The preventive effect of grape seed extract on artificial enamel caries progression in a microbial biofilm-induced caries model

Objectives

The aim of this study was to evaluate the effect of grape seed extract (GSE) on enamel caries lesion formation in an in vitro Streptococcus mutans biofilm model.

Methods

Enamel fragments were prepared from bovine incisors and divided into six treatment groups (n = 12): inoculated Brain Heart Infusion with 1% sucrose (BHIS), 1 mg/mL GSE, 2 mg/mL GSE, 3 mg/mL GSE, 10 ppm fluoride as NaF, and uninoculated BHIS. For biofilm formation, tooth fragments were incubated anaerobically in polystyrene 6-well tissue culture plates containing BHIS, the respective agents, and S. mutans (1 × 10⁵ CFU/mL) for 24 h at 37 °C. Culture medium was replaced with fresh BHIS and respective agents daily over a 7-day period. Following caries lesion formation, lesion depth (LD) and relative optical density (ROD) were determined by polarized light microscopy (PLM) and confocal laser scanning microscopy (CLSM), respectively, to evaluate lesion progression.

Results

LDs of the 2 mg/mL GSE group (122.86 ± 13.41 μm) and the 3 mg/mL GSE group (111.92 ± 11.39 μm) were significantly smaller than those of the 1 mg/mL GSE (198.33 ± 17.70 μm) and control groups (210.86 ± 15.50 μm) (p < 0.05). Compared with the 2 mg/mL and 3 mg/mL groups, the control and 1 mg/mL GSE groups showed significantly lower ROD values when depth was less than 200 μm, indicating greater mineral loss.

Conclusions

Dose-dependent GSE inhibits in vitro enamel caries formation due to its ability to suppress growth of S. mutans and the formation of bio?lm.

Clinical signi?cance

Grape seed extract may be a novel virulence-targeted natural antimicrobial agent for caries prevention.     

In vitro analysis of inhibitory effects of the antibacterial monomer MDPB-containing restorations on the progression of secondary root caries

Objective

This study aimed to analyze in vitro inhibitory effects of restorative materials containing the antibacterial monomer 12-methacryloyloxydodecylpyridinium bromide (MDPB) on the formation of artificial secondary root caries lesions.

Methods

Class V cavities (2 mm × 2 mm) were prepared in 75 human root fragments. Specimens were randomly divided into five groups (n = 15 fragments per group) and restored as follows: (I) MDPB-free adhesive system + MDPB-free composite (negative control); (II) resin modified glass ionomer (RM-GIC; positive control); (III) MDPB-free adhesive system + MDPB-containing composite (2.83% MDPB); (IV) MDPB-containing adhesive system + MDPB-free composite; (V) MDPB-containing adhesive system + MDPB-containing composite. Artificial secondary root caries lesions were produced by a biological artificial caries challenge. The restored specimens were immersed into a culture medium containing Streptococcus mutans and sucrose for 15 days. Histological slices (80 ± 20 μm) of the specimens were used for measuring the mean depths of the artificial lesions produced in both margins of the restorations using polarized light microscopy. Results were expressed in percentage related to the mean depth of the negative control, considered 100%. Data were compared by ANOVA followed by the Tukey's test (p ≤ 0.05).

Results

The depths of lesions adjacent to cavities filled with RM-GIC (GII; 85.17 ± 15.2%) were significantly (p < 0.01) shallower than those adjacent to restorations with MDPB-free composite (GI; 100.00 ± 10.04%), despite the presence of MDPB in the adhesive system (GIV; 101.95 ± 21.32%). The depths of lesions adjacent to cavities restored with MDPB-containing composite (GIII; 82.68 ± 12.81% and GV; 85.65 ± 15.42%), despite the adhesive system used, were similar to those of RM-GIC (GII). Mean lesions depths in these groups decreased from 13% (GV) to 17% (GIII) in relation to the negative control (GI).

