Are periodontitis and dental caries associated? A systematic review with meta-analyses.

AIM: The epidemiological relationship between periodontitis and caries remains controversial, and evidence synthesis is currently lacking. Therefore, this systematic review was designed to answer the following PECO question: 'In human adults (P), do subjects suffering from periodontitis (E) have higher presence/number of untreated carious lesions and caries experience (O) than subjects not suffering from periodontitis (C)?'. MATERIALS AND METHODS: Observational studies that met specific inclusion criteria established to answer to the PECO question were included. Two review authors independently searched for eligible studies, screened the titles and abstracts, carried out the full text analysis, extracted the data and performed the risk of bias assessment. In case of disagreement, a third review author took the final decision during ad hoc consensus meetings. Data synthesis was carried out through random-effects meta-analyses. RESULTS: A total of 18 studies on 21 cohorts, involving 135,018 participants, were included. Meta-analyses showed a significant association between periodontitis and the presence of at least one tooth with either untreated carious lesions (odds ratio [OR] = 1.63; 95% confidence interval [CI]: 1.32-2.01; p <.00; I2 = 83.0%) or caries experience (decayed and filled teeth ≥ 1) (OR = 1.27; 95% CI: 1.01-1.59; p = .038; I2 = 90.0%). Moreover, subjects with periodontitis exhibited a higher number of surfaces (difference in means [MD] = 0.86; 95% CI: 0.46-1.27; p <.001; I2 = 0.0%) and teeth (MD = 0.35; 95% CI: 0.28-0.42; p <.001; I2 = 69.6%) with untreated carious lesions, as well as a higher number of teeth with caries experience (standardized difference in means [SMD] = 1.46; 95% CI: 0.15-2.78; p = .029; I2 = 98.9%) compared with those without periodontitis. Sensitivity analyses focusing on severe periodontitis as exposure mostly showed consistent results. Estimates for caries experience were only slightly attenuated in adjusted models compared with crude models. Subgroup analyses by caries location also indicated that periodontitis was associated only with root caries, while it was not with caries affecting the anatomical crown. CONCLUSIONS: Periodontitis was found to be associated with the presence and number of treated/untreated root carious lesions. Therefore, caries-specific preventive measures (e.g., fluorides) should be considered for individuals with periodontitis.

Association of Root Biofilm Bacteriome with Root Caries Lesion Severity and Activity.

INTRODUCTION: This research aimed to assess the association of root biofilm bacteriome with root caries lesion severity and activity in institutionalised Colombian elderlies and was conducted to gather data on the root caries bacteriome in this population. METHODS: A bacteriome evaluation of biofilm samples from sound and carious root surfaces was performed. Root caries was categorised (ICDAS Root criteria) based on severity (sound surfaces, initial: non-cavitated, moderate/extensive combined: cavitated) and activity status (active and inactive). DNA was extracted and the V4 region of the 16S rRNA gene was sequenced; afterwards the classification of features was conducted employing amplicon sequence variants and taxonomic assignment via the Human Oral Microbiome Database (HOMD). Bacterial richness, diversity (Simpson's and Shannon's indices), and relative abundance estimation were assessed and compared based on root caries severity and activity status (including Sound surfaces). RESULTS: A total of 130 biofilm samples were examined: sound (n = 45) and with root caries lesions (n = 85; by severity: initial: n = 41; moderate/extensive: n = 44; by activity: active: n = 60; inactive: n = 25). Species richness was significantly lower in biofilms from moderate/extensive and active groups compared to sound sites. There was a higher relative abundance of species like Lechtotricia wadei, Capnocytophaga granulosa, Cardiobacterium valvarum, Porphyromonas pasteri - in sound sites; Dialister invisus, Streptococcus mutans, Pseudoramibacter alactolyticus and Bacteroidetes (G-5) bacterium 511 - in moderate/extensive lesions, and Fusobacterium nucleatum subsp. animalis, Prevotella denticola, Lactobacillus fermentum, Saccharibacteria (TM7) (G-5)bacterium HMT 356 - in active lesions. CONCLUSION: Root caries bacteriome exhibited differences in species proportions between the compared groups. Specifically, cavitated caries lesions and active caries lesions showed higher relative abundance of acidogenic bacteria.

A Cross-Sectional Study to Assess Diabetes as a Risk Factor for Root Caries Amongst the Elderly Population in Udupi District, Karnataka State, India.

