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1.
Yasmi O. Crystal Malvin N. Janal Dylan S. Hamilton Richard Niederman 《Journal of the American Dental Association (1939)》2017,148(7):510-518.e4
Background
The caries arrest that can be achieved by using silver diamine fluoride (SDF) offers a minimally invasive and inexpensive alternative to traditional restorative caries treatment. The authors evaluated how the dentinal staining that is associated with SDF influences the acceptance of this treatment among parents of young children in the New York City metropolitan area.Methods
The authors invited the parents of children who had experienced dental caries and who had appointments at the New York University Pediatric Dentistry Clinic and at several private clinics in New Jersey to participate in a Web-based survey designed to assess parents’ demographics, perceptions of photographs of SDF-treated carious teeth, and acceptability of treatment in different behavior management scenarios.Results
Ninety-eight mothers and 22 fathers from diverse backgrounds participated. Most parents (67.5%) judged SDF staining on the posterior teeth to be esthetically tolerable, but only 29.7% of parents made this same judgment about anterior teeth (P < .001). In the absence of their child having behavioral barriers to conventional restorations, 53.6% of parents reported that they were likely to choose SDF to treat their child’s posterior teeth, but only 26.9% of parents were likely to choose SDF to treat their child’s anterior teeth. As the number of children’s behavioral barriers increased, so did the parents’ level of acceptance. In extreme cases, in which parents had to decide whether their children should undergo general anesthesia during treatment, parents’ acceptance rate of SDF as a treatment method increased to 68.5% on posterior teeth and to 60.3% on anterior teeth. Parents’ acceptance of the treatment also varied according to their socioeconomic status.Conclusions
Staining on posterior teeth was more acceptable than staining on anterior teeth. Although staining on anterior teeth was undesirable, most parents preferred this option to advanced behavioral techniques such as sedation or general anesthesia.Practical Implications
Clinicians need to understand parental sensitivities regarding the staining effect of SDF to plan adequately for the use of SDF as a method of caries management in pediatric patients. 相似文献2.
3.
Rebecca L. Slayton Olivia Urquhart Marcelo W.B. Araujo Margherita Fontana Sandra Guzmán-Armstrong Marcelle M. Nascimento Brian B. Nový Norman Tinanoff Robert J. Weyant Mark S. Wolff Douglas A. Young Domenick T. Zero Malavika P. Tampi Lauren Pilcher Laura Banfield Alonso Carrasco-Labra 《Journal of the American Dental Association (1939)》2018,149(10):837-849.e19
Background
An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated evidence-based clinical recommendations for the arrest or reversal of noncavitated and cavitated dental caries using nonrestorative treatments in children and adults.Types of Studies Reviewed
The authors conducted a systematic search of the literature in MEDLINE and Embase via Ovid, Cochrane CENTRAL, and Cochrane database of systematic reviews to identify randomized controlled trials reporting on nonrestorative treatments for noncavitated and cavitated carious lesions. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and move from the evidence to the decisions.Results
The expert panel formulated 11 clinical recommendations, each specific to lesion type, tooth surface, and dentition. Of the most effective interventions, the panel provided recommendations for the use of 38% silver diamine fluoride, sealants, 5% sodium fluoride varnish, 1.23% acidulated phosphate fluoride gel, and 5,000 parts per million fluoride (1.1% sodium fluoride) toothpaste or gel, among others. The panel also provided a recommendation against the use of 10% casein phosphopeptide–amorphous calcium phosphate.Conclusions and Practical Implications
Although the recommended interventions are often used for caries prevention, or in conjunction with restorative treatment options, these approaches have shown to be effective in arresting or reversing carious lesions. Clinicians are encouraged to prioritize use of these interventions based on effectiveness, safety, and feasibility. 相似文献4.