Conclusions

MDPB-containing composite inhibits the progression of artificial secondary root caries lesions regardless of adhesive systems.     

Fracture resistance and cuspal deflection of incompletely excavated teeth

Objectives

Incomplete excavation reduces the risk of pulpal complications, but doubts remain regarding the mechanical properties of incompletely excavated teeth. Remaining carious dentine is suspected to not sufficiently support the restoration and to reduce bond strengths between the tooth and the restoration, with effects possibly varying depending on the depth of the remaining caries lesion. This study investigated fracture resistance (FR) and cuspal deflection (CD) of premolars after leaving or removing demineralized dentine in vitro.

Methods

In 48 premolars, shallow and deep artificial lesions (depths [mean ± SD] of 64 ± 18 μm and 771 ± 176 μm) were created on pulpo-axial walls of standardised mesial-distal-occlusal cavities. Demineralized dentine was either removed or left before adhesively restoring the tooth (n = 12/group). Restored teeth were submitted to thermo-mechanical cycling. CD was subsequently measured at loads of 200 N and 400 N, and teeth submitted to occlusal-perpendicular loading until fracturing occurred.

Results

FR was not significantly different between teeth with or without remaining demineralized dentine regardless of the lesion depth (p > 0.30, t-test). Irrespective of the removal technique, teeth with deep lesions showed significantly decreased FR (p ≤ 0.001). In contrast, CD was significantly increased in teeth with remaining demineralized dentine compared with completely excavated teeth (p ≤ 0.05; Mann–Whitney test).

Conclusions

Remaining demineralized dentine did not significantly decrease the fracture resistance of premolars in vitro. Effects of increased cuspal deflection on restoration margins should be assessed. This study showed no indication that incomplete excavation increases the risk of non-pulpal complications.

Clinical significance

Incomplete caries removal seems suitable to treat especially deep lesions. Leaving demineralized dentine does not seem to affect the fracture resistance of incompletely excavated teeth regardless of the lesion depth.     

Sterile paper points as a bacterial DNA-contamination source in microbiome profiles of clinical samples

Objectives

High throughput sequencing of bacterial DNA from clinical samples provides untargeted, open-ended information on the entire microbial community. The downside of this approach is the vulnerability to DNA contamination from other sources than the clinical sample. Here we describe contamination from sterile paper points (PPs) used in microbial sample collection.

Methods

Peri-implant samples from 48 individuals were collected using sterile PPs. Control samples contained only PPs or DNA extraction blank controls. 16S rRNA gene libraries were sequenced using 454 pyrosequencing. 16S rRNA gene copy numbers were measured by quantitative PCR.

Results

Nearly half of the sequencing reads belonged to two OTUs classified as Enterococcus (25% of reads) or Exiguobacterium (21%), which are not typical oral microorganisms. Of 87 peri-implant samples, only 10 samples (11%) contained neither of the two OTUs. The relative abundance of both unusual OTUs correlated with each other (p < 0.001; r = 0.828, Spearman correlation). The control samples showed that 2 of 4 (50%) of the sterile unused PPs contained bacterial DNA equivalent to 1.2 × 10³ and 1.1 × 10⁴ cells respectively, which was within the range of DNA in the clinical samples (average 1.8 × 10⁷, SD 4.8 × 10⁷, min 4.4 × 10², max 2.8 × 10⁸). The microbial profile from these PPs was dominated (>83% of reads) by the two unusual OTUs.

Conclusions

Sterile PPs can contain contaminating bacterial DNA. The use of PPs as a sampling tool for microbial profiling of clinical samples by open-ended techniques such as sequencing or DGGE should be avoided.

Clinical significance

Clinicians working with PPs as sampling tools for bacterial DNA should consider using an alternative sampling tool, because sterile unused PPs can be a considerable source of foreign bacterial DNA. We recommend sterile curettes for collecting clinical samples for open-ended techniques, such as sequencing or DGGE.     

