Introduction: Dental caries, the most prevalent noncommunicable disease (NCD) in adolescence, may represent a hidden link to systemic inflammatory processes, a common underlying mechanism shared by all major NCDs. Accordingly, this study investigated whether dental caries was associated with systemic inflammatory burden in adolescents. Methods: This population-based study utilized data from the RPS Brazilian Birth Cohort Consortium, specifically the 18–19-year follow-up conducted in São Luís, Brazil (n = 441). The main exposures included the visible plaque index (VPI), number of decayed teeth, DMFT index (decayed, missing, and filling), and PUFA index. The outcome was the allostatic inflammatory load, calculated as the sum of biomarkers – IL-6, IL-18, IL-1β, TNF-α, and C-reactive protein (CRP) – that fell within the high-risk range (≥75th percentile of the sample distribution). Each biomarker contributed one point, resulting in a total score ranging from 0 to 5. Crude and adjusted coefficients were estimated using regression models. Results: The number of decayed teeth (β = 0.031, p = 0.015) and the VPI (β = 0.006, p = 0.001) were positively associated with higher allostatic inflammatory load scores. Among individual biomarkers, both the number of decayed teeth (β = 8.95, SE = 4.09, p = 0.02) and the VPI (β = 1.09, SE = 0.50, p = 0.03) were positively associated with IL-18 levels, whereas no significant associations were observed for the DMFT or PUFA indices (p > 0.05). Conclusion: Dental caries was associated with systemic inflammation in adolescence, possibly reflecting shared underlying risk factors and highlighting the relevance of integrating oral health into strategies addressing common risk factors for non-communicable diseases.

Introduction: This study aimed to assess the sensitivity, specificity, and accuracy of a digital-based method for caries assessment in a rodent model, compared to a conventional modified-Keyes method. Methods: One hundred and eight mandible molars of Sprague-Dawley rats were collected from a cariogenic caries rodent model, including both caries-free and carious teeth. Smooth surfaces were evaluated using digital photography, whereas sulcal lesions and volumetric quantification were assessed with micro-CT and the Amira software. In the conventional assessment, smooth surfaces were examined under a stereomicroscope with tactile probing, and sulcal surfaces were evaluated on stained, sectioned teeth. Sensitivity, specificity, and accuracy of the digital approaches were calculated, with the conventional method serving as the gold standard. Spearman correlation analysis was conducted between conventional enamel caries scores, combined digital (photography and micro-CT) enamel caries scores, and micro-CT quantified remaining enamel volume. Results: A total of 107 m were available for smooth surfaces evaluation, and 98 m were included for sulcal surfaces, tooth-level caries detection and enamel lesion assessments. For smooth surfaces, the digital photographic method demonstrated an accuracy of 88.0%, with a sensitivity of 88.8% and a specificity of 85.7%. In the evaluation of sulcal caries, Micro-CT analysis achieved an accuracy of 96.9%, with 100% sensitivity and 87.0% specificity. For tooth-level caries detection, the combined digital approaches of smooth surface photography and sulcal micro-CT slicing achieved 96.9% accuracy, 97.6% sensitivity, and 92.9% specificity. Conclusions: This study demonstrates the efficacy of digital photography and micro-CT in the caries assessment of rodent models. The findings support the establishment of a standardized, nondestructive imaging protocol to enhance consistency in caries research.

Introduction: This cohort study evaluated the clinical behavior of dental caries lesions classified as inactive on the occlusal surfaces of permanent molars, defining their risk for progression after 13 years, in comparison with sound occlusal surfaces. Methods: Clinical assessments were undertaken at baseline (n = 258), after 1 year (n = 200), 4–5 years (n = 193), and 13 years (n = 102). Plaque and dental caries were recorded on the occlusal surfaces, as well as the eruption stage of permanent molars. Outcomes were progression by activity (active lesion, filling or extraction in the follow-up exam) and progression by severity (dentin cavity, filling or extraction in the follow-up exam). Predictors were occlusal site status, plaque accumulation on occlusal surfaces, eruption stage, type of molar, and dental arch, all of them collected at baseline. Logistic regression models were fitted using generalized estimating equations due to data clustering. Results: A total of 601 occlusal surfaces were reexamined. For the activity criterion, progression rates were 8.7% for sound sites and 18.8% for caries lesions initially classified as inactive (p < 0.05). For the severity criterion, the respective rates were 5.8% and 13.4% (p < 0.001). Inactive occlusal caries lesions had about twice the risk for caries progression than sound surfaces, for both the activity criterion (adjusted OR = 2.09, 95% CI = 1.23–3.52) and the severity criterion (adjusted OR = 2.49, 95% CI = 1.42–4.35). Conclusion: The vast majority (>80%) of lesions initially classified as inactive did not progress after 13 years. However, they showed higher risk for progression than sound occlusal surfaces of the same patients.

