When to intervene in the caries process? A Delphi consensus statement.

Determination of the functional space for fluid movement in the rat dentinal tubules using fluorescent microsphere

Contamination by microorganisms of active and inactive noncavitated lesions was analyzed by scanning electron microscopy. The sample comprised 10 active and 14 inactive smooth surface lesions and 5 sound tooth surfaces. The active lesions were obtained through an in situ model. The inactive lesions and the sound surfaces were obtained from extracted teeth. The samples were split and the two resulting halves were analyzed. The lesion areas were measured in order to compare bacterial contamination in active and inactive lesions. Microorganisms were detected within the enamel in all lesions studied (active and inactive). Sound teeth did not harbor bacteria with the exception of one half tooth where one rod was observed in the enamel. Great variation was observed in bacterial contamination in both active and inactive lesions. Microorganisms penetrated rather deeply into some active as well as into inactive lesions, reaching the dentin in 5 inactive lesions. Bacteria were present in the tubular and intertubular dentin. No difference was observed in the number of microorganisms per square millimeter in the active and inactive lesions (p > 0.05). Cocci and rods comprised 99% of the organisms, while filamentous and spiral bacteria were seldom present. Yeast-like microorganisms were found in inactive lesions. The presence of microorganisms in inactive as well as active noncavitated lesions shows that bacteria inside dental tissue (enamel and dentin) do not impede the arrestment of the caries process.

This study aimed to evaluate the magnitude of the reduction in caries parameters after inclusion of dental caries activity assessment, in an epidemiological survey of preschool children, involving cavitated and noncavitated caries lesions. The survey was carried out in Santa Maria, Brazil, during the National Children's Vaccination Day, and 639 children aged between 12 months and 59 months were included. Fifteen examiners assessed the children based on the International Caries Detection and Assessment System (ICDAS) and additional lesion activity assessment criteria. The mean of decayed surfaces (d-s), the mean of decayed teeth (d-t), caries prevalence, and 95% confidence intervals were calculated, initially by classifying all lesions using the various thresholds defined by the ICDAS. Caries activity status was then evaluated, and inactive lesions were classified as sound in a secondary analysis; subsequently, the same caries parameters, at the same thresholds, were recalculated. The reduction in caries parameters and the number of children requiring assessment to change their classification from decayed to sound (number needed to be assessed) were also calculated. The majority of lesions were classified as active, mainly at cavitated thresholds. When activity was considered, values of all caries parameters decreased. This decrease was more evident at noncavitated thresholds. The number of children requiring assessment to change their classification from decayed to sound was <20 considering all lesions, but this value increased to approximately 100 when we included only cavitated lesions. The inclusion of activity assessment in caries epidemiological surveys has little impact on the d-s, d-t and prevalence of dental caries considering both noncavitated and cavitated lesions.

Quantitative analysis of salivary and biofilm bacteria associated with cavitated and non-cavitated carious lesions in pre-school children

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

Objectives: To assess the level of acceptance and discomfort experienced by secondary school students when undergoing an atraumatic restorative treatment (ART) restoration. Subjects and Methods: Ninety secondary school students, aged 14 and 15 years, were included in the study. The ART restorations were prepared in 90 cavities and restored using an encapsulated high-viscosity glass ionomer. The depth of the cavities was judged from radiographs and clinically into outer, middle and inner third of dentine. Using a graded periodontal probe, cavity size was measured, into approximately half the width of the mesiodistal and buccolingual/palatal distance of the occlusal surface. The students were asked about the level of sensation experienced during cavity preparation immediately after completion of restoration. χ²-Test was used to test the effect of cavity depth and size on sensitivity from the teeth. Results: Of the 90 students, 6 (6.6%) and 26 (29.2%) experienced pain and discomfort, respectively, during cavity preparation, more often in large than in small cavities (p = 0.003) and in cavities extending into the inner third than in the middle and outer third of dentine (p < 0.0001). Only 1 student reported postoperative sensitivity. Conclusions: The ART approach to treat dental cavities was well accepted by this group of secondary school students. Only a few reported pain during cavity instrumentation, and this was more prevalent in large cavities and in cavities with the floor close to the pulp.