Association of DLX3 gene polymorphism and dental caries susceptibility in Japanese children

Objective

In this study, we investigated whether single nucleotide polymorphisms (SNPs) in DLX3 are associated with dental caries susceptibility in Japanese children.

Design

Genomic DNA of 201 Japanese children was extracted from buccal epithelial cells. The subjects were divided into two groups: ‘low level’ group with <10,000 colony forming units (CFU) of Streptococcus mutans/mL saliva (level 0) and ‘high level’ group with ≥10,000 CFU/mL (more than level 1). Each group was further divided according to decayed, missing, filled teeth (dmft) into low caries experience (dmft ≤ 2) and high caries experience (dmft ≥ 3). Seven SNPs in DLX3 were genotyped using TaqMan^® SNP Genotyping Assay.

Results

Statistical significant association was observed between DLX3 (rs2278163) and caries experience in ‘high level Mutans streptococci’ group.

Conclusion

These findings suggest that rs2278163 SNP of DLX3 might be associated with dental caries susceptibility in Japanese children. T and C alleles of rs2278163 SNP may potentially be involved in caries susceptibility and caries protection respectively.     

The effect of casein phosphopeptide–amorphous calcium phosphate on erosive enamel and dentine wear by toothbrush abrasion

Objective

In addition to its role as a remineralizing agent in preventing dental caries, calcium product (CPP–ACP) delivered as a mousse (Tooth Mousse^®, TM) can reduce erosion of enamel and dentine. The aim of this study was to determine whether CPP–ACP could also reduce erosive tooth wear involving toothbrush abrasion.

Methods

Flat, polished enamel and dentine specimens (n = 72) were subjected to 10 wear regimes, with each regime involving erosion in 0.3% citric acid (pH 3.2) for 10 min followed by toothbrush abrasion in a slurry of fluoride-free toothpaste and artificial saliva (1:3 ratio by weight) under a load of 2N for 200 cycles. The specimens were immersed in artificial saliva for 2 h between wear regimes. In the experimental group 1, TM (containing CPP–ACP) was applied at the beginning of each wear episode for 5 min whereas TM− (without CPP–ACP) was applied in the experimental group 2. No mousse was applied in the control group.

Results

TM significantly reduced enamel wear (mean ± S.E., 1.26 ± 0.33 μm in the experimental group 1 vs 3.48 ± 0.43 μm in the control group) and dentine wear (2.16 ± 0.89 μm in the experimental group 1 vs 10.29 ± 1.64 μm in the control group), and dentine wear was significantly less in the experimental group 1 than in the experimental group 2 (5.75 ± 0.98 μm).

Conclusion

The finding that TM reduced erosive tooth wear involving toothbrush abrasion, probably by remineralizing and lubricating eroded tooth surfaces, may have implications in the management of tooth wear.     

A New “Silver-Bullet” to treat caries in children – Nano Silver Fluoride: A randomised clinical trial

Background

Untreated dental caries in children remains a public health challenge in poor communities.

Objectives

This prospective controlled clinical trial investigated the effectiveness of a new anti-caries agent, Nano Silver Fluoride (NSF), applied once a year to arrest caries in children.

Methods

One hundred thirty decayed primary teeth were randomly divided into two groups: NSF as the experimental agent and water as the control group. Teeth were clinically diagnosed and treated by one masked examiner and followed up at seven days and five and 12 months by another calibrated examiner who was blinded to the type of treatment. The criteria of the ICDAS II were followed to determine the activity of lesion and the diagnosis of caries. The Pearson's chi-square test was used to compare the groups during different follow-up exams.