Objectives: To compare the prevalence of root surface carious lesions among the nondiabetic and diabetic elderly population and its association with various risk factors. Methods: An observational analytical cross-sectional study was conducted among 800 elderly participants, 431 males and 369 females, aged 50 years and above, with a minimum of ten teeth present, with 400 being diabetic and 400 nondiabetic from the various hospitals of the Udupi district. Demographics, socioeconomic status, oral hygiene practices, oral abusive habits, and history of type 2 diabetes were collected using an interviewer-administered questionnaire followed by an intraoral examination to assess root caries. The primary outcome measure was the presence of any carious or filled root surface. Binary logistic regression univariate analysis was done for all the predictor variables, and those with significant associations were further analyzed by multivariate analysis with the enter method in a single-step model. An appropriate nomogram was designed for risk prediction. Results: Overall, the root caries prevalence was 37.3%, and the mean root caries index was 14.28%. The prevalence of root caries was 46% in people with diabetes and 28.5% in nondiabetics. Participants with type 2 diabetes, less education, low socioeconomic status, and using finger cleaning had a significantly higher risk of developing root caries. Additionally, those who used removable partial dentures (RPDs) were found to be 4.65 times more likely to have root caries than those who did not use RPDs. Conclusion: Elderly diabetics are at a higher risk for developing root caries and are strongly advised to maintain good oral hygiene practices and to undergo periodic dental evaluations. Therefore, it is crucial to emphasize early diagnosis and treatment of root caries in this population.

Comparative analysis of microbiome in coronal and root caries.

BACKGROUND: The global rise in the elderly population has increased the prevalence of root caries. Streptococcus mutans, Lactobacilli and Actinomyces are considered the primary pathogens of dental caries in culture-based studies. This study aimed to investigate bacterial profiles in coronal and root caries lesions and determine the association of specific bacterial genera at each site. METHODS: Dentine samples from carious lesions were collected from 22 extracted teeth using an excavator. Microbial DNA was extracted from the samples using a protocol developed for this study. 16S rRNA gene amplicon sequencing was employed for microbial analysis. PCR amplification targeted the V3-V4 region of the bacterial 16S rRNA, and the amplicon sequencing used an Illumina MiSeq system (2 × 300 bp paired-end reads). Statistical analysis was performed by the Phyloseq and DESeq2 packages in R. RESULTS: In coronal caries, Olsenella, Lactobacillus and Prevotella were the most prevalent genera, comprising approximately 70% of the microbiome community. In the root caries, however, although Olsenella, Prevotella and Lactobacillus remained the dominant genera, they accounted for only half of the microbiome community. This study identified significant differences in alpha diversity indices between the coronal and root caries. LEfSE analysis revealed several unique genera in each caries lesion. CONCLUSION: The microbiome of root caries lesions was richer and more complex than the coronal caries microbiota. The results suggest that lesion-related variations in the oral microflora may be detected in carious dentine.

A cost-effectiveness analysis of fluoride varnish application in preventing Root caries in elderly persons: a Markov simulation study.

BACKGROUND: Root caries are prevalent issues that affect dental health, particularly among elderly individuals with exposed root surfaces. Fluoride therapy has shown effectiveness in preventing root caries, but limited studies have addressed its cost-effectiveness in elderly persons population. This study aimed to evaluate the cost-effectiveness of a fluoride treatment program for preventing root caries in elderly persons within the context of Chinese public healthcare. METHODS: A Markov simulation model was adopted for the cost-effectiveness analysis in a hypothetical scenario from a healthcare system perspective. A 60-year-old subject with 23 teeth was simulated for 20 years. A 5% sodium fluoride varnish treatment was compared with no preventive intervention in terms of effectiveness and cost. Tooth years free of root caries were set as the effect. Transition probabilities were estimated from the data of a community-based cohort and published studies, and costs were based on documents published by the government. The incremental cost-effectiveness ratio (ICER) was calculated to evaluate cost-effectiveness. Univariate and probabilistic sensitivity analyses were performed to evaluate the influence of data uncertainty. RESULTS: Fluoride treatment was more effective (with a difference of 10.20 root caries-free tooth years) but also more costly (with a difference of ¥1636.22). The ICER was ¥160.35 per root caries-free tooth year gained. One-way sensitivity analysis showed that the risk ratio of root caries in the fluoride treatment group influenced the result most. In the probabilistic sensitivity analysis, fluoride treatment was cost-effective in 70.5% of the simulated cases. CONCLUSIONS: Regular 5% sodium fluoride varnish application was cost-effective for preventing root caries in the elderly persons in most scenarios with the consideration of data uncertainty, but to a limited extent. Improved public dental health awareness may reduce the incremental cost and make the intervention more cost-effective. Overall, the study shed light on the economic viability and impact of such preventive interventions, providing a scientific basis for dental care policies and healthcare resource allocation.

Evaluation of toothpastes for treating root carious lesions - a laboratory-based pilot study.

