International Caries Detection And Assessment System Scores Research Articles

Prevalence of Dental Caries in Permanent Second Molars in Teenagers Using ICDAS

Introduction: Dental caries is a chronic disease of the tooth which is represented by demineralisation and destruction of the organic matter of the tooth. Dental caries are versatile, capable of affecting the crown portion of the tooth initially, and may affect the unprotected root surfaces later on. International Caries Detection and Assessment System (ICDAS) provides a systematic approach of reviewing the available clinical dental caries to evaluate the development of dental caries
 Materials and Methods: This study is a single centered retrospective study in which the data was collected from a private dental college and hospital in Chennai, India. Patient details were collected from the hospital management system and a total of 1804 samples were collected. The data was tabulated using Excel and then statistically analysed using the latest version of SPSS software.
 Results and Discussion: The prevalence of ICDAS score 3 in second molars is higher in 17 year old patients with 2.88% in maxillary right second molars, 3.33% in maxillary left second molars, 3.55% in mandibular left second molars and 3.71% in mandibular right second molars. The prevalence of dental caries in permanent second molar is 9.34%. It is seen that ICDAS score 3 is 8.71% prevalent followed by ICDAS score 5 which is 0.63%.
 Conclusion: Within the limitations of the study, it was found that the prevalence of dental caries in permanent second molars is 9.34% with ICDAS score 3 being the most prevalent followed by ICDAS score 5 which is 0.63%.

The effect of active oxygen-containing toothpaste on Streptococcus mutans and white spot lesions: An in-vivo randomized controlled trial

Fixed appliances limit patients' ability to clean their teeth, thus making orthodontic patients highly susceptible to developing white spot lesions (WSLs). Using patient compliance would be one of the simplest methods to prevent WSLs. A parallel trial design with 34 patients that met the eligibility criteria were randomized to experimental (received Blue M oxygen for health toothpaste) and control (received Colgate Total fluoridated toothpaste) groups. The eligibility criteria were that the patients should be aged 13-30 years, on fixed mechanotherapy, had undergone therapeutic extraction of all first premolars, had completed leveling and aligning, and had satisfactory oral hygiene (assessed using pretreatment and current Simplified Oral Hygiene Index scores). The objectives were to assess the effects of active oxygen-containing toothpaste on Streptococcus mutans (SM) and WSLs in patients undergoing fixed mechanotherapy. The random allocation sequence was generated using the RAND function in Microsoft Excel. The sequence generated was sealed in opaque white envelopes. The investigators and the participants were blinded until allocation. Blinding of the first author (J.A.G.) who dispensed the toothpaste or the participants was not possible. The outcome assessment was blinded by coding the plaque specimens sent for real-time polymerase chain reaction (RT-PCR) to ensure that the final data assessment was blinded. The study setting was the Department of Orthodontics and Dentofacial Orthopedics, Sri Ramachandra Institute of Higher Education and Research (SRIHER) University. The primary outcome was SM counts, which were analyzed using RT-PCR. The secondary outcome was WSL assessment, performed using DIAGNOdent and International Caries Detection and Assessment System (ICDAS) II criteria at baseline and after 4 weeks. The data were subjected to statistical analysis. Thirty-four patients were randomized to 17 per group and analyzed. RT-PCR showed lower SM in the experimental group (Ct= 32.25 ± 10.6) than in the control group (Ct= 30.9 ± 10.49). However, this was not statistically significant (P= 0.70). ICDAS scores remained the same from baseline and after 4 weeks for both groups. The DIAGNOdent values were in tandem with the ICDAS scores and showed minimal change for the 2 groups (P>0.05). A strong positive correlation was observed for DIAGNOdent and ICDAS scores (τb>0.30). No harms or adverse effects were observed or reported by the patients during the experimental period. The active oxygen-containing toothpaste showed a greater inhibitory effect on SM than the fluoridated toothpaste. However, this effect was minimal. Both kinds of toothpaste showed negligible effects on WSLs. Thus, active oxygen-containing toothpaste is as effective as fluoridated toothpaste. The Trial was registered in the Controlled Trials Registry India (CTRI/2021/10/037458). The full protocol can be obtained from any of the authors via e-mail. The project was self-funded.

