Is there an association between maternal factors and the development of early childhood caries?

OBJECTIVE: To assess the possible associations between the following characteristics/behavior of the mother: oral health, oral hygiene, smoking habits, diet, food insecurity, stress, employment, marital status, household income and size and insurance status, with the development of dental caries in their children up to 3 years old. METHODS: Pregnant women aged 18 years or more who delivered at term and whose children had regular dental check-ups were enrolled in a longitudinal study. Oral health status of participants was assessed at enrollment, 2 months and annually thereafter. Sociodemographic characteristics and mothers' behaviors were collected through face-to-face and telephone interviews. RESULTS: By the three-year visit, 6% of the children had 1 or more cavitated dentine caries lesions. Maternal education and state of residence increased the chances of the child presenting with a caries lesion by the age of three, in addition to influencing the magnitude of the associations detected with other variables. Mothers' prior pregnancies, maternal cigarette smoking, household income and untreated dental decay were also significantly related to childhood caries. CONCLUSIONS: Sociodemographic variables were shown to have an important influence on the development of early childhood caries, highlighting the need of addressing structural problems that limit the availability of dental care and healthy foods.

The effect of silver diamine fluoride and cleaning methods on bond strength of glass-ionomer cements to caries-affected dentin.

PURPOSE: To evaluate the effect of silver diamine fluoride (SDF) application on the microshear bond strength (MBS) of glass-ionomer cements (GIC) to caries-affected dentin (Part 1) and dentin cleaning methods to reduce SDF's potential effect on MBS (Part 2). METHODS: For Part 1, 56 extracted human teeth were randomly divided into eight groups with GIC, 38% SDF application and dentin substrate. Samples of artificial caries-affected human dentin were treated or not with 38% SDF and restored with conventional or resin-modified GIC. The same procedures were performed in sound dentin tested for MBS test after 24 hours. In Part 2, different dentin cleaning agents (water, aluminum oxide, and pumice slurry) were tested after SDF application. The procedure was performed on the group that presented the worst values for MBS in Part 1. Fracture mode was evaluated under scanning electron microscope. Data were statistically analyzed by ANOVA. RESULTS: MBS was affected by the presence of caries and the type of material, with the conventional GIC the most affected (P< 0.05). Pumice slurry was superior in comparison to the other agents in cleaning SDF-treated dentin. Fracture evaluation showed more mixed failures in all the groups. CLINICAL SIGNIFICANCE: Clinicians should have caution when selecting the glass-ionomer cement (GIC) for restorations in silver diamine fluoride (SDF)-treated dentin. The mechanical properties of conventional GIC restorations were more affected than resin-modified GICs. Pumice slurry was the most effective cleaning method to minimize the negative effect of SDF on dentin.

Are standardised caries risk assessment models effective?

Data sourcesPubMed, Scopus and Embase were searched from 2000 to 2016.Study selectionA search strategy was developed to identify randomised clinical trials, cross-sectional studies, cohort studies, comparative studies, validation studies and evaluation studies that tested standardised caries risk assessment (CRA) models. There was no restriction with respect to patients' age, but caries data should have been recorded using the Decayed, Missing, Filled Tooth/Surface (DMFT/S) or the International Caries Detection and Assessment System (ICDAS) indices.Data extraction and synthesisTwo authors independently assessed the papers for inclusion, carried out data extraction and the papers' methodological quality using a customised quality assessment tool developed by the National Heart, Lung and Blood Institute and Research Triangle Institute International for Observational Cohort and Cross-Sectional Studies. For comparison between studies, the caries values were organised in two-by-two tables from which sensitivity, specificity values and their 95% confidence intervals were calculated.ResultsA total of 1239 papers were retrieved of which 32 were included. The most frequent CRA model investigated was the Cariogram. Sixteen studies were carried out on children and 12 on adults. The results showed an association between the risk determined by the model and the actual caries status and/or the development of new carious lesions, this association being statistically significant. With respect to the quality of the studies included in the review, 19 were classified as of good quality, while eight and five were judged as of fair and poor, respectively. On the basis of seven studies, it was observed that Cariogram sensibility varied from 41.0 to 75.0, while its specificity ranged from 65.8 to 88.0.ConclusionsThere is insufficient evidence to assert that CRA models are effective in determining patients' actual caries risk or in predicting their probability of developing new carious lesions. Moreover, the validity of standardised CRA models is still limited.