BACKGROUND: Root caries is preventable and can be arrested at any stage of disease development. The aim of this study was to investigate the potential mineral exchange and fluorapatite formation within artificial root carious lesions (ARCLs) using different toothpastes containing 5,000 ppm F, 1,450 ppm F or bioactive glass (BG) with 540 ppm F. MATERIALS AND METHODS: The crowns of each extracted sound tooth were removed. The remaining roots were divided into four parts (n = 12). Each sample was randomly allocated into one of four groups: Group 1 (Deionised water); Group 2 (BG with 540 ppm F); Group 3 (1,450 ppm F) and Group 4 (5,000 ppm F). ARCLs were developed using demineralisation solution (pH 4.8). The samples were then pH-cycled in 13 days using demineralisation solution (6 h) and remineralisation solution (pH 7) (16 h). Standard tooth brushing was carried out twice a day with the assigned toothpaste. X-ray Microtomography (XMT) was performed for each sample at baseline, following ARCL formation and after 13-day pH-cycling. Scanning Electron Microscope (SEM) and 19F Magic angle spinning nuclear magnetic resonance (19F-MAS-NMR) were also performed. RESULTS: XMT results showed that the highest mineral content increase (mean ± SD) was Group 4 (0.09 ± 0.05), whilst the mineral content decreased in Group 1 (-0.08 ± 0.06) after 13-day pH-cycling, however there was evidence of mineral loss within the subsurface for Groups 1, 3 and 4 (p < 0.05). SEM scans showed that mineral contents within the surface of dentine tubules were high in comparison to the subsurface in all toothpaste groups. There was evidence of dentine tubules being either partially or completely occluded in toothpaste groups. 19F-MAS-NMR showed peaks between - 103 and - 104ppm corresponding to fluorapatite formation in Groups 3 and 4. CONCLUSION: Within the limitation of this laboratory-based study, all toothpastes were potentially effective to increase the mineral density of artificial root caries on the surface, however there was evidence of mineral loss within the subsurface for Groups 1, 3 and 4.

Cross-sectional survey and analysis of factors influencing the prevalence of dental caries among older individuals aged 65-74 in Guangdong Province in 2021.

BACKGROUND: The prevalence of oral diseases is subject to change over time. In 2021, Guangdong Province conducted its fourth survey assessing the oral health status of individuals aged 65-74. MATERIALS AND METHODS: Evaluation criteria and potential influencing factors were identified. A sample of residents aged 65-74 from 13 designated monitoring sites in Guangdong Province was randomly selected for the study. Spearman correlation analysis was employed to investigate the clinical correlation between influencing factors and evaluation criteria. Negative binomial and zero-inflated negative binomial regression models were utilized to examine the factors influencing caries prevalence. In contrast, logistic regression was employed to identify the risk factors for caries occurrence. A p-value of ≤0.05 was considered statistically significant. RESULTS: The prevalence of caries rate of crowns, roots, and teeth were 76.36%, 52.25%, and 79.2%, respectively. Individuals with periodontal pockets exhibited a significantly higher risk of root caries. The presence of dental calculus significantly exacerbated the occurrence of crown, root, and dental caries, and increased the risk of crown and dental caries. Consuming sweet foods once or more a week notably increased the average root decayed score (D of roots), the prevalence rate of root caries, and the D score of the Decayed, Missing, and Filled teeth [DMFT] index in individuals already afflicted with this condition. Similarly, the consumption of sweetened drinks significantly elevated the risk of crown and root caries, exacerbating overall caries progression. Frequencies of manual toothbrush and toothpick cleaning showed a negative correlation with average tooth missing score (MT). In contrast, the frequency of manual/electric toothbrush and toothpick cleaning was negatively correlated with the DMFT index. Engaging in dental diagnosis and treatment behaviors significantly increased the number of filled crowns (F), MT, and DMFT scores while reducing the prevalence of dental caries. CONCLUSIONS: In Guangdong Province, caries prevalence among older individuals aged 65-74 remains substantial. Relevant professionals and institutions must provide comprehensive guidance and assistance to the older population, emphasizing the importance of reducing the consumption of sweets and sweetened beverages, adopting correct tooth brushing techniques and frequency (at least twice daily), timely treatment of periodontal diseases, conducting regular epidemiological caries surveys, and addressing economic barriers to accessing caries diagnosis and treatment services.

Clinical Investigation of the Inhibitory Effects of Tooth-Coating Materials on Initial Active Root Caries: A Pilot Randomized Controlled Trial.