Sonia K. Makhija Daniel A. Shugars Gregg H. Gilbert Mark S. Litaker James D. Bader Rebecca Schaffer Valeria V. Gordan D. Brad Rindal Daniel J. Pihlstrom Rahma Mungia Cyril Meyerowitz 《Journal of the American Dental Association (1939)》2017,148(12):922-929
Background
A lesion on an occlusal tooth surface with no cavitation and no radiographic radiolucency but in which caries is suspected owing to surface roughness, opacities, or staining can be defined as a suspicious occlusal carious lesion (SOCL). The authors' objective was to quantify the characteristics of SOCLs and their relationship to lesion depth and activity after these lesions were opened surgically.Methods
Ninety-three dentists participated in the study. When a consenting patient had an SOCL, information was recorded about the tooth, lesion, treatment provided, and, if the SOCL was opened surgically, its lesion depth. The Rao-Scott cluster-adjusted χ2 test was used to evaluate associations between lesion depth and color, roughness, patient risk, and luster.Results
The authors analyzed 1,593 SOCLs. Lesion color varied from yellow/light brown (40%) to dark brown/black (47%), with 13% other colors. Most (69%) of SOCLs had a rough surface when examined with an explorer. Over one-third of the SOCLs (39%) were treated surgically. Of the 585 surgically treated SOCLs, 61% had dentinal caries. There were statistically significant associations between lesion depth and color (P = .03), luster (P = .04), and roughness (P = .01). The authors classified 52% of the patients as being at elevated caries risk. The authors found no significant associations between lesion depth and patient risk (P = .07).Conclusions
Although statistically significant, the clinical characteristics studied do not provide accurate guidance for making definitive treatment decisions and result in high rates of false positives.Practical Implications
Given that 39% of the opened lesions did not have dentinal caries or were inactive, evidence-based preventive management is an appropriate alternative to surgical intervention. 相似文献5.
Yasmi O. Crystal Sasan Rabieh Malvin N. Janal Sarunphorn Rasamimari Timothy G. Bromage 《Journal of the American Dental Association (1939)》2019,150(2):140-146
Background
As silver diamine fluoride (SDF) gains popularity for caries arrest, the authors aimed to investigate the content of fluoride and silver in 38% SDF produced for the US market and its short-term stability.Methods
Five samples of 38% SDF were evaluated when the bottle was first opened, and at 7 and 28 days. Fluoride concentrations were determined with a fluoride ion-selective electrode, and silver concentrations were determined with a simultaneous inductively coupled plasma mass spectrometer. pH was measured with a pH probe. Weight and volume of individual drops were measured.Results
At day 0, 40% of individual measured values were above the expected fluoride concentration, and at day 28, 93% were above the expected fluoride concentration (P = .005). At day 0, 19% of individual measured values were below the lowest expected silver concentration, and at day 28, 93% were below (P < .001). Acidity (pH 10) was consistent over the 3 periods. Mean (standard deviation) weight of a drop was 40 (4.0) milligrams, and mean (standard deviation) volume was 32.55 (1.89) microliters, 30% more than the reported value of 25 μL.Conclusion
Over 28 days, the product pH is stable, whereas the fluoride content tends to increase and the silver content tends to decrease. Drops were larger than expected when dispensed from the bottle.Practical Implications
Drops are larger than expected, so each delivers higher than expected quantities of silver and fluoride. Clinicians should exercise caution when using this product on young children, replace the cap immediately, and use as soon as dispensed. 相似文献6.
Qian Jiang Jialing Li Li Mei Jing Du Luca Levrini Gian Marco Abbate Huang Li 《Journal of the American Dental Association (1939)》2018,149(8):712-720.e12
Background
Clear aligners have become increasingly popular because of their esthetics and comfort. The authors’ aim in this systematic review was to compare periodontal health in patients undergoing orthodontic treatment with clear aligners with that of those undergoing orthodontic treatment with fixed appliances.Types of Studies Reviewed
The authors systematically searched the PubMed, Web of Science, Cochrane Library, and Embase databases to collect related studies. After extracting data and assessing quality, the authors performed a meta-analysis and trial sequential analysis. The authors used the Grading of Recommendations Assessment, Development and Evaluation system to assess the quality of the evidence.Results
The authors included 9 studies in the quantitative synthesis analysis. Clear aligners were better for periodontal health, including plaque index (mean difference [MD], ?0.53; 95% confidence interval [CI], ?0.85 to ?0.20; P = .001), gingival index (MD, ?0.27; 95% CI, ?0.37 to ?0.17; P < .001), and probing depth (MD, ?0.35; 95% CI, ?0.67 to ?0.03; P = .03), than were fixed appliances. However, the trial sequential analysis outcome indicated a false-positive meta-analysis result for probing depth. The authors downgraded the level of the evidence because of the risk of bias and inconsistency.Conclusions and Practical Implications
Clear aligners were better for periodontal health than fixed appliances and might be recommended for patients at high risk of developing gingivitis. However, high-quality studies still are required. 相似文献7.