Management Thresholds for Molars With Occlusal Noncavitated Caries Lesions

AimThere is sparse research on the effect of factors related to the dentist and patient in the caries management decision-making process. This in vitro study explored the influence of factors related to dentists and patients on the management decision of occlusal noncavitated caries lesions in children. Materials and methodsFive investigators in the specialties of dental public health (DPH), paediatric, prosthetic, and operative dentistry and a general dentist (GDP) participated in this study. Initially, the investigators were asked to independently assess the occlusal surfaces of 175 noncavitated permanent molars and choose a management recommendation using 2 caries risk patients’ scenarios. After 1 month, investigators were trained and calibrated to use the International Caries Detection and Assessment System (ICDAS) scoring system. Then, they examined the same teeth, recorded the highest/worst ICDAS score, and chose a management recommendation. Two weeks later, the investigators repeated the teeth examination using magnification loupes and again chose a management recommendation. The teeth were sectioned to study the relationship between the presence of caries and the management recommendations. ResultsFor the low– and the high–caries risk scenarios, ICDAS training increased the operative intervention by 20% to 27% and 14% to 22%, respectively, for both the GDP and the paediatric dentist (P < .0001). For the low–caries risk scenario, using the magnifying loupes increased the operative recommendations for the DPH, GDP, and the operative dentist by 5% to 23% (P < .05). Compared to the low–caries risk scenario, teeth for patients with high caries risk received more surgical interventions (9%-30%) at all examination conditions for the GDP and the paediatric and operative dentists (P < .0001). ConclusionsFor occlusal noncavitated caries lesions, enhancing dentists’ caries detection skills had a significant impact on decisions of surgical intervention. This also influenced the appropriateness of the treatment recommended for the different caries risk groups.

Clinical Analysis of the Diagnostic Accuracy and Time of Execution of a Transillumination Caries Detection Method Compared to Bitewing Radiographs.

Purposes: this clinical study evaluated the accuracy and execution time of a digital imaging fiber-optic transillumination (DIFOTI) technique for the detection of approximal caries in posterior teeth compared to intra-oral examination associated with bitewing radiographs. Methods: one hundred patients were selected and submitted to clinical inspection and bitewing radiographs. The outcomes of this process were converted into scores, according to the International Caries Detection and Assessment System (ICDAS): 0—sound tooth; 1, 2, and 3—carious lesion confined within enamel; 4, 5, and 6—dentin carious lesion. Subsequently, an independent investigator acquired digital images of the same teeth using a DIFOTI device (DIAGNOcam, Kavo Dental), which were also converted into ICDAS scores. The time required for executing diagnostic procedures was measured. The clinical sensitivity and specificity of DIFOTI were analyzed by receiver operating characteristic (ROC) curves. The time necessary to perform the diagnostic methods was evaluated by Mann–Whitney U (alfa = 0.05). Results: the overall test accuracy for the DIFOTI-based device ranged from 0.717 to 0.815 (area under the ROC curve) with p < 0.0001 for all ICDAS scores. Bitewing radiographs took almost twice the time required by DIFOTI (p < 0.001). Conclusions: the DIFOTI-based device DIAGNOcam provided accurate detection of approximal caries in posterior teeth, even at early stages. The technique employed for transillumination caries diagnosis by the same device took less time than conventional bitewing radiographs. Clinical Relevance: transillumination devices, such as DIAGNOcam, can be accurately used for caries diagnosis in approximal surfaces of posterior teeth, demanding less clinical time and without radiation-related risks.

