龋病防治的临床难度评估

龋病是发生于牙体硬组织的慢性感染性疾病,具有发病率高、治疗率低等特点,严重危害口腔和全身健康。加强和完善龋病的规范化治疗是全人群、全生命周期龋病管理面临的关键问题。因此,在龋病诊断和分类的基础上,建立龋病防治临床难度评估系统,主要包括龋病风险评估和龋病治疗难度评估,可为龋病管理提供有效的依据。本文围绕龋病防治难度评估系统,从龋病的诊断和分类、龋病风险评估和龋病治疗难度评估等龋病防治临床管理的重要组成部分进行归纳与阐述。     

根面龋的预防与治疗

随着我国人口老龄化加剧,根面龋的发生率逐年升高。与冠部龋坏不同,根面龋多发生于老年患者牙龈退缩后暴露的根面上,主要累及根部牙骨质和牙本质,在发病特点、临床表征、诊断和防治上都有其特异性。本文从根面龋的病因和危险因素、病理和临床表现、分类、三级预防等方面进行阐述,以期为根面龋的临床防治提供参考。     

微创去腐技术治疗龋齿临床分析

目的：分析微创去腐技术治疗龋齿的临床效果。方法：搜集2012年3月—2013年3月我院接收的龋齿74例患者,随机分为甲组和乙组。对甲组37例进行微创去腐技术治疗,对乙组37例进行传统治疗。观察、比较甲组和乙组治疗效果。结果：甲组疼痛情况较好,优于乙组;治疗时间短于乙组;填充物完好率高于乙组,复发率低于乙组,预后情况优于乙组,差异显著,有统计学意义（P〈0.05）。结论：微创去腐技术治疗龋齿效果较好,患者疼痛较小,治疗快速,预后良好,值得推广。     

In vitro effect of a resin infiltrant on different artificial caries-like enamel lesions

ObjectivesA resin infiltrant was employed for the treatment of active white spot lesions due to its ability to penetrate into the enamel pores and prevent the progression of the lesion. However, limited information is available about its mechanical effect on different artificial enamel lesions as well as on its resistance to further demineralization. Therefore, this study aimed to evaluate the effects of the Icon® infiltrant on different artificial caries-like enamel lesions and its resistance to new acid challenges.DesignArtificial lesions were produced in bovine enamel using three different protocols (demineralization/remineralization cycling, DE-RE; 8% methylcellulose gel, MC; and methyl ethyl diphosphonate solution, MHDP; n = 13). The specimens were treated with Icon® and subjected to a new acid challenge using DE-RE cycling. The surface and cross-sectional hardness were evaluated in sound, demineralized, treated and further demineralized enamel areas. Data were statistically analyzed using ANOVA and Tukey’s test (p < 0.05).ResultsAll of the demineralizing protocols produced subsurface artificial caries lesions. The infiltrant was able to partially recover the surface hardness and prevent further surface hardness loss in enamel previously demineralized using the DE-RE and MHDP protocols. In regard to cross-sectional hardness, no positive effect was found.ConclusionsThe effect of the infiltrant depends on the type of lesion created in vitro, and its action is limited to the lesion surface.     

Characterization of the clustered regularly interspaced short palindromic repeats sites in Streptococcus mutans isolated from early childhood caries patients

ObjectiveThe aim of this study was to analyze the characteristics of the clustered regularly interspaced short palindromic repeats (CRISPR) sites in 45 clinical Streptococcus mutans strains and their relationship to the clinical manifestations of early childhood caries (ECC).MethodsForty-five S. mutans strains were isolated from the plaque samples taken from sixty-three children. CRISPR sites were sequenced and BLAST was used to compare these sites to those in the CRISPRTarget database. The association between the distribution of CRISPR sites and the manifestation of caries was analyzed by Chi-Square test. Further, biofilm formation (by crystal violet staining) and the synthesis of polysaccharide (by anthrone-sulfuric method) of all clinical isolated S. mutans strains with both CRISPR sites and no CRISPR site were comapared. Finally, acidogenicity and acidurity of two typical strains were determined using pH drop and acid tolerance assays. Biofilm formation and EPS synthesis by two typical strains were compared by 3D CLSM (Confocal Laser Scanning Microscope) assays and the expression of gtf genes were evaluated using qPCR.ResultsWe found that most of the spacers in the clinical S. mutans strains were derived from Streptococcus phages APCM01 and M102. The number of CRISPR sites in these strains was associated with the clinical manifestations of ECC. Moreover, we found that the biofilm formation and EPS synthesis ability of the S. mutans strains with both CRISPR sites was significant improved.ConclusionsAn association was found between the distribution of CRISPR sites and the clinical manifestations of caries. The CRISPR sites might contribute to the cariogenic potential of S. mutans.     

Minimal intervention dentistry for managing dental caries – a review

This publication describes the history of minimal intervention dentistry (MID) for managing dental caries and presents evidence for various carious lesion detection devices, for preventive measures, for restorative and non‐restorative therapies as well as for repairing rather than replacing defective restorations. It is a follow‐up to the FDI World Dental Federation publication on MID, of 2000. The dental profession currently is faced with an enormous task of how to manage the high burden of consequences of the caries process amongst the world population. If it is to manage carious lesion development and its progression, it should move away from the ‘surgical’ care approach and fully embrace the MID approach. The chance for MID to be successful is thought to be increased tremendously if dental caries is not considered an infectious but instead a behavioural disease with a bacterial component. Controlling the two main carious lesion development related behaviours, i.e. intake and frequency of fermentable sugars, to not more than five times daily and removing/disturbing dental plaque from all tooth surfaces using an effective fluoridated toothpaste twice daily, are the ingredients for reducing the burden of dental caries in many communities in the world. FDI's policy of reducing the need for restorative therapy by placing an even greater emphasis on caries prevention than is currently done, is therefore, worth pursuing.