Dentin Involvement Research Articles

Hypersensitivity in Molar Incisor Hypomineralization: Superficial Infiltration Treatment

To date, there are no standardized protocols available in the literature for hypersensitivity treatment in molar incisor hypomineralization (MIH) patients. The aim of this study was to evaluate the efficacy of erosion–infiltration treatments with resin in children with a strong hypersensitivity and also to develop a minimally invasive diagnostic–therapeutic pathway for young MIH patients. Patients with clinical signs of MIH were enrolled according to international guidelines. A total of 42 patients (8–14 years old) with sensitivity of at least one molar and patients with post eruptive enamel fractures, but without dentin involvement or cavitated carious lesions were selected. A single superficial infiltration treatment with ICON (DMG, Germany) was performed with a modified etching technique. Sensitivity was tested with the Schiff Scale and Wong Baker Face Scale and was repeated at 12 months follow-up. All patients reported lower sensitivity values at the end of the treatment. Significant differences of sensitivity according to the Schiff scale were reported between T0 and all subsequent follow-ups, p < 0.05. The treatment of erosion infiltration with ICON resin is a minimally invasive preventive treatment that significantly improves the problem of hypersensitivity in permanent molars with MIH.

Diagnosis of Occlusal Tooth Wear Using 3D Imaging of Optical Coherence Tomography Ex Vivo.

The aim of this study was to assess the utility of 3D imaging of optical coherence tomography (OCT) for the diagnosis of occlusal tooth wear ex vivo. Sixty-three extracted human molars with or without visible tooth wear were collected to take digital intraoral radiography and 3D OCT images. The degree of tooth wear was evaluated by 12 examiners and scored using 4-rank scale: 1—slight enamel wear; 2—distinct enamel wear; 3—tooth wear with slight dentin exposure; 4—tooth wear with distinct involvement of dentin. The degree of tooth wear was validated by the histological view of confocal laser scanning microscopy (CLSM). The sensitivity, specificity, and area under the curve (AUC) of receiver operating characteristic analysis were calculated. Diagnostic accuracy was compared with the agreement with CLSM observation using weighted kappa. The results were statistically analyzed at a significance level of α = 0.05. Three-dimensional OCT showed significantly higher sensitivity (p < 0.05) for all the diagnostic thresholds of enamel wear and dentin exposure than digital radiography (0.82, 0.85, and 0.79 vs. 0.56, 0.52, and 0.57, respectively). Three-dimensional OCT showed higher AUC and kappa coefficients than digital radiography (p < 0.05), where mean AUC and Kappa values were 0.95 and 0.76 for OCT and 0.92 and 0.47 for radiography, respectively. No significant difference of specificity was observed (p > 0.05). Three-dimensional OCT could visualize and estimate the degree of tooth wear and detect the dentin exposure at the tooth wear surface accurately and reproducibly. Consequently, a new guideline for tooth wear assessment can be proposed using OCT.

Holocephalan (Chondrichthyes) dental plates with hypermineralized dentine as a substitute for missing teeth through developmental plasticity.

All extant holocephalans (Chimaeroidei) have lost the ability to make individual teeth, as tooth germs are not part of the embryonic development of the dental plates or of their continuous growth. Instead, a hypermineralized dentine with a unique mineral, whitlockin, is specifically distributed within a dentine framework into structures that give the dental plates their distinctive, species-specific morphology. Control of the regulation of this distribution must be cellular, with a dental epithelium initiating the first outer dentine, and via contact with ectomesenchymal tissue as the only embryonic cell type that can make dentine. Chimaeroids have three pairs of dental plates within their mouth, two in the upper jaw and one in the lower. In the genera Chimaera, Hydrolagus and Harriotta, the morphology and distribution of this whitlockin within each dental plate differs both between different plates in the same species and between species. Whitlockin structures include ovoids, rods and tritoral pads, with substantial developmental changes between these. For example, rods appear before the ovoids and result from a change in the surrounding trabecular dentine. In Harriotta, ovoids form separately from the tritoral pads, but also contribute to tritor development, while in Chimaera and Hydrolagus, tritoral pads develop from rods that later are perforated to accommodate the vasculature. Nevertheless, the position of these structures, secreted by the specialized odontoblasts (whitloblasts), appears highly regulated in all three species. These distinct morphologies are established at the aboral margin of the dental plate, with proposed involvement of the outer dentine. We observe that this outer layer forms into serially added lingual ridges, occurring on the anterior plate only. We propose that positional, structural specificity must be contained within the ectomesenchymal populations, as stem cells below the dental epithelium, and a coincidental occurrence of each lingual, serial ridge with the whitlockin structures that contribute to the wear-resistant oral surface.