Results

At seven days, 81% of teeth in the NSF group exhibited arrested caries, whereas in controls, no teeth had arrested decay (p < 0.001) [PF, prevented fraction = 81%]. After five months, the NSF group had 72.7% with arrested decay, and the control group had 27.4% (p < 0.001) [PF = 62.5%]. At 12 months, 66.7% of the lesions treated with NSF were still arrested, while the control group had 34.7% remaining arrested (p = 0.003) [PF = 50%]. The number need to treat (NNT) at five months was two, and at 12 months, the number was three.Clinical Signi?cance: The NSF formulation is effective to arrest active dentine caries and not stain teeth.

Conclusions

NSF was demonstrated to be effective in arresting caries in children in poor communities.     

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.     

Effect of pit and fissure sealants on caries detection by a fluorescent camera system

Objective

The aim of this study was to evaluate the effect of sealant placement on the detection of caries by a fluorescent camera (FC), the Spectra caries detector.

Materials and methods

In a laboratory study, FC images and readings were obtained from 31 extracted teeth, before and following application of clear sealants (Shofu Clear or Delton unfilled), or opaque sealants (3M Clinpro or Delton FS). Teeth were then sectioned and examined for enamel or dentine caries. Using each tooth's true caries diagnosis, the sensitivity and specificity of the FC measurements in detecting dentine caries was calculated. In the clinical study, FC readings were obtained from 41 molars in children prior to and following application of clear sealants.

Results

Following application of Shofu or Delton unfilled there were reductions in the mean FC readings of 10% (p = 0.5) and 8.2% (p = 0.009), respectively. Application of two opaque sealants, 3M or Delton FS significantly reduced mean FC readings 16.2% and 20.8% (p < 0.5), respectively. Although the carious lesions could still be observed in FC images from teeth with opaque sealants there was a significant loss of sensitivity in detecting dentinal caries. Clear sealant application caused an insignificant loss of detection sensitivity. Following application of clear sealants to children's molars there was a small (4.01%) but significant (p < 0.01) reduction in FC readings recorded from these teeth.

Conclusions

The FC can detect caries under clear sealants with little loss of sensitivity. Although lesions can be seen through opaque sealants, loss of sensitivity precludes accurate lesion assessment.     

Caries-preventive effectiveness of fluoride varnish as adjunct to oral health promotion and supervised tooth brushing in preschool children: A double-blind randomized controlled trial

Objectives

To evaluate the effect of biannual fluoride varnish applications in preschool children as an adjunct to school-based oral health promotion and supervised tooth brushing with 1000 ppm fluoride toothpaste.

Methods

424 preschool children, 2–5 year of age, from 10 different pre schools in Athens were invited to this double-blind randomized controlled trial and 328 children completed the 2-year programme. All children received oral health education with hygiene instructions twice yearly and attended supervised tooth brushing once daily. The test group was treated with fluoride varnish (0.9% diflurosilane) biannually while the control group had placebo applications. The primary endpoints were caries prevalence and increment; secondary outcomes were gingival health, mutans streptococci growth and salivary buffer capacity.

Results

The groups were balanced at baseline and no significant differences in caries prevalence or increment were displayed between the groups after 1 and 2 years, respectively. There was a reduced number of new pre-cavitated enamel lesions during the second year of the study (p = 0.05) but the decrease was not statistically significant. The secondary endpoints were unaffected by the varnish treatments.

Conclusions

Under the present conditions, biannual fluoride varnish applications in preschool children did not show significant caries-preventive benefits when provided as an adjunct to school-based supervised tooth brushing with 1000 ppm fluoride toothpaste.

Clinical significance

In community based, caries prevention programmes, for high caries risk preschool children, a fluoride varnish may add little to caries prevention, when 1000 ppm fluoride toothpaste is used daily.     

Light cola drink is less erosive than the regular one: An in situ/ex vivo study

Objective

This in situ/ex vivo study assessed the erosive potential of a light cola drink when compared to a regular one.

