Surface Caries Research Articles

Extensive Dental Caries in Patients with Oral Chronic Graft-versus-Host Disease

The oral cavity is one of the sites most frequently affected by chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic cell transplantation (alloHCT) and can be a significant source of patient morbidity due to both mucosal and salivary gland involvement. The development of dental decay is a potentially devastating oral complication that has only rarely been reported in the transplantation literature. The purpose of this study was to comprehensively characterize a cohort of patients with cGVHD who subsequently developed extensive dental caries. A retrospective case-record review was conducted for patients who had undergone alloHCT at Dana-Farber/Brigham and Women's Cancer Center between 1990 and 2010 and developed cGVHD-associated rampant dental decay. All patients underwent dental evaluation, involving soft and hard tissue examination and dental radiography, before and after alloHCT. Any dental caries diagnosed at the pre-alloHCT evaluation were treated definitively, such that all patients were considered free of caries at the time of admission for alloHCT. A total of 21 patients were identified, with a median time of cGVHD onset of 5.4 months (range, 2.2-18.5 months) after alloHCT. All patients were diagnosed with oral cGVHD, with 90% demonstrating mucosal involvement and 95% demonstrating salivary gland involvement. Post-alloHCT dental evaluation was performed at a median of 22 months (range, 4-81) after alloHCT, when 10 patients were diagnosed with gross caries and 8 patients had 4 or more affected teeth. Cervical and interproximal patterns of dental caries were frequently diagnosed. The proportions of patients with gross caries, one surface caries, and more than one surface caries (classified as 0, 1-3, and ≥4, respectively) were significantly higher after alloHCT than before alloHCT, with at least 50% of patients experiencing an increase. Patients with oral cGVHD who were free of caries at the time of transplantation developed extensive areas of cervical decay at a median of less than 2 years after alloHCT. This is the first comprehensive characterization of this severe late complication of alloHCT and oral cGVHD. Greater awareness by transplantation oncologists and dentists, as well as more aggressive preventive measures, are needed, as are further prospective studies to better elucidate the incidence of this complication, identify risk factors, and evaluate the effectiveness of preventive interventions.

AP-PCR detection of Streptococcus mutans and Streptococcus sobrinus in caries-free and caries-active subjects

The aim of the study was to identify the number and distribution of genotypes of Streptococcus mutans (S. mutans) and Streptococcus sobrinus (S. sobrinus) isolated from caries-free and caries-active subjects. Non-stimulated saliva, buccal smooth surface of the right upper teeth, fissures of sound occlusal surface, and carious surface were sampled from 7 caries-free and 7 caries-active (DMFT ≥ 6) students aged 22-24 years. S. mutans and S. sobrinus were isolated using Chelex-100 and primarily identified by colony morphology and biochemical characteristics. The isolates of S. mutans were genotyped using arbitrarily primed polymerase chain reaction. A total of 516 isolates of S. mutans were genotyped from 47 sites in 14 students, and 44 different genotypes were determined. All of the caries-free individuals harbored S. mutans but not S. sobrinus, although individuals 3 and 7 had no S. mutans in their saliva. The CFU value of S. mutans on carious surfaces was the highest, and values in saliva, fissures, and occlusal surfaces were higher in caries-active individuals than in caries-free individuals. We detected 28 genotypes of S. mutans in caries-free individuals, each of who carried more than 3 genotypes. However, we found only 16 genotypes of S. mutans in caries-active individuals, each of who carried no more than 3 genotypes. More genotypes are harbored in the saliva, fissures, and smooth surfaces of caries-free individuals than of caries-active individuals. The proportion of samples positive for S. mutans and S. sobrinus was significantly higher in caries-active individuals than in caries-free individuals, and the presence of these species is a risk factor for high DMFT in dental caries. Isolates of S. mutans exist that have apparent genetic diversity. The genotypes of isolates might relate to differences in caries susceptibility.