Laser-Doppler microvascular flow of dental pulp in relation to caries progression

Pulpal blood supply can be measured noninvasively and objectively via laser-Doppler fluxmetry. The aim of the study was to measure and compare pulpal laser-Doppler (LD) flux values for permanent non-carious teeth and carious teeth with different degrees of caries progression. Conventional sensitivity tests were also conducted for a comparative analysis to clarify the difference between tooth sensitivity and vitality. Carious lesions were detected and assessed in 15 adult subjects using the International Caries Detection and Assessment System (ICDAS) criteria. Pulpal sensitivity of selected carious teeth (without previous prosthetic restoration or endodontic treatment) and suitable caries-free teeth were then tested with a cold stimulus and subsequently with a weak electric current, whereas their pulpal LD flux was recorded at a separate visit using individually designed silicone probe holders. The LD flux values for teeth with an ICDAS score 6 were significantly lower compared to the values for teeth with an ICDAS score 1 (p < 0.05). Pulpal LD flux values of teeth with active caries were significantly lower than those of teeth with solely inactive carious lesions (p < 0.05). The degree of agreement between sensitivity and vitality testing was fair within both of the pairs: cold test/LDF (κk = 0.232, p = 0.00) and electric test/LDF (κk = 0.354, p = 0.00). Pulpal LD flux measurement proved to be reliable in the pulp vitality assessment of carious and non-carious teeth and might improve the reliability of clinical decisions when used in addition to standard clinical diagnostic protocols.

Clinical and radiographic evaluation of caries depth, root resorption and furcation lesion in primary molars

Primary molars with furcation lesions have a negative impact on the child's quality of life. We determined the prevalence of furcation lesions and their influence on the root resorption process in primary molars. It is Cross-sectional study of patients aged 3 to 12 years that was apply a health questionnaire was applied and the teeth were submitted to physical examination using the International Caries Detection and Assessment System (ICDAS) and periapical radiography. Criteria for radiographic interpretation were established and assessments performed by three different specialists. The kappa coefficient measured interexaminer agreement and level of significance of 5% was adopted for all tests. The sample consisted of 26 patients and 50 primary molars. The second molar received ICDAS score 6 in 38.5% of the sample. The interexaminer agreement was almost perfect between the radiologist and pediatric dentist for caries depth on the mesial (K=0.97) and occlusal surface (K=0.97); In root resorption for mesial (K=0.89) and distal (K=0.93). The detection of furcation lesions was present in 42.3% of the sample; 50% of the teeth had at least 1/3 of the mesial root resorbed and 75% of the distal root and the presence of furcation lesions in primary molars influenced root resorption.

Performance of Dental Undergraduate Students using International Caries Detection and Assessment system (ICDAS)

Objectives: This study aimed to assess intra- and inter-examiner reliability of International Caries Detection and Assessment System (ICDAS) and modified epidemiology ICDAS (MOD) code by undergraduate dental students with different clinical experiences. Methods: A total of 150 dental undergraduate students with varying clinical experiences (0, 1 and 2 years of clinical experience) were recruited. Participants received training through a theoretical lecture on ICDAS criteria by an experienced National Benchmark Group (NBG) examiner and underwent e-learning program prior to ICDAS calibration. Visual examination on extracted permanent teeth (N= 45) with different location and stages of caries progression ranging from ICDAS scores 0 to 6, was performed using the ICDAS criteria. The assessments were repeated after one hour. The data were analysed to evaluate inter-examiner and intra-examiner reliability in the form of kappa scores using SPSS 23 Software. Results: Mean kappa values for intra- and inter-examiner reliability for ICDAS code, were between 0.41 to 0.60, and 0.61 to 0.80 respectively. For MOD code, mean kappa values for intra- and inter-examiner reliability were between 0.61 to 0.80. Good intra-examiner agreement (&gt;0.61) was observed in both ICDAS and MOD code for all groups. Conclusion: All students performed similar agreement, therefore, clinical experience within 2 years does not influence the performance of visual inspection in detecting caries using ICDAS. The results of the study shows that ICDAS and modified epidemiology ICDAS codes has good reproducibility and is feasible to be used as a tool in clinical practice as well as patient education.