Different Treatment Modalities followed by Dental Practitioners for Ellis Class 2 Fracture – A Questionnaire-based Survey

Introduction:Dental trauma is one of the most commonly seen injuries involving teeth and surrounding structures. The frequent causes of dental trauma are usually falls, traffic accidents, fights and sports injuries. Rapid treatment can prevent long-term damage to the orofacial structures and save the teeth. Ellis class 2 fracture is classified as the involvement of enamel and dentin excluding pulp. Dental practitioners are used to treating Ellis class 2 fracture very often in their dental practice and is usually considered as a dilemma among dental practitioners for the different treatment modalities followed for treatment of Ellis class 2 fracture. A survey is done among dental practitioners to assess the different treatment modalities followed by them in the case of Ellis class 2 fracture.Materials and Methods:A survey was done among 380 dental practitioners in the Chennai region in which 360 dental practitioners responded. The survey was distributed through electronic media and other means of communication. The survey data was collected, analysed and interpreted.Results:The results suggested that about 90% of dental practitioners had adequate knowledge and attitude towards the management of dental traumatic injuries. However, the practical application of the different treatment modalities was seen to be varied among dental practitioners. Based on this survey it was clear that majority of the dental practitioners in Chennai have good knowledge, attitude but there was a lack of clinical practice regarding the different treatment modalities followed by general practitioners for Ellis class 2 fracture.Conclusion:The survey shows that dental practitioners have a sound knowledge, attitude, but the practical application of the various treatment modalities available was seen to vary among various dental practitioners for Ellis class 2 fracture.

DIVERGENCES IN CLINICAL AND RADIOGRAPHIC ASPECTS OF RADIATION-RELATED CARIES: A REPORT OF 2 CASES

Radiation-related caries (RRC) are rampant caries, which affect up to 25% of patients who undergo head and neck radiotherapy (HNRT). They are characterized by: (1) diffuse brown colorations of the enamel or dentin smooth surfaces; (2) generalized cervical caries; and (3) a tendency to rapidly progress to tooth crown amputation. Herein, we present 2 original cases of patients with RRC with an indolent clinical appearance in the so-called “occult caries” or “hidden caries” pattern, which were demonstrated by means of digital panoramic radiography and cone beam computed tomography. RRC represent advanced fronts of demineralization with the involvement of deep dentin and pulp chamber. In conclusion, advanced RRC may develop under unsuspicious clinical patterns, often leading to late diagnosis and a high potential for tooth destruction; such findings emphasize the importance of systematic clinical and radiographic examination of teeth in populations of patients who are post-HNRT. Radiation-related caries (RRC) are rampant caries, which affect up to 25% of patients who undergo head and neck radiotherapy (HNRT). They are characterized by: (1) diffuse brown colorations of the enamel or dentin smooth surfaces; (2) generalized cervical caries; and (3) a tendency to rapidly progress to tooth crown amputation. Herein, we present 2 original cases of patients with RRC with an indolent clinical appearance in the so-called “occult caries” or “hidden caries” pattern, which were demonstrated by means of digital panoramic radiography and cone beam computed tomography. RRC represent advanced fronts of demineralization with the involvement of deep dentin and pulp chamber. In conclusion, advanced RRC may develop under unsuspicious clinical patterns, often leading to late diagnosis and a high potential for tooth destruction; such findings emphasize the importance of systematic clinical and radiographic examination of teeth in populations of patients who are post-HNRT.

