Sound Permanent Teeth Research Articles

Quantitative analysis of remineralization of artificial carious lesions with commercially available toothpastes using EDAX: An in vitro study

Introduction: Noninvasive approach for treating demineralized teeth is gaining importance in preventive dentistry. Various fluoridated and nonfluoridated remineralizing agents are utilized for treating early enamel carious lesions. Aim: To quantitatively assess the remineralizing potential of various dentifrices quantitatively from the array of products available in the market. Materials and Methods: Enamel blocks were prepared from seventy sound permanent teeth. The baseline amount of calcium, phosphorous, and fluoride was evaluated. After those samples were transferred in Modified TenCate’s solution for demineralization for 96 h, the amount of demineralization carried out to detect change in mineral content. Following this, samples were randomly grouped into five – Group 1: Fluoridated sensitive toothpaste, Group 2: Fluoridated toothpaste with Anticay Technology, Group 3: Nonfluoridated natural extracts toothpaste, Group 4: Nonfluoridated ayurvedic toothpaste, and Group 5: De-ionized water. Remineralizing agents applied twice daily for 28 days. The final mineral content of remineralized enamel was evaluated. Intra-group and inter-group comparisons were statistically analyzed using independent and paired sample t-test and analysis of variance. Results and Discussion: The mean calcium, phosphorous, fluoride, and Ca/P ratio of fluoridated and nonfluoridated toothpastes showed statistically significant difference (significant at P < 0.05). Intergroup comparison shows fluoridated toothpaste showing greater potential for remineralization (significant at P < 0.05). Conclusion: Fluoridated toothpaste with anticay technology showed better remineralizing capacity followed by sensitive and nonfluoridated natural toothpaste. Nonfluoridated ayurvedic toothpaste showed the least remineralizing potential.

Patients Knowledge and Perception about Orthodontic Extraction of Sound Permanent Teeth

BACKGROUND
 There are many beliefs & misconceptions of patients associated with the orthodontic extraction of sound teeth. The decision to extract creates a cycle of doubts in the patients' minds. So, the purpose of this study was to assess the knowledge and perception of patients undergoing extractions of sound permanent teeth for orthodontic reasons in a dental teaching institute.
 METHODS
 This prospective study involved patients who were advised and indicated for orthodontic extraction of sound permanent teeth. A questionnaire which was content, and face validated was used to measure the patients’ responses, which included questions about the knowledge and perception of patients regarding the extraction of sound permanent teeth for orthodontic reason. The returned questionnaires were analysed, and responses were tabulated and subjected to various statistical tests.
 RESULTS
 The overall level of knowledge was 38.18 % above average and the level of perception was 45.45 % above average. There was no statistically significant association between age groups with the level of knowledge (P=0.4980). Percentagewise: higher the age group, the higher the knowledge. While there was a statistically significant association (P=0.0490) between age groups with the level of perception. Percentagewise in ≤19 yrs. it was 38.10 % as compared to 69.23 % in ≥20 yrs. age who had an above average level of perception. A statistically significant association between the ANOVA test (F=8.0794, P=0.0009) and Tukey's post hoc test was seen between education level with mean perception level. Subjects with a higher degree had above-average perception levels followed by secondary and higher secondary education levels. Knowledge level was significantly higher in subjects residing in an urban area as compared to rural area (t=-2.9097, P=0.0053), percentage wise also urban area had more level of mean knowledge (53.33 %) as compared to rural area (20 %).
 CONCLUSIONS
 The overall level of knowledge and perception in patients reporting for orthodontic extraction of sound teeth was less. The study concluded the need for more awareness about the orthodontic extraction of sound teeth which can lead to more satisfaction and less anxiety, especially in lower age groups and rural populations.

Comparative Evaluation of Microhardness and Enamel Solubility of Treated Surface Enamel with Resin Infiltrant, Fluoride Varnish, and Casein Phosphopeptide-amorphous Calcium Phosphate: An In Vitro Study.