Treating High-Caries Risk Occlusal Surfaces in First Permanent Molars through Sealants and Supervised Toothbrushing: A 3-Year Cost-Effective Analysis.

We conducted a 3-year cost-effectiveness analysis on the cavitated dentine carious lesion preventive capabilities of composite resin (CR) (reference group) and atraumatic restorative treatment (ART) high-viscosity glass-ionomer cement (HVGIC) sealants compared to supervised toothbrushing (STB) in high-risk first permanent molars. School children aged 6-7 years in 6 schools (2 per group) received CR and ART/HVGIC sealants or STB daily for 180 days each school year. Data were collected prospectively and cost estimates were made for sample data and a projection of 1,000 sealants/STB high-risk permanent molars. Although STB had the best outcome, its high implementation cost (95% of cost for supervisors visiting schools 180 days/school year) affected the results. ART/HVGIC was cost-effective compared to CR for the sample data (savings of USD 37 per cavitated dentine carious lesion prevented), while CR was cost-effective compared to ART/HVGIC for the projection (savings of USD 17 per cavitated dentine carious lesion prevented), and both were cost-saving compared to STB. Two STB scenarios were tested in sensitivity analyses with variations in caries incidence and number of supervision days; results showed STB had lower costs and higher savings per cavitated dentine carious lesion prevented than CR and ART/HVGIC. A major assumption is that both scenarios have the same high effectiveness rate experienced by STB under study conditions; however, they point to the value of further research on the benefits of adopting STB as a long-term venture in a general population of school children.

Do parents and children perceive molar-incisor hypomineralization as an oral health problem?

BACKGROUND: Very little is known about how patients perceive molar-incisor hypomineralization (MIH). AIM: The aim of this study was to identify whether parents and children perceive opacities associated with MIH as an oral health problem. DESIGN: A case-control study was designed in which 131 children diagnosed with MIH were matched by age, sex, and school to 131 children without MIH. The Child and Parent Questionnaire about Tooth Appearance was used to assess reports from parents, who were interviewed by telephone, and children, who were interviewed on school premises. The Spearman correlation and Wilcoxon and Fisher's exact tests were used to assess the data. RESULTS: For the first part of the questionnaire, children avoided smiling because of the appearance of their teeth, and mothers seemed to be distressed by the appearance of their children's teeth (P < 0.05). For the second part, children showed dissatisfaction with their 'tooth alignment' and 'tooth discoloration' compared with the controls, while mothers were not satisfied with their children's tooth discoloration in comparison with controls (P < 0.05). Children and mothers were concerned about tooth discoloration (P < 0.05). CONCLUSION: Poor agreement was found between the reports of children and their mothers, but both children and mothers in the MIH group perceived MIH opacities negatively in comparison with controls.

Long-term Effect of Supervised Toothbrushing on Levels of Plaque and Gingival Bleeding Among Schoolchildren.