Background and Objectives: Caredyne ZIF-C is a novel, capsule-mixed zinc-containing prototype glass ionomer cement (GIC). Zinc ions are reported to inhibit root dentin demineralization, dentin collagen degradation, bacterial growth, acid production, and in vitro bacterial biofilm formation. However, the effectiveness of GICs against initial root caries lesions is unclear. Therefore, this study aimed to evaluate the efficacy of GICs, especially the new zinc-containing Caredyne ZIF-C GIC, as tooth-coating materials in patients with initial active root caries. Materials and Methods: A total of 58 lesions in 47 older adults (age > 65 years) were randomly allocated to one of the following three groups: Caredyne ZIF-C, Fuji VII (a conventional GIC), and sodium fluoride (NaF). All the lesions were treated with the assigned materials without removing the infected dentin, and the rates of dental plaque attachment and coating material fall-out were evaluated after 3, 6, and 12 months. The failure rate was defined as the number of teeth that needed restoration due to caries progression. Results: The plaque attachment rates tended to be lower in the material-coated root surfaces than in the healthy exposed root surfaces after 3, 6, and 12 months, although the differences among the three groups were not significant. Moreover, the coating material fall-out rate tended to be lower in the Caredyne ZIF-C group than in the Fuji VII group. There was no significant difference in the failure rate among the three groups at the 12 months mark. Conclusions: Though this pilot study offers a new direction for suppressing the progression of initial active root caries by controlling plaque attachment using GICs including Caredyne ZIF-C, clinical studies with a larger sample size are needed.

Immediate and sustained root caries prevention of fluoride varnish combined with toothpastes: findings of clinical relevance?

DESIGN: An in vitro study to determine the immediate and sustained effect of fluoride varnish and its combination with fluoride toothpastes in preventing the development of root caries. CASE SELECTION: Human root dentine samples (150) were randomly divided into five experimental protocols of 30 specimens each: 1) fluoride varnish (22,600 ppm fluoride and 1-5% CPP-ACP); 2) fluoride varnish followed by Paste One (1100 ppm sodium fluoride and CPP-ACP); 3) fluoride varnish followed by Paste Plus (900 ppm sodium fluoride and CPP-ACP); 4) fluoride varnish followed by Paste One and Paste Plus; and 5) no treatment (control). A layer of varnish was applied to specimens except the control group and was left in situ for 18 h. The varnish layer was removed, and the various toothpaste treatments were initiated. Half of the specimens in each group were assigned to a short-term incubation model in which they were immediately subjected to a 7-day cariogenic challenge consisting of a combination of human saliva and artificial saliva containing 2% sucrose. The other half of the specimens in each group were assigned to the long-term incubation model in which the experimental protocol was continued for 8 weeks before initiating the seven-day cariogenic challenge. The protocols were evaluated by assessing dentine porosity (rhodamine intensity), mineral density, biofilm biomass, and viability assays. DATA ANALYSIS: Confocal laser scanning microscopy was used to determine dentine porosity and Levene's test was used to verify the assumption of equality of variances and normal distribution of errors before two-way ANOVA and the Games-Howell test were carried out at a significance level of 0.05 for both incubation models. Microcomputed tomography was used to determine mineral density with statistical analysis involving Levene's test, two-way ANOVA and Tukey's test at a significance level of 0.05 for both incubation models. Biomass was evaluated using a biofilm biomass assay with analysis of optical density data using Levene's test, ANOVA and Scheffe's test at a significance level of 0.05. RESULTS: For both the short- and long-term incubation models, all the experimental regimes resulted in a statistically significant decrease in dentine porosity and an increase in mineral density when compared to the control group. Fluoride varnish followed by both pastes and fluoride varnish followed by Paste One resulted in a statistically significant decrease in dentine porosity for some depths in both models when compared to fluoride varnish alone. Changes in dentine porosity and mineral density were observed within groups over time. All the experimental regimes demonstrated anti-biofilm effects. Immediate and sustained anti-caries effects were observed for all preventive protocols, with the combination of fluoride varnish and Paste One resulting in superior additional anti-caries effects. CONCLUSIONS: The authors concluded that all protocols demonstrated immediate and sustained anti-caries effects against the development of root caries despite variations in effects over time. The combination of fluoride varnish and Paste One resulted in additional anti-caries effects that were consistently superior, with no additional effects being observed when Paste Plus was added in combination. The authors suggest that, within the study's limitations, topical fluoride varnish seems to have a protective effect on root surfaces for up to eight weeks and that fluoride varnish should be considered as an important adjunct strategy in the prevention of root caries in older adults.

A Bibliometric Analysis of Studies on Root Caries.