Root caries on a Paranthropus robustus third molar from Drimolen.

Dental caries is often perceived as a modern human disease. However, their presence is documented in many early human groups, various nonhuman primates and, increasingly, our hominin ancestors and relatives. In this study, we describe an antemortem lesion on the root of a Paranthropus robustus third molar from Drimolen, South Africa, which likely represents another example of caries in fossil hominins. The molar, DNH 40, is dated to 2.0-1.5 Ma and displays a lesion on the mesial root surface, extending from the cementoenamel junction 3 mm down toward the apex. The position and severity of the lesion was macroscopically recorded and micro-CT scanned to determine the extent of dentine involvement. A differential diagnosis indicates root caries, as the lesion is indistinguishable from clinical examples. Although necrotic in appearance, external tertiary dentine is evident on a micro CT scan. Gingival recession and/or continuous eruption of the tooth as a result of extensive occlusal wear would have occurred to facilitate caries formation. Therefore, the lesion is likely linked to relative old age of this individual. This new example increases the total number of carious lesions described in P. robustus teeth to 10, on occlusal, interproximal, and now, root surfaces. Beyond the consumption of caries-causing food, caries formation would have also required the presence of requisite intraoral cariogenic bacteria in this individual and the species. Of interest, the presence of tertiary dentine on the outward surface suggests the DNH 40 lesion may have been arrested, that is, no longer active, perhaps relating to a change in diet or oral microbiome just prior to the individual's death.

Association of Salivary Microbiota with Dental Caries Incidence with Dentine Involvement after 4 Years.

Salivary microbiota alterations can correlate with dental caries development in children, and mechanisms mediating this association need to be studied in further detail. Our study explored salivary microbiota shifts in children and their association with the incidence of dental caries with dentine involvement. Salivary samples were collected from children with caries and their subsequently matched caries-free controls before and after caries development. The microbiota was analyzed by 16S rRNA gene-based high-throughput sequencing. The salivary microbiota was more diverse in caries-free subjects than in those with dental caries with dentine involvement (DC). Although both groups exhibited similar shifts in microbiota composition, an association with caries was found by function prediction. Analysis of potential microbiome functions revealed that Granulicatella, Streptococcus, Bulleidia, and Staphylococcus in the DC group could be associated with the bacterial invasion of epithelial cells, phosphotransferase system, and D-alanine metabolism, whereas Neisseria, Lautropia, and Leptotrichia in caries-free subjects could be associated with bacterial motility protein genes, linoleic acid metabolism, and flavonoid biosynthesis, suggesting that functional differences in the salivary microbiota may be associated with caries formation. These results expand the current understanding of the functional significance of the salivary microbiome in caries development, and may facilitate the identification of novel biomarkers and treatment targets.

Accuracy of Different Methods for Assessing Erosive Tooth Wear.

The detection of exposed dentine caused by erosive tooth wear is difficult. To the authors' knowledge, there are no studies available on the impact of magnification and/or dye on the detection of erosive lesions. Therefore, the aim of this study was to investigate if the accuracy of assessing exposed dentine by the naked eye could be improved by using a microscope, dyeing, or a combination of both. The collected data were compared with the assessment of histological sections, which was considered the gold standard. A total of 70 teeth (24 teeth with slight erosion and 46 teeth with dentine involvement) showing different grades of erosive tooth wear were assessed 4 times by 17 examiners (9 aged <40 y, 8 aged ≥40 y). The first assessment was performed without magnification and without dye, the second assessment with magnification and without dye, the third assessment without magnification and with dye, and the fourth assessment with magnification and with dye. The examiners decided if dentine was exposed in the area of interest (positive test result) or not (negative test result). Subsequently, the teeth were histologically evaluated. Enamel was still present in 6 teeth and dentine was exposed in 64 teeth. Microscope magnification without dye performed the best, with 86% of all assessments being correct. The use of microscope magnification had a significant impact for dentists older than 40 y ( P = 0.02). The authors conclude that the assessment of exposed dentine was best when a microscope was used alone and that an additional dyeing of the samples did not improve performance. Knowledge Transfer Statement: Clinicians can use the results of this study when they assess erosive tooth wear. It will help clinicians to detect erosive tooth wear correctly, particularly the involvement of dentine. Using a microscope in the diagnostic process has a direct impact on the right assessment and consequently on prevention and/or minimally invasive treatment.