Relative performance of different dental professional groups in screening for occlusal caries

The use of role substitution, where different levels of practitioner undertake the duties of the most qualified clinician, is common in medicine and dentistry. Proponents argue that role substitution has the potential to increase dentists' efficiency and effectiveness, thereby freeing up resources to improve access and reduce oral health inequalities. Given the current global economic climate, many countries are re-examining models of service provision to utilize role substitution. The objective of this study was to determine whether different members of the dental team could meet the diagnostic threshold set by the World Health Organization, when screening photographs of occlusal surfaces for dental caries. Participants were sampled purposively and included; final-year dental students, final-year hygiene-therapy students, primary care dentists, hygiene-therapists and dental nurses. Following a brief training package, participants were asked to score 102 clinical photographs of both carious and noncarious extracted teeth and determine whether the tooth was 'healthy' or had 'suspected decay'. The time delay between consecutive photographs was set at 8-s. Judgment decisions were compared against the International Caries Detection and Assessment System as the gold standard, with scores of two or less representing 'healthy'. Sensitivity, specificity and predictive values were determined for each participant and clinical group. Kappa was calculated to determine test-retest reliability. Dental nurses had the highest median sensitivity (87.9%), although all groups were comparable. The median specificity for the groups was lower than their sensitivity scores, with dentists scoring the highest (71.0%). Dentists also scored the highest median positive predictive value (57.8%), whilst dental nurses scored the highest negative predictive value (91.3%). The median level of agreement was high for all groups; the highest median score was for the final-year dental students (88.9%). Even with minimal training, different members of the dental team show the potential to screen for occlusal caries to a similar standard as primary care dentists. This requires further testing in vivo, but has important implications for the productivity and design of the future dental workforce.

Severe Dental Caries in Patients with Oral Chronic Graft-Versus-Host Disease

The oral cavity is one of the most frequently affected sites by cGVHD following allogeneic hematopoietic cell transplantation (alloHCT), and can be a significant source of patient morbidity due to both mucosal and salivary gland involvement. The development of dental decay is a potentially devastating oral complication that has only rarely been reported in the transplantation literature. The purpose of this study was to comprehensively characterize a cohort of patients with cGVHD that subsequently developed extensive dental caries. A retrospective case-record review was conducted for patients who had undergone alloHCT at Dana-Farber/Brigham and Women's Cancer Center between 1990 and 2010 and developed cGVHD-associated rampant dental decay. All patients underwent dental evaluations before and after alloHCT that consisted of a soft and hard tissue examination and dental radiographs. Caries diagnosed from the pre-alloHCT evaluation were treated definitively such that all patients were considered free of caries at the time of admission for HCT. A total of 21 patients were identified with a median time of cGVHD onset of 5.4 months (range 2.2-18.5) post-alloHCT. All patients were diagnosed with oral cGVHD, with 90% demonstrating mucosal involvement, and 95% with salivary gland involvement. Post-alloHCT dental evaluation was performed at a median of 22 months (range 4-81) after alloHCT. when ten patients were diagnosed with gross caries and eight patients presented four or more affected teeth. Cervical and interproximal patterns of dental caries were frequently diagnosed. The proportion of patients with gross, one surface, and greater than one surface caries, categorized as 0, 1-3, or ≥4, were significantly higher post-alloHCT compared to pre-alloHCT with at least 50% of patients experiencing an increase. Patients with oral cGVHD, who were free of caries at the time of transplantation, developed extensive areas of cervical decay in a median time of less than two years post-alloHCT. This is the first comprehensive characterization of this severe late complication of alloHCT and oral cGVHD. Greater awareness on the part of transplant oncologists and dentists as well as more aggressive preventive measures are warranted, as well as prospective studies to better elucidate the incidence of this complication, identify risk factors, and evaluate the effectiveness of preventive interventions.

