Anti-caries effect of fluoridated milk-based drink consumed by older adults on an in vitro root caries experimental model.

OBJECTIVE: This study aimed to evaluate the anti-caries effect of a fluoridated milk-based drink on a root caries model by assessing mineral loss and both biofilm microbial viability and acidogenicity under increasing concentrations of fluoride supplementation. DESIGN: Streptococcus mutans UA159 biofilms were grown on root dentin slabs for five days. The slabs were randomly assigned to following groups: milk-based drink (G1) and milk-based drink supplemented with 5-ppm NaF (G2), 10 ppm NaF (G3), and 20 ppm NaF (G4). A 10% sucrose and 0.9% NaCl solution were used as positive and negative-caries controls, respectively. Slabs/biofilms were exposed to the different treatments 3 times/day for 5 min. To estimate biofilm acidogenicity, the pH of the spent media was serially measured to calculate the area above the curve. Viable bacteria and dentin demineralization were assessed after the experimental phase. Results were compared using ANOVA followed by the Tukey test. RESULTS: G1 exhibited slightly lower acidogenicity than the positive caries control group (p < 0.05). G2, G3, and G4 induced lower acidogenicity than 10% sucrose and the non-supplemented milk-based drink. The lowest acidogenicity was found in G4 (p < 0.05). Fluoride-supplemented milk-based drinks (G2, G3, and G4) resulted in lower bacterial counts (p < 0.05) and induced lower demineralization (p < 0.05) than the positive caries control and non-supplemented milk-beverage (G1). There was a dose-dependent inhibition of demineralization with fluoride-supplemented milk-based drinks. CONCLUSIONS: Fluoride supplementation of a milk-based drink for older adults may reduce its cariogenicity in root dentin.

Radiographic pattern of underlying dentin lesions (ICDAS 4) in permanent teeth.

OBJECTIVE: To assess the radiographic pattern of underlying dentine shadows (UDS) in the occlusal surfaces of permanent teeth. METHODS: A total of 282 permanent posterior teeth pertaining to 91 individuals, 142 UDS and 140 non-cavitated enamel lesions (NCEL), were included for comparison. UDS was defined as shadows of discolored dentin visible through the enamel surface which may or may not show signs of localized enamel breakdown, classified as code 4 by the International Caries Detection and Assessment System group. Data collection included the application of a questionnaire, clinical examination, and bilateral bitewing radiographs. The risk for presenting radiolucency was estimated using logistic regression model with generalized estimating equations. RESULTS: Approximately 79% of UDS exhibited no radiolucency. The proportion of teeth exhibiting a radiolucency restricted to the enamel-dentin junction was 20.4% for UDS and 3.6% for NCEL (p < 0.001, chi-square test). UDS had a sixfold increased risk for exhibiting radiolucency compared with NCEL (OR = 5.78, 95% CI = 2.73-12.22, p < 0.001). Despite this finding, it is important to highlight that virtually all cases were located at the enamel-dentin junction, and only one tooth in each category of clinical status exhibited radiolucency at the outer one half of dentin. No tooth exhibited radiolucency reaching the deep dentin. CONCLUSION: The present study showed that UDS presented radiolucency in very few cases. The vast majority of lesions showed no radiolucency. CLINICAL RELEVANCE: Our findings suggest that only a small proportion of UDS would demand restorative treatment.

Long-term follow-up of inactive occlusal caries lesions: 4-5-year results.