Methods

During 2 experimental 14-days crossover phases, eight volunteers wore palatal devices with 2 human enamel blocks. The groups under study were: group light, erosive challenge with light cola drink and group regular, erosive challenge with regular cola drink. During 14 days, erosive challenges were performed extraorally 3X/day. In each challenge, the device was immersed in 150 ml of light cola (group light) or regular cola (group regular) for 5 min. Erosion was analysed by surface profilometry (μm) and surface microhardness change (%SMH). The data were statistically analyzed using paired t test (p < 0.05).

Results

Group light (0.6 ± 0.2 μm) showed significantly lesser wear than group regular (3.1 ± 1.0 μm). There was no significant difference between the groups for the %SMH (group light −63.9 ± 13.9 and group regular −78.5 ± 12.7).

Conclusions

The data suggest that the light cola drink is less erosive than the regular one.     

Marginal integrity and secondary caries of selectively excavated teeth in vitro

Objectives

Selective caries removal involves sealing of carious dentine beneath restorations, which might decrease their marginal integrity and increase the susceptibility for secondary caries and microleakage. The present study compared these marginal characteristics of restorations in selectively and completely excavated teeth.

Methods

In 32 premolars, shallow and deep artificial lesions were created on pulpo-axial walls of mesial-distal-occlusal cavities, with mesial and distal margins located in enamel and dentine, respectively. Demineralised dentine was either removed or left before adhesively restoring the teeth (n = 8), which were then submitted to thermo-mechanical cycling. The integrity of gingivo-cervical margins was assessed using scanning electron microscopy. In half of each margin, caries was induced adjacent to restorations using a continuous-culture biofilm model, and resulting lesions were evaluated using transversal microradiography. The other half of each margin was used to assess microleakage.

Results

Integrity or microleakage of margins located in enamel did not differ significantly between groups, and bacterial biofilms did not induce distinct caries lesions in enamel. Dentinal margins in teeth with deep compared with shallow lesions showed a significantly higher proportion of marginal imperfections, gaps and microleakage (p ≤ 0.05, Mann–Whitney/χ²-test). In contrast, neither marginal integrity nor microleakage differed significantly between completely and selectively excavated teeth (p > 0.05). Dentinal mineral loss adjacent to restorations did not differ significantly between groups (p > 0.80).

Conclusions

The marginal characteristics of restorations were affected by the depth of sealed or excavated lesions, but not by the performed caries excavation. This study did not find selective excavation detrimental for restoration integrity in vitro.

Clinical significance

Selective excavation of deep lesions was shown to reduce pulpal risks, whilst leaving caries beneath restorations is feared to compromise the marginal characteristics of the subsequently placed restoration. Based on the present in vitro study, such assumptions cannot be supported.     

Randomised in situ trial on the effect of milk and CPP-ACP on dental erosion

Objectives

This randomised in situ study aimed to analyse the effect of milk (with or without 5 ppm F) and CPP-ACP pastes (with or without 900 ppm F) on dental erosion.

Methods

The study was a seven phase (5 days each) crossover design involving 15 participants wearing intraoral appliances with enamel and dentine specimens. Specimens were extraorally eroded (erosive soft drink, 6 × 90 s/day) and brushed (2 × 30 s/day, 2 N) using a non-fluoridated toothpaste (negative control). The test products were milk, milk + 5 ppm F (twice daily, each 100 ml/2 min), CPP-ACP paste, CPP-ACP paste + 900 ppm F (3 min/day) or a SnCl₂/AmF/NaF mouthrinse (positive control, 30 s/day), which were applied immediately after erosion with the appliances in the oral cavity. In an additional group, a fluoridated toothpaste was used without any additional test product. Tissue loss was determined profilometrically after 5 days and statistically analysed by linear mixed models methodologies (p < 0.05).

Results

Compared with the negative control (non-fluoridated toothpaste only, enamel: 2.2 ± 1.3 μm; dentine: 3.8 ± 2.2 μm), enamel and dentine loss was significantly reduced by the use of fluoridated toothpaste (enamel: 1.1 ± 1.0 μm; dentine: 2.4 ± 1.7 μm) and the SnCl₂/AmF/NaF mouthrinse (1.5 ± 1.5 μm; dentine: 1.8 ± 1.9 μm).