Yvonne S. Lin Marilynn L. Rothen Peter Milgrom 《Journal of the American Dental Association (1939)》2019,150(3):186-192
Background
Silver diamine fluoride (SDF) is used topically to prevent or arrest caries. The authors' aim was to characterize the kinetics of silver and fluoride after topical application of SDF.Methods
Sixteen adults participated in a pharmacokinetics study after the application of 38% SDF to 5 teeth (approximately 50 microliters, estimated 4-11 milligrams per participant). Serum and urine samples were collected over 24 hours after application and were analyzed for silver and fluoride.Results
Silver serum peak was 0.67 (standard deviation [SD], 0.49) nanograms per milliliter; median time to peak was 3 hours. The estimated elimination half-life of silver was 46 (SD, 26) hours. No silver was recovered in urine. Baseline fluoride serum levels ranged from less than 10 through 50 ng/mL (< 0.01-0.05 parts per million) and fluctuated around baseline after SDF. The 24-hour urinary fluoride was 1.29 (SD, 0.81) mg.Conclusions
SDF was well tolerated in this study, and no adverse events related to SDF were reported.Practical Implications
This clinical study confirmed that topical application of 38% SDF, in growing use in the United States, is safe and well tolerated in healthy adults. 相似文献8.
Yi-Fang Huang Chung-Ta Chang Chih-Hsin Muo Hsiang-Hsi Hong Yu-Fu Shen Chia-Chang Lin Shih-Ping Liu 《Journal of cranio-maxillo-facial surgery》2018,46(11):1979-1983
Purpose
The aim of this study was to investigate how the physical variables of fibular reconstructed mandibles with dental implants affects the relative bite force in oral cancer patients.Materials and methods
Over 7 years of follow-up, 13 oral cancer patients were enrolled who included 51 successful implants in the fibular flap. The tactile sensor analyzer evaluated the bite force. The crown-implant ratio, fibular, and rehabilitated dental length were measured using radiographic images. Linear regression was used to analyze the bite force related to the variables of the implants in the fibular reconstructed mandible.Results
Even when the results showed no statistical significance (P > 0.05), increasing the crown-implant ratio, length of the fibular flap, and implant prosthetic reconstructed dentition had a tendency to decrease the bite force (estimate from ?0.08% to ?4.27%); there was a positive trend of occlusal force and the length of rehabilitative dentition compared with the dental antagonist (estimate = 6.95).Conclusion
In this study, the crown-implant ratio, implant dentition, and fibular flap length revealed no significant impact on the bite force or implant success in oral cancer patients; however, a trend to weaken the bite force was suggested once the numerical values of these variables increased. 相似文献9.
Mahshid Majlessi Koopaeei Marita R. Inglehart Neville McDonald Margherita Fontana 《Journal of the American Dental Association (1939)》2017,148(2):64-74
Background
There is a large variation among clinicians when managing deep carious lesions (DCLs). The purpose of this study was to assess general dentists’ (GDs), pediatric dentists’ (PDs), and endodontists’ (EDs) diagnostic methods, clinical decision-making considerations, treatment strategies, and knowledge, behavior, and attitudes related to the diagnosis and treatment of DCLs.Methods
A total of 175 GDs, 511 PDs, and 377 EDs responded to a nationwide Web-based survey.Results
Most EDs (68%) and GDs (47%) practiced complete caries removal. PDs (31%) were more likely than GDs (12%) and EDs (4%) to remove carious tissues partially. Dentin hardness was the most important diagnostic criterion used during caries excavation (GDs, 90%; PDs, 72%; EDs, 88%). Only 30% of GDs, 17% of PDs, and 90% of EDs used diagnostic tests (for example, a cold test) when assessing pupal health. A substantial percentage of respondents considered endodontic treatment as a choice for treating DCLs in asymptomatic teeth in young patients (GDs, 40%; PDs, 30%; EDs, 40%). GDs rarely used a rubber dam when treating these lesions.Conclusions
Most respondents practiced complete caries removal until hard dentin was felt, using hardness as the primary excavation criterion, and did not use pulp diagnostic tests routinely before making decisions about treatment of teeth with DCLs.Practical Implications
Efforts should be made to translate the growing body of evidence supporting the use of conservative caries removal criteria to preserve pulpal health and tooth structure integrity when managing DCLs. 相似文献10.