Detection of Root Caries Using Laser-Based Detection Device - DIAGNOdent

Introduction: Dental care for older population is becoming a matter of concern within the National health services (NHS) United Kingdom (UK) due to increasing life expectancy of older people and retention of their natural teeth. The aim of study was to relate the International Caries Detection and Assessment System (ICDAS) scores with severity index in order to detect root caries and DIAGNOdent readings, at an early stage, to manage these lesions non-invasively. Methods: Fresh 95 extracted teeth were collected from Oral Surgery and Dental Emergency Department at Barts and the London, Queen Mary University of London. In this in vitro study, 19 out of 95 teeth had root caries. Prior to recording the readings, extracted teeth were cleaned and polished. Each lesion underwent clinical examination. To detect root caries DIAGNOdent readings (ICDAS), severity index were obtained. Pearson’s correlation coefficients tests were applied. Results: The correlation between cavitation and ICDAS scores shows the significant value of 0.01. The DIAGNOdent reading with momentum and peak values was 45.37 with standard deviation of 32.16 and for peak with the mean value of 49.79 and 31.72 of standard deviation. Regarding, readings of DIAGNOdent and severity index establishment of correlation was difficult to establish. The reason was score of severity index regarding specimen no.1 is 3.3 was illustrative of lesion that is leathery. Conclusion: The DIAGNOdent readings system did not support the detection of root caries. However, the severity index scoring system is in need of greater categories regarding caries of the root.

Correlation between parotid saliva composition and dental caries using 31P-NMR and ICDAS score

ObjectivesThe preservation of enamel mineral is influenced by the supersaturation of salivary secretions with respect to calcium phosphate salts. The aim was to measure the chemical environmental state of phosphate ions in a subject’s parotid saliva, and to correlate this with their dental caries score, by means of 31P-Nuclear Magnetic Resonance Spectroscopy (31P-NMR) and the International Caries Detection and Assessment System (ICDAS). DesignUnilateral paraffin wax stimulated parotid saliva samples were collected from 21 healthy adult subjects using a Lashley cup. The flowrate was recorded during collection. Clinical caries scores of each subject were classified using the ICDAS score. The pH was recorded for each saliva sample. 31P-NMR spectra of each saliva sample were obtained to determine the phosphorus chemical environment. All the collected data were analysed by Pearson’s correlation. ResultsParotid saliva flow rates were in the range from 0.07 to 0.56 ml/min. The pH varied from 5.9 to 7.6. Each 31P-NMR spectrum showed a single broad line with a chemical shift between 0.07 and 2.38 ppm. At neutral pH the maximum chemical shift was 2.05 ppm, whereas at a lower pH values the phosphorous chemical shift reduced, to 0.34 at pH 5.9. The flowrate and the 31P-NMR chemical shift correlated positively (r = 0.71; p < 0.05). The ICDAS score correlated negatively with the 31P-NMR chemical shift (r = 0.43; p < 0.05). ConclusionsThis parotid saliva 31P-NMR study has shown that different phosphate states exist within saliva, which significantly influence its inorganic chemical behaviour, and therefore its cariostatic activity.

T2 Mapping as a Tool for Assessment of Dental Pulp Response to Caries Progression: An in vivo MRI Study

Among radiological methods, magnetic resonance imaging (MRI) excels in its ability to image soft tissue at great contrast and without the need of harmful radiation. This study tested whether in vivo MRI based on standard MRI sequences run on a standard clinical MRI system can be used to quantify dental pulp response to caries progression using the T₂ mapping method. In the study, 74 teeth were scanned on a 3-T MRI system, and caries was assessed according to the International Caries Detection and Assessment System (ICDAS). The T₂ maps were processed to obtain T₂ profiles along selected root canals (from crown to apex), and the profiles were sorted according to both tooth type (single-rooted vs. molar) and ICDAS score. In all the examined dental pulps, it was found that T₂ values decrease with an increase in the ICDAS score. In the coronal part of dental pulps, average T₂ values of 166, 153, and 115 ms were found in ICDAS groups 0, 1–3, and 4–6, respectively. In single-rooted teeth, T₂ values were found approximately constant as a function of dental pulp depth, while in multi-rooted teeth, they were found increasing in the coronal part and decreasing towards the root apex. The study confirmed that T₂ mapping of dental pulp can be used to reliably quantify its response to caries progression and that it has a potential to become a complementary diagnostic tool to standard radiographic methods in the assessment of dental pulp response to caries.