Prevention of root caries

Randomised controlled trial. Elders having at least five teeth with exposed roots, no serious medical problems and basic self-care ability (including oral hygiene practices) were randomly allocated into one of four prevention groups. Individualised oral hygiene instruction was provided to each participant, focusing on effective brushing with a manual toothbrush, and use of fluoride toothpaste was recommended. Before applications of the study agents, a piece of gauze was used to clean and dry the teeth. Then water (placebo control), chlorhexidine varnish (Cervitec, Ivoclar Vivadent AG, Schaan, Liechtenstein), sodium fluoride varnish (Duraphat, Pharbil Waltrop GmbH, Waltrop, Germany) or SDF solution (Saforide, Toyo Seiyaku Kasei Co. Ltd., Osaka, Japan) was applied onto the exposed root surfaces of participants in the respective groups by means of a disposable microbrush. The participants were instructed not to eat for half an hour after treatment. Applications of water or SDF solution were repeated every 12 months, and applications of chlorhexidine varnish or sodium fluoride varnish were repeated every three months. Root Caries Index (RCI) was calculated as follows: (no. of root caries lesions/no. of teeth with gingival recession/person) × 100. Treatment effects were also measured by prevented fraction (PF), relative risk and the number (of elders) needed to treat (NNT) to prevent one elder from developing root caries. Two thirds (203/306) of the included elders were followed for three years. Significantly lower relative risks for developing new root caries were found in the elders in the chlorhexidine, sodium fluoride and SDF groups compared with the control (OHI only) group. The mean numbers of new root caries surfaces in the four groups were 2.5, 1.1, 0.9 and 0.7 respectively (ANOVA, p < 0.001). The prevented fraction and numbers needed to treat are shown in Table 1. Applications of SDF solution, sodium fluoride varnish and chlorhexidine varnish are more effective in preventing new root caries than OHI alone. The results of this study provide support for the clinical and community use of the three test materials, in addition to improvement in oral hygiene, to prevent the development of root caries in institutionalised elders.

Prevalence of dental caries and dental care utilisation in preschool urban children enrolled in a comparative-effectiveness study.

To assess dental caries prevalence and dental care utilisation in pre-school children enrolled in urban childcare centres that participated in a comparative effectiveness study. Cross-sectional study. Caries prevalence was determined in a cohort of children 12-60 months of age. Eligible children were randomised into two groups: group one received a traditional visual/tactile oral examination and group two received a teledentistry examination. Questionnaires were administered to the children's parents/guardians to gather demographics and information about using dental and medical services. Of 234 children examined, approximately 28% had caries experience. The mean dfs score was 1.56 with a range of 0-34 carious surfaces. The mean dfs score for the children examined by means of teledentistry was 1.75 and for the children examined by means of the traditional visual/tactile method mean dfs was 1.40; the means between the two groups were not significantly different. Twenty-six children showed evidence of being treated for dental caries. According to the parents, 31.5% of the children had never had a dental check-up before, only 3% of the children were lacking dental insurance and majority of the parents (92%) did not perceive accessing dental care for the children as a problem. The Wilcoxon Mann-Whitney test and the Kruskal-Wallis test were used to assess statistical differences among groups of children. The data showed that 28% of the children had caries and, of these, 61% had never been treated for caries, thus indicating that continued efforts are needed to improve oral health care utilisation by inner-city preschool children.

Practitioner, patient and carious lesion characteristics associated with type of restorative material: Findings from The Dental Practice-Based Research Network

<h2>ABSTRACT</h2><h3>Background</h3> The authors conducted a study to identify factors associated with the materials that dentists in The Dental Practice-Based Research Network (DPBRN) use when placing the first restoration on permanent posterior tooth surfaces. <h3>Methods</h3> A total of 182 DPBRN practitioner-investigators provided data regarding 5,599 posterior teeth with caries. Practitioner-investigators completed an enrollment questionnaire that included the dentist's age, sex, practice workload, practice type and number of years since graduation. When patients who had provided informed consent to participate in the investigation sought treatment for a previously unrestored carious surface, the practitioner-investigator recorded patient and tooth characteristics. <h3>Results</h3> Practitioner-investigators used amalgam more often than they used direct resin-based composite (RBC) for posterior carious lesions. Practitioner and practice characteristics (years since graduation and type of practice); patient characteristics (sex, race, age and dental insurance status); and lesion characteristics (tooth location and surface, preoperative and postoperative lesion depth) were associated with the type of restorative material used. <h3>Conclusions</h3> Several practitioner and practice, patient and lesion characteristics were associated significantly with use of amalgam and RBC: geographical region, years since dentist's graduation, patient's dental insurance status, tooth location and surface, and preoperative and postoperative lesion depth. <h3>Clinical Implications</h3> Despite advances in esthetic dentistry, U.S. dentists still are placing amalgam on posterior teeth with carious lesions. Amalgam was used more often than RBC in older patients, who may have had deeper carious lesions.