The wolf in sheep's clothing: Microtomographic aspects of clinically incipient radiation-related caries.

BackgroundRadiation-related caries (RRC) can cause rapid progression, with a high potential for dental destruction affecting mainly cervical and incisal areas. Unlike the injuries that occur in the conventional caries, incipient RRC present in unusual surfaces have difficult diagnosis and classification stages of cavitation.Material and MethodsEvaluate the radiographic patterns of demineralization of RRC by using micro-CT. Ten teeth with incipient RRC and 10 teeth with incipient conventional caries (control group) matched by anatomic teeth group and caries affected surfaces were evaluated by X-ray microtomography (micro-CT) Skyscan 1174V2 (50Kv, 1.3 megapixel, Kontich, Belgium). Teeth were placed in a standard position for micro-CT (coronal, transaxial and sagittal sections) during images acquisition. Lesions were classified according to the depth of invasion and relationship with enamel, dentin and pulp.ResultsRRC samples presented deeper lesions with higher involvement of enamel and dentin. Control group presented focal and superficial lesions with lower involvement of enamel and dentin.ConclusionsIncipient RRC present aggressive microtomographic patterns of demineralization when compared to conventional caries, as indicated by deep lesions, regardless of its clinically incipient aspects. Key words:Head and neck cancer, radiotherapy, microtomography, radiation caries.

A new primary dental care service compared with standard care for child and family to reduce the re-occurrence of childhood dental caries (Dental RECUR): study protocol for a randomised controlled trial.

BackgroundIn England and Scotland, dental extraction is the single highest cause of planned admission to the hospital for children under 11 years. Traditional dental services have had limited success in reducing this disease burden. Interventions based on motivational interviewing have been shown to impact positively dental health behaviours and could facilitate the prevention of re-occurrence of dental caries in this high-risk population. The objective of the study is to evaluate whether a new, dental nurse-led service, delivered using a brief negotiated interview based on motivational interviewing, is a more cost-effective service than treatment as usual, in reducing the re-occurrence of dental decay in young children with previous dental extractions.Methods/DesignThis 2-year, two-arm, multicentre, randomised controlled trial will include 224 child participants, initially aged 5 to 7 years, who are scheduled to have one or more primary teeth extracted for dental caries under general anaesthesia (GA), relative analgesia (RA: inhalation sedation) or local anaesthesia (LA). The trial will be conducted in University Dental Hospitals, Secondary Care Centres or other providers of dental extraction services across the United Kingdom. The intervention will include a brief negotiated interview (based on the principles of motivational interviewing) delivered between enrolment and 6 weeks post-extraction, followed by directed prevention in primary dental care. Participants will be followed up for 2 years. The main outcome measure will be the dental caries experienced by 2 years post-enrolment at the level of dentine involvement on any tooth in either dentition, which had been caries-free at the baseline assessment.DiscussionThe participants are a hard-to-reach group in which secondary prevention is a challenge. Lack of engagement with dental care makes the children and their families scheduled for extraction particularly difficult to recruit to an RCT. Variations in service delivery between sites have also added to the challenges in implementing the Dental RECUR protocol during the recruitment phase.Trial registrationISRCTN24958829 (date of registration: 27 September 2013), Current protocol version: 5.0.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-1010-9) contains supplementary material, which is available to authorized users.