Introduction: The main cause of failure in restorations is the development of caries around restorations (CARs). Therefore, the aim of this study was to assess the evidence related to the development of CAR with fluoride-releasing restorative materials compared to non-fluoride releasing in deciduous and permanent teeth. Methods: Randomized clinical trials were included. Literature searches were conducted without language/data restrictions in 6 databases and in the grey literature in June 2024. ROB2 tool assessed the risk of bias. Through meta-analyses, expressed by the risk difference (RD) with a 95% confidence interval, the outcome was evaluated considering the follow-up period (12, 18–24, and ≥36 months), type of dentition and fluoride-releasing restorative materials, number of surfaces treated, and the type of dental isolation performed. Meta-regression models were applied with the above variables as moderators. The certainty of the evidence was assessed by GRADE. Results: Forty-six studies were selected. Among them, 29 presented some concerns and 9 showed high risk of bias. The type of dentition and dental materials, number of surfaces, and dental isolation did not influence the outcome (p > 0.05). Although after 36 months of follow-up, deciduous and permanent teeth restored with fluoride-releasing materials had a lower risk of CAR (RD −0.015 [−0.024, −0.006], p = 0.002, I2 = 0%), the moderators did not influence this effect by meta-regression models. The certainty of the evidence ranged from low to moderate. Conclusion: Fluoride-releasing restorative materials were more effective in preventing CAR after 36 months of follow-up. However, this result should be interpreted with caution, considering the low to moderate certainty of the evidence, the included studies’ risk of bias, and the small RD.

Plain Language SummaryThis study explored whether mixing a small amount of nitrate from spinach with sugar (i.e., 5 mg nitrate per 2 g sucrose) could reduce the drop in pH that usually occurs in saliva after consuming sugar. When sugar is eaten, bacteria in the mouth produce acid, which can lead to tooth demineralization over time. Nitrate is a natural compound found in vegetables like spinach and can be converted by bacteria in the mouth into other substances that may help reduce saliva acidogenicity. In this study, 18 healthy adults participated in three separate test sessions. In each session, they rinsed their mouths with one of three solutions: sugar-only, spinach-only, or spinach plus sugar. Saliva samples were collected before and after each rinse (up to 24 min) to measure pH (acidity), nitrate, nitrite, and lactate levels. The results showed that rinsing with the sugar-only solution caused a drop in salivary pH. However, in the spinach plus sugar condition, the drop in pH was less severe and recovered more quickly. This suggests that nitrate may help reduce the acid effects of sugar in the mouth. Saliva from all participants was also able to convert nitrate to nitrite, which supports this effect. These findings support the idea that natural nitrate, when delivered together with sugar, could help mitigate pH drops. However, more studies are needed to test whether this approach can help prevent dental demineralization in real-life settings.

Introduction: Universal coverage for oral healthcare is expected to improve population oral health. However, empirical evidence to substantiate this expectation is scarce and inconsistent. This study investigated the association between municipal oral healthcare coverage and dental caries among 5-year-old children. Methods: This study pooled together individual-level data from 7,185 5-year-old children who participated in the National Oral Health Survey – SB Brasil 2023 and monthly data on municipal oral healthcare coverage from January 2019 to December 2023. Dental caries was determined at cavity level in clinical examinations and summarised using the numbers of decayed teeth (dt), missing and filled teeth (mft) and decayed, missing, and filled teeth (dmft). Group-based trajectory modelling was used to identify four distinct classes of municipal oral healthcare coverage: always-low, medium-low, medium-high, and always-high. Multilevel negative binomial regression models, with children nested within municipalities, were fitted to test the association between municipal oral healthcare coverage and each caries measure, adjusting for demographic factors, socioeconomic conditions, and oral healthcare-seeking behaviour. Results: The variance partition coefficient of the empty model (no predictors) indicated that 4.1%, 3.1%, and 4.4% of the variance in the dmft, dt, and mft scores was attributable to differences between municipalities. Greater municipal oral healthcare coverage was not associated with the dmft and dt scores after adjusting for covariates. In contrast, municipal oral healthcare coverage was associated with the mft score after adjustments. Children in municipalities with medium-low (1.09, 95% CI: 0.72–1.66), medium-high (1.45, 95% CI: 0.93–2.26), and always-high coverage (1.50, 95% CI: 0.88, 2.56) had on average higher mft scores compared to those in municipalities with always-low coverage (p value for trend = 0.047). Conclusion: This study shows that greater oral healthcare coverage was positively associated with more caries treatment experience but not with current untreated disease.