Longitudinal associations between children's dental caries and risk factors

Dental caries is a common disease in children of all ages. It is desirable to know whether children with primary, mixed, and permanent dentitions share risk factors for cavitated and non-cavitated caries. To assess the longitudinal associations between caries outcomes and modifiable risk factors. One hundred and fifty-six children in the Iowa Fluoride Study met inclusion criteria of three dental examinations and caries-related risk factor assessments preceding each examination. Surface-specific counts of new non-cavitated caries and cavitated caries at the primary (Exam 1: age 5), mixed (Exam 2: age 9) and permanent (Exam 3: age 13) dentition examinations were outcome variables. Explanatory variables were caries-related factors, including averaged beverage exposure frequencies, tooth brushing frequencies, and composite water fluoride levels collected from 3-5, 6-8, and 11-13 years, dentition category, socioeconomic status, and gender. Generalized linear mixed models (GLMMs) were used to explore the relationships between new non-cavitated or cavitated caries and caries-related variables. Greater frequency of 100 percent juice exposure was significantly associated with fewer non-cavitated and cavitated caries surfaces. Greater tooth brushing frequency and high socioeconomic status (SES) were significantly associated with fewer new non-cavitated caries. Children had significantly more new cavitated caries surfaces at the mixed dentition examination than at the primary and permanent dentition examinations. There were common caries-related factors for more new non-cavitated caries across the three exams, including less frequent 100 percent juice exposure, lower tooth brushing frequency and lower SES. Less frequent 100 percent juice exposures might be associated with higher exposures to several other cariogenic beverages.

FARKLI ÇÜRÜK RİSK GRUPLARINDA YENİ ÇÜRÜK GELİŞİMİNİN İNCELENMESİ / DETERMINING THE FUTURE CARIES DEVELOPMENT IN DIFFERENT CARIES RISK GROUPS

OZET Bu calismanin amaci , Istanbul Universitesi Dishekimligi Fakultesi Pedodonti klinigine basvuran farkli curuk risk gruplarinda olan 117 cocuk hastada yeni curuk gelisimini tespit etmek ve anlamli curuk risk faktorlerin i belirlemektir. Cocuk hastalarda ilk olarak curuk risk gruplari belirlendi ve kontrol randevularinda yeni curuk gelisimleri saptandi . Sonuc olcumleri olarak d is curugu artisi ile multipl lojistik regresyon analizi duzenlendi. Yeni curuk olusumu saptanan cocuklarda, dis fircalama sikliginin gunde birden az ve a tistirma sikliginin gunde ikiden fazla olmasi risk faktorleri (OR=1.58 ve 1.89, sir a siyla ) olarak belirlendi. Dusuk risk grubunda total yeni curuk olusumu nun , orta ve yuksek risk grubundakilerden anlamli derecede az oldugu saptandi (p <.05). Orta ve yuksek risk grubunda total yeni curuk yuzeyi olusumunun dusuk risk grubundakilerden anlamli decede fazla oldugu belirlendi (p <.05). Curuk risk gruplarinda, tedavi uygulamalarinin yani sira hastaligin kontrol altina alinmasi hedeflenmelidir. Curuk sayisi artisinin onlenmesi icin, yuksek risk grubundaki curuk gelistiren cocuklarin belirlenmesi, neden olan risk faktorlerinin elimine edilmesi ve kisiye ozgu koruyucu uygulama programlarina yonlendirilmesi hedeflenmelidir. Anahtar Kelimeler: Dis curugu riski, risk faktorleri, cocuk, Kohort calisma ABSTRACT The aims of this study were to evaluate the development of new lesions in 117 children from different caries risk groups and to determine significant risk factors in a pediatric clinic of Istanbul University Faculty of Dentistry. The initial caries risk assessment was performed and follow-up visits were used to determine the future caries development. A multiple logistic regression analysis was performed with net caries increment as outcome measure. Brushing less than once a day and the consumption of more than two between-meal snacks per day were confirmed as risk factors (OR=1.58 and 1.89, respectively) in children who developed new caries. The total amount of new caries lesions in low-risk group was significantly less than in moderate and high-risk groups (p <.05). The total amount of new caries surfaces in high and moderate groups was significantly higher than in low-risk subjects (p <.05). The results suggest that in high risk subjects, operative treatments must be combined with control of the disease activity. In order to prevent caries increament, it is important that children at high risk of developing caries are identified and targeted for specific individual or group preventive measures. Key Words: Caries risk, risk factors, children, Cohort-study