The diagnosis and therapeutic protocols of approximal caries by final-year dental students at Al-Quds University, Palestine

Abstract Introduction: In this study, the major criterion used by 69 final-year dental students of Al-Quds University, Palestine, to ascertain the presence of approximal carious lesions through radiographs, and their subsequent treatment plan is outlined. Methods: This study was designed to be cross-sectional, whereby a questionnaire containing schematic radiographic diagrams of approximal carious lesions in molars of deciduous and permanent dentition were depicted. Th e extent of caries was divided into fi ve groups indicating different levels of enamel and dentin involvement: Caries extending to the external one-third of enamel, external two-thirds of enamel, up to the dentino-enamel junction (DEJ), external one-third of dentin, and two-thirds of dentin. Results: The absolute and relative frequencies of the study group′s responses were recorded. Th e treatment decisions taken for caries in deciduous and permanent dentition were neither affected by age nor gender. Of the 69 subjects, 26.1% (18/69) chose to treat the approximal caries when it had spread to the DEJ in the deciduous dentition and 39.1% (27/69) chose to treat caries at the DEJ in the permanent dentition, showing a significant statistical variation in response. When studying the difference in response to treating deciduous and permanent dentitions, treating a lesion at the DEJ and within the outer third of dentin in deciduous dentition was lower than the latter in permanent dentition, with a treatment response of 26.1% (18/69) for deciduous and 39.1% (27/69) for permanent dentition for a lesion at the DEJ, and 24.3% (17/69) in deciduous and 33.3% (23/69) for permanent dentition for a lesion in the outer third of dentin. Conclusion: These results show a significant difference in the choice to treat approximal caries in deciduous and permanent dentitions, indicating a greater preference for treating caries within dentin in permanent dentition than in deciduous dentition.

Selamento de lesão de cárie em metade externa de dentina em molar decíduo – relato de caso clínico com proservação de 12 meses

Introdução: A paralisação de lesões de cárie em metade externa de dentina é feita por meio de tratamentos conservadores. Objetivos: Relatar um caso clínico de um dente decíduo com lesão de cárie oclusal com pequena abertura e envolvimento dentinário radiograficamente restrito à metade externa de dentina; lesão controlada pela aplicação de um selante resinoso. Métodos: O selamento da superfície foi feito com o selante Fluoroshield aplicado com auxílio de uma sonda exploradora após condicionamento ácido da superfície. Resultados: As reavaliações foram feitas clínica e radiograficamente por 12 meses, sendo analisada a integridade do material e a estabilização da lesão de cárie. Após um ano, a integridade do selante e a não evolução radiográfica da lesão favoreceram um bom prognóstico ao caso. Conclusão: O selamento, desde que controlado periodicamente, atua de modo positivo na paralisação das lesões, podendo ser considerado como uma alternativa conservadora ao tratamento restaurador convencional.

ÇOCUKLARDA DENTAL EROZYON VE KORUYUCU UYGULAMALAR

Dental erosion is irreversible and progressive destruction of dental hard tissues without bacterial relationship. Internal and external acid sources that causes the formation of acidic pH in the oral environment, plays a role in the formation of dental erosion. While dietary acidic drinks and foods and drugs used are creating external acid sources, gastrooesophageal reflux and vomiting causes of internal acid source reach the oral cavity. In addition , bavarage intake with baby bottle, drinking can of carbonated beverages by foaming at the mouth and following acidic food consumption brushing teeth with an abrasive featured toothpaste and excessive force, increase the risk of dental erosion formation. The most common erosion areas are occlusal surface of the molars and palatal and incisal surfaces of the incisors. Dentin involvement of erosion in primary teeth is faster than permanent teeth, due to morphological differences and thinner enamel structure. In the prevention of dental erosion, firstly, patients and parents should be informed about food and beverages which has high erosive potential. Consumption of acidic foods and beverages should be limited and only at meal time. Patients who has dental erosion risk, should be recommended use of low abrazive toothpaste with high fluoride content and a soft-bristled toothbrush. In primary dentition, restorative treatment of erosion lesions is not indicated if the child does not have any symptoms. In the case of tooth sensitivity, small areas of erosion observed can be covered with resin materials. Depending on the etiologic factors, severity and progressive pattern of disease, all patients with dental erosion should be checked regularly