Aim and objectiveThe aim and objective of this study was to do a comparative evaluation of microhardness and enamel solubility (ES) of the treated surface enamel with resin infiltrant, fluoride varnish, and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP).Materials and methodsAn in vitro study was conducted on freshly extracted 85 sound permanent teeth of which 5 teeth were subjected to check for microhardness by the Vickers microhardness tester and the remaining teeth were exposed to demineralizing solution to create initial enamel lesions. These 80 teeth were assigned to four groups: group I—negative control (n = 20), group II—resin infiltrant (n = 20), group III—fluoride varnish (n = 20), and group IV—CPP-ACP (n = 20), and microhardness was checked after application. These teeth were exposed to caries attack three times a day for three consecutive days. The ES of these four groups was checked by calcium ion loss in the artificial cariogenic solution and whole saliva by an atomic absorption spectrophotometer.ResultsIt was found that none of the experimental groups reached the microhardness values of sound intact teeth. At 3rd day, the values of microhardness were: group II = group III > group IV > group I. Maximum ES was found for group I (control) followed with group IV.ConclusionAll agents used in study remineralized initial carious lesion. Fluoride varnish has the highest microhardness and showed least ES compared to other remineralizing agents.Clinical significanceFluoride varnish can be regarded as the choice of material to be used for the treatment of incipient carious lesions because of the low application frequency (once every 3–6 months), requires minimal patient compliance as it is a noninvasive procedure and less time consuming.How to cite this articleDhillon SN, Deshpande AN, Macwan C, et al. Comparative Evaluation of Microhardness and Enamel Solubility of Treated Surface Enamel with Resin Infiltrant, Fluoride Varnish, and Casein Phosphopeptide-amorphous Calcium Phosphate: An In Vitro Study. Int J Clin Pediatr Dent 2020;13(S-1):S14–S25.

Detecting early erosive tooth wear using an intraoral scanner system

ObjectivesTo assess the feasibility of detecting and monitoring early erosive tooth wear using a 3D intraoral scanner (IOS) aided by specific software. MethodsExtracted sound permanent teeth were assembled in two shortened artificial dental arches and scanned at different intervals with an IOS (3Shape TRIOS® 3) before and after an erosion/abrasion protocol (i.e. 1 h up to 24 h immersion in citric acid solution and subsequent brushing). The 3D models obtained at consecutive time points were superimposed with the baseline model using dedicated software (3Shape TRIOS® Patient Monitoring, version 2.1.1.0) and reference surface alignment. Surface profile differences between the baseline 3D model and the respective models from different time points were expressed as tooth substance loss.Non-parametric tests were used to assess the significance of tooth substance loss at different time points. Spearman’s correlation was applied between the tooth substance loss at the end of each erosion/abrasion cycle and the immersion time in acid. ResultsSignificant tooth substance loss (0.08 mm, IQR = 0.05) was detected by the software after 3 h of erosive-abrasive challenge (p = 0.045). The overall median loss increased gradually from baseline to 24 h showing a strong correlation with the immersion time in acid (rs = 0.971, p < 0.01). ConclusionsThe use of an IOS aided by specific software showed good performance for early detection and monitoring of tooth wear in vitro and has promising potential for in vivo application. Clinical significanceDetection and monitoring of early erosive tooth wear can be reliably aided by intraoral scanning supported by specific software. The measurement error and uncertainty involved in this method should be taken into consideration when interpreting the tooth substance loss measurements. Furthermore, presuming the difficulty in defining reference surfaces in vivo, clinical validation is needed to determine the system’s in vivo performance.

Grape seed extracts inhibit dentin matrix degradation by MMP-3.