PURPOSE: To test the hypothesis that, in high caries-risk children, supervised toothbrushing (STB) reduces visible plaque levels and gingival bleeding to a greater extent than does unsupervised toothbrushing (USTB) in comparable children and in low caries-risk USTB children over 4 years. MATERIALS AND METHODS: High caries-risk schoolchildren, ages 6 to 7, were allocated to three oral healthcare protocols using a cluster-randomised design: 1. Ultra-Conservative Treatment (UCT): small cavities in primary molars were restored using ART, while medium and large cavities were left open and cleaned under daily supervised toothbrushing together with the remaining dentition (UCT/STB); 2. Conventional Restorative Treatment (CRT): primary molars were restored with amalgam, while high caries-risk first permanent molars received resin sealants (CRT/USTB); 3. Atraumatic Restorative Treatment (ART): primary molars were restored using ART, while high caries-risk first permanent molars received ART sealants (ART/USTB). Low caries-risk children (dmft ≤ 1) formed the no-treatment/USTB group. 273 children were examined at baseline (T0) and after 4 years (T1) according to the VPI and GBI indices. Data were analysed using linear and logistic regression. RESULTS: Mean VPI and mean GBI scores were statistically significantly lower at T1 than at T0. Reduction in mean VPI scores in UCT/STB children was statistically significantly higher than for CRT+ART/USTB children over 4 years (p = 0.03), but no difference was observed between UCT/STB and no-treatment/USTB children (p = 0.361). No statistically significant difference in the reduction of mean GBI scores was observed between UCT/STB and CRT+ART/USTB (p = 0.62) and no-treatment/USTB children (p = 0.74). CONCLUSION: In high caries-risk children, the protocol based on supervised toothbrushing presented greater reduction in visible plaque levels than did protocols based on restorations and sealants over 4 years.

Effectiveness of an oral health program for mothers and their infants.

BACKGROUND: The baby oral health program (bOHP) provides pregnant women and their future babies with oral care. AIM: To assess the bOHP effectiveness by comparing caries prevalence in infants enrolled and not enrolled in the oral health program (OHP). DESIGN: Mothers who had been invited to participate in the bOHP from 2006 to 2009 were contacted. Two groups were formed: 87 pairs of mothers and infants who effectively participated in the OHP (G1) and 107 pairs who did not (G2). Mothers and infants were given a dental examination. Socio-economic status (SES) and education level (EL) questionnaires were completed. t-tests and multivariate logistic regression were used in analyzing data. RESULTS: Statistically significant differences were observed in the mean age of mothers (G1 = 33.8 years; G2 = 35.6 years; P = 0.015) and mean decayed, missed and filled surface (DMFS) score (G1 = 24.71; G2 = 32.58; P < 0.001), not in SES (P = 0.758) and EL (P = 0.109). Mean age and mean dmfs scores of G1 and G2 children were 4.2 and 4.4 years (P = 0.068), and 0.25 and 4.12 (P < 0.001), respectively. The odds ratio (OR) for children in G2 to develop dentine lesions, as opposed to those in G1, was 48.56. CONCLUSION: The bOHP was effective in preventing caries in infants enrolled in the program.

The Caries Assessment Spectrum and Treatment (CAST) instrument: construct validation.

The Caries Assessment Spectrum and Treatment (CAST) is a newly developed epidemiological instrument. The aim of this study was to investigate its construct validity. Four calibrated examiners, using CAST codes 0-6, visually examined 109 surfaces of extracted and exfoliated teeth. These teeth were then hemisectioned, photographed, and assessed histologically by two calibrated examiners using the Downer criteria. Twenty-eight of the 109 teeth were scanned using micro-computed tomography (micro-CT) and assessed by the same examiners using the same criteria. Validation was determined through calculation of the sensitivity, specificity, and Youden index for two categories of carious lesions examined visually, with histology and micro-CT as gold standards. Interexaminer consistency was κ = 0.76: SE ± 0.05 between visual and histological assessments of teeth and was κ = 0.89: SE ± 0.08 between visual and micro-CT assessments. For the category 'healthy' vs. 'diseased' (CAST codes 0-2 vs. CAST codes 3-6), sensitivity, specificity, and Youden index values of 100%, 92.9%, and 93%, respectively, for micro-CT, and 96.6%, 86%, and 83%, respectively, for histology, were obtained. For the category 'dentine' vs. 'non-dentine lesions' (CAST codes 0-3 vs. CAST codes 4-6) sensitivity, specificity, and Youden index values of 90%, 100%, and 90%, respectively, for micro-CT, and 81.4%, 100%, and 81%, respectively, for histology, were obtained. Construct validity of the CAST instrument was obtained.