Conclusions

Milk and CPP-ACP were not effective in reducing enamel and dentine loss significantly, independently of the presence of fluoride.

Clinical significance

Enamel and dentine erosion were significantly reduced by the use of a fluoridated toothpaste or a SnCl₂/AmF/NaF mouthrinse, but not by milk or CPP-ACP under the conditions of the present study.

Clinical trials registration

NCT01566357.     

Mineral distribution and CLSM analysis of secondary caries inhibition by fluoride/MDPB-containing adhesive system after cariogenic challenges

Objective

To evaluate the inhibition zone formation (IZ) and mineral distribution along the interface of adhesive systems either containing fluoride and antibacterial primer or not, after chemical and biological artificial caries challenges.

Methods

Forty-eight third molars were used. Artificial caries was developed with S. mutans in a 4 mm × 4 mm area of occlusal dentin surface. Carious dentin was removed and cavities were restored with Adper Scotchbond Multi-Purpose (SBM) and Clearfil Protect Bond (CPB) (n = 24). Samples were submitted to secondary caries development by chemical (C) (acidic gel) or biological (B) (S. mutans culture) methods for 5 days. Four groups were tested (n = 12): (1) SC (SBM + C); (2) SB (SBM + B); (3) CC (CPB + C); (4) CB (CPB + B). The IZ and outer lesion (OL) formations were analyzed by confocal laser scanning microscopy (CLSM). The distribution of calcium (Ca) and phosphorus (P) content along the interface was analyzed by micro X-ray fluorescence spectrometer by energy-dispersive (μEDX).

Results

The frequency of IZ formation and mean values of IZ thickness differed among the groups. The CC group presented the lowest OL depth. μEDX analysis showed that CPB had the highest mineral loss by the biological method, but the lowest mineral loss by the chemical method. SC and SB groups showed intermediate values of mineral loss.

Conclusion

The mineral loss along the dentin/restoration interface was affected by the artificial caries method, and hybrid layer formation by adhesive systems used. The adhesive system containing fluoride and antibacterial primer did not prevent secondary caries formation.     

Reinforcement of dentin in self-etch adhesive technology: A new concept

Objective

Characterize the ultramorphology and secondary caries inhibition potential of different dentin adhesive systems in order to find a satisfactory explanation resist to recurrent caries.

Methods

Human premolar dentin was treated with one of the two self-etching adhesive systems, Clearfil SE Bond, Clearfil Protect Bond or an acid-etching adhesive system, Single Bond. The bonded interface was exposed to an artificial demineralizing solution (pH 4.5) for 90 min and then 5% sodium hypochlorite for 20 min. Transmission electron microscopic observation was performed at the adhesive–dentin interface. The width of the reinforced zone was measured and data were analyzed with univariate analysis of variance under general linear model. In order to identify type of crystallites in the reinforced zone selected area electron diffraction was performed.

Results

An acid–base resistant zone (ABRZ) was found adjacent to the hybrid layer in the outer lesion front with only Clearfil SE Bond and Clearfil Protect Bond, while Single Bond was devoid of this protective zone. Crystallite arrangement and the ultramorphology were almost similar in the corresponding regions of Clearfil SE Bond and Clearfil Protect Bond. However, thickness of the ABRZ at the mid portion was 1159(±41.91) nm in Clearfil protect Bond, which was significantly thicker than that of Clearfil SE Bond (F = 514.84, p < 0.001). Selected area electron diffraction confirmed the crystallites in the zone as apatite.

Conclusions

The self-etching adhesive systems created a new reinforced acid resistant dentin under the hybrid layer. Difference in the thickness of the zone expressed a different potential for demineralization inhibition.     