Value of bitewing radiographs for detecting approximal caries in 6‐year‐old children in the Netherlands

When diagnosing caries using clinical judgment only, the prevalence of approximal caries is highly underestimated. Yet, surveys on this topic predominantly included adolescents and young adults. To determine the additional diagnostic value of bitewing radiographs in 6-year-old children and to detect approximal dentin caries in the primary dentition. A total of 50 children were assessed both clinically (dmfs, oral hygiene) and radiographically by two experienced dentists. The relation between dmfs-scores and amount of plaque was established using Pearson's correlation coefficients at a significance level of 0.05. In nine patients (18%) it was impossible to make radiographs. Bitewing radiography appeared to have an additional effect of 97% when only caries in dentin is considered. The additional value for detecting inadequate restorations was 600%. Furthermore, the dmfs was highly correlated to the amount of plaque found. Although not possible to achieve in all 6-year-old children, bitewing radiographs can reveal a considerable amount of carious surfaces and inadequate restorations, which appear clinically sound or adequate.

A Randomized Trial on Root Caries Prevention in Elders

Root caries is common in institutionalized elders, and effective prevention methods are needed. This clinical trial compared the effectiveness of four methods in preventing new root caries. From 21 residential homes, 306 generally healthy elders having at least 5 teeth with exposed sound root surfaces were randomly allocated into one of four groups: (1) individualized oral hygiene instruction (OHI); (2) OHI and applications of 1% chlorhexidine varnish every 3 months; (3) OHI and applications of 5% sodium fluoride varnish every 3 months; and (4) OHI and annual applications of 38% silver diamine fluoride (SDF) solution. Two-thirds (203/306) of the elders were followed for 3 years. Mean numbers of new root caries surfaces in the four groups were 2.5, 1.1, 0.9, and 0.7, respectively (ANOVA, p < 0.001). SDF solution, sodium fluoride varnish, and chlorhexidine varnish were more effective in preventing new root caries than giving OHI alone.

The impact of changing dental needs on cost savings from fluoridation

Although community water fluoridation has been one of the cornerstone strategies for the prevention and control of dental caries, questions are still raised regarding its cost-effectiveness. This study assessed the impact of changing dental needs on the cost savings from community water fluoridation in Australia. Net costs were estimated as Costs((programme)) minus Costs((averted caries).) Averted costs were estimated as the product of caries increment in non-fluoridated community, effectiveness of fluoridation and the cost of a carious surface. Modelling considered four age-cohorts: 6-20, 21-45, 46-65 and 66+ years and three time points 1970s, 1980s, and 1990s. Cost of a carious surface was estimated by conventional and complex methods. Real discount rates (4, 7 (base) and 10%) were utilized. With base-case assumptions, the average annual cost savings/person, using Australian dollars at the 2005 level, ranged from $56.41 (1970s) to $17.75 (1990s) (conventional method) and from $249.45 (1970s) to $69.86 (1990s) (complex method). Under worst-case assumptions fluoridation remained cost-effective with cost savings ranging from $24.15 (1970s) to $3.87 (1990s) (conventional method) and $107.85 (1970s) and $24.53 (1990s) (complex method). For 66+ years cohort (1990s) fluoridation did not show a cost saving, but costs/person were marginal. Community water fluoridation remains a cost-effective preventive measure in Australia.