Ramon Targino Firmino Fernanda Morais Ferreira Saul Martins Paiva Ana Flávia Granville-Garcia Fabian Calixto Fraiz Carolina Castro Martins 《Journal of the American Dental Association (1939)》2017,148(8):604-613
Background
The authors systematically reviewed the scientific evidence regarding an association between oral health literacy (OHL) and oral conditions.Types of Studies Reviewed
The authors performed an electronic search of 8 databases up through October 2016, as well as a manual search. The authors included studies in which the investigators evaluated oral conditions and measured OHL through a validated tool and studies in which OHL was an explanatory variable. The authors assessed risk of bias by using the Newcastle-Ottawa Scale.Results
The authors included 10 cross-sectional studies. Risk of bias was high in most studies (n = 6). Dental caries and periodontal status were the most common oral conditions reported (each outcome was reported in 5 studies). Investigators in 4 studies found a statistically significant association between dental caries and lower levels of OHL (P < .05), with investigators in 3 of the studies finding this in primary teeth. A reduced number of teeth and loss of attachment were associated with lower levels of OHL (P < .05). Findings for deep periodontal pockets, bleeding on probing, severity of periodontal disease, history of extractions, dental treatment need, and dental plaque were inconclusive. Investigators barely reported other clinical conditions such as temporomandibular joint problems, oral mucosal lesions, enamel opacities, dental fluorosis, and use of and need for dental prostheses.Conclusions and Practical Implications
There seems to be a weak association between lower levels of OHL and dental caries in primary teeth. Similar findings for adults and between OHL and other oral conditions remain unsubstantiated because the results are controversial, with considerable clinical and statistical heterogeneity between studies. 相似文献11.
Introduction
This prospective study evaluated the outcome of Biodentine (Septodont, Saint Maur des Fosses, France) pulpotomy in young permanent teeth with carious exposure.Methods
Twenty permanent molar teeth in 14 patients with carious pulp exposure were treated with Biodentine pulpotomy. The age of the patients ranged from 9–17 years (12.3 ± 2.7 years). A preoperative pulpal and periapical diagnosis was established. After informed consent, the tooth was anesthetized, isolated via a dental dam, and disinfected with 5% sodium hypochlorite before caries excavation. Full pulpotomy was performed by amputating the exposed pulp to the level of the canal orifices, hemostasis was achieved via a cotton pellet moistened with 2.5% sodium hypochlorite, a 3-mm layer of Biodentine was placed as the pulpotomy agent, a Vitrebond liner (3M ESPE, St Paul, MN) was applied, and the tooth was subsequently restored. Postoperative periapical radiographs were taken after placement of the permanent restoration. Clinical and radiographic evaluation was completed after 6 months and 1 year postoperatively. Pain levels were scored preoperatively and 2 days after treatment. Statistical analysis was performed using the Fisher exact test.Results
Clinical signs and symptoms suggestive of irreversible pulpitis were established in all teeth and symptomatic apical periodontitis in 14 of 20 (70%). Two days after treatment, all patients reported complete relief of pain. All teeth were clinically successful at 6 months and 1 year postoperatively. Radiographically, immature roots showed continued root development; dentin bridge formation was detected in 5 of 20 teeth. Seven of 7 teeth with preoperative periapical rarefaction showed signs of healing; 1 tooth had signs of internal root resorption at 1 year with an overall success rate of 95% (19/20).Conclusions
Young permanent teeth with carious exposure can be treated successfully with full pulpotomy using Biodentine, and clinical signs and symptoms of irreversible pulpitis are not a contraindication. 相似文献12.
K. Siva sankar K. Pranitha A.J. Sai Sankar B. Sujatha V. Sai krishna K. Kiran kumar 《Pediatric Dental Journal》2018,28(3):160-164
Background
Remineralizing agents are found to be effective in the remineralization of early enamel caries and the remineralized enamel crystallites are more resistant to decalcification and also have the same orientation as the original enamel crystallites. Although child formula fluoridated dentifrices are used safely by young children their remineralizing capability remains questionable.Aim
To evaluate the remineralizing potential of three commercially available pediatric dentifrices on artificial carious lesions in primary teeth.Materials and methods
A total of fifty sound human primary teeth were coated with nail varnish leaving a window of 2 mm × 4 mm on buccal surface and were subjected to demineralization for a period of 96 h and then sectioned. Out of the hundred sections obtained, ninety sections are equally divided into three groups with thirty in each group: Group I (Colgate Spider man), Group II (Kids bunny), Group III (Kidodent) subjected to remineralization respectively for 10 days using pH cycling model. The sections were then evaluated under the stereomicroscope for the remineralization values using MICAP image analyser software.Results
Statistical analysis was done by using ANOVA test which showed that all the three dentifrices showed remineralization with artificial carious lesions. Among the three test groups, Group I showed higher remineralization potential compared with the other two pediatric dentifrices which was statistically significant (p < 0.05).Conclusion
All the three dentifrices demonstrated remineralization of carious lesions by virtue of decrease in lesion depth. 相似文献13.