Proximal dental lesions, limited to dentine, are traditionally treated by invasive (drill and fill) means. Non-invasive alternatives (e.g. fluoride varnish, flossing) might avoid substance loss but their effectiveness depends on patients' adherence. Recently, micro-invasive approaches for treating proximal caries lesions have been tried. These interventions install a barrier either on top (sealing) or within (infiltrating) the lesion. Different methods and materials are currently available for micro-invasive treatments, such as sealing via resin sealants, (polyurethane) patches/tapes, glass ionomer cements (GIC) or resin infiltration. To evaluate the effects of micro-invasive treatments for managing proximal caries lesions in primary and permanent dentition in children and adults. We searched the following databases to 31 December 2014: the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via OVID, EMBASE via OVID, LILACs via BIREME Virtual Health Library, Web of Science Conference Proceedings, ZETOC Conference Proceedings, Proquest Dissertations and Theses, ClinicalTrials.gov, OpenGrey and the World Health Organization (WHO) International Clinical Trials Registry Platform. We searched the metaRegister of Controlled Trials to 1 October 2014. There were no language or date restrictions in the searches of the electronic databases. We included randomised controlled trials of at least six months' duration that compared micro-invasive treatments for managing non-cavitated proximal dental decay in primary teeth, permanent teeth or both, versus non-invasive measures, invasive means, no intervention or placebo. We also included studies that compared different types of micro-invasive treatments. Two review authors independently screened search results, extracted data and assessed the risk of bias. We used standard methodological procedures expected by Cochrane to evaluate risk of bias and synthesise data. We conducted meta-analyses with the random-effects model, using the Becker-Balagtas method to calculate the odds ratio (OR) for lesion progression. We assessed the quality of the evidence using GRADE methods. We included eight trials, which randomised 365 participants. The trials all used a split-mouth design, some with more than one pair of lesions treated within the same participant. Studies took place in university or dental public health clinics in Brazil, Colombia, Denmark, Germany, Thailand, Greenland and Chile. Six studies evaluated the effects of micro-invasive treatments in the permanent dentition and two studies on the primary dentition, with caries risk ranging from low to high. Investigators measured caries risk in different studies either by caries experience alone or by using the Cariogram programme, which combines eight contributing factors, including caries experience, diet, saliva and other factors related to caries. The follow-up period in the trials ranged from one to three years. All studies used lesion progression as the primary outcome, evaluating it by different methods of reading radiographs. Four studies received industry support to carry out the research, with one of them being carried out by inventors of the intervention.We judged seven studies to be at high overall risk of bias, primarily due to lack of blinding of participants and personnel. We evaluated intervention effects for all micro-invasive therapies and analysed subgroups according to the different treatment methods reported in the included studies.Our meta-analysis, which pooled the most sensitive set of data (in terms of measurement method) from studies presenting data in a format suitable for meta-analysis, showed that micro-invasive treatment significantly reduced the odds of lesion progression compared with non-invasive treatment (e.g fluoride varnish) or oral hygiene advice (e.g to floss) (OR 0.24, 95% CI 0.14 to 0.41; 602 lesions; seven studies; I(2) = 32%). There was no evidence of subgroup differences (P = 0.36).The four studies that measured adverse events reported no adverse events after micro-invasive treatment. Most studies did not report on any further outcomes.We assessed the quality of evidence for micro-invasive treatments as moderate. It remains unclear which micro-invasive treatment is more advantageous, or if certain clinical conditions or patient characteristics are better suited for micro-invasive treatments than others. The available evidence shows that micro-invasive treatment of proximal caries lesions arrests non-cavitated enamel and initial dentinal lesions (limited to outer third of dentine, based on radiograph) and is significantly more effective than non-invasive professional treatment (e.g. fluoride varnish) or advice (e.g. to floss). We can be moderately confident that further research is unlikely to substantially change the estimate of effect. Due to the small number of studies, it does remain unclear which micro-invasive technique offers the greatest benefit, or whether the effects of micro-invasive treatment confer greater or lesser benefit according to different clinical or patient considerations.

