruskal Wallis, Friedman, and Wilcoxon tests (α=0.05). According to SD-OCT results, fluoride varnish was found to be the most effective agent in reducing lesion depth (p=0.005). All agents increased the SMH values after pH cycling. No significant difference was found among fluoride varnish, BAG, and EMD+PA groups. These SMH values were significantly higher than EMD+EDTA and control groups (p<0.001). All groups showed lower DDPen scores compared with the control group (p<0.001), however, no significant difference was found among the remineralization agents. In FluoreCam assessment, size and intensity values of all treated groups showed improvement. However, there was no significant difference between the treatment groups in terms of FluoreCam size measurements (p=0.186). 58S5 BAG and EMD+PA have remineralization capacity as effective as fluoride varnish. EMD+PA showed better SMH and lesion intensity results than EMD+EDTA.

Effect of radiotherapy on microhardness and surface morphology of pretreated primary teeth with silver diamine fluoride: an in vitro study

Abstract Background: Children with head and neck cancer undergo radiation therapy, which has proved to be a successful treatment option. One of the common side effect of radiation therapy has been radiation induced caries. This is not as a result of the decreased salivary flow, but rather as a result of the direct impacts of these harmful rays on the enamel of the teeth. Silver diamine fluoride (SDF) is an effective remineralising agent for initial carious lesions and prevents demineralisation of the already deep carious agent. Various studies have also proved its effectiveness in improving the microhardness of the teeth. Hence, the objective of this study was to evaluate whether radiotherapy causes changes in the microhardness and surface morphology of enamel in primary teeth pretreated with SDF. Method: 22 primary teeth samples were divided into two groups with 11 samples in each group. The study group samples were pretreated with SDF and in the control group no pretreatment was done. Both groups were subjected to radiotherapy of 60 Gy radiation for a duration of 30 days. The samples were tested using the Vickers microhardness test and scanning electron microscope (SEM) analysis for surface morphological changes post radiotherapy. Results: It was found that there was a statistically significant difference (p&lt;0.001) in mean microhardness values between the two groups. The mean microhardness of the SDF group (254.07 ± 35.84) was significantly higher that the control group (88.18 ± 6.79). SEM image of enamel of control teeth displayed loss of smooth homogeneous surface and more amorphous structures were seen which was very evident in comparison to the SDF group. Conclusion: Following radiation therapy, SDF application led to greater microhardness of the enamel surface and less morphological alteration in the surface enamel of primary teeth.

Is Italian Dentists’ Knowledge of Enamel Development Defects Adequate? A Nationwide Survey

ObjectivesCorrect identification and management of Developmental Defects of Enamel (DDEs) are essential to provide the best possible treatment. The present survey aims to investigate Italian dentists’ knowledge of DDEs, their ability to recognise the different clinical pictures, and to choose the most appropriate clinical approach. MethodsA cross-sectional survey was planned based on a questionnaire including 27 closed-ended questions, and that proposed 4 clinical pictures, molar incisor hypomineralisation (MIH), amelogenesis imperfecta (AI), dental fluorosis (DF), and an initial caries lesion (ICL). It was distributed by e-mail to all Italian dentists (N = 63,883) through the Italian Federation of Doctors and Dentists. Discrete variables were expressed as absolute and relative frequencies (%). A multivariate analysis assessed whether socio-demographic variables correlated with the answers’ truthfulness. ResultsAbout 5017 questionnaires were included and analysed. Although 90.19% of the sample stated that they had received information on DDEs, a significant percentage did not recognise MIH (36.36%), AI (48.34%), DF (71.50%), and ICL (46.62%). Only 57.07% correctly classified enamel hypomineralisation as a qualitative defect, and even fewer, 54.45%, classified enamel hypoplasia as a quantitative defect. According to the logistic regressions, female dentists, dentists who treat mainly children and received information about DDEs, were more likely to recognise the 4 clinical pictures (P < .01). ConclusionsItalian dentists showed many knowledge gaps on DDEs that need to be filled; those who received formal training were more capable of correctly identifying the defects and were more likely to prescribe an appropriate management approach for the defects. Clinical significanceIncreasing university courses and continuing education on diagnosing and managing DDEs seems reasonable to fill the knowledge gap on DDEs.