Riccardo Nucera Angela Militi Antonino Lo Giudice Vanessa Longo Rosamaria Fastuca Alberto Caprioglio Giancarlo Cordasco Moschos A. Papadopoulos 《Journal of Evidence》2018,18(1):41-58
Objective
To evaluate the skeletal and dental effects of headgear treatment by systematically reviewing the best available scientific evidence.Materials and Methods
A survey of articles published up to February 2017 investigating the effects of headgear in the treatment of patients with class II malocclusion was performed using 19 electronic databases. Only randomized clinical trials and prospective controlled clinical trials investigating growing patients with class II malocclusion treated with headgear were included. Two authors performed independently study selection, data extraction, and risk of bias assessment. All pooled data analyses were performed using the random-effect model. Statistical heterogeneity was evaluated.Results
In total, 6 trials were included (4 randomized clinical trials and 2 prospective controlled clinical trials), grouping data from 337 patients (170 treated patients and 167 untreated controls). The ages of the patients varied across the studies, but the majority of the trials had a sample with an age range between 8 and 9 years. The times of daily wear of the appliance varied across studies from 8 to 14 h/d. The significant mean differences in treatment effects compared with the untreated controls were ?1.41° per year for SNA angle cephalometric parameter (95% confidence interval [CI]: ?2.25° to ?0.56°), ?0.57 mm/y for anterior maxillary displacement (95% CI: ?0.75 to ?0.40 mm), ?1.42° per year for ANB angle cephalometric parameter (95% CI: ?2.12° to ?0.72°), and ?1.31 mm/y for the overjet cephalometric parameter (95% CI: ?2.34 to ?0.29 mm).Conclusion
Headgear treatment is effective in restricting sagittal maxillary growth and reducing the overjet in the short term. 相似文献14.
Micah Chan Tenzin Dadul Robert Langlais David Russell Mansur Ahmad 《Journal of the American Dental Association (1939)》2018,149(1):51-58
Background
Extraoral bite-wing (EB) radiography is an imaging technology used in dentistry. The authors conducted an in vivo study comparing the accuracy of intraoral bitewing (IB) radiographs and EB radiographs for proximal caries and bone loss diagnosis.Methods
The authors recruited 116 patients who received IB radiographs to receive EB radiographs. The 5 calibrated authors made a consensus radiographic diagnosis of proximal caries and crestal bone loss. For this study, they assumed IB radiographs as the criterion standard. Next, they obtained EB radiographs for the 116 patients and calculated sensitivity, specificity, and false-positive rates against each patient’s IB radiograph.Results
The patients’ EB radiographs revealed a significantly greater number of caries and crestal bone loss findings compared with their IB radiographs. The EB radiographs had a high to excellent sensitivity and moderate to low specificity of caries and crestal bone loss findings, respectively. Considering IB radiographs to be the criterion standard, the false-positive rate for EB radiographs was moderate for caries and high for bone loss diagnosis.Conclusions
The EB radiographs, which generate fewer images of overlapping proximal surfaces, have the advantage of detecting more carious lesions and bone loss findings than the IB radiographs do, but with the disadvantage of more false-positive diagnoses. Further research is needed to evaluate if the false-positive findings represent true carious lesions and bone loss.Practical Implications
EB radiography is a promising technology, which has several advantages over traditional IB radiography. Clinicians should be aware of false-positive diagnosis of caries and bone loss with EB radiography. 相似文献15.