The caries assessment spectrum and treatment (CAST) instrument: its reproducibility in clinical studies.

A new caries assessment instrument, the Caries Assessment Spectrum and Treatment (CAST), was developed. It covers carious lesion progression from no lesion, sealants and restorations to lesions in enamel and dentine, advanced stages in pulpal and tooth-surrounding tissues, and tooth loss owing to dental caries, in nine codes. The objective of this study was to determine the reproducibility of the CAST instrument in primary and permanent dentitions, using three age groups. Two epidemiological surveys were conducted in Brazil, covering three age groups: 2-6-year-old and 6-9-year-old children and 19-30-year-old adults. Four trained and calibrated examiners performed the examinations. Reproducibility was calculated for intra- and inter-examiner at surface and tooth levels and expressed as unweighted kappa-coefficient value (κ) and percentage of agreement (Po) for CAST codes (0-7) and for the categories healthy (0-2) versus diseased (3-7), and non-cavitated (0-3) versus cavitated (4-7) teeth. Using CAST codes (0-7) for the 2-6-year-old age group in primary dentitions, inter-examiner consistency was κ = 0.74 and Po was 98.3%. In the 6-9-year-old age group in primary dentitions, inter-examiner consistency ranged from κ = 0.68 to κ = 0.86 and Po was ≥ 93.7%. In the 19-30-year-old age group inter-examiner consistency was κ = 0.87 and Po was 94.1%. The reproducibility of the CAST instrument for use in the primary dentition of 2-6-year olds and of 6-9-year olds was 'substantial' to 'almost perfect'. The reproducibility for its use in the permanent dentition of 19-30-year olds was 'almost perfect'. The CAST instrument can reliably be applied in epidemiological studies covering these ages.

Effect of different protocols for treating cavities in primary molars on the quality of life of children in Brazil--1 year follow-up.

The aim of this study was to test the hypothesis that the conventional restorative treatment (CRT) and the atraumatic restorative treatment (ART) protocols, in comparison with the ultra-conservative treatment (UCT) protocol, would increase the quality of life of children over a period of 1 year. Cavitated primary molars of 302 children 6-7 years of age were treated according to the CRT, ART and UCT protocols at the school compound. Children's parents completed the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) at baseline and one year later. Paired t-test, Chi-square test and ANOVA were applied in analysing the data. Questionnaires from 277 and 160 children were collected at baseline and after 1 year, respectively. A statistically significant difference in B-ECOHIS scores over the 1-year period was found for domains 'child symptoms' (P = 0.03) and 'child psychology' (P = 0.02). Treatment protocols did not statistically significantly influence the changes in B-ECOHIS scores over the 1-year period (P = 0.78). It can be concluded that the UCT protocol was as good as the two restorative protocols. All treatment protocols were effective in reducing children's experience of pain, their sleeping problems and their irritability and/or frustration levels over the 1-year period.

Efficacy and safety of an intraoral electrostimulation device for xerostomia relief: a multicenter, randomized trial.

OBJECTIVE: To evaluate the efficacy and safety of an intraoral electrostimulation device, consisting of stimulating electrodes, an electronic circuit, and a power source, in treating xerostomia. The device delivers electrostimulation through the oral mucosa to the lingual nerve in order to enhance the salivary reflex. METHODS: The device was tested on a sample of patients with xerostomia due to Sjögren's syndrome and other sicca conditions in a 2-stage prospective, randomized, multicenter trial. Stage I was a double-blind, crossover stage designed to compare the effects of the electrically active device with the sham device, each used for 1 month, and stage II was a 3-month open-label stage designed to assess the long-term effects of the active device. Improvement in xerostomia severity from baseline was the primary outcome measure. RESULTS: A total of 114 patients were randomized. In stage I, the active device performed better than the sham device for patient-reported xerostomia severity (P<0.002), xerostomia frequency (P<0.05), quality of life impairment (P<0.01), and swallowing difficulty (P<0.02). At the end of stage II, statistically significant improvements were verified for patient-reported xerostomia severity (P<0.0001), xerostomia frequency (P<0.0001), oral discomfort (P<0.001), speech difficulty (P<0.02), sleeping difficulty (P<0.001), and resting salivary flow rate (P<0.01). CONCLUSION: Our findings indicate that daily use of the device alleviated oral dryness, discomfort, and some complications of xerostomia, such as speech and sleeping difficulties, and increased salivary output. The results show a cumulative positive effect of the device over the period of the study, from baseline to the end of the trial.