Intake of dairy products and the prevalence of dental caries in young children

Objectives

In vitro studies show that milk or milk components may have cariostatic properties. However, the results of epidemiological studies on the association between intake of dairy products and dental caries have been inconsistent. The purpose of this cross-sectional study was to examine the association between intake of dairy products and the prevalence of dental caries in young children.

Methods

Study subjects were 2058 Japanese children aged 3 years. Information on diet was assessed with a self-administered brief diet history questionnaire for children. The consumption of dairy products was categorized into 3 levels in order to represent the tertiles as closely as possible. Dental caries was assessed by a visual examination. Adjustment was made for sex, toothbrushing frequency, use of fluoride, between-meal snack frequency, maternal smoking during pregnancy, environmental tobacco smoke exposure at home, and paternal and maternal educational levels.

Results

Compared with yogurt consumption at the lowest tertile (<1 time/week), its intake at the highest level (≥4 times/week) was significantly associated with a lower prevalence of dental caries, showing a clear dose–response relationship (adjusted prevalence ratio = 0.78, 95% confidence interval: 0.62–0.98, P for trend = 0.04). There were no material associations between intake of cheese, bread and butter, or milk and the prevalence of dental caries.

Conclusions

These data suggest that a high consumption of yogurt may be associated with a lower prevalence of dental caries in young children.     

A new use for self-etching resin adhesives: Cementing bone fragments

Objectives

To evaluate the bond capacities of four self-etching resin cements and the self-etching adhesives of the same manufacturer when used to cement bone fragments and compare them with a well-known N-butyl-2-cyanoacrylate bone adhesive.

Methods

125 cylindrical bone specimens from pig mandibular ramus bone were prepared using terphane burs and cemented to the corticals of 125 other specimens obtained from pig mandibular body bone using the following bond systems: Group A: Adper PLP/Relyx; group B: Optibond/Maxcem; group C: Hystoacryl; group D: AdheSE/Multilink; group E: G-Bond/G-Cem. Shear bond strength was measured 15 min after cement application using a universal testing machine.

Results

Shear bond strength results: group A 2.54 ± 0.23 MPa; group B 4.83 ± 0.4 MPa; group C 2.90 ± 0.24 MPa; group D 2.10 ± 0.17 MPa; group E 4.22 ± 0.24 MPa. Values for shear bond strength were significantly greater for group B and E compared to groups A, C and D (p < 0.005, test Mann–Whitney). SEM images showed the presence of a hybrid layer similar to that formed by these bond systems when used on dentine.

Conclusion

Within the limitations of an in vitro investigation, results show that self-etching resin cements together with self-etching adhesives may be used for cementing bone fragments.     

Is non-cavitated proximal lesion sealing an effective method for caries control in primary and permanent teeth? A systematic review and meta-analysis

Objectives

The aim of this study was to perform a systematic review and meta-analysis on the effectiveness of sealing non-cavitated proximal caries lesions in primary and permanent teeth.

Data

Only controlled clinical trials and randomized controlled clinical trials that evaluated the effectiveness of sealing on non-cavitated proximal caries with a minimum follow-up of 12 months were included in the study. The primary outcome should be arrestment/progression of proximal caries evaluated by bitewing radiographs. A risk of bias evaluation based on the Cochrane Collaboration common scheme for bias was carried out for each study. The meta-analysis was performed on the studies considered low risk of bias and with pair-wise visual reading results through RevMan software.

Sources

A comprehensive search was performed in the Systematic Electronic Databases: Pubmed, Cochrane Library, Scopus, IBI Web of Science, Lilacs, SIGLE, and on website Clinical trials.gov, through until June 2013.

Study selection

From 967 studies identified, 10 articles and 3 studies with partial results were assessed for eligibility. However three articles were excluded and our final sample included 10 studies. According to the risk of bias evaluation, six studies were considered “high” risk of bias, and four “low” risk of bias. The forest plot of the meta-analysis showed low heterogeneity (I² = 29%) and a favourable outcome for the Infiltrant. The chance of caries progression when this technique was used was significantly lower (p = 0.002) compared with Placebo.