This study aimed to review the current state of the root caries field, explore the current hot topic, and anticipate future research frontiers. The Web of Science Core Collections was searched to acquire publications that were relevant to root caries from 1992 to 2021. After retrieval and manual screening, the co-occurrence and co-operation analysis of keywords and countries/institutions/authors were performed through CiteSpace and VOSviewer based on two periods (1992-2006 and 2007-2021). From 1992 to 2021, 451 unique publications were selected. The USA, which has been the center of international cooperation, has produced the most publications in the research area in 1992-2021. Journal of Dental Research and Caries Research are the main counterpart journals in the field of root caries. The University of London is the institution with the highest number of publications in the analyzed 30 years. "Demineralization," "remineralization," "aged," "dentin," and "fluoride" have been commonly used as keywords throughout the past 30 years. More studies from different aspects have been published in the field of root caries in recent years (2007-2021). The findings of this study provide a full picture of the last 30 years in this research area; hopefully, they also provide essential information for researchers and policymakers to make decisions.

Caries Experience in Elderly People Consuming a Milk-Based Drink Nutritional Supplement: A Cross-Sectional Study.

Nutritional supplements have been recommended to cope with malnutrition in elderly persons. In Chile, the Supplementary Nutrition Program for the Elderly (PACAM, for its Spanish acronym) consists in a monthly distribution of a low-fat-milk-based drink that contains 8% sucrose. The aim of this study was to determine whether older persons consuming the milk-based drink have a higher caries experience when compared to those not receiving the supplement. A cross-sectional study was conducted in the Maule Region in Chile. The representative sample comprised two groups: (a) PACAM consumers (CS) (n = 60) and (b) nonconsumers (NCS) (n = 60). Participants received intraoral examination and coronal (DMFT/DMFS) and root caries (RCI index) experience were recorded. Additionally, questionnaires regarding acceptability and consumption habits of PACAM and a 24-h diet recall were applied. The influence of predictors was calculated using binary logistic regression for a dichotomized DMFS and Poisson Regression for root caries lesions. A p value <0.05 was considered significant. No differences were detected in food consumption patterns between study groups (p > 0.05). CS participants had increased dairy product consumption. Higher DMFS mean value was observed in the CS (85.35 ± 39.0) compared with NCS (77.28 ± 28.9) (p = 0.043). The multivariate analysis showed nonconsumers of the milk-based product (ß = -0.41, p = 0.02) are less likely to have root surfaces affected by caries. Additionally, CS show higher RCI, compared to nonconsumers (ß = -0.17, p = 0.02). Daily consumption of a PACAM's milk-based drink supplement seems to increase coronal and root caries risk. Based on these results, composition modification of milk-based drinks with added sucrose appears mandatory.

Immediate and Sustained Root Caries Prevention of Fluoride Varnish Combined with Toothpastes.

The aim of this study was to determine the immediate and sustained effect of a fluoride varnish and its combinations with toothpastes in preventing root caries development using a salivary microcosm in vitro model. Human root dentin specimens (n = 150) were randomly divided into 5 experimental protocols (n = 30): (1) Fluoride Varnish (V); (2) V followed by Paste One (V + PO); (3) V followed by Paste Plus (V + PP); (4) V followed by PO and PP (V + PO + PP); and (5) No treatment (control). One varnish layer was applied on the specimens (except for the control group) and kept for 18 h. Then, the varnish was removed and toothpaste treatments were initiated according to experimental groups. For the short-term incubation model (n = 15), the specimens were also immediately subjected to 7-day cariogenic challenge. For that, human saliva was used as bacterial inoculum and McBain artificial saliva containing 2% sucrose as growth medium. The other half of the specimens (n = 15) were used to study the varnish's sustained effect by long-term incubation (8 weeks) before cariogenic challenge. The protocols' anti-caries properties were evaluated by dentin porosity (rhodamine intensity; RI) and mineral density, while their anti-biofilm effects were evaluated using biofilm's biomass and viability assays. For short- and long-term incubation models, all experimental regimens resulted in statistically significant decreases (p < 0.05) in the RI (up to 180 µm and 120 µm, respectively) as well as higher mineral density compared to No treatment (p < 0.001). V + PO + PP and/or V + PO resulted in statistically lower RI compared to V for some depths (p < 0.05) in both models. There were changes in RI and mineral density within groups over time. All experimental treatments exhibited anti-biofilm effects. All prevention protocols exhibited immediate and sustained anti-caries effect against root caries development. The combination of a fluoride varnish with PO resulted in superior additional anti-caries effects.

Classification of a patient's caries activity based on lesion activity assessment among adults: findings from a prospective cohort study.