Since Matrix metalloproteinases (MMPs) have been suggested to contribute to dentin caries progression, the hypothesis that MMP inhibition would affect the progression of dentin caries is clinically relevant. Grape seed extracts (GSE) have been previously reported to be natural inhibitors of MMPs.Objective: To evaluate the capacity of a GSE mouthrinse to prevent the degradation of demineralized dentin matrix by MMP-3 (stromelysin-1).Materials and Methods: Standardized blocks of dentin obtained from sound permanent teeth extracted for orthodontic reasons were demineralized with Ethylenediaminetetraacetic acid (EDTA) and pretreated either with (A) GSE (0.2% w/v), (B) amine fluoride (AmF) (20% w/v), (C) a mouthrinse which contains both, (D) placebo, (E) sodium fluoride (0.15 mg.ml−1), (F) PBS, (G) Chlorhexidine digluconate (CHX), or (H) zinc chloride (ZnCl2). The dentin blocks were then incubated with activated recombinant MMP-3. The supernatants were analyzed by Western Blot for several dentin matrix proteins known to be MMP-3 substrate. In parallel, scanning electron microscopy (SEM) was performed on resin replica of the dentin blocks.Results: Western blot analysis of the supernatants revealed that MMP-3 released from the dentin matrix small proteoglycans (decorin and biglycan) and dentin sialoprotein (DSP) in the AmF, sodium fluoride, PBS and placebo pretreated groups, but not in the GSE and mouthrinse pretreated groups. SEM examination of resin replica showed that the mouthrinse and its active components not only had an anti-MMP action but also modified the dentin surface accessibility.Conclusion: This study shows that GSE either alone or combined with AmF as in the evaluated mouthrinse limits dentin matrix degradation. This association may be promising to prevent the progression of caries within dentin. However, the procedure should be adapted to clinically relevant durations.

Al and Fe levels in mixed saliva of children related to elution behavior from teeth and restorations

Objectives The levels of trace elements in mixed saliva were not well-defined. This study was performed to determine Al and Fe concentrations in mixed saliva of children and to investigate the relationship between these levels and dental caries. Methods Among 562 collected mixed saliva specimens, 514 and 548 samples for analyses of Al and Fe levels were obtained, respectively. The Al and Fe concentrations were determined using flameless atomic absorption spectrometry. Results The Al and Fe concentrations in children without a history of caries were 0.093 ± 0.136 and 0.121 ± 0.128 μg/mL, respectively. The Fe level depended on sex. The Fe level in girls who experienced caries was significantly higher than that without caries history. The Al and Fe levels were significantly higher in children with treated caries than children without caries history. The Fe concentrations were affected by restoration type. Composite resin increased the Fe level significantly especially in girls, and the Fe level was also higher in boys treated with both composite resin and metal restorations. In children without caries history, the Al level was inversely proportional to the number of deciduous teeth and increased with the number of permanent teeth. In contrast, the Fe level showed the reverse tendency. Conclusions The Fe level in mixed saliva of children was influenced by the restoration type. It was suggested that Al was eluted more from sound permanent teeth than sound deciduous teeth, while Fe was eluted in the opposite manner.

The remineralization aspect of enamel according to change of the degree of saturation of the organic acid buffering solution in pH 5.5

The purpose of this study is to observe and compare the reminer alization tendencies of artificial enamelcaries lesion by remineralization solutions of different degree of saturations at pH 5.5, using a polarizingmicroscope and computer programs (Photoshop, Image pro plus, Scion Image, Excel).For this study, 48 sound permanent teeth with no signs of demin eralization, cracks, or dental restora-tions were used. The specimens were immersed in lactic acid demineralization solution for 2 days in orderto produce artificial dental caries that consist of surface and subsurface lesions. Each of 9 or 10 specimenswas immersed in pH 5.5 lactic acid buffering remineralization solution of four different degrees of satura-tion (0.507, 0.394, 0.301, and 0.251) for 12 days. After the de mineralization and remineralization, imageswere taken by a polarizing microscope (×100). The results were obtained by observing images of the speci-mens, and using computer programs, the density of caries lesions were estimated.While the group with the lowest degree of saturation (0.251) showed total remineralization feature fromthe surface to the subsurface of the lesion, the group with the highest degree of saturation (0.507) showeddemineralization mainly on the surface of the lesion at the constant organic acid concentration 0.01M and pH 5.5.