OBJECTIVE: To assess the clinical behavior of inactive caries lesion on the occlusal sites of permanent molars over 4-5 years and to estimate the risk for progression of caries-inactive sites compared with sound ones. METHODS: Clinical examinations were conducted at baseline (n = 258) and after 4-5 years and included the recording of dental plaque and dental caries at the occlusal surfaces and the eruption stage of each permanent molar. RESULTS: One hudred ninety-three schoolchildren were followed (response rate of 74.8%), totalizing 1152 teeth. Of the children, 30.6% (n = 59) presented at least one molar containing an active lesion, filling, or that had been extracted; according to the activity criterion, inactive lesions presented around a twofold increased risk for caries progression than sound surfaces (OR = 2.34 95%CI = 1.51-3.62). Thirteen percent (n = 25) of the children presented at least one molar progressing to dentine cavity, filling, or extraction; according to the severity criterion, inactive caries lesions presented a significantly higher risk for progression when compared with sound surfaces (OR = 2.69, 95% CI = 1.50-4.83). CONCLUSION: The vast majority of lesions (85-90%) identified as inactive enamel caries at baseline did not progress over 4-5 years. Despite this fact, it was possible to detect an increased risk for caries progression in caries-inactive occlusal sites compared with the sound ones. CLINICAL RELEVANCE: Considering the low progression rates, inactive caries lesions do not need a specific caries-controlling treatment and should be monitored longitudinally in the same manner as sound surfaces.

Partial caries removal in deep caries lesions: a 5-year multicenter randomized controlled trial.

OBJECTIVE: This multicenter randomized controlled clinical trial aimed to compare the outcomes of stepwise excavation (SW) and partial caries removal (PCR) regarding the maintenance of pulp vitality in deep caries lesions over 5 years. METHODS: At baseline, 299 permanent molars with deep caries lesions were randomly assigned to control or test groups. The control group received the stepwise excavation treatment (SW), while the test group received partial caries removal from the pulpal wall followed by restoration in a single session (PCR). Treatments were conducted in two centers located in the cities of Porto Alegre (South Brazil) and Brasília (Midwest Brazil). Survival analysis was performed to compare PCR and SW over time (Weibull regression models). The primary outcome of this study was pulp vitality, determined by the combination of the following characteristics: positive response to cold test, negative response to percussion, absence of spontaneous pain, and absence of periapical lesion (radiographic examination). RESULTS: This 5-year study includes data pertaining to 229 teeth: 121 teeth actually examined at the 5-year appointment, and 108 teeth contributed with data collected in previous follow-ups (18 months or 3 years). Survival analysis showed success rates of 80% in PCR group and 56% in SW group (p < 0.001). Failure was significantly associated with treatment [PCR, HR=0.38; 95%CI=0.23-0.63)] and region [South, HR=2.22; 95%CI=1.21-4.08]. CONCLUSION: PCR significantly reduced the occurrence of pulp necrosis when compared with SW. CLINICAL RELEVANCE: This study supports the PCR as a single-visit technique to manage deep caries lesions in permanent teeth.

Dental erosion among South Brazilian adolescents: A 2.5-year longitudinal study.

OBJECTIVES: This population-based longitudinal study investigated the incidence, progression and risk factors for dental erosion among South Brazilian adolescents. METHODS: Eight hundred and one schoolchildren attending 42 public and private schools were clinically examined at 12 years of age; clinical examinations were repeated after 2.5 years (SD=0.3). After tooth cleaning and drying, permanent incisors and first molars were classified using the Basic Erosive Wear Examination (BEWE) scoring criteria. Questionnaires were used to collect data on socio-demographic characteristics, dietary habits, toothbrushing frequency and general health. Poisson regression analysis was used to assess the association between dental erosion incidence and explanatory variables, with adjusted incidence risk ratios (IRR) and 95% CI estimated. RESULTS: Among those who did not have dental erosion at baseline, 49 of 680 schoolchildren (7.1%; 95% CI=5.2-9.1) developed erosive lesions over the follow-up period. Among schoolchildren who had dental erosion at baseline, 31 of 121 (25.4%; 95% CI=17.6-33.3) had new or more severe lesions. Boys were more likely to develop dental erosion than girls (IRR=1.88; 95% CI=1.06-3.32). CONCLUSIONS: A moderate incidence of dental erosion was observed among South Brazilian adolescents, with boys being at higher risk. The high progression rate of 25% observed here is very concerning, and it should be taken in consideration when designing preventive strategies for dental erosion.

Dental caries, fluorosis, oral health determinants, and quality of life in adolescents.