Assessing the Impact of Early Childhood Caries on the Development of First Permanent Molar Decays

Aim: The aim of this study was to evaluate whether the treated and untreated severe early childhood caries (ECC) in children would make any impact on the Permanent First Molar (PFM) decays.Materials and Methods: Our descriptive epidemiological study was conducted in Ataturk University, Faculty of Dentistry, Department of Pediatric Dentistry/Erzurum-Turkey, between 2011 and 2017. We included a total of 90 children (44 girls, 46 boys), and divided them into 3 equal groups. They were 6–9 years old with a mean age of 7.38 ± 0.89. Group 1 consisted of the patients who had previously been treated under GA, Group 2 included the patients with untreated ECC and with no previous dental treatment, and Group 3 consisted of the patients who had been periodically treated in normal clinical settings. Each patient was processed through; dmft scoring and PFM caries evaluation process in accordance with International Caries Detection and Assessment System (ICDAS), respectively. The obtained data was analyzed with SPSS v20.0. And also, we used One-way ANOVA, Kruskal-Wallis and Mann Whitney U tests.Results: In accordance with ICDAS, we found that Group 3 had the highest mean number of PFMs (2 ± 1.43) and Group 2 had the lowest (1.43 ± 1.45). In Group 2, the number of ICDAS-determined carious PFMs were significantly lower than the other groups (p < 0.05). However, ICDAS score 6 was 0 in Group 1, while it was determined higher as 4.2% in Group 2.Conclusion: In respect to our research outcomes, which revealed that regardless of treated or not severe ECC had a significant impact on the PFMs, we strongly recommend that the parent of the children experiencing ECC should be informed about the risk of future caries in PFMs.

Monitoring regression of post-orthodontic lesions with impedance spectroscopy: a pilot study.

To investigate if the alternating current impedance spectroscopy (ACIS) technology could be used to monitor remineralization of post-orthodontic white spot lesions (WSLs) after debonding of fixed orthodontic appliances. The study group consisted of 28 adolescents (aged 12-16 years) with at least two WSLs on their maxillary incisors, canines, or first premolars at debonding. Buccal surfaces (n = 194) were visually examined and scored with modified International Caries Detection and Assessment System (ICDAS) criteria and with the CarieScan Pro device by three examiners according to manufactures manual (test method). In addition, 31 surfaces with ICDAS = 0 were monitored by ACIS, serving as controls. Follow-up examinations were carried out after 8 and 16 weeks. Modified ICDAS scores, captured from digital photographs by three independent examiners, served as reference method. Four patients were lost to follow-up. Data were analysed in a mixed statistical model considering systematic effects of visit, tooth and observer, random effects of patients, and visits within patients. Over 50 per cent of all surfaces had marked WSL at baseline and the corresponding values at 8 and 16 weeks were 33 per cent and 22 per cent. The ACIS readings mirrored the visual scores; the baseline estimate (56.3) was significantly decreased after 8 weeks (P < 0.05). The lateral incisors exhibited the highest values whereas the lowest were recorded for the central incisors. ICDAS is not the same as a 'true' gold standard. The high prevalence of WSL may jeopardize the external validity. The ACIS technology may to some extent be used to monitor the regression of post-orthodontic WSLs.

Efficacy of photodynamic therapy vs ultrasonic scaler for preventing gingival inflammation and white spot lesions during orthodontic treatment.