Occlusal Caries Extension in Relation to Visual and Radiographic Diagnostic Criteria: Results from a Microcomputed Tomography Study

This in vitro study aimed to evaluate occlusal caries extension in relation to visual and radiographic diagnostic criteria and their clinical value to indicate operative or preventive dental care. A total of 196 third molars with clinically sound occlusal fissures or noncavitated lesions were collected. Before microcomputed tomography (μCT) investigation, each tooth was examined visually and radiographically. Kühnisch's μCT-based caries-extension index (CE index) was used to determine the caries depth on a numeric scale (0 = sound; 0.01-0.99 = enamel caries; 1.0-1.99 = dentin caries). Sensitivities (SEs), specificities (SPs), and area under the receiver operating characteristic curve (Az value) were also calculated. Based on μCT data, the following mean CE index values and standard deviations (SDs) were documented according to the visual criteria: sound = 0.6 (0.4); first visible signs = 0.9 (0.4); established lesions = 1.3 (0.3); microcavities = 1.4 (0.2); dentin exposure = 1.5 (0.2); and large cavities = 1.5 (0.3). The radiographic categories according to Marthaler (enamel caries [D0-2], caries in the outer half of dentin [D3], and caries in the inner half of dentin [D4]) were related to CE index values of 0.9 (0.4), 1.4 (0.2) and 1.6 (0.4), respectively. Caries detected visually or radiographically showed an SE of 84% and an SP of 85% (Az = 0.85). When both methods were used to predict dentin involvement simultaneously, SE = 27%, SP = 100%, and Az = 0.63; this combined visual and radiographic approach was associated with a perfect specificity and no false-negative decisions. The proportion of false-positive diagnoses was moderately high, and lesion extension in these cases was mainly limited to the outer 20% of the dentin. Our results might be useful for differentiating between preventive and operative dental care for pits and fissures.

Erosive tooth wear and wedge-shaped defects in 1996 and 2006: cross- sectional surveys of Swiss army recruits.

The purpose of this study was to determine the prevalence and possible etiological factors of erosive tooth wear and wedge-shaped defects in Swiss Army recruits and compare the findings with those of an analogous study conducted in 1996. In 2006, 621 recruits between 18 and 25 years of age (1996: 417 recruits; ages 19 to 25) were examined for erosive tooth wear and wedge-shaped defects. Additional data was acquired using a questionnaire about personal details, education, dentition’s subjective condition, oral hygiene, eating and drinking habits, medications used, and general medical problems. In 2006, 60.1% of those examined exhibited occlusal erosive tooth wear not involving the dentin (1996: 82.0%) and 23.0% involving the dentin (1996: 30.7%). Vestibular erosive tooth wear without dentin involvement was seen in 7.7% in 2006 vs. 14.4% in 1996. Vestibular erosive tooth wear with dentin involvement was rare in both years (0.5%). Oral erosive tooth wear lacking exposed dentin was also rare in those years, although more teeth were affected in 2006 (2.1%) than in 1996 (0.7%). The examinations in 2006 found one or more initial wedge-shaped lesions in 8.5% of the recruits, while 20.4% of the study participants exhibited such in 1996. In 1996, 53% consumed acidic foods and beverages more than 5 times/day; in 2006, 83.9% did so. In neither study did multivariate regression analyses show any significant correlations between occurrence and location of erosive tooth wear and wedge-shaped defects and various other parameters, e.g., eating and hygiene habits, or dentin hyper-sensitivity. Despite a significant increase in consumption of acidic products between 1996 and 2006, the latter study found both fewer erosive tooth wear and fewer wedge-shaped defects (i.e., fewer non-carious lesions.).