Objectives: To develop an automated fluorescence-based caries scoring system for an intraoral scanner and totest the performance of the system compared to state-of-the-art methods. Methods: Seventy-three permanent posterior teeth were scanned with a three-dimensional (3D) intraoral scanner prototype which emitted light at 415 nm. An overlay representing the fluorescence signal from the tissue was mapped onto 3D models of the teeth. Multiple examination sites (n = 139) on the occlusal surfaces were chosen, and their red and green fluorescence signal components were extracted. These components were used to calculate 4 mathematical functions upon which a caries scoring system for the scanner prototype could be based. Visual-tactile (International Caries Detection and Assessment System, ICDAS), radiographic (ICDAS), and histological assessments were conducted on the same examination sites. Results: Most index tests showed significant correlation with histology. The strongest correlation was observed for the visual-tactile examination (r_s = 0.80) followed by the scanner supported by the caries classification function that quantifies the overall fluorescence compared to sound surfaces (r_s = 0.78). Additionally, this function resulted in the highest intra-examiner reliability (κ = 0.964), and the highest sum of sensitivity (SE) and specificity (SP) (sum SE-SP: 1.60–1.84) at the 2 histological levels where the comparison with visual-tactile assessment was possible (κ = 0.886, sum SE-SP = 1.57–1.81) and at the 3 out of 4 histological levels where the comparison with radiographic assessment was possible (κ = 0.911, sum SE-SP = 1.37–1.78); the only exception was for the lesions in the outer third of dentin, where the radiographic assessment showed the highest sum SE-SP (1.78). Conclusion: A fluorescence-based caries scoring system was developed for the intraoral scanner showing promising performance compared to state-of-the-art caries detection methods. The intraoral scanner accompanied by an automated caries scoring system may improve objective caries detection and increase the efficiency and effectiveness of oral examinations. Furthermore, this device has the potential to support reliable monitoring of early caries lesions.

This in vitro study examined the utility of comparing red fluorescence between active and inactive caries lesions and investigated whether changes in red fluorescence and fluorescence loss are influenced by lesion activity following remineralization. Sixty-two noncavitated smooth surface caries lesions on extracted human teeth were classified into active or inactive lesions using the Nyvad system prior to a 12-day pH-cycling procedure. Quantitative light-induced fluorescence-digital images were used to measure fluorescence parameters before and after pH cycling. At baseline, the intensity (ΔR) and area (AΔR) of red fluorescence were 1.5- and 2.2-fold higher in active lesions than in inactive lesions (p<0.05). The ratio of AΔR to lesion area was associated with classification of active lesions (odds ratio = 1.031; 95% confidence interval = 1.005-1.058). After pH cycling, the active lesions showed about 2- and 8-fold greater reductions in the median values of AΔR and fluorescence loss related to lesion volume (ΔQ) compared with inactive lesions (p<0.05). In conclusion, red fluorescence differs depending on lesion activity, and the red fluorescence area and lesion volume change following remineralization. The results suggest that measuring red fluorescence may be a useful way of objectively evaluating lesion activity of smooth surface lesions.

To assess the undergraduate students' performance in detecting and staging caries and assessing activity using visual inspection. Two independent reviewers searched the literature through PubMed/MEDLINE, Scopus, Lilacs databases, and OpenSINGLE. Meta-analyses summarized the results concerning reproducibility and accuracy at D1 (considering all lesions) and D3 (including only cavitated lesions or lesions into dentin) levels. For activity, we considered sound surfaces plus inactive caries lesions vs active lesions. Meta-regression assessed the effect of methodological variables on the outcomes. Fourteen studies were included. The mean reproducibility values were ≥0.52, except for interexaminer agreement when assessing caries activity (0.39; 95% CI 0.10-0.67). The intra-examiner reproducibility tended to be higher than the interexaminer reproducibility. Overall, undergraduate students' performance in staging caries lesions using visual examination was good (AUC>0.85 and DOR>25). The sensitivity values were moderate; however, these were associated with excellent specificity values. Despite few pooled studies, caries activity assessment revealed moderate overall performance, with lower pooled sensitivity than pooled specificity. Students' education level and background clinical experience had no influence on the accuracy and reproducibility of the visual inspection. Undergraduate students' performance in detecting and staging caries using visual inspection was good, although caries activity assessment still requires improvement.

A few clinical observations reported that children with attention deficit hyperactivity disorder (ADHD) have poor oral health compared to children without ADHD. However, evidence is not conclusive. We assess the association between hyperactivity/inattention and oral health in a population-based study. As part of the ongoing birth cohort studies German Infant Nutritional Intervention-plus (GINIplus) and Influences of lifestyle-related factors on the immune system and the development of allergies in childhood-plus (LISAplus), 1,126 children at age 10years (±10.2) from Munich (Germany) were included in the present analysis. During the dental examination, oral hygiene, non-cavitated and cavitated caries lesions, dental trauma, and enamel hypomineralization (EH) in the permanent dentition (MIH/1) were recorded. Children with a Molar-Incisor-Hypomineralization were subcategorized into those with EH on at least one first permanent molar (MIH/1A), and on at least one first permanent molar and permanent incisor (MIH/1B). Data on children's hyperactivity/inattention symptoms were collected by parent-reported Strength and Difficulties Questionnaire. Logistic regressions and zero-inflated Poisson regression models were applied adjusted for gender, parental education, parental income, and methylphenidate or atomoxetine medication. Logistic regressions showed that non-cavitated caries lesions were positively related with the presence of hyperactivity/inattention (ORadj = 1.51,CI95% = 1.08-2.11). When adjusted for parental background, an association showed between hyperactivity/inattention symptoms and MIH/1A but did not reach statistical significance (ORadj = 1.59,CI95% = 1.00-2.53). Children with borderline and abnormal values of hyperactivity/inattention symptoms showed more non-cavitated caries lesions. Severe levels of hyperactivity/inattention may contribute to a higher risk for MIH/1A in school age. Adequate dental preventive care for children with hyperactivity/inattention, especially from a low social background, is of importance for optimal caries prevention.