OBJECTIVE: This study aimed to assess the extent to which dental caries and fluorosis, in addition to sociodemographic and oral health behavior determinants, impact the oral health-related quality of life (OHRQoL) of adolescents. METHODS: All adolescents attending from sixth to eighth grades in the Region of Itapoã, Federal District of Brazil (n = 1122), were screened, and 618 10-15-year-olds were selected. Parents answered a questionnaire about their family's socioeconomic status. Adolescents answered a questionnaire about demographic and oral health behavior determinants in addition to the Child Perception Questionnaire. RESULTS: Cavitated dentine lesions and fluorosis were observed in 39.5 and 48.5 %, respectively. The outcome was a high score on OHRQoL (median split >9). The prevalence of adolescents with at least one domain being impacted "often" or "every day/almost every day" was 34.8 %. Adolescents with tooth brushing frequency ≤once per day and with moderate or severe cavitated dentine lesions reported a significant impact on their OHRQoL (p = 0.002; p = 0.001). Fluorosis did not impact daily life performances (p = 0.545). CONCLUSION: Increased impact on OHRQoL was related to the severity of cavitated dentine lesions, but fluorosis resulting from combined fluoride exposure from early ages was not of concern for the adolescents. CLINICAL RELEVANCE: Combined fluoride exposure from fluoridated drinking water, consumption of food prepared with fluoridated water, and daily twice brushing with conventional fluoride toothpaste from early ages may be recommended to control caries progression at population level without impact on OHRQoL. This information is particularly relevant for supporting oral health police for disadvantaged populations.

Comparative effectiveness of water and salt community-based fluoridation methods in preventing dental caries among schoolchildren.

OBJECTIVE: To compare the effectiveness of water and salt community-based fluoridation methods on caries experience among schoolchildren. METHODS: Data derived from two population-based oral health surveys of 12-year-old schoolchildren exposed to different community-based fluoridation methods were compared: artificially fluoridated water in Porto Alegre, South Brazil and artificially fluoridated salt in Montevideo, Uruguay. Data on socio-demographic characteristics, maternal education and oral hygiene were collected. Dental caries was defined according to the WHO criteria (cavitated lesions) and to the modified WHO criteria (active noncavitated lesions and cavitated ones). The association between community-based fluoridation methods and dental caries was modelled using logistic (caries prevalence) and Poisson regression (DMFT). Odds ratios (OR), rate ratios (RR), and the 95% confidence intervals (CI) were estimated. RESULTS: A total of 1528 in Porto Alegre and 1154 in Montevideo were examined (response rates: 83.2% and 69.6%, respectively). Adjusted estimates for caries prevalence and DMFT showed that schoolchildren from Porto Alegre were less affected by dental caries than their counterparts from Montevideo, irrespective of the criteria used. After adjusting for important characteristics, schoolchildren exposed to fluoridated salt had significantly higher likelihood of having caries (WHO criteria) than those exposed to fluoridated water (OR for prevalence=1.61, 95% CI=1.26-2.07; RR for DMFT=1.32, 95% CI=1.16-1.51). Similar differences were observed using the modified WHO criteria. CONCLUSION: Fluoridated water appears to provide a better protective effect against dental caries than fluoridated household salt among schoolchildren from developing countries.

Managing Carious Lesions: Consensus Recommendations on Terminology.

Variation in the terminology used to describe clinical management of carious lesions has contributed to a lack of clarity in the scientific literature and beyond. In this article, the International Caries Consensus Collaboration presents 1) issues around terminology, a scoping review of current words used in the literature for caries removal techniques, and 2) agreed terms and definitions, explaining how these were decided.Dental cariesis the name of the disease, and thecarious lesionis the consequence and manifestation of the disease-the signs or symptoms of the disease. The termdental caries managementshould be limited to situations involving control of the disease through preventive and noninvasive means at a patient level, whereascarious lesion managementcontrols the disease symptoms at the tooth level. While it is not possible to directly relate the visual appearance of carious lesions' clinical manifestations to the histopathology, we have based the terminology around the clinical consequences of disease (soft, leathery, firm, and hard dentine). Approaches to carious tissue removal are defined: 1)selective removal of carious tissue-includingselective removal to soft dentineandselective removal to firm dentine; 2)stepwise removal-including stage 1,selective removal to soft dentine, and stage 2,selective removal to firm dentine6 to 12 mo later; and 3)nonselective removal to hard dentine-formerly known ascomplete caries removal(technique no longer recommended). Adoption of these terms, around managing dental caries and its sequelae, will facilitate improved understanding and communication among researchers and within dental educators and the wider clinical dentistry community.