OBJECTIVE: To investigate whether the classification of a patient's caries activity based on lesion activity assessment can predict the increment and progression of coronal and root caries lesions among adults. METHODS: This population-based prospective cohort study followed 413 individuals (mean age 54.1) from southern Brazil for 4 years. Data collection included a questionnaire and clinical examination to record coronal/root caries and gingival recession. The main outcomes were caries increment measured as decayed, missing and filled tooth surfaces (DMFS) and caries progression (surface-level analysis). The main predictor variable was patients' caries activity at baseline ("caries-inactive" or "caries-active"). Negative binomial regression models (unadjusted and adjusted) were used. RESULTS: Caries-active individuals were more likely to present DMFS increment than caries-inactive ones when migrations among DMFS components were considered (IRR [incidence risk ratio] = 1.26, 95%CI [confidence interval] = 1.01-1.58). On the other hand, no such association was found when these migrations were disregarded. The risk for coronal caries progression on filled surfaces was 90% higher among caries-active patients (IRR=1.9; 95%CI=1.4-2.6). In addition, patient's caries activity was able to predict higher risk for root caries progression in newly exposed root surfaces (IRR=1.9; 95%CI=1.0-3.6). CONCLUSION: The classification of a patient's caries activity based on lesion activity was able to foresee lesion progression on the coronal and root surfaces more susceptible to caries among adults. Clinical relevance Classifying a patient's caries activity is a useful tool for the clinical management of dental caries in adults.

Accuracy of different approaches for detecting proximal root caries lesions in vitro.

OBJECTIVES: The objective was to evaluate the diagnostic accuracy of radiographic evaluation (XR), visual-tactile assessment (VT), laser-fluorescence (LF) (DIAGNOdent Pen/KaVo), and near-infrared-light transillumination (NILT) (DIAGNOcam/KaVo) on proximal root caries lesions in vitro. METHODS: Two-hundred extracted permanent premolars and molars with and without proximal root caries lesions were allocated to 50 diagnostic models simulating the proximal contacts between teeth and mounted in a phantom dummy head. Two independent examiners used the diagnostic approaches to detect any or advanced root caries lesions, with histologic evaluation of the lesions serving as reference. Receiver operating characteristic (ROC) curves were employed, and sensitivity, specificity, and the area under the ROC curve (AUC) are calculated. Significant differences in mean AUCs between approaches were assumed if p < 0.05 (two-sample t-test). RESULTS: NILT was not applicable for proximal root caries detection. The sensitivity/specificity to detect any lesions was 0.81/0.63 for XR, 0.76/0.88 for VT and 0.81/0.95 for LF, and the sensitivity/specificity to detect advanced lesions was 0.43/0.94 for XR, 0.66/0.99 for VT, and 0.83/0.78 for LF, respectively. For both, any and advanced root caries lesions, mean AUCs for LF and VT were significantly higher compared to XR (p < 0.05). For any root caries lesions, LF was significantly more accurate than VT (p = 0.01), but not for advanced root caries lesions (p = 0.59). CONCLUSIONS: Under the in vitro conditions chosen, LF and VT were more accurate than XR to detect proximal root caries lesions, with LF being particularly useful for initial lesion stages. CLINICAL RELEVANCE: LF might be a useful diagnostic aid for proximal root caries diagnosis. Clinical studies are necessary to corroborate the findings.

Design, development and validation of a questionnaire to assess dentists' knowledge and experience in diagnosing, recording, and managing root caries.

OBJECTIVES: The prevalence of root caries is increasing globally, especially in the elderly population, and even though the number of patients with root caries lesions is augmenting, there are still many discrepancies in how dentists manage this condition. The present study aimed to develop and validate a questionnaire to evaluate how dentists diagnose, record and manage root caries lesions, and to verify the validity and reliability of this questionnaire. MATERIALS AND METHODS: An expert panel developed a self-administered questionnaire survey with three domains: (1) dentists' knowledge on diagnosis, recording, and managing root caries; (2) information about their current general clinical routines; (3) their demographics. The original English [E] version was translated into three different languages (French [F], German [G], Italian [I]), and subsequently back-translated into English by independent dentists. For the validation, 82 dentists (20-22 for each of the translated versions) accepted to answer the questionnaire at two different time-points (with 1-week interval). The data was quality checked. Construct validity, internal reliability, and intra-class correlation (ICC) were assessed. RESULTS: Seventy-seven dentists completed the questionnaire twice [E: 17; F: 19; G: 19; I: 22]. The mean ICC (standard deviation) was 0.98(0.03) for E, 0.90(0.12) for F, 0.98 (0.04) for G, and 0.98 (0.01) for I. Overall, the test-retest reliability was excellent (mean ICC (SD): 0.96 (0.08)). Furthermore, the questionnaire demonstrated good internal reliability (inter-observer reliability; Fleiss kappa: overall:0.27(fair); E:0.30 (fair); F: 0.33(fair); G: 0.33(fair); I: 0.89 (almost perfect)). CONCLUSION: The questionnaire was validated and is suitable to be used in the four languages to assess the knowledge of dentists on diagnosing, recording and managing root caries. CLINICAL SIGNIFICANCE: The present questionnaire was validated and seems to be a good tool to evaluate how dentists diagnose, record, and manage root caries lesions both in its original (English) and its translated (French, German, and Italian) versions.

Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Adults: A Systematic Review for the US Preventive Services Task Force.

Importance: Dental caries and periodontal disease are common adult oral health conditions and potentially amenable to primary care screening and prevention. Objective: To systematically review the evidence on primary care screening and prevention of dental caries and periodontal disease in adults to inform the US Preventive Services Task Force. Data Sources: MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (to October 3, 2022); surveillance through July 21, 2023. Study Selection: Diagnostic accuracy studies of primary care screening instruments and oral examination; randomized and nonrandomized trials of screening and preventive interventions; cohort studies on primary care oral health screening and preventive intervention harms. Data Extraction and Synthesis: One investigator abstracted data; a second checked accuracy. Two investigators independently rated study quality. Diagnostic accuracy data were pooled using a bivariate mixed-effects binary regression model. Main Outcomes and Measures: Dental caries, periodontal disease, morbidity, quality of life, harms; and diagnostic test accuracy. Results: Five randomized clinical trials, 5 nonrandomized trials, and 6 observational studies (total 3300 participants) were included. One poor-quality trial (n = 477) found no difference between oral health screening during pregnancy vs no screening in caries, periodontal disease, or birth outcomes. One study (n = 86) found oral health examination by 2 primary care clinicians associated with low sensitivity (0.42 and 0.56) and high specificity (0.84 and 0.87) for periodontal disease and with variable sensitivity (0.33 and 0.83) and high specificity (0.80 and 0.93) for dental caries. Four studies (n = 965) found screening questionnaires associated with a pooled sensitivity of 0.72 (95% CI, 0.57-0.83) and specificity of 0.74 (95% CI, 0.66-0.82) for periodontal disease. For preventive interventions no study evaluated primary care counseling or dental referral, and evidence from 2 poor-quality trials (n = 178) of sealants, and 1 fair-quality and 4 poor-quality trials (n = 971) of topical fluorides, was insufficient. Three fair-quality trials (n = 590) of persons with mean age 72 to 80 years found silver diamine fluoride solution associated with fewer new root caries lesions or fillings vs placebo (mean reduction, -0.33 to -1.3) and decreased likelihood of new root caries lesion (2 trials; adjusted odds ratio, 0.4 [95% CI, 0.3-0.7]). No trial evaluated primary care-administered preventive interventions. Conclusions and Relevance: Screening questionnaires were associated with moderate diagnostic accuracy for periodontal disease. Research is needed to determine benefits and harms of oral health primary care screening and preventive interventions.

Effect of a single application of silver diamine fluoride on root caries after 12 months in institutionalised older adults-A randomised clinical trial.

OBJECTIVE: Silver diamine fluoride (SDF) has been shown to be highly effective against caries, in particular for arresting root surface caries and for dentine caries in primary teeth. SDF may complement fluoride varnish routines for treatment of root caries in nursing home residents. The aim of this randomised, single-blinded, placebo-controlled trial was to evaluate the additive effect of a single annual application of SDF for prevention and treatment of incipient root caries in older adult nursing home residents. METHOD: Four hundred older adult nursing home residents (≥70 years old) with at least one exposed root surface (on teeth 15, 14, 13, 23, 24, or 25) were identified during routine dental examination visits in the domiciliary dental care setting. Eligible patients, who were able to understand the implication of consenting to the study, were invited to participate. Their cleaned root surfaces were randomly allocated to treatment with SDF (Advantage Arrest Silver Diamine Fluoride 38%, Advantage Arrest, LLC, Redmond, OR 97756, USA, Lot 16 152) or with placebo (tap water), each for 1 minute. RESULTS: Of the 400 eligible individuals, 42 declined to participate and two forms were destroyed. The remaining 356 participants (89.0%; mean age 87.7 years) were randomly allocated, with 174 going to the SDF group and 182 to the placebo group. At 1 year, 273 participants (76.7%) were available for assessment: 135 in the SDF group and 138 in the placebo group. By that time, 109 individuals (39.9%) demonstrated root caries progression or regression. Among those 118 (16.7%) of the 708 included root surfaces had developed caries There were no statistically significant differences in the primary outcome related to treatment with SDF or placebo, at either patient or root surface level. CONCLUSION: Based on the finding of this clinical trial, it is concluded that a single SDF application to complement a risk-based preventive programme including fluoride varnish applications did not have a statistically significant additional preventive effect on root caries development in a group of older adult nursing home residents with limited caries activity and cognitive capacity to cooperate in oral care activities.

Salivary levels of five microorganisms of root caries in nursing home elderly: a preliminary investigation.