Microleakage of three different sealants on sound and questionable occlusal surfaces of permanent molars: An in vitro study

This was to evaluate the microleakage of 3 different sealants, applied on sound and questionably carious occlusal surfaces with and without a bonding agent. A total of 120 human molars were selected, photographed with a digital video microscope, and assigned by 3 independent examiners, according to the criteria of ICDAS II, in 2 groups of 60 teeth each. Group A: teeth with deep, clear, sound occlusal surfaces (ICDAS II, code 0). Group B: teeth with questionable occlusal surfaces, having deep, stained pits and fissures with probable incipient, but non-cavitated carious lesions (ICDAS II, codes 1 and 2). Each group was divided into 2 subgroups of 30 teeth each (bonding or no bonding) and then into 3 subgroups of 10 teeth each according to the type of sealant used: one conventional (Conseal) and 2 fluoridated (Conseal F and Teethmate F). After the application of the bonding agent and the sealant to the appropriate teeth, all specimens were subjected to thermal cycling and immersed in a 10% methylene blue dye solution for 4 hours. Average and summed microleakage for each sample were estimated from dye penetration scores on 3 mesiodistal sections of the tooth across the sealed occlusal surface. Non-parametric Friedman's 2-way ANOVA by ranks and Conover-Inman pair wise comparisons were used for differences at the 0.05 level of significance. According to Friedman's 2-way ANOVA by ranks analysis, although there were no significant differences between the different sealants (chi(2) = 0.048, df = 2, P = .976), there were significant differences between the sound and questionably carious occlusal surfaces (chi(2) = 24, df = 3, P = .000). Conover- Inman pair wise comparisons showed no differences between the groups using and not using bonding agents, on sound (SNB-SWB, P = .4561) or questionable occlusal surfaces (QNB-QWB, P = .0842). Sealant microleakage on questionably carious occlusal surfaces was statistically significantly higher than that of sound occlusal surfaces. Using a bonding agent or fluoridated FS did not influence microleakage significantly, either on sound or on questionable fissured surfaces.

The influence of dental caries on body growth in prepubertal children

Dental decay and dental treatment are suggested to be related to body growth in children. The aim of this study was first to assess the relation between dental caries and body proportions cross-sectionally in a Suriname caries child population and secondly to investigate whether dental treatment had a significant influence on body growth of these children in a randomised controlled trial using different treatment strategies. Three hundred eighty 6-year-old children with untreated dental decay participated in the study. Caries prevalence and presence of dentogenic infections were recorded. All children were randomly assigned to four different treatment groups ranging from full dental treatment to no invasive treatment at all. Body growth was evaluated by children's height, weight and body mass index. Participants were evaluated after 6 months and 1, 2 and 3 years. Cross-sectionally, negative correlations were observed between anthropometric measures and the number of untreated carious surfaces and caries experience of the children. Next, no significant differences in growth pattern between the treatment groups were observed. Based on these results, it is suggested that caries activity is a negative predictor for body growth in children and dental intervention does not show significant improvement within 3 years.

Fissure sealant retention and caries development after resealing on first permanent molars of children with low moderate and high caries risk

