Enhancement of mineral density and mechanical properties in root caries treated with silver diammine fluoride and glass ionomer cement, with emphasis on silver ion distribution.

OBJECTIVES: This study aimed to measure the distribution of silver ion (Ag+), mineral recovery, and nanohardness in carious lesions and comprehensively evaluate the degree of dentin restoration. METHODS: Sixty human teeth with root caries were randomly assigned to the control, silver diammine fluoride (SDF) [Safo], and SDF+Glass ionomer cement (GIC) treatment [Safo+Fuji] groups. Micro-computed tomography (micro-CT) was performed at five time points for each sample before/after treatment to evaluate mineral density within and around carious lesions. Three months following treatment, 12 samples were selected for synchrotron radiation X-ray fluorescence analysis to evaluate Ag+ distribution, while 15 samples were selected for nanoindentation. Data were analyzed using Dunnett's T3 test for micro-CT and Wilcoxon rank sum test with Bonferroni correction (p = 0.017) for nanoindentation. The correlation between hardness and mineral change was analyzed using the Spearman rank correlation coefficient. RESULTS: The Safo and Safo+Fuji groups showed significantly higher mineral recovery rates than did the control group (p < 0.001). In the Safo group, Ag+ accumulated in the deeper layers rather than the superficial layer of caries. In the Safo+Fuji group, Ag+ was found evenly distributed throughout caries, with only a few Ag+ detected in the GIC layer. Hardness in the Safo+Fuji group was significantly higher compared with the Safo group at depths in the range of 10-50 µm. CONCLUSION: In the presence of GICs, SDF exhibited high remineralization capacity when diffusing throughout carious lesions over time. Combined treatment with SDF and GIC could strengthen root dentin even in the presence of caries. CLINICAL SIGNIFICANCE: We found that combination treatment with SDF and GIC could increase mineral density in caries and improve the hardness of the tooth structure compared with fluoride-based agents alone. These findings might pave the way for future clinical trials to determine the therapeutic potential of nanotechnology-based restorative materials.

Effectiveness of fluorides in root caries prevention, Department of Veterans Affairs (2009-2018).

AIMS: The aim of this study was to examine the effectiveness of topical fluorides in prevention of root caries-related treatment in high caries risk Veterans. METHODS: This retrospective analysis of longitudinal data examined the effectiveness of professionally applied or prescription (Rx) fluoride treatment, in VHA clinics from FY 2009-2018. Professional fluoride treatments included 5% Sodium Fluoride (NaF) varnish (22 600 ppm fluoride), 2% NaF gel/rinse (9050 ppm fluoride), and 1.23% APF gel (12 300 ppm fluoride). The Rx for daily home use was 1.1% NaF paste/gel (5000 ppm fluoride). Outcomes studied were new root caries restorations or extractions and percent of patients with treatment over 1 year. Logistic regressions were adjusted for age, gender, race, ethnicity, chronic medical or psychiatric conditions, number of medication classes, anticholinergic drugs, smoking, baseline root caries treatment, preventive care, and time between first-last restoration in the index year. RESULTS: Root caries at baseline was associated with a high risk for new root caries. Veterans without root caries during the index year who received a fluoride gel/rinse intervention were 32-40% less likely to receive caries-related treatment for root caries during the follow-up period. Once Veterans had root caries, fluorides did not exhibit a positive effect. CONCLUSION: In older adults with high caries risk, early fluoride prevention is key, before root caries requires treatment.

Systematic review and network meta-analysis of restorative therapy and adhesive strategies in root caries lesions.

AIM: This systematic review and network meta-analysis (NMA) aimed to establish a clinically relevant hierarchy of the different adhesive and/or restorative approaches to restore cavitated root caries lesions through the synthesis of available evidence. MATERIALS AND METHODS: A systematic search was conducted in Medline/Web of Science/Embase/ Cochrane Library/Scopus/grey literature. RCTs investigating ≥2 restorative strategies (restorative /adhesive materials) for root caries lesions in adult patients were included. Risk of bias within studies was assessed (Cochrane_RoB-2) and the primary outcome was survival rate of restorations at different follow-up times (6-/12-/24-months). Network meta-analyses were conducted using a random effects model stratified by follow-up times. I2-statistics assessed the ratio of true to total variance in the observed effects. All available combinations of adhesives (1-SE: one-step self-etch; 2-3ER: two-/three-step etch-and-rinse) and restorative materials (conventional composite (CC) as well as conventional and resin-modified glass ionomer cements (GIC, RMGIC)) were included. Risk of bias across studies and confidence in NMA (CINeMA) were assessed. RESULTS: 547 studies were identified and nine were eligible for the NMA. In total, 1263 root caries lesions have been restored in 473 patients in the included clinical trials. Patients involved were either healthy (n = 6 trials), living in nursing homes (n = 1 trial) or received head-and-neck radiotherapy (n = 2 trials). There was statistically weak evidence to favour either of material/material combination regarding the survival rate. A tendency for higher survival rate (24-months) was observed for 2-3ER/CC (OR24mths 2.65; 95%CI=1.45/4.84) as well as RMGIC (OR24mths 2.05; 95%CI=1.17/3.61) compared to GIC. These findings were though not statistically significant and confidence of the NMA was low. CONCLUSION: An evidence-based choice of restorative strategy for managing cavitated root caries lesions is currently impossible. There is a clear need for more standardised, well-designed RCTs evaluating the retention rate of root caries restoration approaches.