Development of a novel in vitro model for non-cavitated carious lesion formation reflecting carious lesion activity

BackgroundOral biofilms are a critical component in dental caries formation. However, current remineralization studies often overlook the impact of microbial factors. Therefore, a comprehensive clinically relevant assessment of caries is needed. This study aimed to develop a novel in vitro model capable of generating non-cavitated carious lesions that incorporates both mineral loss and microbial activity using quantitative light-induced fluorescence-digital (QLF-D) technology. MethodsA total of 44 artificial early carious lesions were formed using bovine incisors. The extent of fluorescence loss (ΔF) was analyzed using a QLF-D camera. Oral microcosm biofilms were then employed to construct 22 active and 22 inactive carious lesions. The red fluorescence emission rate (ΔR) and bacterial viability (RatioG/G+R) was measured using QLF-D camera and a live-dead bacterial assay, respectively. Independent t-tests were performed to compare ΔF, ΔR, and bacterial viability of artificial carious lesions according to their activity status. ResultsNo significant difference in ΔF between the lesions was found based on activity status (p = 0.361). However, the ΔR of active lesions was 1.82 times higher than that of inactive lesions, and the RatioG/G+R was 1.49 times higher in active lesions than in inactive lesions (both p < 0.001). ConclusionsThe significant differences observed in ΔR and RatioG/G+R between active and inactive lesions emphasize the importance of considering lesion activity status when evaluating the potential efficacy of remineralization agents. This study presents a novel in vitro remineralization assessment model that reflects carious lesion activity while controlling baseline mineral distributions of lesions.

Distribution of initial caries lesions in relation to fixed orthodontic therapy. A systematic review and meta-analysis.

Initial caries lesion (ICLs) adjacent to orthodontic brackets are the most common side effect of orthodontic treatment with fixed appliances. The reported prevalence is uncertain and varies considerably across studies, from 27% to 97%. This paper was designed to evaluate and synthesize the available evidence on the prevalence and incidence rates of ICLs in relation to orthodontic treatment. Selection criteria: The review (Prospero protocol CRD42023412952) included randomized and non-randomized clinical trials of interventions, cohort studies, and cross-sectional studies, published after 1990 on the prevalence or incidence of ICLs during or after orthodontic treatment with fixed appliances. Search methods: Pubmed, Scopus, and Embase databases were searched from 1990 until 01 May 2023. The risk of bias assessment was performed with RoB 2 and ROBINS-I tool and the Joanna Briggs Institute Critical Appraisal Checklist. Data collection and analysis: The proportion of individuals with ICLs, reported as the number/percentage of individuals/teeth with ICLs or mean number of ICLs per subject, were used to synthesize results. The search yielded a total of 468 papers; 21 studies were included in the systematic review, 2 of which were not included in the meta-analysis. The prevalence rate [95%CI] of ICLs was 0.57% [0.48; 0.65] in 1448 patients, 0.22% [0.14; 0.33] in 11583 teeth, with a mean number of lesions equal to 2.24 [1.79; 2.70] in 484 patients evaluated. The incidence rate of new carious lesions developed during orthodontic treatment was 0.48% [0.33; 0.63] in 533 patients, 0.15% [0.08; 0.26] in 1890 teeth with a mean number of ICLs equal to 2.29 [1.12; 3.46] in 208 patients evaluated. Although the high number of included studies and the overall good quality, there was a significant heterogeneity in the collected data. The prevalence and incidence rates of ICLs in subjects undergoing orthodontic treatment are quite high and raise some concerns in terms of risk assessment of orthodontic treatment. ICLs represent an alarming challenge for both patients and professionals. Effective caries prevention strategies during treatment need to be considered and implemented where appropriate.