Mohammed Nadeem Ahmed Bijle Cynthia Kar Yung Yiu Manikandan Ekambaram 《Journal of Evidence》2018,18(3):203-217.e4
Objective
This article aims to assess systematic reviews and/or meta-analyses on calcium-based caries preventive agents, evaluating reported evidence, thereby summarizing a critical appraisal on the subject.Materials and methods
A systematic search was done using PubMed, Cochrane Library, and Web of Science. Systematic reviews and/or meta-analyses addressing PICO: P: any age or gender; I: calcium-based caries preventive agents; C: with/without control; and O: any early caries lesion measures were included. Inter-reviewer reliability was assessed using Cohen's kappa coefficient.Results
One hundred sixty-four records were identified, of which 10 (κ = 1.00) were included for quality evaluation. Seven reviews were systematic reviews (only), whereas 3 were meta-analyses. None of the articles provided with an “a priori” review design. Majority of the reviews (7 of 10) were of high quality as assessed by Assessing the Methodological Quality of Systematic Reviews, whereas 3 articles were scored as moderate quality of evidence. All the included meta-analyses were of high-quality evidence as assessed by meta-evaluation of meta-analysis: 10 appraisal questions for biologists. Eight reviews addressed the intervention: casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)/casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP). Two reviews were performed on arginine-containing formulations. Majority of the high-quality systematic reviews were inconclusive over the effects of CPP-ACP/CPP-ACFP.Conclusion
This meta-evaluation suggests that CPP-ACP/CPP-ACFP can be considered as an adjunct to fluorides but not as an alternative until long-term well-designed clinical trials assessed by systematic reviews and meta-analysis are available. Arginine-containing dentifrice with an insoluble calcium base and fluoride seem to be a promising agent, but more well-designed non-industry–supported clinical trials can provide better insights in future. 相似文献16.
Shwetha V. Kumar Suhasini Bangar Ana Neumann Krishna Kumar Kookal Alfa Yansane Oluwabunmi Tokede Enihomo Obadan-Udoh Elizabeth Mertz Kristen Simmons Joshua Even Joanna Mullins Joel White Elsbeth Kalenderian Muhammad Walji 《Journal of the American Dental Association (1939)》2018,149(9):756-764.e1
Background
Although sealants are highly effective in preventing caries in children, placement rates continue to be low. The authors’ goals were to implement and assess the performance of 2 existing sealant quality measures against a manual audit of charts at 4 dental institutions and to identify measurement gaps that may be filled by using data from electronic health records.Methods
The authors evaluated the performance of 2 quality measures designed for claims-based data: the Dental Quality Alliance (DQA) sealant measure, which includes patients at risk of developing elevated caries, and the Oregon Health Authority (OHA) sealant measure (irrespective of caries risk). The authors adapted and validated these measures at 4 sites: 3 dental schools and 1 large dental accountable care organization.Results
The overall modified DQA and modified OHA measure scores in the 6- through 9-year-old age group were 37.0% and 31.6% and in the 10- through 14-year-old age group were 15.8% and 6.6%, respectively. Results from the manual review of charts showed that 67.6% of children who did not receive sealants did not have any teeth to seal because their molars had not yet erupted, had been extracted, had been sealed previously, or had existing caries or restorations.Conclusions
Both the DQA and OHA measures, which rely mainly on Current Dental Terminology procedure codes, led to underestimation of the care delivered from a practice perspective. Future sealant quality measures should exclude patients whose teeth cannot be sealed.Practical Implications
This study’s results support the suitability of using electronic health record data for assessing the quality of oral health care, particularly for measuring sealant placement in children. 相似文献17.
Maria Auxiliadora Pereira Reginaldo Batista dos Santos-Júnior Johnny Alexandre Tavares Alaíde Hermínia Oliveira Pollyana Caldeira Leal Wilton Mitsunari Takeshita Antônio Márcio Barbosa-Júnior Luiz Eduardo Braga Bertassoni André Luis Faria-e-Silva 《Journal of the American Dental Association (1939)》2017,148(6):369-376
Background
Clinicians often use calcium hydroxide liners during stepwise treatment of advanced caries. In this randomized clinical trial, the authors compared the short-term outcome of stepwise caries removal with and without use of a calcium hydroxide liner in conjunction with provisional resin-modified glass ionomer (RMGI) restorations.Methods
The authors included in the trial 98 patients aged 15 to 30 years who had a deep carious lesion in a posterior tooth. The authors measured the dentin thickness radiographically and recorded its color, consistency, and moisture, as well as the bacterial count of the lesions. After partial caries removal, the authors assigned patients randomly to have their caries provisionally restored using RMGI with (control group) or without (test group) a calcium hydroxide liner. The primary outcome measure was tooth vitality after 90 days. Secondary outcomes included changes in dentinal, radiographic, and microbiological characteristics of the lesions.Results
The authors found no statistically significant difference between the test and control groups in tooth vitality after 90 days. Irrespective of calcium hydroxide liner use, the authors observed darker, harder, drier, and less contaminated dentin after the provisional restorations, but dentin thickness remained unchanged.Conclusions
On the basis of this 3-month clinical trial’s results, the use of a calcium hydroxide liner during stepwise caries excavation and provisional restoration did not provide any additional benefit.Practical Implications
After 3 months, using a calcium hydroxide liner does not appear to offer any additional benefit when clinicians use RMGI provisional restorations during stepwise caries removal. Longer studies are needed to confirm these results. 相似文献18.