BACKGROUND: Streptococcus, Bifidobacteria, Lactobacillus and Actinomyces are acidogenic aciduria that may be associated with root caries (RC). The aim of the study was to analyze Streptococcus mutans (S. mutans), Streptococcus sobrinus (S. sobrinus), Bifidobacterium spp., Lactobacillus spp. and Actinomyces naeslundii (A. naeslundii) in the saliva of nursing home elderly, to assess the correlation between bacterial composition and RC for five putative catiogenic organisms. METHODS: In this study, we collected 43 saliva samples and divided into two groups: the root caries group (RCG, n = 21) and the caries-free group (CFG, n = 22). Bacterial DNA was extracted from the saliva samples. The presence and abundance of the five microorganisms were detected by Quantitative real-time PCR (qPCR). Spearman correlation test was performed to evaluate the relationship between the numbers of root decayed filled surfaces (RDFS) and root caries index (RCI) and salivary levels of the bacteria. RESULTS: The salivary levels of S. mutans, S. sobrinus, Bifidobacterium spp. and Lactobacillus spp. were significantly higher in RCG than in CFG (p < 0.05). RDFS and RCI (RDFS/RCI) were positively associated with salivary levels of S. mutans, S. sobrinus and Bifidobacterium spp. (r = 0.658/0.635, r = 0.465/0.420 and r = 0.407/0.406, respectively). No significant differences in presence and amounts of A. naeslundii was observed between the two groups (p > 0.05). CONCLUSION: S. mutans, S. sobrinus and Bifidobacterium spp. in saliva appear to be associated with RC in the elderly. Taken together, the findings indicate that specific salivary bacteria may be involved in the progression of RC.

Caries experience and risk indicators of having decayed teeth among 65-year-olds in Oslo, Norway: a cross-sectional study.

BACKGROUND: Meeting the oral health needs of the increasing population of older adults presents a major challenge in dental care. Knowledge about the oral health status in the young-elderly age group is essential for the planning of future oral health education and prevention programs. The aims of the present study were therefore to investigate the caries experience among 65-year-olds in Oslo, Norway, and to explore associations between having decayed teeth and sociodemographic, behavioural, and biological factors. METHODS: A random sample of 65­year­olds in Oslo answered a questionnaire and underwent clinical and radiographic examinations (n = 457, 52% men and 48% women) at the Research Clinic, Faculty of Dentistry, University of Oslo, between February and December 2019. Primary- and secondary coronal and root caries lesions, root remnants, and missing and restored teeth were recorded. Decayed teeth (DT) were defined as teeth with coronal- and root caries lesions that had progressed into dentine and root remnants, and the DMFT/S scores were calculated. RESULTS: The mean number of teeth was 25 (SD: 4) and the mean DMFT was 19.4 (SD: 4.7). Thirty seven percent of the individuals had at least one decayed tooth (DT > 0), and the mean number of filled teeth (FT) was 16.1 (SD: 5.4). Multivariable logistic regression analysis showed that male gender (OR: 1.8, 95% CI: 1.2-2.8), basic level of education (OR: 1.9, 95% CI: 1.2-2.9), irregular dental attendance (OR: 2.2, 95% CI: 1.0-4.8), and hyposalivation (OR: 2.1, 95% CI: 1.0-4.4) were significant risk indicators for having decayed teeth (DT > 0) (p < 0.05). CONCLUSIONS: In conclusion, 65-year-olds in Oslo had a low average number of decayed and missing teeth, and a high number of restored teeth. Irregular dental attendance and hyposalivation were the strongest risk indicators for having decayed teeth. Based on the present results, it will be important to ensure access to regular dental care and to increase the emphasis on caries preventive measures for individuals with hyposalivation in this age group.

Prevalence of root caries in Indian population - a systematic review and meta-analysis.

AIM: To evaluate the pooled prevalence of root caries among Indian population through systematic review and meta-analysis. MATERIALS AND METHODS: The study protocol adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and was registered in PROSPERO (CRD42022367365). Research articles published in English language till July 2022 were evaluated with the use of databases like PubMed, Science Direct, Google Scholar, Cochrane, and Scopus and employed standard Boolean operators. RESULTS: The search turned up a total of 194 articles; however, only 14 of those matched the requirements for inclusion and were used to compile the meta-analysis. MedCalc® Statistical Software version 20.2 was used to determine the pooled estimates. Using the random effect model, the analysis was carried out. By estimating the heterogeneity using Higgins' I2 statistics, the extent and importance of differences between the chosen studies were ascertained. Publication bias was assessed using the funnel plot and Egger's test. The random effects model yielded a pooled prevalence of 27.617 (95% CI = 17.422-39.154). CONCLUSION: Three out of ten persons in India may be affected by root caries, which is a serious health issue. To enhance the quality of life for the aged population, oral health policies and preventive actions should concentrate on this issue.