The complex designs of fixed orthodontic appliances hinder proper access for cleaning, favouring the development of gingival inflammation and white spot lesions around brackets. The aim of this study was to evaluate the effectiveness to avoid these undesirable effects by using two prophylactic methods: Photodynamic Therapy (PDT) and conventional ultrasonic scaler (US), in patients during fixed orthodontic treatment. Twenty patients under orthodontic treatment for at least 15 months were randomly divided into two groups: PDT mediated by methylene blue (MB) and US. Both treatments were applied in repeated doses (four times in intervals of 2 weeks in the beginning of the study (T0), with booster doses at 3, 6 and 9 months, T1, T2 and T3, respectively). Periodontal clinical parameters (full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS) and probing depth (PD)) were recorded as well as the International Caries Detection and Assessment System (ICDAS) index. Samples of subgingival plaque and saliva (for determination of 4 periodontopathogens and mutans streptococci, respectively), were collected at T0 and at the follow-ups of T1, T2 and T3. The evolution of FMPS, FMBS, PD, ICDAS scores as well as the counts of periodontopathogens and salivary mutans streptococci was similar after US or PDT implementation. Greatest periodontal scores reduction took place at T1 for FMBS and PD and at T2 for FMPS. Main microbial reduction took place at T1. ICDAS index began to increase from T2. No statistically significant intergroup differences were observed. Additional treatment of PDT or US in repeated doses delayed undesired side effects during fixed orthodontic treatment in young patients with low caries risk and signs of gingival inflammation.

MI Varnish and MI Paste Plus in a caries prevention and remineralization study: a randomized controlled trial.

White spot lesions (WSLs) are a complication of orthodontic therapy. This study investigated the effect of MI (minimally invasive) Paste Plus (MIPP) and MI Varnish (MIV) on WSLs in orthodontic patients during a 12-month, randomized, single-blind, prospective, standard-of-care controlled clinical trial. Forty subjects, recruited from the UCSF School of Dentistry Orthodontics Clinic, were randomly assigned to the experimental (twice-daily 1100ppm fluoride toothpaste, daily MIPP, quarterly MIV application) or control group (twice-daily 1100ppm fluoride toothpaste, fluoride rinse recommendation). Facial surfaces of incisors, canines, and first bicuspids were evaluated at baseline, 3, 6, and 12months using the enamel decalcification index (EDI) and the international caries detection and assessment system (ICDAS). Findings from 37 subjects are reported. At 12months, teeth receiving experimental treatment were at lower but not significantly different odds of increased EDI scores (odds ratio, OR 0.63; intra-patient cluster-adjusted 95% CI 0.43, 1.18) and not associated with increased ICDAS scores (OR 0.99; 95% CI 0.64, 1.54). There was no statistically significant difference in mean patient-level EDI sum (experimental group 40.2; control 41.3; t test p= 0.80), ICDAS score (experimental 22.3; control 22.6; Mann-Whitney U test p= 0.80), or percentage of scored surfaces with ICDAS > 0 (experimental 54.6%; control 55.2%; t test p= 0.88). Salivary fluoride levels were significantly higher at 12months for the experimental than for the control group (0.20 ± 0.26 versus 0.04 ± 0.04ppm, Mann-Whitney U test p< 0.01). Applying daily MIPP and quarterly MIV resulted in no statistically significant differences in EDI sum and ICDAS scores. Higher salivary fluoride levels in the experimental group suggest that MIPP and MIV effectively deliver fluoride when used clinically. Daily MIPP and quarterly MIV applications do not appear to reduce significantly WSLs incidence during fixed orthodontic treatment.

The oral adverse effects of isotretinoin treatment in acne vulgaris patients: A prospective, case-control study.