Erosive tooth wear and wedge-shaped defects in 1996 and 2006: cross- sectional surveys of Swiss army recruits.

The purpose of this study was to determine the prevalence and possible etiological factors of erosive tooth wear and wedge-shaped defects in Swiss Army recruits and compare the findings with those of an analogous study conducted in 1996. In 2006, 621 recruits between 18 and 25 years of age (1996: 417 recruits; ages 19 to 25) were examined for erosive tooth wear and wedge-shaped defects. Additional data was acquired using a questionnaire about personal details, education, dentition’s subjective condition, oral hygiene, eating and drinking habits, medications used, and general medical problems. In 2006, 60.1% of those examined exhibited occlusal erosive tooth wear not involving the dentin (1996: 82.0%) and 23.0% involving the dentin (1996: 30.7%). Vestibular erosive tooth wear without dentin involvement was seen in 7.7% in 2006 vs. 14.4% in 1996. Vestibular erosive tooth wear with dentin involvement was rare in both years (0.5%). Oral erosive tooth wear lacking exposed dentin was also rare in those years, although more teeth were affected in 2006 (2.1%) than in 1996 (0.7%). The examinations in 2006 found one or more initial wedge-shaped lesions in 8.5% of the recruits, while 20.4% of the study participants exhibited such in 1996. In 1996, 53% consumed acidic foods and beverages more than 5 times/day; in 2006, 83.9% did so. In neither study did multivariate regression analyses show any significant correlations between occurrence and location of erosive tooth wear and wedge-shaped defects and various other parameters, e.g., eating and hygiene habits, or dentin hyper-sensitivity. Despite a significant increase in consumption of acidic products between 1996 and 2006, the latter study found both fewer erosive tooth wear and fewer wedge-shaped defects (i.e., fewer non-carious lesions.).

Erosive tooth wear and wedge-shaped defects in 1996 and 2006: cross- sectional surveys of Swiss army recruits.

The purpose of this study was to determine the prevalence and possible etiological factors of erosive tooth wear and wedge-shaped defects in Swiss Army recruits and compare the findings with those of an analogous study conducted in 1996. In 2006, 621 recruits between 18 and 25 years of age (1996: 417 recruits; ages 19 to 25) were examined for erosive tooth wear and wedge-shaped defects. Additional data was acquired using a questionnaire about personal details, education, dentition’s subjective condition, oral hygiene, eating and drinking habits, medications used, and general medical problems. In 2006, 60.1% of those examined exhibited occlusal erosive tooth wear not involving the dentin (1996: 82.0%) and 23.0% involving the dentin (1996: 30.7%). Vestibular erosive tooth wear without dentin involvement was seen in 7.7% in 2006 vs. 14.4% in 1996. Vestibular erosive tooth wear with dentin involvement was rare in both years (0.5%). Oral erosive tooth wear lacking exposed dentin was also rare in those years, although more teeth were affected in 2006 (2.1%) than in 1996 (0.7%). The examinations in 2006 found one or more initial wedge-shaped lesions in 8.5% of the recruits, while 20.4% of the study participants exhibited such in 1996. In 1996, 53% consumed acidic foods and beverages more than 5 times/day; in 2006, 83.9% did so. In neither study did multivariate regression analyses show any significant correlations between occurrence and location of erosive tooth wear and wedge-shaped defects and various other parameters, e.g., eating and hygiene habits, or dentin hyper-sensitivity. Despite a significant increase in consumption of acidic products between 1996 and 2006, the latter study found both fewer erosive tooth wear and fewer wedge-shaped defects (i.e., fewer non-carious lesions.).