The effect of lactic acid concentration and ph of lactic acid buffer solutions on enamel remineralization

There are considerable in vitro and in vivo evidences for remineralization and demineralization occurring simultaneously in incipient enamel caries. In order to “heal”the incipient dental caries, many experiments have been carried out to determine the optimal conditions for remineralization. It was shown that remineralization is affected by different pH, lactic acid concentrations, chemical composition of the enamel, fluoride concentrations, etc. Eighty specimens from sound permanent teeth without demineralization or cracks, 0.15 mm in thickness, were immersed in lactic acid buffered demineralization solutions for 3 days. Dental caries with a surface zone and subsurface lesion were artificially produced. Groups of 10 specimens were immersed for 10 or 12 days in lactic acid buffered remineralization solutions consisting of pH 4.3 or pH 6.0, and 100, 50, 25, or 10 mM lactic acid. After demineralization and remineralization, images were taken by polarizing microscopy (x100) and micro-computed tomography. The results were obtained by observing images of the specimens and the density of the caries lesions was determined. 1.As the lactic acid concentration of the remineralization solutions with pH 4.3 was higher, the surface zone of the carious enamel increased and an isotropic zone of the subsurface lesion was found. However, the total decalcification depth increased at the same time. 2.In the remineralization solutions with pH 6.0, only the surface zone increased slightly but there was no significant change in the total decalcification depth and subsurface zone. In the lactic acid buffer solutions with the lower pH and higher lactic acid concentration, there were dynamic changes at the deep area of the dental carious lesion.

The remineralizing features of pH 5.5 solutions of different degree of saturations on artificially demineralized enamel

The purpose of this study is to observe and compare the remineralization tendencies of artificially demineralized enamel by remineralization solutions of different degree of saturations at pH 5.5, using a polarizing microscope and computer programs (Photoshop, Image pro plus, Scion Image, Excel). For this study, 36 sound permanent teeth with no signs of demineralization, cracks, or dental restorations were used. The specimens were immersed in lactic acid demineralization solution for 3 days in order to produce dental caries artificially that consist of surface and subsurface lesions. Each of 9 or 10 specimens was immersed in pH 5.5 lactic acid buffered remineralization solution of three different degrees of saturation (0.25, 0.30, 0.35) for 12 days. After the demineralization and remineralization, images were taken by a polarizing microscope . The results were obtained by observing images of the specimens, and using computer programs, the density of caries lesions were determined. In conclusion, in the group with the lowest degree of saturation, remineralization occurred thoroughly from the surface to the subsurface lesion, whereas in the groups with greater degree of saturation showed no significant change in the subsurface lesion, although there was corresponding increase in the remineralization width on the surface zones.

Dental health, received care, and treatment needs in 11‐ to 13‐year‐old children with immigrant background in Heidelberg, Germany

The purpose of the survey was to evaluate the caries experience, the provided care, and the unmet treatment need in 11- to 13-year-old schoolchildren with immigration background compared to children without migration experience. A cross-sectional study of 502 schoolchildren, 48% of which have immigration background, was conducted. Schools in areas of disadvantaged socio-economic status were chosen for this study. DMFT scores, fissure sealants, and the occurrence of orthodontic treatments were recorded. The mean DMFT score of the immigrant children was significantly higher than that of the nonmigrants: 1.5 vs. 0.8. The SiC Index was also significantly different in both groups: 3.7 vs. 2.4, respectively. The Unmet Restorative Treatment Need Index was twofold higher in the immigrants compared to the nonmigrants. Only 45.6% of the immigrants had sound permanent teeth compared to 65.5% of the nonmigrants. The average number of sealants per child was 1.9 vs. 2.8, respectively. In addition, only 31.5% of the immigrants were provided with an orthodontic treatment compared to 48.3% of the nonmigrants. Children with immigration background demonstrated more caries and received less dental care when compared to children without migration experience. The community prevention programmes, addressed similarly to all children, could not close the gap in oral health between immigrant and non-immigrant children.