Isotretinoin is the most effective therapy to treat severe acne vulgaris and its systemic adverse effects have been well documented, but little is known on dental side effects over the course of treatment. This prospective case-control study aimed to evaluate the oral adverse effects of isotretinoin in Turkish patients with acne vulgaris; compare oral conditions between patients and normal controls; and investigate the association between salivary parameters and International Caries Detection and Assessment System (ICDAS) scores. For 6 months, the patients (n = 45) received isotretinoin daily (0.5 mg/kg). The age-matched untreated controls (n = 45) were patients without acne. Both groups were examined before the study and at 6 months for salivary flow, buffer capacity, microbiologic tests, and caries status (based on the ICDAS). Salivary parameters and ICDAS scores were analyzed by Spearman's rank correlations. Data were statistically analyzed by the Mann-Whitney U test, Wilcoxon signed rank tests, and McNemar's Chi-square tests (P < 0.05). Twenty-two isotretinoin-treated patients and 18 controls completed the study. At baseline, the groups were not significantly different in the evaluated parameters (P > 0.05). At 6 months in the isotretinoin-treated group, salivary flow and buffer capacity significantly decreased, and the ICDAS scores significantly increased (P < 0.05). The changes in these criteria from baseline were insignificant in the controls (P > 0.05). Intraoral pathogen counts were not significantly different between the groups, compared to baseline (P > 0.05). Stimulated salivary parameters in both groups were not correlated significantly with the ICDAS scores. Isotretinoin significantly affected salivary flow, buffer capacity, caries lesion activity scores for 6 months. However, salivary parameters and caries lesion activity scores had no significant correlations.

Caries Incidence in a Healthy Young Adult Population in Relation to Diet.

In the past, epidemiological studies focused on cavitated stages of caries. The arrival of the International Caries Detection and Assessment System (ICDAS) in 2004 allowed for clinical measurements of the initial stages of enamel caries. However, since the introduction, most studies applying the ICDAS still have studied the diseased population. The objective of this cross-sectional observational study was to describe early enamel caries in a large healthy young adult population and determine the relationship with diet and oral hygiene measures. The study population consisted of 268 healthy participants without frank cavitation. The examinations were done visually and radiographically using ICDAS on all tooth surfaces. In total, 8.6% of the surfaces (occlusal > approximal > smooth) had caries, of which 92.0% were confined to enamel (28.5% ICDAS score 1, 54.0% score 2, 8.6% score 3). Thirteen percent of the occlusal and 63% of the approximal caries were found with radiography. Thus, radiography is quintessential for the diagnosis of approximal enamel lesions. We found a positive correlation between enamel caries (ICDAS 1 to 3) and the consumption of mono- and disaccharides and carbohydrates ( r = 0.226 and r = 0.188, respectively, both P < 0.01), as well as a negative correlation with alcohol consumption ( r = -0.202, P < 0.01). There was also a positive correlation between enamel caries and the energy intake from mono- and disaccharides (sugar kJ, r = 0.206, P < 0.01), which was independent of body mass index. Only 11 participants consumed less than 10% of total energy as sugar kJ, which is the recommended percentage of kJ from free sugar by the World Health Organization. No clear correlation was found with oral hygiene. In conclusion, in this healthy young adult population, caries was found in 97.8% of the subjects, mostly initial enamel caries (ICDAS 1 to 2) in the occlusal surface of molars, and was related with dietary factors.

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

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

White spot lesions after orthodontic treatment assessed by clinical photographs and by quantitative light-induced fluorescence imaging; a retrospective study

Objective. White spot lesions (WSL) are an important side-effect of orthodontic multi-bracket (MB) treatment. Standardized monitoring of such WSL may help in caries management. Materials and methods. In this retrospective study the discriminatory power of caries assessment on routine digital oral photographs was compared to quantitative light-induced fluorescence (QLF) imaging in monitoring WSL development after debonding of orthodontic appliances. Oral and QLF photographs captured directly after debond (T1) and 1 year thereafter (T2) of 51 subjects, treated with full MB orthodontic appliances were used. Oral photographs were assessed by use of The International Caries Detection and Assessment System (ICDAS) at both time points independently and by side-by-side comparison to assess visual transition (VT). QLF photographs were categorized based on integrated fluorescence loss at T1 and T2. Results. At T1 433 and 384 lesions on 918 buccal surfaces were detected using ICDAS and QLF, respectively. For both methods these numbers were reduced at T2. Changes within ICDAS scores were recorded by VT and showed mainly lesion improvement within ICDAS score 2. Conclusion. The oral and QLF photographs both showed regression of WSL after debonding of MB orthodontic appliances. The VT evaluation was found to have higher discriminatory power in comparison to ICDAS.