Managing Carious Lesions: Consensus Recommendations on Carious Tissue Removal.

The International Caries Consensus Collaboration undertook a consensus process and here presents clinical recommendations for carious tissue removal and managing cavitated carious lesions, including restoration, based on texture of demineralized dentine. Dentists should manage the disease dental caries and control activity of existing cavitated lesions to preserve hard tissues and retain teeth long-term. Entering the restorative cycle should be avoided as far as possible. Controlling the disease in cavitated carious lesions should be attempted using methods which are aimed at biofilm removal or control first. Only when cavitated carious lesions either are noncleansable or can no longer be sealed are restorative interventions indicated. When a restoration is indicated, the priorities are as follows: preserving healthy and remineralizable tissue, achieving a restorative seal, maintaining pulpal health, and maximizing restoration success. Carious tissue is removed purely to create conditions for long-lasting restorations. Bacterially contaminated or demineralized tissues close to the pulp do not need to be removed. In deeper lesions in teeth with sensible (vital) pulps, preserving pulpal health should be prioritized, while in shallow or moderately deep lesions, restoration longevity becomes more important. For teeth with shallow or moderately deep cavitated lesions, carious tissue removal is performed according toselective removal to firm dentine.In deep cavitated lesions in primary or permanent teeth,selective removal to soft dentineshould be performed, although in permanent teeth,stepwise removalis an option. The evidence and, therefore, these recommendations support less invasive carious lesion management, delaying entry to, and slowing down, the restorative cycle by preserving tooth tissue and retaining teeth long-term.

Restorative materials containing antimicrobial agents: is there evidence for their antimicrobial and anticaries effects? A systematic review.

The aim of this systematic literature review was to investigate whether the incorporation of antimicrobial agents into dental restorative materials truly exerts an antimicrobial effect against common cariogenic bacteria (primary outcome), and whether the inclusion of antimicrobial agents is able to prevent caries around restorations (secondary outcome). MEDLINE, via PubMed, was searched for papers published between 1980 and 30 November 2014. A total of 1126 articles were retrieved. After inclusion/exclusion assessment, 147 full text articles were read and included in the review, comprising 130 in vitro, 1 in situ, and 4 in vivo studies, as well as 12 literature reviews. In about 78% of in vitro studies, and in all identified in situ and in vivo studies, a positive antimicrobial effect had been found. However, the anticaries effect had not been tested in any of the selected studies. It was concluded that there is indeed evidence that restorative dental materials containing antimicrobial agents exert an antimicrobial effect, both in laboratory and in clinical studies. However, no evidence has been found regarding the role of these agents in preventing or controlling dental caries, or in preventing caries around restorations.

One-year evaluation of inactive occlusal enamel lesions in children and adolescents.

OBJECTIVES: The aims of this study were to compare caries incidence and progression on sound occlusal surfaces and on surfaces presenting inactive enamel lesions in children and adolescents over 1 year and to estimate the risk of caries incidence and progression on these surfaces. METHODS: This prospective cohort study followed 200 7-15-year-old caries-inactive schoolchildren over 1 year. Stage of eruption, occlusal plaque, and occlusal caries were recorded on permanent molars. Statistical analysis was performed using generalized estimating equations with a logistic link function. RESULTS: Twenty-two children (11 %) presented "caries progression" (at least one active lesion on molar teeth). At site level, no difference was observed in caries incidence and progression between sites classified either sound (2.6 %) or with inactive enamel lesion (3.9 %) at the baseline examination (χ (2) test, p = 0.48). Adjusted for plaque, stage of eruption, type of molar and dental arch, inactive enamel lesions presented a similar risk for caries progression than sound occlusal surfaces (OR = 0.98, 95 % CI = 0.40-2.38). CONCLUSION: Within the limitations of this study, no difference was observed in caries incidence, progression, and risk on sound occlusal sites in comparison with sites presenting inactive enamel lesions. CLINICAL RELEVANCE: Occlusal surfaces harboring inactive caries lesions did not require additional attention than the one normally given to sound occlusal surfaces over a 1-year period.