Trends in dental caries prevalence in 12-year-old schoolchildren between 1976 and 2001 in Bauru, Brazil

To evaluate the trends in dental caries prevalence in 12-year-old schoolchildren between 1976 and 2001 in Bauru, Brazil. Study design. An epidemiological survey was performed by trained, calibrated examiners by the same research group in 1976, 1984, 1990, 1995 and 2001, using the decayed, missing and filled teeth (DMFT) index. Urban elementary schools were chosen because they provide a fair representation of the city's population in terms of socio-economic status. The study included 261, 321, 253, 377 and 211 subjects from the same regions in 1976, 1984, 1990, 1995 and 2001, respectively. The prevalence of caries and the DMFT index were used. A remarkable decrease was seen in the DMFT index at age 12 (84.53%) between 1976 and 2001. The DMFT indices at age 12 were 9.89, 7.01, 3.97, 4.13 and 1.53 in 1976, 1984, 1990, 1995 and 2001, respectively. The percentage of schoolchildren presenting with sound permanent teeth (DMFT = 0) increased from 0.40 to 45.50% between 1976 and 2001. Over the same period, the percentage of schoolchildren with six or more decayed teeth decreased from 86.99% to 5.21%. The phenomenon of dental caries polarization is already perceptible in Bauru, Brazil. The increase in the number of schoolchildren with sound permanent teeth (DMFT = 0) suggests that the dental health policy in Bauru has had a positive effect in children's dental health, and should therefore be considered for other cities.

Comparative Study to Quantify Demineralized Enamel in Deciduous and Permanent Teeth Using Laser– and Light–Induced Fluorescence Techniques

Caries is a disease that affects both deciduous and permanent dentitions. Caries progresses more rapidly in deciduous enamel than in permanent enamel. Therefore, new caries diagnostic methods need to be tested on the deciduous teeth as well. Quantitative laser–induced fluorescence (QLF I) as well as the quantitative light–induced fluorescence (QLF II) seem promising for the quantification of mineral loss from dental caries but have only been tested on the permanent dentition. The objective of this study was to determine and compare the ability of QLF I and QLF II to quantify mineral loss from carious lesions in both deciduous and permanent teeth. Thirty sound deciduous and 30 sound permanent teeth were cleaned and divided into three groups each containing 10 deciduous and 10 permanent teeth. Windows on the buccal or labial enamel surfaces were demineralized for 48, 72, or 96 h. Images of demineralized enamel were captured using QLF I and QLF II. The images were analyzed to determine the mean change in fluorescence radiance (ΔF, %). The teeth were then sectioned for assessment of lesion depth (µm) and integrated mineral loss (IML, vol% ×µm) using transverse microradiography (TMR), as the ‘gold standard’ for lesion analysis. The results indicated a good correlation for ΔF between QLF I and QLF II in both deciduous (r = 0.96) and permanent teeth (r = 0.98). There was a good correlation between ΔF and TMR (lesion depth and IML) in deciduous teeth (r = 0.76 and 0.84 with QLF I, r = 0.81 and 0.88 with QLF II). In permanent teeth, the correlation between ΔF and TMR (lesion depth and IML) was lower than in deciduous teeth (r = 0.07 and 0.53 with QLF I, r = 0.15 and 0.62 with QLF II). From these results it can be concluded that either QLF method is capable of quantifying mineral loss in early carious lesions in deciduous teeth. Moreover, under the conditions of this study, the use of either QLF method to quantify mineral loss in early carious lesions in deciduous teeth is slightly more accurate than in permanent teeth.