Sonia K. Makhija James D. Bader Daniel A. Shugars Mark S. Litaker Sanket Nagarkar Valeria V. Gordan D. Brad Rindal Daniel J. Pihlstrom Rahma Mungia Cyril Meyerowitz Gregg H. Gilbert 《Journal of the American Dental Association (1939)》2018,149(4):299-307.e1
Background
A suspicious occlusal carious lesion (SOCL) can be defined as a lesion with no cavitation and no radiographic radiolucency but for which caries is suspected. The authors evaluated whether using a device changed the percentage of SOCLs that were opened surgically and, among those SOCLs that were opened, the proportion that had penetrated into dentin.Methods
Eighty-two dentists participated. In phase 1 of the study, dentists identified approximately 20 SOCLs, obtained patient consent, and recorded information about the lesion, treatment or treatments, and depth, if opened. Dentists were then randomly assigned into 1 of 3 groups: no device, DIAGNOdent (KaVo), and Spectra (Air Techniques). In phase 2, dentists enrolled approximately 20 additional patients and recorded the same phase 1 information while using the assigned device to help make their treatment decisions. A mixed-model logistic regression was used to determine any differences after randomization in the proportion of lesions opened and, if opened, the proportion of lesions that penetrated into dentin.Results
A total of 1,500 SOCLs were enrolled in each phase. No statistically significant difference was found in the change in proportion of lesions receiving invasive treatment from phase 1 to phase 2 across the 3 groups (P = .33) or in the change in proportion of percentage of opened lesions that extended into dentin (P = .31).Conclusion
Caries-detecting devices in the study did not change substantially dentists’ decisions to intervene or the accuracy of the intervention decision in predicting lesion penetration into dentin.Practical Implications
The caries-detecting devices tested may not improve dentists’ clinical decision making for SOCLs. 相似文献19.
Lydie A. Lebrun-Harris María Teresa Canto Pamella Vodicka 《Journal of the American Dental Association (1939)》2019,150(4):246-258
Background
Research has identified significant gaps in preventive oral health care among certain subpopulations of US children. The authors of this study sought to estimate children’s preventive oral health care use and oral health and investigate associations with child, family, and health care characteristics.Methods
Data for this observational, cross-sectional study came from the 2016 National Survey of Children’s Health. Children aged 2 through 17 years were included (n = 46,100). Caregiver-reported measures were preventive dental visits, prophylaxis, toothbrushing or oral health care instructions, fluoride, sealants, fair or poor condition of the teeth, and problems with carious teeth or caries. Univariate, bivariate, and multivariable logistic regression analyses were conducted.Results
As reported by parents or caregivers, 8 in 10 children had a preventive dental visit in the past year but lower rates of specific services: 75% prophylaxis, 46% fluoride, 44% instructions, and 21% sealants. In addition, 12% had carious teeth or caries and 6% had fair or poor condition of the teeth. In adjusted analyses, young children (aged 2-5 years), children with no health insurance, and those from lower-income and lower-educated households had decreased likelihood of a preventive dental visit as well as specific preventive services. Children with preventive health care visits and a personal physician or nurse had increased likelihood of receiving preventive oral health care.Conclusions
Preventive oral health services are lagging among young children and children from lower socioeconomic backgrounds. Further studies are needed to identify interventions that encourage use of specific preventive services.Practical Implications
Dentists should work with caregivers and primary care providers to promote preventive oral health care, especially among young children and those from lower socioeconomic backgrounds. 相似文献20.
Jacqueline M. Burgette John S. Preisser R. Gary Rozier 《Journal of the American Dental Association (1939)》2018,149(12):1024-1031.e2