Association of Interdental Cleaning and Untreated Root Caries in Adults in the United States of America.

PURPOSE: This study aimed to evaluate the association between interdental cleaning and untreated root caries amongst middle-aged and older adults in the US. MATERIALS AND METHODS: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) (2015-2016 and 2017-2018). Adults aged ≥40 years who underwent full mouth examination and root caries assessment were included. Participants were classified based on their interdental cleaning frequency as none, 1-3 d/wk, and 4-7 d/wk. Associations between interdental cleaning and untreated root caries were assessed using a weighted multivariable logistic regression model adjusted for sociodemographics, general behaviour, general health condition, oral conditions, oral health behavior, and dietary factors. Subgroup analyses stratified by age and sex were performed after adjusting for covariates in the logistic regression models. RESULTS: The prevalence of untreated root caries was 15.3% amongst 6217 participants. Interdental cleaning for 4-7 d/wk was a significant risk factor (odds ratio, 0.67; 95% confidence interval, 0.52-0.85). It was associated with a 40% reduction in the risk of untreated root caries in participants aged 40 to 64 years and a 37% reduction in women. Untreated root caries was also significantly associated with age, family income, smoking status, root restoration, number of teeth, untreated coronal caries, and recent dental visit. CONCLUSIONS: Interdental cleaning for 4-7 d/wk was associated with fewer untreated root caries amongst middle-aged adults and women in the US. The risk of root caries increases with age. Low family income was a risk indicator for root caries amongst middle-aged adults. Additionally, smoking, root restoration, number of teeth, untreated coronal caries, and recent dental visits were common risk factors for root caries in middle-aged and older people in the US.

Patient Living with Human Immunodeficiency Virus and Depression with High HIV Viral Load Presenting for Evaluation of Root Caries.

A 26-year-old man living with HIV and depression presents with symptoms of tooth sensitivity. His laboratory studies are all within normal limits except for a high viral load. The patient does not require any special dental management protocol and should be treated like other patients, with his laboratory studies reviewed every 6 months to 1 year. HIV is now a chronic medical conditions, with most patients having stable disease if they are compliant with their medications. Universal infection control protocols should be followed for all patients regardless of their HIV status.

Oral health for baby boomers: Past, present, and future.

AIMS: This paper reviews the oral health services which were available for early (1945-1955) and late (1956-1964) baby boomers, as well as predicts their future oral healthcare needs. METHODS AND RESULTS: The knowledge, beliefs, and attitudes of the parents of the baby boomers toward dental hygiene and oral healthcare, are reviewed. The introduction of dental health screenings occurred from 1910 to early 1970s, the creation of the first dental hygiene school and the introduction of water fluoridation influenced oral healthcare. Technology introduced in the dental offices in the 1960s included the high-speed handpiece, followed by intraoral suction in 1979. Baby boomers are keeping their teeth at higher rates than preceding generations due to improved prevention and advances in the treatment of periodontal disease, and overall lower rates of smoking in older adults, when compared to younger adults. However, access to dental care remains an issue for many. Advances in prevention and treatment of periodontal disease, early detection of root caries, new restorative techniques, and improved technologies to replace teeth are also discussed. CONCLUSIONS: Early detection of periodontal disease, oral, and oropharyngeal cancer, risk factors for tooth loss and untreated caries are needed to improve the oral health for baby boomers. Access to oral healthcare is still an issue due to socio-economic disparities in America.

The Opinions and Practices of Saudi Arabian Dentists about Cervical Margin Relocation.