This was to evaluate the retention of fissure sealants (FS) and their effectiveness after resealing on caries reduction applied to first permanent molars, in a sample of children stratified according to their caries risk status in a private practice setting. The sample was 1,274 FS applied on first permanent molars (FPM) of 380 children (6 to 8 years old). Follow-up and monitoring for resealing was 3 years after FS placement, having at least one recall visit per year. Caries risk was based on baseline dmft index: low (dmft=0), moderate (dmft=1-4), high (dmft >4), with almost half of the teeth belonging to the high-risk group. All sealed teeth were evaluated and recorded for FS failure and resealing in case of partial/total loss, as well as caries development. Survival analysis using the Cox Proportional Hazards regression model was used for data evaluation. Of the 1,274 sealed surfaces, 927 (72.8%) needed no intervention 185 (14.5%) needed only resealing and 162 (12.7%) developed caries during the study. Of 162 carious surfaces, 107/ 675 (15.9%) were from the high caries risk children, compared with 17/144 (11.8%) and 38/455 (8.3%) from the moderate and low caries risk group respectively. The highest number of failures, 4.9% and resealing were found at first recall, declining to 1.4% at the end of the study. Development of caries followed a steady rate of 6-8% per year. Cox proportional hazards model indicated, regardless if resealing or caries development was considered a failure or resealing was a success and caries development a failure, only the high dmft index appeared in both cases to significantly increase the chance (158% and 173% respectively) of FS failure and caries development compared with moderate and low dmft index. Other variables when inserted into the hazard model, such as age, sex and number of visits, either did not show a significant effect or only marginally affected FS retention, without modifying the association between caries risk and sealant failure. Children of a high baseline caries risk status showed lower FS retention rates and higher occlusal caries prevalence following FS loss compared with those of moderate and low risk status. Resealing does not seem to dramatically change the final outcome of the higher risk group to develop more caries, necessitating other more effective measures to increase the retention of FS on these highly vulnerable areas.

Caries preventive effect of fluoride in milk, salt and tablets: A literature review

There are a number of studies in the literature about the effectiveness of fluoride in tablets, fluoride added to frequently-consumed food like milk, or to food additives like salt, in prevention of dental caries. This literature has been evaluated in different evidence based reviews. The scope of this paper was to identify the most recent evidence-based reviews on the effect in caries prevention from added fluoride in milk, salt and fluoride tablets/drops including newer RCT studies, and to synthesize the findings into practice guidelines. The key question was as follows: Does regular use of fluoride in milk, salt and fluoride tablets/ drops prevent dental caries among children and adolescents? MEDLINE, EMBASE and EBM reviews (Cochrane database of systematic reviews) were searched using modified filters from a Cochrane review. One evidence-based report on fluoridated milk was identified. Salt fluoridation was covered by three HTA reviews. One Cochrane protocol on the caries preventive effect of fluoridated salt was identified. Very few studies of good quality were identified in general. Two studies on fluoridated milk were tabulated and seven studies dealing with fluoride tablets/ drops were analysed. One study showed a 78% reduction in caries in newly erupted permanent teeth among 8 year olds after 3 years with fluoridated milk. For primary teeth one study showed 31% caries reduction. The differences between fluoride-group and control were statistically significant. The reduction in caries prevalence in the fluoride tablet group compared with a negative control varied from 81% (carious surfaces in permanent teeth erupted in the study period) to 49% in DMFS for all permanent teeth. No RCT studies on fluoridated salt were identified. There is limited evidence that F tablets and drops are effective, and compliance is a key factor. There are good reasons to believe that fluoride in different applications and formulas does work as caries preventive agents under supervision. There is a need for new, well-designed studies within this field, but the use of negative controls without any fluoride exposure is difficult due to ethical reasons. In particular new research is needed concerning possible caries preventive effect of fluoridated milk and salt.

A Review of Slow-Release Fluoride Devices

Fluoride has been used to combat dental caries using a number of different clinical approaches. An exciting relatively new development is fluoride slow-releasing devices that consistently elevate intra-oral fluoride levels of plaque and saliva for prolonged periods of up to two years. The literature on the use of slow-releasing fluoride devices in dentistry were reviewed. A Medline search on key words was carried out. All papers in English were individually reviewed. Slow-releasing fluoride devices have been shown to be effective in elevating salivary fluoride levels in both animals and human studies and to enhance the remineralisation of dental enamel. They have been demonstrated to be safe to use and without the risk of fluoride toxicity. A double blind randomised clinical trial demonstrated 76% fewer new carious surface increment in high caries-risk children after two years. These devices have a number of potential uses in dentistry and in particular have great potential for caries prevention of non-compliant high caries-risk groups.