Photodynamic therapy disinfection of carious tissue mediated by aluminum-chloride-phthalocyanine entrapped in cationic liposomes: an in vitro and clinical study.

Photodynamic therapy (PDT) is a technique employed in the treatment of several superficial infections, such as caries. PDT uses a non-toxic drug termed photosensitizer (PS) followed by light irradiation. The cytotoxic effects of the therapy are related to the production of reactive species produced after light activation of a photosensitizer, which reacts with surrounding molecules and disrupts several of the cell's functions. Within this context, this study aimed to develop a clinical protocol involving PDT application mediated by aluminum-chloride-phthalocyanine (AlClPc) entrapped in cationic liposomes against cariogenic bacteria in caries lesions. Cationic liposomes were used to delivery AlClPc preferentially to bacterial cells due to the strong anionic superficial charges of these cell types. The results are represented in two fundamental steps: (1) in vitro evaluation of AlClPc delivery to cariogenic bacteria and pulp cells, as well as its potential phototoxicity; (2) a clinical study involving volunteer patients that were treated with the PDT protocol mediated by AlClPc-cationic liposome. The main results showed that the AlClPc-cationic liposome was preferentially absorbed by bacterial cells compared to eukaryotic dental pulp cells, and it was efficient in the reduction of microbial load from bacterial cultures. In addition, the clinical study showed a mean reduction of 82% of total bacterial in the treated cavities after PDT application. Taken together, the results presented in this study showed that the antimicrobial PDT protocol mediated by cationic liposomes containing AlClPc is safety for clinical application and is efficient in the reduction of bacterial load in caries lesions.

Survival of atraumatic restorative treatment (ART) sealants and restorations: a meta-analysis.

UNLABELLED: The purpose of this study is to perform a systematic investigation plus meta-analysis into survival of atraumatic restorative treatment (ART) sealants and restorations using high-viscosity glass ionomers and to compare the results with those from the 2005 ART meta-analysis. Until February 2010, four databases were searched. Two hundred four publications were found, and 66 reported on ART restorations or sealant survival. Based on five exclusion criteria, two independent reviewers selected the 29 publications that accounted for the meta-analysis. Confidence intervals (CI) and or standard errors were calculated and the heterogeneity variance of the survival rates was estimated. Location (school/clinic) was an independent variable. The survival rates of single-surface and multiple-surface ART restorations in primary teeth over the first 2 years were 93% (CI, 91-94%) and 62% (CI, 51-73%), respectively; for single-surface ART restorations in permanent teeth over the first 3 and 5 years it was 85% (CI, 77-91%) and 80% (CI, 76-83%), respectively and for multiple-surface ART restorations in permanent teeth over 1 year it was 86% (CI, 59-98%). The mean annual dentine lesion incidence rate, in pits and fissures previously sealed using ART, over the first 3 years was 1%. No location effect and no differences between the 2005 and 2010 survival rates of ART restorations and sealants were observed. The short-term survival rates of single-surface ART restorations in primary and permanent teeth, and the caries-preventive effect of ART sealants were high. CLINICAL RELEVANCE: ART can safely be used in single-surface cavities in both primary and permanent teeth. ART sealants have a high caries preventive effect.

The Caries Assessment Spectrum and Treatment (CAST) index: face and content validation.