AIM: The aim of this study was to assess the opinions and practices of different dentists about the cervical margin relocation (CMR) concept. MATERIALS AND METHODS: A total of 432 general dentists, advanced general dentists (AGDs), periodontists, restorative dentists, and prosthodontists practicing in Saudi Arabia were approached in person or asked to complete an electronic survey (Google Forms) assessing demographic data and their opinions and practice of CMR. Differences between groups were assessed using the Chi-squared test, and binary regression models were constructed to identify predictors of opinions and practice of CMR. RESULTS: About half of the surveyed dentists practiced CMR when indicated, but many felt that it represents an invasion of the biological width and might affect crown survival. Participants had several, often concurrent concerns about CMR. The opinions and practices of CMR were influenced by several factors including educational degree, work setting, country of clinical training, years of experience, and specialty. CONCLUSION: The relatively conservative attitude of dentists towards CMR is justifiable, as it is a relatively new concept with little long-term clinical data. Clinical trials with sufficient follow-up periods are now needed to evaluate outcomes from CMR to provide further confidence to dentists to implement the procedure. CLINICAL SIGNIFICANCE: Deep proximal carious lesions extending subgingivally is a common clinical scenario. Assessing the opinion and practice of dentists towards conservative treatment with CMR provides the basis for encouraging practitioners to use the procedure both clinically and in clinical trials.

Development of a Root Caries Prediction Model in a Population of Dental Attenders.

Root caries prevalence is increasing as populations age and retain more of their natural dentition. However, there is generally no accepted practice to identify individuals at risk of disease. There is a need for the development of a root caries prediction model to support clinicians to guide targeted prevention strategies. The aim of this study was to develop a prediction model for root caries in a population of regular dental attenders. Clinical and patient-reported predictors were collected at baseline by routine clinical examination and patient questionnaires. Clinical examinations were conducted at the 4-year timepoint by trained outcome assessors blind to baseline data to record root caries data at two thresholds - root caries present on any teeth (RC > 0) and root caries present on three or more teeth (RC ≥ 3). Multiple logistic regression analyses were performed with the number of participants with root caries at each outcome threshold utilized as the outcome and baseline predictors as the candidate predictors. An automatic backwards elimination process was conducted to select predictors for the final model at each threshold. The sensitivity, specificity, and c-statistic of each model's performance was assessed. A total of 1,432 patient participants were included within this prediction model, with 324 (22.6%) presenting with at least one root caries lesion, and 97 (6.8%) with lesions on three or more teeth. The final prediction model at the RC >0 threshold included increasing age, having ≥9 restored teeth at baseline, smoking, lack of knowledge of spitting toothpaste without rinsing following toothbrushing, decreasing dental anxiety, and worsening OHRQoL. The model sensitivity was 71.4%, specificity 69.5%, and c-statistic 0.79 (95% CI: 0.76, 0.81). The predictors included in the final prediction model at the RC ≥ 3 threshold included increasing age, smoking, and lack of knowledge of spitting toothpaste without rinsing following toothbrushing. The model sensitivity was 76.5%, specificity 73.6%, and c-statistic 0.81 (95% CI: 0.77, 0.86). To the authors' knowledge, this is the largest published root caries prediction model, with statistics indicating good model fit and providing confidence in its robustness. The performance of the risk model indicates that adults at risk of developing root caries can be accurately identified, with superior performance in the identification of adults at risk of multiple lesions.

Manejo de cárie radicular: um guia para o dentista brasileiro baseado na tradução e adaptação cultural do consenso internacional/ORCA E EFCD / Management of root caries: a guide for the Brazilian dentist based on the translation and cultural adaptation of the international consensus/ORCA and EFCD

Objetivo: A cárie radicular é um problema da Odontologia moderna, porém é notável a falta de diretrizes sobre o seu manejo. Objetivamos elaborar e adaptar um guia a partir da tradução das recomendações do consenso in-ternacional European Organization for Caries Research (ORCA) e European Federation of Conservative Dentistry (EFCD) para as tomadas de decisão clínica na intervenção do processo de cárie na pessoa idosa, com foco na cárie radicular. Materiais e métodos: O protocolo de tradução das recomendações do consenso internacional consistiu nas etapas: (1) tradução inicial, (2) síntese da tradução, (3) retradução, (4) revisão por comitê de especialistas, com adaptação cultural. A partir da tradução, foi desenvolvido um guia com diretrizes para tratamento de cárie radicular no Brasil. Resultados: Para prevenção de novas lesões é recomendada a escovação diária com dentifrício >1.500ppm/F. Dentifrícios com 5.000ppm/F ou vernizes (>20.000ppm/F) podem ser indicados para paralisar lesões radiculares ativas e para prevenção em pessoas idosas com alta suscetibilidade à cárie radicular, e o Diamino Fluoreto de Prata (>30%) para paralisar lesões ativas. Intervenções invasi-vas diretas são indicadas dependendo da situação clínica. Discussão: Nota-se uma falta de interesse em estudos primários sobre tratamentos para cárie radicular, criando assim uma lacuna em relação ao seu manejo, que reflete no nível de evidência detectado pelo consenso. Conclusão: Guias clíni-cos são importantes para reduzir a lacuna entre a pesquisa e a prática clínica. Essa tradução para o português facilitará o acesso dos dentistas bra-sileiros em relação a evidência consolidada até o momento para o manejo de cárie radicular.