Association between two visual criteria in assessing non-cavitated caries lesion activity on occlusal surfaces of permanent molars.

OBJECTIVE: This study aimed to evaluate the association between two visual criteria in assessing non-cavitated caries lesion activity on occlusal surfaces of permanent molars. MATERIALS AND METHODS: Thirty-nine patients with at least one permanent molar with non-cavitated caries lesion on the occlusal surface were selected. Molars were assessed according to their activity status following two criteria: ICDAS-LAA and a qualitative criterion based on clinical characteristics. RESULTS: The results showed that the LAA criterion seems to overestimate caries activity. A weak association between both criteria in assessing caries lesion activity and low specificity for ICDAS-LAA was observed. CONCLUSIONS: The ICDAS-LAA criterion is not suitable to assess non-cavitated caries lesion activity on occlusal surfaces of permanent molars because it assesses the lesions to be active more frequently than the qualitative criterion. CLINICAL RELEVANCE: The determination of caries lesion activity is a key decision point in the treatment of caries disease. This study discusses the best option to assess the activity of non-cavitated occlusal caries lesions.

Eruption stage of permanent molars and occlusal caries activity/arrest.

This study assessed the association between the eruption stage of permanent second molars and occlusal caries activity among 12-year-old schoolchildren from South Brazil. A cross-sectional study was performed in Porto Alegre using a multistage probability sampling strategy to select a representative sample. Clinical examination was conducted to assess the eruption stage of permanent molars, Gingival Bleeding Index, and, after tooth cleaning and drying, caries experience (noncavitated and cavitated lesions, including caries activity assessment). Data were collected on sex, socioeconomic status, mother's education, brushing frequency, and consumption of soft drinks. Generalized estimating equations were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Overall, 983 schoolchildren with 3,071 second molars were available for analysis. Whereas active caries was observed in 6.6% of fully erupted permanent second molars, caries affected 26.2%, 29.6%, and 18.2% of erupting molars classified as stages 1, 2, and 3, respectively: stage 1, partially erupted occlusal surface; stage 2, fully erupted occlusal surface, <1/2 crown exposed; and stage 3, fully erupted occlusal surface, >1/2 crown exposed. After adjusting for socioeconomic and behavioral variables, partially erupted molars were significantly more likely to present active caries lesions than molars in full occlusion: stage 1, OR = 4.99 (95% CI = 3.38, 7.38); stage 2, OR = 5.18 (95% CI = 3.14, 8.53); stage 3, OR = 3.20 (95% CI = 2.21, 4.64). Similar results were found when clinical variables were included in the adjusted model. In conclusion, most occlusal caries lesions tend to arrest/revert when teeth reach the occlusal plan; however, an important proportion of these lesions remains active and in need of proper management. Children at risk should be targeted with preventive and minimally invasive strategies.

Tooth loss prevalence and risk indicators among 12-year-old schoolchildren from South Brazil.

This population-based cross-sectional study aimed to assess the prevalence and risk indicators for tooth loss due to dental caries among 12-year-old schoolchildren from South Brazil. 1,528 out of 1,837 (participation rate = 83.17%) schoolchildren were included. Tooth loss prevalence was 5.81% (95% CI = 3.71-8.98) and 0.08 (95% CI = 0.04-0.12) teeth were missing. Schoolchildren with low socioeconomic status (OR = 2.28, 95% CI = 1.23-4.21), who repeated years in school (OR = 1.56, 95% CI = 1.01-2.42), and with gingivitis (OR = 1.81, 95% CI = 1.33-2.45) were more likely to have missing teeth. Schoolchildren brushing 2 times/day (OR = 0.78, 95% CI = 0.64-0.96) or more (OR = 0.49, 95% CI = 0.33-0.74), and those with dental insurance or private dentists (OR = 0.60, 95% CI = 0.39-0.93) were less likely to present missing teeth. © 2014 S. Karger AG, Basel.