OBJECTIVES: The aim of this study was to establish the face and content validity of the Caries Assessment Spectrum and Treatment (CAST) index. This hierarchical epidemiological index consists of 10 codes covering the spectrum of carious lesion progression and describing conditions ranging from the absence of carious lesions to the presence of sealants and restorations, the presence of lesions in enamel and dentine, and the presence of advanced stages of carious lesion in pulpal tissue and tissue surrounding the tooth. METHODS: Using the RAND modified e-Delphi consensus method, a set of 17 statements related to the content, including the codes and descriptions used, and suitability of the CAST index were scored on a scale of 1-9 by 15 senior epidemiologists from 15 countries over three rounds of assessment. Agreement of ≥ 75% was required to indicate consensus on a statement. RESULTS: Consensus was reached on 14 statements in the first round, none in the second and on the remaining three statements in the third round. To obtain feedback on the initial validation of the index and to test its external validity, 41 epidemiologists from 24 countries were requested to assess the validated statements. Minor changes to 10 of the 17 statements' content and descriptions were suggested; this necessitated the resubmission of the modified CAST index to the original 15 epidemiologists. Consensus of ≥ 80% was reached on all 10 statements regarding codes and their descriptions. CONCLUSIONS: After a total of four rounds with the panel members and one round with the feedback group, the CAST index was approved for face and content validity. External validity was obtained. The participating epidemiologists found the RAND modified e-Delphi consensus method to be a suitable instrument for reaching consensus.

Minimal intervention dentistry for managing dental caries - a review: report of a FDI task group.

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

Pain experience after conventional, atraumatic, and ultraconservative restorative treatments in 6- to 7-yr-old children.

The hypothesis was tested that the level of pain experienced by children during conventional restorative treatment is higher than during atraumatic restorative treatment (ART) or an ultraconservative treatment. The sample consisted of 244 children, 6- to 7 yr of age, who had at least two teeth with dentine carious lesions. Before the first treatment session (Tx-1), in which one of the carious teeth was treated using one of the treatments, the level of dental anxiety was assessed using the Facial Image Scale (FIS). The child reported the intensity of pain experienced during the procedure using the Wong-Baker FACES Pain Rating Scale. When conventional restorative treatment was used, more children needed local anaesthesia. Analyses excluding the data of children who had received local anaesthesia showed no treatment group effect on the Wong-Baker score, a FIS Tx-1 effect on the Wong-Baker score, and a statistically significant correlation between FIS Tx-1 and Wong-Baker scores. There was no significant difference in the pain levels of children treated using conventional restorative treatment, atraumatic restorative treatment or ultraconservative treatment. Local anaesthesia had to be administered more frequently to children in the conventional restorative group than to those in the other two treatment groups.

The Caries Assessment Spectrum and Treatment (CAST) index: rational and development.

Serious difficulties in reporting results were encountered when using ICDAS II and PUFA separately in an epidemiological survey in a child population in Brazil. That necessitated the development of a comprehensive but pragmatic caries assessment index. This publication describes the rationale, development and content of a novel caries assessment index. Strengths and weaknesses of ICDAS II, PUFA and other indices were analysed. The novel caries index developed for use in epidemiological surveys is termed 'Caries Assessment Spectrum and Treatment' (CAST). 'Spectrum' indicates what is considered the main strength of the new index - its usefulness in describing the complete range of stages of carious lesion progression: from no carious lesion, through caries protection (sealant) and caries cure (restoration) to lesions in enamel and dentine, and the advanced stages of carious lesion progression in pulpal and tooth-surrounding tissue. CAST combines elements of the ICDAS II and PUFA indices, and the M- and F-components of the DMF index. A DMF score can easily be calculated from the CAST score, thereby enabling retention of the use of existing DMF scores. The CAST index for use in epidemiological surveys is very promising. It should be validated and its reliability and usefulness be tested in different age groups in different countries and cultures.

Global Oral Health Policies and Guidelines: Using Silver Diamine Fluoride for Caries Control.