Prävention, Diagnostik und Therapie der Fissurenkaries bei bleibenden Zähnen

Background: Pits and fissures are structures being most prone to caries in permanent teeth. Possible measures are monitoring, preventive sealing, minimally invasive preparation and sealing, and finally conventional restoration. The German guideline covers statements regarding indication and procedures of pit and fissure sealings including appropriate materials. Furthermore, the topics caries risk diagnosis, occlusal caries diagnosis, and caries activity are reflected facing actual publications.Methods: The present paper focuses on dental management of pits and fissures facing the background of German and American Guidelines. This also involves description and judgement of clinical procedures from preventive sealings to final restorations.Results: German and US guidelines cover indications and technical procedures of pit and fissure sealings with moderate to good evidence backup. Caries diagnosis on the basis of ICDAS-II allows differentiated decisions mostly resulting in sealing or minimally invasive restorations. Boderlines between initial caries with or without dentin involvement (ICDAS-Codes 1 und 2) are traditionally difficult. Minimally invasive preparation is ideally managed using special rotary burs. Flowable resin composites are the materials of choice for restorations, probably with additionally applied sealant in non-prepared areas.Conclusions: Pit and fissure caries is today reliably diagnosed using visual and fluorescence-based methods even in intact enamel surfaces. For both non-invasive sealings and minimally invasive restorations, quality standards of adhesive dentistry have to be taken into account.

Validation of swept source optical coherence tomography (SS-OCT) for the diagnosis of smooth surface caries in vitro

ObjectiveAn accurate evaluation of the extent of dental caries and possible progress of the lesion from enamel into dentin is very important in clinical dentistry. Dentists need an imaging technology that can noninvasively and reliably quantify the extent of caries. This study aimed to evaluate the effectiveness of non-polarized swept source optical coherence tomography (OCT) in evaluating the extent of caries on smooth enamel surfaces. MethodsOne-hundred and twenty-seven investigation sites on the enamel surfaces of 93 extracted teeth were selected randomly and examined visually. The presence and extent of caries were scored by experienced and inexperienced dentists using each observation method (0: no caries; 1: enamel demineralization without surface breakdown; 2: enamel breakdown due to caries; 3: deep caries involving the dentin). The same locations were then examined using OCT, following which the teeth were sectioned using a diamond saw and viewed directly under a confocal laser scanning microscope (CLSM). Sensitivity and specificity indices for OCT and VI were calculated and compared. The results were analysed statistically using receiver operating characteristic (ROC) curves. ResultsEnamel and dentin caries were outlined by a visible boundary on the cross-sectional OCT images. The modality showed superior results for the detection of dentinal caries; higher sensitivity and Az values could be obtained in the ROC curves, especially by experienced dentists. ConclusionsCross-sectional imaging of the natural caries lesions on smooth enamel surface by OCT enables efficient diagnosis of the lesion type, extent and dentin involvement. Clinical significanceSS-OCT can demonstrate the cross-sectional image of smooth surface enamel caries as highlighted zone in tomogram. It is crucial to determine the extent of the lesion, whether it reaches beyond DEJ or not by a non-invasive and safe technique. OCT can give clinicians information about internal tooth structure and will help clinical decision making on surgical intervention.

Root damage and repair in patients with temporary skeletal anchorage devices

The aim of this study was to evaluate the reparative potential of cementum histologically after intentional root contact with a temporary skeletal anchorage device. Seventeen patients (8 male, 9 female; mean age, 16.2 years; range, 13.5-21.6 years) who were scheduled for extraction of 4 first premolars as part of their orthodontic treatment participated in this study. The roots of the premolars were intentionally injured with a temporary skeletal anchorage device. The teeth were extracted at 4, 8, or 12 weeks after the injury. Root contact with the temporary skeletal anchorage device was confirmed by using a stereomicroscope. Histologic samples were prepared. Demineralized serial sections were stained with eosin and hematoxylin, and cementum repair was assessed histomorphometrically. Despite varying depths of the injuries, including involvement of dentin, reparative cementum formation was observed in all sections. Healing cementum was almost exclusively of the cellular type; 70% of all the teeth exhibited good repair by the end of week 12. This study established that healing of cementum takes place after an injury with a temporary skeletal anchorage device, and it is a time-dependent phenomenon.