Clinical and radiographic diagnosis of underlying dark shadow from dentin (ICDAS 4) in permanent molars.

This study investigated the radiographic pattern of underlying dark shadow from dentin (ICDAS 4) in permanent molars and assessed the association between enamel breakdown and radiographic features. Ninety-five teeth (54 patients) were clinically and radiographically assessed. The majority of ICDAS 4 caries lesions presented enamel breakdown (n = 78, 82.1%) and no radiographic image (n = 64, 67.4%) or a radiolucent zone restricted to the enamel-dentin junction (n = 17, 17.9%). No association was found between enamel breakdown and radiographic features. This study suggests that a radiographic examination is needed prior to the decision making process for underlying dark shadows from dentin.

Clinical and ultrastructural effects of different liners/restorative materials on deep carious dentin: a randomized clinical trial.

We evaluated the effect of calcium hydroxide cement (CHC) and glass ionomer cement (GIC) on carious dentin and bacterial infections after partial caries removal and sealing. Sixty permanent teeth with deep lesions underwent partial caries removal, the application of CHC, GIC or wax, i.e. negative control (NC), and were then sealed for 3-4 months. After the partial caries removal and the sealing period, the dentin was clinically assessed (colour and consistency) and analysed by scanning electron microscopy to assess dentin organization and bacterial infections. The effect of the treatment in each group was assessed by the Wilcoxon and χ2 tests, differences among groups by the Kruskal-Wallis test and the correlations between variables by Spearman correlation. No clinical symptoms or radiographic signals of pulpits or pulp necrosis were observed during the study. Dentin darkening was observed after the sealing period in the CHC and NC groups (p < 0.05). However, there was no difference in the colour after treatment among the 3 groups (p > 0.05). Dentin hardening occurred in all groups after treatment (p < 0.05), also with no differences (p > 0.05). Dentin samples showed better organization after the sealing period than after partial caries removal, with total or partial obliteration of dentinal tubules (CHC p < 0.03, GIC p < 0.05, NC p < 0.01) and a reduction of bacterial infections (CHC p < 0.03, GIC p < 0.05, NC p < 0.03). No differences were observed. Correlations between the different criteria, except for colour and bacterial infection, were detected in all cases. Partial caries removal and sealing resulted in dentin hardening, decreased bacterial numbers and dentin reorganization, irrespective of the dentin protection used.

Partial removal of carious dentine: a multicenter randomized controlled trial and 18-month follow-up results.

AIM: The aim of this study was to evaluate the effectiveness of partial removal of carious dentine and restoration in a single session (PDR) and stepwise excavation (SW), both of which are treatments for deep carious lesions, in Public Health Services in Brazil. INCLUSION CRITERIA: patients ≥6 years old, permanent molars with deep caries lesions (having a radiolucency halfway or more into dentine) and pulp vitality but absence of spontaneous pain, positive percussion test, and periapical alterations. The subjects received either PDR (test group) or SW (control group). The radiological and clinical exams were performed after a mean time of 18 months. OUTCOMES: success was defined as pulp sensitivity to cold test and absence of periapical alterations. RESULTS: Of the 299 treatments performed, 146 were SW and 153 were PDR; 122 were amalgam restorations and 168 resin-composite restorations. There were no differences between the groups regarding the baseline characteristics (i.e. age, gender and family income). After 18 months, 212 evaluations were performed, which indicated 99 and 86% success rates in the PDR and SW groups, respectively (p = 0.016). Reasons for failure were: PDR - 1 pulpitis; SW - 8 pulpitis; 1 osteitis; 4 necrosis; 1 endodontic treatment. None of the baseline variables were significantly associated with the outcomes. CONCLUSION: The retention of carious dentine does not interfere in pulp vitality. Data from this 18-month study suggest that the procedure of reopening the cavity to remove the residual infected dentine is not necessary.