Aim: Root caries are a problem in modern dentistry, but the lack of guidelines regarding their management is notable. We aim to develop and adapt a guide based on the translation of the recommendations of the international consensus as outlined by the European Organization for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD) for clinical decision-making in the intervention of the caries process in the elderly, with a focus on root caries. Materials and methods: The protocol for translating the recommendations of the international consensus consisted of the following steps: (1) initial translation, (2) synthesis of the translation, (3) back-translation, (4) review by an expert committee with cultural adaptation. Based on the translation, a guide was developed with guidelines for the treatment of root caries in Brazil. Results: To prevent new lesions, daily brushing with toothpaste >1,500ppm/F is recommended. Toothpaste with 5,000ppm/F or varnishes (>20,000ppm/F) may be recommended to paralyze active root lesions and for prevention in elderly people with high susceptibility to root caries, and Silver Diamine Fluoride (>30%) to paralyze active lesions. Direct invasive interventions are indicated depending on the clinical situation. Discussion: There is a lack of interest in primary studies on treatments for root caries, thus creating a gap in relation to its management, which is reflected by the level of evidence detected in the consensus. Conclusion: Clinical guidelines are important to reduce the gap between research and clinical practice. This translation into Portuguese will facilitate access by Brazilian dentists to the consolidated evidence gathered to date for the management of root caries.

Evaluation of quantitative light-induced fluorescence to assess lesion depth in cavitated and non-cavitated root caries lesions - An in vitro study.

BACKGROUND: This in vitro study aimed to assess carious lesions on root surfaces using quantitative light-induced fluorescence (QLF) and to compare the readings with axial lesion depth on µCT. METHODS: The root surfaces of 107 extracted human teeth were included after visual-tactile inspection. For further analysis, the following parameters were assessed: clinical findings (non-cavitated: leathery or hard, cavitated), QLF- (QLF-D Biluminator 2+), and µCT-images (Bruker Skyscan 1172). The shape of the undamaged tooth surface of the cavitated lesions was virtually re-constructed during µCT analysis. Clinical surface texture,% fluorescence loss, and lesion depth (µCT) were determined. STATISTICAL ANALYSIS: chi²-test, Spearman-Rho test, regression analysis. RESULTS: ∆F was significantly lower in non-cavitated leathery (-50.37 ± 15.10) and cavitated (-61.23 ± 9.92) compared to non-cavitated surfaces with a hard texture (-17.04 ± 16.10, p < 0.01). For non-cavitated surfaces, a negative correlation was observed between ∆F and lesion depth in µCT images regardless of texture (-0.748, p < 0.01). Regression analysis revealed that ∆F predicted lesion depth in µCT for non-cavitated surfaces (ß: 0.703, CI95: 0.67--0.43, p < 0.01). CONCLUSION: The percentage of fluorescence loss (∆F) in QLF predicted lesion depth of non-cavitated demineralized root surfaces. Therefore, QLF can be recommended for estimating the lesion depth of carious root lesions and seems to expand the possibilities of follow-up and lesion monitoring, especially for non-cavitated surfaces.

[Research on microflora and the qualitative composition of periodontal pathogens by PCR method in patients with root caries and external cervical resorption]. / Issledovanie mikroflory i opredelenie kachestvennogo sostava parodontopatogenov metodom PTsR u patsientov s kariesom tsementa i naruzhnoi tservikal'noi rezorbtsiei.

OBJECTIVE: The aim of the study was to study the microflora of periodontal pockets and gingival fluid; determine the qualitative composition of periodontal pathogens by PCR; to determine the main associations of microorganisms, to determine the periodontal index in patients with cement caries, external pathological resorption and in patients from the comparison group. MATERIAL AND METHODS: The examination included 80 patients, including 28 patients with a diagnosis of cement caries, 25 patients with a diagnosis of external cervical root resorption, 27 patients in the comparison group without tooth root damage. Based on the results of microbiological studies in various clinical conditions of the oral cavity, in particular, in different forms of lesions of the periodontium and hard tissues of teeth, the predominant microbial representatives and their combinations were identified. RESULTS: According to the study, it was revealed that all patients with cement caries and external pathological resorption have pathological processes arising in the periodontium. The study of the qualitative composition of the microflora showed that in patients with cement caries, the following associations of microorganisms are most often found: Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Tannerella forsythia, Porphyromonas gingivalis, Candida albicans, Treponema denticola. Patients with external pathological resorption of microorganisms were found in patients with external pathological resorption of microorganisms: Prevotella intermedia, Treponema denticola, Candida albicans, Tannerella forsythia, Porphyromonas gingivalis, Epstein-Barr virus. These periodontal pathogenic microorganisms have a wide range of pathogenicity factors, which allows them to induce a prolonged inflammatory process. CONCLUSION: The study of the microflora of periodontal pockets and gingival sulcus in case of caries of cement and external pathological resorption is an important link in preventing the development and aggravation of pathological conditions of hard tissues of the tooth root and periodontal tissues.