Plain Language SummaryWhile fluoride exposure is a well-established factor in the development of dental fluorosis (DF), individual variability in susceptibility suggests that additional factors may also contribute to its manifestation. The etiology of molar incisor hypomineralization (MIH), in turn, is multifactorial and remains not fully understood. This study investigates the association between MIH, DF, caries experience, and polymorphisms in the AQP5, MMP2, and COMT genes in children chronically exposed to high fluoride levels in drinking water. We hypothesize that genetic polymorphisms in these genes modulate enamel development in children living under such exposure conditions, thereby contributing to variability in susceptibility to DF, MIH, and caries. A total of 268 schoolchildren aged 6–12 years from an area endemic for fluorosis were included. Dental conditions were diagnosed using established criteria, and saliva samples were collected to analyze genetic markers in the AQP5, MMP2, and COMT genes. Statistical analyses, including logistic regression, examined the relationship between genetic variants and dental conditions. The marker in the AQP5 gene was significantly associated with both DF and MIH, presenting different risk patterns depending on the genetic model analyzed (dominant vs. recessive). DF appears to have a protective effect against MIH, highlighting the complex interplay between genetic and environmental factors in dental conditions.

Plain Language SummaryTooth decay (also called dental caries) is one of the most common chronic diseases, especially in children. Silver diammine fluoride (SDF) is a liquid treatment that can stop tooth decay without using drills or fillings. It works by killing the bacteria that cause decay and helping to harden the tooth. However, SDF turns the treated area dark black, which many patients and parents find unattractive, especially on front teeth. In this study, researchers tested whether using a mineral called zinc before applying SDF could reduce the black staining while still keeping the tooth decay-fighting benefits. They created artificial tooth decay on human tooth samples in the laboratory and then tested SDF alone or SDF combined with two levels of zinc. The team looked at changes in tooth color, surface texture, and how well the treatments worked against harmful bacteria. The results showed that applying zinc before SDF helped reduce the dark staining, especially at higher concentrations of zinc. Importantly, the bacteria-killing power of SDF was not weakened by the zinc. Both the zinc + SDF and SDF-only treatments were equally effective in stopping the growth of bacteria and reducing acid damage. These findings suggest that adding zinc before SDF might be a helpful way to make this treatment more appealing to patients, especially in visible teeth, without losing its ability to stop tooth decay.

Plain Language SummaryTooth decay is a major health issue for children around the world. The World Health Organization recommends using simple, low-cost treatments to prevent and manage tooth decay as part of essential health care. To make smart decisions about which treatments to use, it is important to understand which ones give the best results for the money. This study reviewed existing research that compares the costs and benefits of preventive and no-drill dental treatments for children under 12 years of age. Researchers searched several medical databases for relevant studies published in English, Spanish, or Portuguese up to the end of 2023. They found 62 studies that met the criteria. Almost all of them used cost-effectiveness analysis, while very few looked at broader economic impacts like cost-benefit or cost-utility. The most commonly studied treatments were dental sealants and fluoride varnish. Only a few studies looked at silver diamine fluoride, another promising, no-drill, low-cost option. Most of the research focused on clinical outcomes (such as fewer cavities) rather than how treatments affect the child’s daily life or well-being. Also, none of the studies included community input, and there was very little research involving children from Africa, low- and lower-middle-income countries, or Indigenous communities. In conclusion, more research is being done on the costs and benefits of dental care for children, but there are still gaps. Future studies should include voices from local communities and look at how treatments affect families and children beyond just dental health.

Introduction: Despite efforts to reduce sugar consumption, Italy continues to experience high levels of caries, particularly among 12-year-old children. The introduction of a sugar tax is one strategy that gained traction as a mean of curbing excessive sugar intake. This study aimed to assess the potential impact of a sugar tax on reducing caries prevalence through the analysis of two scenarios: a hypothetical implementation of the tax in 2008 (Scen1), compared against actual 2017 data, and a projection of the effects of the planned 2025 tax extending to 2034 (Scen2). Methods: The evaluation utilizes a Markov model to evaluate the health and economic outcomes of a 20% ad valorem tax on sugar-sweetened beverages. Outcomes included the caries experience, as DMFT index and QALYs (Quality-Adjusted Life Year/s), direct dental costs, and indirect costs as forgone earnings due to care, assuming a 100% pass-through to consumers. A 3% annual discount rate was applied to all costs. Sub-analysis also included geographical macro-areas of Italy (North-West, North-East, Centre, South, Islands), based on main socioeconomic determinants. A probabilistic sensitivity analysis, involving a Monte Carlo simulation with 1,000 iterations, was conducted to assess the robustness of the model, generating estimates of mean values and 95% uncertainty intervals. Results: In Scen1, the simulation suggested that a 20% ad valorem tax would have resulted in a 0.05 reduction of the DMFT, yielded a cost saving of EUR 18.5 million, and EUR 24,520 per QALY gained. The projected 2025–2034 implementation estimated to decrease the DMFT by 0.07, save EUR 38.6 million, and EUR 31,933 per QALY gained. Significant benefits were observed in southern Italy, an area with higher caries rates and lower dental care utilization, where the impact was pronounced in both scenarios. Conclusion: Integrating a sugar tax into a broader public health strategy can significantly reduce caries and healthcare costs, especially in disadvantaged settings. These findings highlight the need for policymakers to pair sugar taxes with additional preventive measures for optimal public health outcomes.