Influence of eruption stage and biofilm accumulation on occlusal caries in permanent molars: a generalized estimating equations logistic approach.

The aim of this study was to estimate the independent effects of biofilm accumulation and eruption stage on the occurrence of active caries lesions on occlusal surfaces of permanent molars. The sample consisted of 298 schoolchildren (6-15 years) who were examined by a calibrated examiner at a dental unit, using artificial light, a dental mirror and a WHO probe. The occurrence of visible biofilm on occlusal surfaces and the eruption stage of each permanent molar were recorded. After professional prophylaxis and air drying, the occlusal surfaces were classified as sound, caries-inactive or caries-active. To evaluate the association of eruption stage and biofilm accumulation with active caries lesions, a logistic regression model was used. Since data were clustered, odds ratios were obtained using generalized estimating equations with a logistic link function. 1,779 permanent molars were examined. All eruption stages were associated with active caries lesions. After adjustment for biofilm accumulation and type of molar, molars with occlusal surfaces partially exposed to the oral cavity were 63.6 times more susceptible to caries activity than molars with full occlusion (95% CI = 22.0-183.7). After adjustment for eruption stage and type of molar, teeth with a high degree of biofilm accumulation were 14.5 times more susceptible to caries activity than those without visible biofilm accumulation (95% CI = 6.5-32.4). No association between active caries and hardly detectable biofilm was found in this population. The present study found that the eruption stage of permanent molars is strongly associated with active caries lesions, adjusted for biofilm accumulation and type of molar.

Randomized trial of partial vs. stepwise caries removal: 3-year follow-up.

This randomized, multicenter clinical trial evaluated the effectiveness of 2 treatments for deep caries lesions - partial caries removal (PCR) and stepwise excavation (SW) - with respect to the primary outcome of pulp vitality for a 3-year follow-up period. Inclusion criteria were as follows: patients with permanent molars presenting deep caries lesions (lesion affecting ≥ 1/2 of the dentin on radiographic examination), positive response to a cold test, absence of spontaneous pain, negative sensitivity to percussion, and absence of periapical lesions (radiographic examination). Teeth randomly assigned to PCR (test) received incomplete caries removal and filling in a single session. Outcome success was evaluated by assessment of pulp vitality, determined by pulp sensitivity to a cold test and the absence of periapical lesions. Data were analyzed by a Weibull regression model with shared frailty term (survival analysis). At baseline, 299 treatments were executed: PCR, 152 and SW, 147. By the end of the 3-year follow-up period, 213 teeth had been evaluated. Adjusted survival rates were 91% for PCR and 69% for SW (p = 0.004). These results suggest that there is no need to re-open a cavity and perform a second excavation for pulp vitality to be preserved (Clinical trials registration NCT00887952).

Multidisciplinary research agenda for novel antimicrobial agents for caries prevention and treatment.

Antimicrobial methods to augment fluoride-mediated caries inhibition are necessary. Several methods are described here, but none was considered likely to be as effective as fluoride usage. None had been tested in effective models to demonstrate their ability to act either additively or synergistically with fluoride-containing toothpastes. Dental caries is a biofilm-mediated disease: The composition of the biofilm associated with caries initiation and progression is diverse. Caries-associated taxa - including mutans streptococci, lactobacilli, bifidobacteria, and yeasts - may be useful surrogate markers for in vivo investigations. In vitro testing should progress from single-species planktonic cells to multi-species biofilms prior to essential testing in randomized control trials (RCTs). Modern high-throughput sequencing techniques need to be applied to the study of bacterial acquisition from birth and of the composition of the biofilm associated with the formation of white-spot lesions. The determination of the functions of the biofilm and the phenotype of the bacterial components may be determined by RNA-seq techniques, since they must be conserved between caries lesions and will include the ability to produce acids and survive and proliferate in acidic conditions. The application of such methods will significantly improve our understanding of the etiology and progression of dental caries.