Occlusal caries detection and monitoring using a 3D intraoral scanner system. An in vivo assessment.

OBJECTIVE: To assess the agreement in detecting and monitoring occlusal caries over thirty months using conventional visual and radiographic assessment and an intraoral scanner system which supports automated caries scoring. METHODS: Ninety-one young participants aged 12-19 years were included in the study. All occlusal surfaces were examined visually, radiographically (when indicated), and scanned with the TRIOS 4 intraoral scanner. TRIOS Patient Monitoring software (vers. 2.3, 3Shape TRIOS A/S, Denmark) was used for automated caries detection on the 3D digital models. RESULTS: Fifty-five of the study participants were re-examined after 30-months. Significant differences regarding caries detection were found between the conventional methods and the automated caries scoring system (p < 0.01), with moderate positive percent agreement (49-61%) and high negative percent agreement (87-98%). All methods reported significant caries progression over the follow-up period (p < 0.01). However, the automated system showed significantly more caries progression than the other methods (p < 0.01). CONCLUSIONS: The software for automated caries detection and classification showed moderate positive agreement and strong negative agreement with the conventional methods considering both the baseline and the follow-up assessments. The automated caries scoring system detected significantly fewer caries lesions and tended to underestimate the caries severity. All methods indicated significant caries progression over the follow-up period, while the automated system detected more caries progression. CLINICAL SIGNIFICANCE: The TRIOS system supporting automated occlusal caries detection and classification can assist in detecting and monitoring occlusal caries on permanent teeth as a complementary tool to the conventional methods. However, the operator should be aware that the automated system shows a tendency to underestimate the caries presence and lesion severity.

Cariogenic Diet Assessment and Analysis Tools in Children and Adolescents: A Systematic Review.

PURPOSE: To collect and evaluate the available evidence on existing tools used in research and clinical practice to assess and analyse the diet of children and adolescents for its cariogenicity. MATERIALS AND METHODS: Multiple databases were searched up to October 2022, with no date, publication, or language restrictions, followed by a manual search. Study screening, data extraction, and risk of bias assessment were performed in duplicate. Dietary assessment tools and dental clinical parameters tested were retrieved for qualitative assessment and synthesis. RESULTS: Of the 2896 papers identified, 9 cohort and 23 cross-sectional studies fulfilled the inclusion criteria. To assess dietary data, 13 studies used a 24-h recall, 11 used a food diary, and 7 used a food frequency questionnaire. For analysis, five studies reported using the Healthy Eating Index, ten used a score based on consumption of sugars, and the remaining analysed cariogenic diet based on the weight and frequency of sugars consumed, or the daily caloric intake from free sugars. Risk of bias assessment suggested that 65.7% of the studies were of moderate and 31.5% of high quality. CONCLUSION: Inconsistency exists regarding methods used for the assessment and analysis of dietary cariogenicity. Although every dietary assessment tool has different strengths and limitations, the 24-h recall was the most commonly used method for the assessment of dietary cariogenicity and the most consistent in detecting a positive relationship between sugary diet and carious lesions. A standardised method for cariogenic analysis of dietary data needs to be determined.

Clinical and digital assessment of tooth wear.

The aim of this study was to compare the assessment of tooth wear performed on digital models with the one conducted at the clinical examination. Seventy-eight volunteers (29 males and 49 females, age range 20-30 years) with at least 24 teeth, normal oral function, and a neutral transverse relationship were examined. During the clinical examination, dental wear was registered according to the Basic Erosive Wear Examination (BEWE) index. Subsequently, the BEWE index was blindly applied by two examiners on digital models obtained from the volunteers. Data were analyzed using weighted Cohen's kappa coefficient and correlation tests with a confidence interval of 95%. All volunteers showed signs of tooth wear. Anterior teeth showed increased severity of tooth wear than first molars. Early loss of tooth substance could be identified on the digital models, including in areas with challenging direct intraoral visual access. Approximately 50% of the scores based on clinical examination agreed with those based on examination of digital models (k = 0.543, p < 0.01). A moderate, positive correlation was observed between scores registered clinically and on digital models (Spearman's rho = 0.560, p < 0.001). Considering the rather low agreement between the clinical and digital scores, alternatives to using BEWE on digital models are needed.

Chair-side saliva diagnostic tests: An evaluation tool for xerostomia and caries risk assessment in children with type 1 diabetes.

OBJECTIVES: The aim of this cross-sectional study was to investigate how the level of metabolic control affects salivary function, xerostomia prevalence and incidence of caries, in children and adolescents with type 1 diabetes. METHODS: For the purpose of this study, a total of 150 children and adolescents (10-18 years old) were examined and allocated among 3 groups: 50 patients poorly-controlled (HbA1c≥7.5%), 50 well-controlled (HbA1c<7.5%) and 50 age- and sex-matched healthy controls. All subjects were examined for dental caries, oral hygiene and salivary factors. Assessments of salivary characteristics included self-reported xerostomia, quantification of resting and stimulated whole saliva flow rates, pH values, buffering capacity and saliva's viscosity. A questionnaire and a chair-side saliva testing kit were used for the evaluation of salivary function. Caries incidence was recorded using DMFT index. Plaque index and gingival index were additionally evaluated. Data were analysed by Chi-square and Kruskal-Wallis tests. RESULTS: Higher caries levels, higher prevalence of xerostomia and a decreased unstimulated salivary flow rate were recorded in poorly-controlled diabetics. The average caries indexes were DMFT(poor c) 3.6, DMFT(well c)1.2, DMFT(healthy) 1.5, p < 0.05). Salivary status and caries index were not found to be significantly different between well-controlled patients and healthy controls. CONCLUSIONS: The results of this study indicated that chair-side salivary tests provide the practitioners with an easy-to use and quick method for the evaluation of salivary function and caries risk assessment in young patients with diabetes. CLINICAL SIGNIFICANCE: The use of chair-side salivary tests provide the practitioners with an easy-to use and quick method for caries risk assessment and confirmation of clinical symptoms and signs in young patients with diabetes. They could be easily incorporated into daily office routine and may provide a useful tool for screening at risk patients and a simple way to communicate with the patients the need for further interventions for prevention.