Silver diamine fluoride (SDF) was developed in Japan in the 1960s. It is a clear solution containing silver and fluoride ions. Because of its anti-bacterial and remineralizing effect, silver diamine fluoride has been used in managing dental caries for decades worldwide. This paper aims to summarize and discuss the global policies, guidelines, and relevant information on utilizing SDF for caries management. SDF can be used for treating dental caries in most countries. However, it is not permitted to be used in mainland China. Several manufacturers, mainly in Australia, Brazil, India, Japan, and the United States, produce SDF at different concentrations that are commercially available around the world. The prices differ between contents and brands. Different government organizations and dental associations have developed guidelines for clinical use of SDF. Dental professionals can refer to the specific guidelines in their own countries or territories. Training for using SDF is part of undergraduate and/or postgraduate curriculums in almost all countries. However, real utilization of SDF of dentists, especially in the private sector, remains unclear in most places because little research has been conducted. There are at least two ongoing regional-wide large-scale oral health programs, using SDF as one of the components to manage dental caries in young children (one in Hong Kong and one in Mongolia). Because SDF treatment does not require caries removal, and it is simple, non-invasive, and inexpensive, SDF is a valuable strategy for caries management in young children, elderly people, and patients with special needs. In addition, to reduce the risk of bacteria or virus transmission in dental settings, using SDF as a non-aerosol producing procedure should be emphasized under the COVID-19 outbreak.

An assessment of three contemporary dental caries epidemiological instruments: a critical review.

Aim Dental caries epidemiological surveys produce information that may be used to assist health policy makers in the planning of preventive and curative strategies. The detection instruments used in these surveys should be able to identify the correct, true stage of the disease or medical condition. This makes it essential that valid instruments are used. This study aimed to critically review commonly used visual/tactile caries assessment instruments in epidemiological surveys with respect to their manageability, reproducibility and validity, and how results are reported.Method A Pubmed search identified the following international visual/tactile instruments for caries detection more than once between 2013 and 2018: World Health Organisation (WHO), International Caries Detection and Assessment System (ICDAS) and Caries Assessment Spectrum and Treatment (CAST).Results The review revealed that the WHO instrument can be considered a screening instrument, that the ICDAS instrument lacks sufficient validity and takes time to apply and that the CAST instrument is promising, but requires further field testing before it can be considered a fully proven caries-assessment instrument in epidemiology. It is recommended that calculating caries prevalence should be based on the presence of cavitated dentine carious lesions, that the prevalence of enamel carious lesions be reported separately and that the dmf/DMF index not be used in its current form.Conclusion Researchers/dentists should be knowledgeable of the limitations and advantages of common caries assessment instruments. Caries prevalence should not be based on the dmf/DMF index but on cavitated dentine carious lesions (d/D-component) as the M- and F-component do not refer to a disease stage.

Impact of proximal cavities and primary molar absence on space in the dental arches.

BACKGROUND: A recently proposed treatment protocol for dental caries in primary teeth, called Ultra Conservative Treatment (UCT), keeps medium to large cavities open so that children can keep them clean with tooth brushing and fluoride toothpaste. However, carious lesions have been related to malocclusion and decrease of space for the eruption of the permanent successor. METHODS: This cross-sectional study evaluated dental casts of 235 schoolchildren, aged 6-7 years old of six public schools in deprived suburban areas, and with at least two cavitated dentin carious lesions. The casts were grouped according to the location of cavitated dentin lesions into non-proximal cavity (NPC), proximal cavity with buccal or lingual surface contact point to adjacent tooth (PCCP) and proximal cavity without contact to adjacent tooth (PCWC), as well as the absence of primary molars due carious lesions (PMA). The relationship between location of cavitated dentin lesions or absence of primary molars with C+D+E and D+E space was analyzed. RESULTS: Children with absence of primary molars exhibited the smallest C+D+E and D+E space in the maxilla (P < 0.001) and mandible (P < 0.001), followed by proximal cavity without buccal or lingual surface contact. No significant difference was observed between NPC and PCCP groups in upper and lower arches. DISCUSSION: PCWC are associated with minor (less than the leeway space) C+D+E and D+E space loss in both arches, and additional space loss is noted when primary molars are prematurely lost. These results may have implications for orthodontic and restorative dental care decisions in children.