Effect of ionizing radiation and cariogenic biofilm challenge on root-dentin caries.

OBJECTIVES: To evaluate the effect of ionizing radiation and cariogenic biofilm challenge using two continuous flow models, normal and reduced salivary flow, on the development of initial root-dentin caries lesions. MATERIALS AND METHODS: Microcosm biofilms were grown under two salivary flow rates (0.06 and 0.03 mL min-1) and exposed to 5% sucrose (3 × daily, 0.25 mL min-1, 6 min) dripped over non-irradiated and irradiated root-dentin blocks for up to 7 days. The vibration modes of root dentin, matrix/mineral (M/M), and carbonate/mineral (C/M) ratios were evaluated by FTIR. The mineral density was assessed by micro-CT. RESULTS: With normal salivary flow, FTIR revealed an increase in the organic matrix (amide III) and a decrease in the mineral phase (ν4, ν2 PO43-, AII + ν2 CO32-, C/M) in caries lesions. Irradiated dentin exhibited a reduction in the mineral phase (ν1, ν3 PO43-, ν2 CO32-, C/M). Differences in mineral densities were not significant. With reduced salivary flow, FTIR also revealed increased organic matrix (amide III) for irradiated caries lesions and decrease in mineral phase (v4, v2 PO43-, v2 CO32-, and C/M) in caries lesions. ν1, ν3 PO43- precipitated on the surface of irradiated dentin and a lower mineral density was observed. CONCLUSIONS: Initial caries lesions differed between non-irradiated and irradiated dentin and between normal and reduced salivary flow rates. Significant mineral loss with exposure of the organic matrix and low mineral density were observed for irradiated dentin with a reduced salivary flow rate. CLINICAL RELEVANCE: Ionizing radiation associated with a reduced salivary flow rate enhanced the progression of root-dentin caries.

What are the main factors associated with root caries?

Data sources Medline, EMBASE, PubMed and Scopus databases were used as the data sources for the systematic review. Articles published between 1 January 1990 to 31 October 2018 were included with no language restrictions. A manual search of the references lists of the selected studies and review articles was conducted.Study selection Two independent researchers identified observational studies that investigated at least one risk factor of root caries in the study population. Studies were only included if they demonstrated statistical analysis of data on root caries, had a sample size of >100 and were in vivo. A third researcher was consulted to achieve consensus if there was disagreement. Methodological quality was evaluated via the modified Newcastle-Ottawa Scale for cross-sectional studies.Data extraction and synthesis Data was extracted and pooled into descriptive summary tables with study characteristics and results. Data on the presence and extent of root caries was recorded in addition to information on the relationship between the studied factors and root caries found in the unadjusted and adjusted data. Due to heterogeneity of key aspects among the included studies, meta-analysis was not conducted. Data were grouped under six categories - sociodemographic, general health behaviour, general health condition, fluoride exposure, oral health behaviour and oral health condition - and qualitatively analysed.Results Following screening of 984 articles, 62 were included in methodological quality assessment. Twenty-five were classified as moderate quality, 37 as low quality and 18 excluded. Of the 44 included articles which were qualitatively analysed, a higher association of dental caries was found in tobacco users and those with low socioeconomic status, gingival recession, poor oral hygiene and in older age groups.Conclusions Based on the present evidence, there are a number of factors associated with root caries. More high-quality observational analytical studies are needed in this field in future studies.

Análise in vitro da capacidade de soluções contendo fluoreto e/ou trimetafosfato na remineralização da dentina e na inibição da atividade de metaloproteinases da matriz dentinária / In vitro analysis of the capacity of solutions containing fluoride and/or trimetaphosphate in the remineralization of dentin and in the inhibition of the activity of dentin matrix metalloproteinases