Multiple sclerosis: Classification revisited reveals homogeneity and recapitulation

This paper provides recommendations for dentists for the treatment of dental caries in children, with an emphasis on early childhood caries (ECC), primary teeth, and occlusal surfaces in permanent teeth. A consensus workshop followed by an e-Delphi consensus process was conducted with an expert panel nominated by the European Organization for Caries Research (ORCA) and European Federation of Conservative Dentistry (EFCD)/German Association of Conservative Dentistry (DGZ) boards. Based on 3 systematic reviews and a nonsystematic literature search, recommendations were developed. The caries decline has led to a more polarized disease distribution in children and adolescents along social gradients which should be taken into account when managing the caries process at all levels, such as the individual, the group, or a population. The control or reduction of caries activity is the basis for successful caries management. In children, caries management requires adequate daily oral hygiene and fluoride application via toothpaste, ensured by caregivers, and especially for ECC prevention an emphasis on sugar intake reduction is needed. These noninvasive interventions are also suitable to arrest or control initial or even cavitated dentine caries lesions in the absence of irreversible pulpitis. Fluoride varnish or silver diammine fluoride can be added as supplementary agents. In pits and fissures, composite resin materials can be used as preventive sealants and for defect-oriented minimally invasive restorations. In primary molars, preformed metal crowns are more successful than multisurface fillings, especially in caries-active patients. With persisting high caries activity, multiple lesions, and limited cooperation, caries control should consist of robust measures with high success rates, even including extraction in selected cases. This applies especially to treatments performed under general anesthesia.

Expression patterns of Group III metabotropic glutamate receptors mGluR4 and mGluR8 in multiple sclerosis lesions

To record the prevalence and document the types of eye disease in population of Thoroughbred racehorses in Victoria, Australia. Prospective study. Two hundred four Thoroughbred racehorses. All horses and both eyes were examined at four metropolitan and two country racing stable complexes. Ophthalmic exam was performed following dark adaptation with a transilluminator, biomicroscope, and direct ophthalmoscope. Intraocular pressures were measured when indicated. Both pupils were dilated with tropicamide when indicated. One hundred eighty-two (89.2%) flat-racing and 22 (10.8%) jump-racing (hurdle or steeple) horses were examined. Age range: 2-9 years (mean 3.7 years, median 3); 97 (47.5%) male-neuter, 74 (36. 3%) female, 33 (16.2%) male. Potential vision-threatening eye disease was present in 15 (7.4%) different horses: complete lenticular cataracts 3, posterior lens luxation and cataract 1, large peripapillary 'butterfly' inactive lesions 3, large peripapillary 'butterfly' active lesions 2, peripapillary focal inactive 'bullet hole' chorioretinal lesions (> 20) 5, optic nerve atrophy 1. Non-vision threatening eye disease was present in 117 (57.4%) different horses, involving one or more ocular structures: lower eyelid scars 3; periocular fibropapillomatous disease 1; third eyelid squamous cell carcinoma 1; corneal scars 6; corneal band opacity 2; anterior iris synechia 1; developmental cataracts 36 (17.2%); peripapillary focal inactive 'bullet hole' chorioretinal lesions (< 20) 103 (50.0%); linear peripapillary hyperpigmentation bands 16 (7.9%). Unusual variations of normal ocular anatomy and colobomata was recorded in 11 (5.4%) different horses: granular iridica hypoplasia 3, granular iridica hyperplasia 2, multilobular granular iridica cyst 1, microcornea 1, hyaloid remnant 1, rotated optic nerve head 1, coloboma of the lens 1, atypical coloboma of the retina 1. This survey demonstrates that the prevalence of vision-threatening eye disease in racing horses may be greater than previously perceived, and highlights the importance of ocular examination within any routine physical examination of horses.