Abstracts from other journals

Purpose: In 1987, Jamaica initiated a comprehensive island‐wide salt fluoridation program. A survey was conducted in 1995 to monitor the impact of salt fluoridation among children in Jamaica. Methods: Dental examinations of 1120 children aged 6–8, 12, and 15 years were conducted according to World Health Organization criteria to assess dental caries, fluorosis, the presence of and need for dental sealants, and Community Periodontal Treatment Needs (CPI). Results: Age specific DMFT means observed in 1995 were 0·2 at age 7, 0·4 at age 8, 1·1 at age 12 and 3·0 at age 15. The mean DMFT scores in children 6, 12 and 15 years of age were dramatically lower than the corresponding scores of 1·7, 6·7 and 9·6 obtained at the baseline examination in 1984 for children of the same age groups, respectively (baseline data for 7‐ and 8‐year‐olds were not collected). The mean percentage of sound permanent teeth for all age groups was 90% in 1995. Tile percentage of children caries‐free at baseline was 27·6% for 6 years, 2·8% for 12 years and 0·3% for 15 years of age. In 1995, the percentage of caries‐free children (permanent teeth) was 61%. In 1984, 23 children were scored as having very mild or mild fluorosis. In 1995, five children were scored in the same categories of fluorosis, using Dean’s criteria; thus, fluorosis remained at negligible levels in 1995. Conclusions: The oral health survey conducted in Jamaica in 1995 indicated a significant decline in dental caries compared with findings in 1984. The major change in Jamaica during the interval was the introduction of salt fluoridation in 1987. Dental fluorosis was low in the 1995 survey.

Salt fluoridation and dental caries in Jamaica.

In 1987, Jamaica initiated a comprehensive island-wide salt fluoridation program. A survey was conducted in 1995 to monitor the impact of salt fluoridation among children in Jamaica. Dental examinations of 1,120 children aged 6-8, 12, and 15 years were conducted according to World Health Organization criteria to assess dental caries, fluorosis, the presence of and need for dental sealants, and Community Periodontal Treatment Needs (CPI). Age specific DMFT means observed in 1995 were 0.2 at age 7, 0.4 at age 8, 1.1 at age 12 and 3.0 at age 15. The mean DMFT scores in children 6, 12 and 15 years of age were dramatically lower than the corresponding scores of 1.7, 6.7 and 9.6 obtained at the baseline examination in 1984 for children of the same age groups, respectively (baseline data for 7- and 8-year-olds were not collected). The mean percentage of sound permanent teeth for all age groups was 90% in 1995. The percentage of children caries-free at baseline was 27.6% for 6 years, 2.8% for 12 years and 0.3% for 15 years of age. In 1995, the percentage of caries-free children (permanent teeth) was 61%. In 1984, 23 children were scored as having very mild or mild fluorosis. In 1995, five children were scored in the same categories of fluorosis, using Dean's criteria; thus, fluorosis remained at negligible levels in 1995. The oral health survey conducted in Jamaica in 1995 indicated a significant decline in dental caries compared with findings in 1984. The major change in Jamaica during the interval was the introduction of salt fluoridation in 1987. Dental fluorosis was low in the 1995 survey.

Evaluation of a pit‐ and fissure‐sealing program in a public dental health service after 2 years

The aim of the present study was to test the caries-preventive effect of a bis-GMA type fissure sealant (Concise Enamel Bond System) in a public dental health service for children. The study compared one group of children, in which all sound permanent teeth were sealed, and a control group in which no sealants were placed. During the study period all children received systematic restorative care, while sealing was performed on the basis of diagnoses made at subsequent examinations by one of the authors. After 2 years a total of 187 children were available for re-examination. Sealant retention was comparable to that obtained in previous studies, but no statistically significant reduction in overall caries increment could be demonstrated. Further analysis showed that only 223 sites had been sealed, while the majority of all erupting sites (394) were either carious or filled before they were screened for the purpose of sealing. It is therefore assumed that only teeth less susceptible to occlusal decay were sealed, thereby explaining the lack of benefit derived from the sealing program.