Objetivo: O objetivo deste estudo foi investigar o potencial anti-proteolítico contra MMP-2 e MMP-9 e a capacidade de induzir a remineralização da dentina, através de soluções contendo diferentes concentrações de TMP (na sua forma cíclica), diferentes concentrações de F e associação TMP/F. Métodos: Blocos de dentina radicular (6mmx4mmx2mm, n = 130) foram selecionados e divididos aleatoriamente em 13 grupos/soluções experimentais (n = 10): 1) Placebo (sem F/TMP); 2) 0,3% TMP hidrolisado; 3) 1% TMP hidrolisado; 4) 3% TMP hidrolisado; 5) 0,3% TMP; 6) 1% TMP; 7) 3% TMP; 8) 250 ppm F; 9 500 ppm F; 10) 1100 ppm F; 11) 250 ppm F associado a 0,3% TMP; 12) 500 ppm F associado a 1% TMP e 13) 1100 ppm F associado a 3% TMP. A avaliação do potencial anti-proteolítico das soluções experimentais contra as metaloproteinases da matriz dentinária (- 2 e -9) foi realizado por meio da análise zimográfica. Para as análises mecânicas, três áreas foram determinadas para cada espécime: 1- controle (sem tratamento); 2- desmineralizado (cárie artificial); 3- tratado (desmineralizado e submetido a ciclagem de pH por 7 dias, e tratado por 1 min com as soluções experimentais). Os espécimes de dentina foram analisados quanto à porcentagem de recuperação de dureza superficial (%SHR), em dureza transversal (%CSHR) e por microtomografia computadorizada (IMC). Para os dados de dureza e Micro-CT, os resultados foram analisados por ANOVA de medidas repetidas seguida do teste de Student-Newman-Keuls (p <0,05). Resultados: A análise zimográfica mostrou que 1100 ppm F + 3% de TMP promoveu inibição completa da atividade gelatinolítica (MMP-2; MMP-9). Os grupos com TMP não hidrolisados apresentaram efeito remineralizador (% SHR e % CSHR) superior aos grupos hidrolisados. O grupo 1100F + TMP promoveu a maior %SHR e %CSHR entre todos os grupos (p <0,001), sendo respectivamente 15,4 e 10,5%, superior ao grupo 1100F. Os grupos contendo 1100F e 1100F + 3%TMP apresentaram maior concentração mineral. Conclusão: Com base nos resultados, 3% TMP atua como um agente antiproteolítico contra metaloproteinases da matriz dentinária. Além disso, quando suplementado com 1100F, 3% TMP potencializa a remineralização, aumentando significativamente as propriedades mecânicas da dentina tratada. Os tratamentos com TMP não hidrolisado e associado ao F maior que as soluções fluoretadas sem o TMP. Significância clínica: Dessa forma, uma potencial estratégia preventiva e terapêutica pode ser considerada na clínica odontológica, principalmente na terapia da cárie radicular, como também para método preventivo de lesões iniciais de cárie dentinária ou no pré-tratamento da dentina, utilizando-os como agentes cross-linker em procedimentos restauradores(AU)

Objective: The aim of this study was to investigate the anti-proteolytic potential against MMP-2 and MMP-9 and the ability to induce dentin remineralization, through solutions containing different concentrations of TMP (in its cyclic form), different concentrations of F and TMP / F association. Methods: Root dentin blocks (6mmx4mmx2mm, n = 130) were selected and randomly divided into 13 groups / experimental solutions (n = 10): 1) Placebo (without F / TMP); 2) 0.3% hydrolyzed TMP; 3) 1% hydrolyzed TMP; 4) 3% hydrolyzed TMP; 5) 0.3% TMP; 6) 1% TMP; 7) 3% TMP; 8) 250 ppm F; 9,500 ppm F; 10) 1100 ppm F; 11) 250 ppm F associated with 0.3% TMP; 12) 500 ppm F associated with 1% TMP and 13) 1100 ppm F associated with 3% TMP. The evaluation of the antiproteolytic potential of experimental solutions against dentin matrix metalloproteinases (- 2 and -9) was carried out by means of zymographic analysis. For mechanical analysis, three areas were determined for each specimen: 1- control (without treatment); 2- demineralized (artificial caries); 3- treated (demineralized and subjected to pH cycling for 7 days, and treated for 1 min with the experimental solutions). The dentin specimens were analyzed for the percentage of recovery of superficial hardness (% SHR), in crosssectional hardness (% CSHR) and by computed microtomography (∆IMC). For the hardness and Micro-CT data, the results were analyzed by repeated measures ANOVA followed by the Student-Newman-Keuls test (p <0.05). Results: The zymographic analysis showed that 1100 ppm F + 3% TMP promoted complete inhibition of gelatinolytic activity (MMP-2; MMP-9). The groups with non-hydrolyzed TMP showed a remineralizing effect (% SHR and % CSHR) superior to the hydrolyzed groups. The 1100F + TMP group promoted the highest % SHR and % CSHR among all groups (p <0.001), being 15.4 and 10.5%, respectively, higher than the 1100F group. The groups containing 1100F and 1100F + 3% TMP showed higher mineral concentration. Conclusion: Based on the results, 3% TMP acts as an antiproteolytic agent against dentinal matrix metalloproteinases. In addition, when supplemented with 1100F, 3% TMP enhances remineralization, significantly increasing the mechanical properties of the treated dentin. Treatments with non-hydrolyzed TMP and associated with F greater than fluoridated solutions without TMP. Clinical significance: Thus, a potential preventive and therapeutic strategy can be considered in the dental clinic, mainly in the treatment of root caries, as well as for the preventive method of initial lesions of dental caries or in the pretreatment of dentin, using them as agents cross-linker in restorative procedures(AU)

Inequalities in Untreated Root Caries and Affordability of Dental Services among Older American Adults.