A comparison of root caries diagnosis based on visual-tactile criteria and DIAGNOdent in vivo

Objectives This clinical study aimed to evaluate the validity of using DIAGNOdent in diagnosing root caries, and to assess the sensitivity and specificity of different cut-off DIAGNOdent values in assessing root caries with reference to visual-tactile criteria. Methods Exposed root surfaces were assessed by one examiner for root caries on 266 subjects using visual-tactile criteria and DIAGNOdent 2095 after dental scaling. Associations between DIAGNOdent values and visual-tactile diagnosis of root caries were determined. The cut-off level for statistical significance was 0.05. The sensitivity and specificity of DIAGNOdent with difference cut-off points were analysed compared to visual-tactile diagnosis of root caries. Results There was significant difference between DIAGNOdent values obtained from sound and carious root surfaces ( p < 0.001). On carious surfaces, active root caries obtained significantly higher DIAGNOdent values than inactive root caries ( p < 0.001). With increasing cut-off point DIAGNOdent values from 5 to 35, sensitivity decreased from 91.4% to 16.2% and specificity increased from 64.4% to 98.2%. A cut-off point of DIAGNOdent value between 5 and 10 produced the highest combined sensitivity and specificity. Conclusions There was a significant difference in DIAGNOdent values between sound and carious root surfaces diagnosed by visual-tactile criteria supporting the validity of DIAGNOdent for assessing root caries. A DIAGNOdent value between 5 and 10 produced the highest combined sensitivity and specificity when visual-tactile assessment of root caries was regarded as the criterion. These findings have implications in using and explaining DIAGNOdent values in assessing root caries.

The Influence of an Oral Health Education Program Provided in a Community Dental Clinic on the Prevalence of Caries Among 12-14 Year-Old Children

To evaluate the effectiveness of an oral health education program when given in a public dental clinic, by assessing caries and restorations. This was done by assessing changes in caries prevalence in the mouth of children aged 12 to 14 year- old. Data was obtained from files of patients treated in the Dental Volunteers for Israel (DVI) clinic in Jerusalem. Children must prove understanding and also application of what they learned in the educational program in order to receive restorative dental treatment. 280 children were included in the intervention group. The control group constituted 173 children who had never had any restorative treatment in the DVI clinic. The extent of caries surfaces differed greatly between the intervention and the control groups. 35.2% of the control group, and as many as 64% of the intervention group had low caries (DMFS < 3). The situation is reversed when comparing the difference in the restored teeth surfaces between the two groups--56.6% of the control group had no restorations and 66.2% of the children in the intervention group had treated teeth. DMFS scores reveal fewer differences between the two groups. The mean carious surface was 1.8 times greater in the control group, and the restored surfaces were 2.1 times greater for the intervention children. Nevertheless when comparing DMFS means between control and intervention groups t-test result shows no statistical significant difference for the slightly lower DMFS levels in the intervention group. This study shows that even a comprehensive preventive program given by professional personnel, followed by free dental treatment, is not enough to improve dental health status for children from a lower socioeconomic class. Still, a consideration of the ethical responsibility of the profession to educate children about oral diseases and their prevention should be carried out, irrespective of the implementation of the knowledge.

Effects of Dental Caries on Nutritional Status Among First-Grade Primary School Children

The aim of this study was to explore association between caries prevalence and nutritional status among first-grade primary school children. A cross-sectional study of 212 students was conducted. All students were weighed and measured and then the body mass index (BMI) was calculated. Each student underwent dental examination and was interviewed. Overall, caries prevalence was 80.2% and the average decayed, missing, and filled surfaces (dmfs) were 12.4 +/- 12.3. Although none of the students was in the underweight category, 45.8% were in low percentile (5th < BMI-for-age < 15th). Multiple logistic regression showed that each extra carious surface (dmfs) increased the odds of being at risk for underweight (5th < BMI-for-age < 15th) by 3.1% after adjusting for gender and dental visits. Our findings stressed that caries has significant implications on overall child health and health personnel should increase awareness of negative impacts and promote healthy nutritional choices for children.