Conclusion

Our results suggest that the technique of sealing non-cavitated proximal caries seems to be effective in controlling proximal caries in the short and medium term. Further long-term randomized clinical trials are still necessary to increase this evidence.

Clinical significance

Contemporary dentistry is focused in minimally invasive approaches that prevent the destruction of sound dental tissues next to carious lesions. This paper searches for evidence of the efficacy of sealing/infiltrating non-cavitated proximal caries in arresting caries progression both in permanent and primary teeth.     

Validity of caries risk assessment programmes in preschool children

Objectives

Various programmes have been developed for caries risk assessment (CRA). Nevertheless, scientific evidence on their validity is lacking. This study aimed to compare the validity of 4 CRA programmes (CAT, CAMBRA, Cariogram, and NUS-CRA) in predicting early childhood caries.

Methods

A total of 544 children aged 3 years underwent oral examination and biological tests (saliva flow rate, salivary buffering capacity and abundance of cariogenic bacteria mutans Streptococci and Lactobacilli). Their parents completed a questionnaire. Children's caries risk was predicted using the 4 study programmes without biological tests (screening mode) and with biological tests (comprehensive mode). After 12 months, caries increment in 485 (89%) children was recorded and compared with the baseline risk predictions.

Results

Reasoning-based programmes (CAT and CAMBRA screening) had high sensitivity (≥93.8%) but low specificity (≤43.6%) in predicting caries in children. CAMBRA comprehensive assessment reached a better balance (sensitivity/specificity of 83.7%/62.9%). Algorithm-based programmes (Cariogram and NUS-CRA) generated better predictions. The sensitivity/specificity of NUS-CRA screening and comprehensive models were 73.6%/84.7% and 78.1%/85.3%, respectively, higher than those of the Cariogram screening (62.9%/77.9%) and comprehensive assessment (64.6%/78.5%). NUS-CRA comprehensive model met the criteria for a useful CRA tool (sensitivity + specificity ≥ 160%), while its screening model approached that target.

Conclusions

Our results supported algorithm-based approach of caries risk modelling and the usefulness of NUS-CRA in identifying children susceptible to caries.

Clinical significance

This prospective study provided evidence for practitioners to select tools for assessing children's caries risk, so that prevention measures can be tailored and treatment plan can be optimised.     

Relationship between daily habits, Streptococcus mutans, and caries among schoolboys

Objectives

The purpose of this study was to examine the associations between daily habits, Streptococcus mutans, and caries using International Caries Detection and Assessment System Caries Index (ICDAS CI); and compare it to the DMF index.

Subjects and methods

Altogether 122 children were examined and interviewed. Saliva and plaque samples were collected and analyzed by Dentocult SM^® Strip Mutans test. ICDAS CI was calculated by counting all ICDAS caries scores of all surfaces divided by total number of carious teeth.

Results

ICDAS CI was significantly (p < 0.01) and strongly associated with DMFT/dmft (ρ = 0.72), DMFS/dmfs (ρ = 0.72), total number of carious teeth (DT/dt) (ρ = 0.77), enamel caries surfaces (ρ = 0.61) and dentine caries surfaces (ρ = 0.75). Plaque S. mutans was significantly (p < 0.05) correlated with ICDAS CI and DT/dt. Children who brushed once a day or more had significantly lower ICDAS CI (p < 0.01). Children who consumed sweets or drank soft drinks more than once a day had significantly higher ICDAS CI (p < 0.05). No significant association was found between ICDAS CI and frequency of flossing, use of mouthrinse, or gum chewing.

Conclusion

ICDAS CI seems to have similar trends as DMF indices, but includes more information about the stage, severity, and progress of the caries lesions of the patient.