The growing geriatric population is facing numerous economic challenges and oral health changes. This study explores the relationship between affordability of dental care and untreated root caries among older American adults, and whether that relationship is independent of ethnicity and socioeconomic factors. Data from 1776 adults (65 years or older) who participated in the National Health and Nutrition Examination Survey (NHANES) were analyzed. The association between affordability of dental care and untreated root caries was assessed using logistic regression models. Findings indicated that untreated root caries occurred in 42.5% of those who could not afford dental care, and 14% of those who could afford dental care. Inability to afford dental care remained a statistically significant predictor of untreated root caries in the fully adjusted regression model (odds ratio 2.79, 95% confidence interval: 1.78, 4.39). Other statistically significant predictors were gender (male), infrequent dental visits, and current smoking. The study concludes that the inability to afford dental care was the strongest predictor of untreated root caries among older Americans. The findings highlight the problems with access to and use of much needed dental services by older adults. Policy reform should facilitate access to oral healthcare by providing an alternative coverage for dental care, or by alleviating the financial barrier imposed on older adults.

Endogenous YAP1 activation drives immediate onset of cervical carcinoma in situ in mice.

Cervical cancer (CC) is usually initiated by infection with high-risk types of human papillomavirus (HPV). The HPV E6 and E7 proteins target p53 and RB, respectively, but other cellular targets likely exist. We generated uterus-specific MOB1A/B double KO (uMob1DKO) mice, which immediately developed cervical squamous cell carcinoma in situ. Mutant cervical epithelial cells showed YAP1-dependent hyperproliferation, altered self-renewal, impaired contact inhibition, and chromosomal instability. p53 activation was increased in uMob1DKO cells, and additional p53 loss in uMob1DKO mice accelerated tumor invasion. In human CC, strong YAP1 activation was observed from the precancerous stage. Human cells overexpressing HPV16 E6/E7 showed inactivation of not only p53 and RB but also PTPN14, boosting YAP1 activation. Estrogen, cigarette smoke condensate, and PI3K hyperactivation all increased YAP1 activity in human cervical epithelial cells, and PTPN14 depletion along with PI3K activation or estrogen treatment further enhanced YAP1. Thus, immediate CC onset may initiate when YAP1 activity exceeds an oncogenic threshold, making Hippo-YAP1 signaling a major CC driver.

Bacterial analysis of biofilms from tooth root surfaces presenting different caries activity / Análise bacteriológica de biofilmes de superfícies dentárias radiculares apresentando diferentes estágios de atividade de cárie

This study evaluated the numbers and determined the proportion of mutans streptococci and Lactobacillus spp., which are possible relevant cariogenic organisms, in biofilms recovered from lesions at root surfaces with active caries lesions (ARC), inactive caries lesions, and sound root surfaces (SRS). Samples were cultured in MSB agar for mutans streptococci counts, Rogosa agar for Lactobacillus spp. counts, and brain-heart infusion agar for total viable anaerobic counts. After incubation, the number of colony-forming units (CFUs) was determined and compared between groups by the Mann-Whitney U test with a significance level set at 95%. The proportion of counts of mutans streptococci and Lactobacillus spp. in the total viable microorganisms was also analyzed by Chi-square test. Ninety samples (30 from each surface) from 37 patients were cultured and analyzed. The CFU was similar between mutans streptococci and Lactobacillus spp.These species were present in at least half of the samples and no difference was found in the frequency of isolation of these species. Only 6 samples showed a proportion of more than 10% of mutans streptococci; 4 of the samples were from ARC. Most (93%) SRS samples did not contain viable Lactobacillus spp. The data indicate the low counts of mutans streptococci and Lactobacillus spp. in root sur-faces, regardless of the activity of caries lesions.

O estudo analisou contagens e proporções de mutans strep-tococci e Lactobacillus spp., que podem ser microorganismos importantes em lesões de cárie radicular com diferentes atividades. Biofilmes foram coletados em três locais: ARC ­ superfície radicular com lesão ativa de cárie; IRC ­ superfícies radiculares com lesão inativa de cárie; SRS ­ superfícies de raizes hígidas. As amostras foram cultivadas em agar MSB para contagens de mutans streptococci; agar Rogosa para Lactobacillus spp., e agar BHI para contagens de microrganis-mos viáveis anaeróbicos totais. Após a incubação, o número de unidades formadoras de colônias (UFCs) foi determinado e comparado entre os grupos pelo teste de Mann-Whitney U test. O nível de significância foi estabelecido em 95%. A pro-porção de contagem de mutans streptococci e Lactobacillusspp. no total de microrganismos viáveis também foi analisado através do teste de qui-quadrado. Um total de 90 amostras de 37 pacientes foram cultivadas e analisadas: 30 amostras de ARC, 30 de IRC e 30 de SRS. Números de UFC foram seme-lhantes entre os grupos para ambos, mutans streptococci e Lactobacillus spp. Estas espécies estavam presentes em pelo menos metade de todas as amostras e nenhuma diferença foi encontrada na frequência de isolamento dessas espécies dentro dos grupos. Apenas 6 amostras apresentaram mais de 10% de mutans streptococci e 4 foram de ARC. Em relação aos Lactobacillus spp., 93% das amostras não apresentaram proporção dessas bactérias nas SRS. Mutans streptococci e Lactobacillus spp. estão presentes em baixa proporção nas superfícies radiculares, independentemente da atividade das lesões de cárie.