Discrimination between Intact and Decayed Pulp Regions in Carious Teeth by ADC Mapping

The aim of this study was to evaluate an advanced magnetic resonance imaging (MRI) method, apparent diffusion coefficient (ADC) mapping, in the functional assessment of carious teeth. 38 extracted human teeth with scores of 0, 3 and 6 according to International Caries Detection and Assessment System (ICDAS) criteria were screened and subsequently analyzed by MRI at 2.35 T. Histology sectioning of teeth was used for the gold standard by analyzing two extreme cases (intact and severely decayed). ADC maps of the same teeth were calculated from corresponding diffusion-weighted images and used to obtain ADC distributions along dental pulp as functions of the relative pulp length measured from the occlusal pulp side. The measured distributions were analyzed for the best fit by a four-parameter three-segment linear regression model for ADC distribution along the pulp. MRI results were in good agreement with findings in histological sections of identical teeth. The best fit model parameters, relative decayed region depth, relative transition region width and ADC values of intact and decayed pulp tissue, showed statistically significant differences between the ADC values of intact and decayed pulp tissue (1.0 × 10^-9 m²/s vs. 0.74-0.89 × 10^-9 m²/s) and the relative decayed region depth progressing with ICDAS score (3 vs. 46% with ICDAS 3 vs. ICDAS 6). The results of this feasibility study confirmed relevance of ADC mapping for the discrimination and localization of intact and decayed regions in dental pulps of carious teeth.

Feeding and smoking habits as cumulative risk factors for early childhood caries in toddlers, after adjustment for several behavioral determinants: a retrospective study

BackgroundSeveral maternal health determinants during the first period of life of the child, as feeding practice, smoking habit and socio-economic level, are involved in early childhood health problems, as caries development. The potential associations among early childhood caries, feeding practices, maternal and environmental smoking exposure, Socio-Economic Status (SES) and several behavioral determinants were investigated.MethodsItalian toddlers (n = 2395) aged 24–30 months were recruited and information on feeding practices, sweet dietary habit, maternal smoking habit, SES, and fluoride supplementation in the first year of life was obtained throughout a questionnaire administered to mothers. Caries lesions in toddlers were identified in visual/tactile examinations and classified using the International Caries Detection and Assessment System (ICDAS). Associations between toddlers’ caries data and mothers’ questionnaire data were assessed using chi-squared test. Ordinal logistic regression was used to analyze associations among caries severity level (ICDAS score), behavioral factors and SES (using mean housing price per square meter as a proxy).ResultsCaries prevalence and severity levels were significantly lower in toddlers who were exclusively breastfed and those who received mixed feeding with a moderate–high breast milk component, compared with toddlers who received low mixed feeding and those exclusively fed with formula (p < 0.01). No moderate and high caries severity levels were observed in an exclusively breastfed children. High caries severity levels were significantly associated with sweet beverages (p < 0.04) and SES (p < 0.01). Toddlers whose mothers smoked five or more cigarettes/day during pregnancy showed a higher caries severity level (p < 0.01) respect to those whose mothers did not smoke. Environmental exposure to smoke during the first year of life was also significantly associated with caries severity (odds ratio =7.14, 95% confidence interval = 6.07-7.28). No association was observed between caries severity level and fluoride supplementation. More than 50% of toddlers belonging to families with a low SES, showed moderate or high severity caries levels (p < 0.01).ConclusionsHigher caries severity levels were observed in toddlers fed with infant formula and exposed to smoke during pregnancy living in area with a low mean housing price per square meter.