[Ruinous dentition as consequence of root caries]. / Desolate dentitie als gevolg van wortelcariës.

An 88-year-old patient was referred to a geriatric dentist because of seriously neglected dentition and with the desire to look decent again. The deterioration of the dentition turned out to be the result of cognitive and physical decline and polypharmacy. The Clinical Practice Guideline (KPR) 'Root caries in (frail and care-dependent) older people provides recommendations to prevent deterioration of the dentition caused by root caries in older people. The timely recognition of risk factors, the use of additional fluoride measures and the intensification of professional oral care are the central points. In short: not to lose sight of an older patient. It can prevent the destruction of the teeth that the older patient has taken good care of until then.

Factors associated with development of root caries in dentition without root caries experience in a 2-year cohort study in Japan.

OBJECTIVES: To investigate factors associated with the development of root caries in dentition without root caries experience and interactive relationships between risk factors. METHODS: We conducted surveys, consisting of an oral examination (oral hygiene, assessment of the number of teeth, coronal and root caries) and a self-reported questionnaire, among employees of a company in Tokyo, Japan in 2016 and 2018. Questionnaires collected data on smoking status, oral hygiene habits, sugar intake, and frequency of dental visits. Multiple logistic regression and decision tree analyses were used to determine factors associated with the development of root caries. RESULTS: A total of 299 participants aged 25-63 years were included in the analysis. Males, older adults, smokers/past smokers had a significantly greater risk of developing root caries. The risk of developing root caries was significantly associated with the number of teeth with gingival recession at baseline (6-9 teeth, odds ratio [OR]: 7.69, 95 % confidence interval [CI]: 2.31-25.56; 10+ teeth, OR: 9.19, 95 % CI: 2.73-30.95, relative to ≤5 teeth); and with the number of coronal decayed and filled (DF) teeth (11-13 teeth, OR: 3.21, 95 % CI: 1.12-9.24; and ≥14 teeth, OR: 3.60, 95 % CI: 1.27-10.20, relative to ≤10 teeth). Other factors associated with root caries development differed according to the number of teeth with gingival recession and included drinking sugar-sweetened beverages, and the amount of toothpaste used. CONCLUSIONS: Gingival recession and number of coronal DF teeth were associated with the development of root caries. CLINICAL SIGNIFICANCE: Multiple factors are associated with root caries development. The effect of risk factors such as drinking sweetened beverages and less toothpaste use is greater in individuals with greater gingival recession and more coronal decayed and filled teeth. Dental practitioners should focus on modifiable risk factors to prevent root caries.

Assessment of non-cavitated root caries lesions by quantitative light-induced fluorescence-An in vivo feasibility study.

OBJECTIVES: To evaluate the reproducibility of quantitative light-induced fluorescence (QLF) for the detection and assessment of demineralization states of non-cavitated root surfaces and to determine the correlation between visual inspection and QLF-analysis. METHODS: 46 exposed non-cavitated root surfaces of 12 participants were classified in three scores: sound (0), lesion ≤ 5 mm (1a), lesion > 5 mm in diameter (1b). Three examiners imaged every root surface three times using QLF (QRayCam) and measured fluorescence loss (ΔF) and lesion volume (ΔQ). The QLF-images were analyzed by three examiners. The intra- and interexaminer reproducibilities were calculated (intraclass correlation coefficient, ICC). The correlation between the scores of root caries and QLF-analysis was determined (rank correlation coefficient, Spearman-Rho ρ). RESULTS: Intra- and interexaminer reproducibility (ICC) was 0.98 and 0.95 for ΔF, 0.94 and 0.91 for ΔQ, respectively. A significant correlation was observed between the scores and ΔF (ρ = -0.53, p < 0.01). CONCLUSION: QLF as a reproducible diagnostic tool enables non-invasive detection and differentiation of non-cavitated root caries lesions on root surfaces in vivo. It can be recommended in addition to the clinical evaluation for prospective follow-up examinations of demineralization states of exposed root surfaces.