Comparison of the Detection of Early Occlusal Caries in Extracted Human Permanent Molar Teeth by Electrical Conductance and Biopsy Means.

OBJECTIVES: An in vitro study was performed to detect occlusal caries lesions of extracted permanent human molars by electrical conductance measurement with the Ortek ECD™ electronic device, and each tooth was sectioned and biopsied to validate and evaluate results. METHODS: Thirty-nine permanent molars were extracted. Thirteen were freshly erupted and had little opportunity to develop lesions. Twenty-six were in the mouth longer and likely to be carious. After extraction and storage in a mild disinfectant, each tooth was thoroughly rinsed with distilled water and positioned upright to enable its electrical conductance measurement. Electrical conductance was measured in pits and fissures of carious and non-carious permanent molars with an Ortek ECD. Crowns were sectioned horizontally producing 630 µm thick slices and examined individually for demineralization by light microscopy and photography. Tooth biopsy was analyzed to ascertain the degree of tooth demineralization. RESULTS: Visual examination by light microscopy and photography of the sections of non-carious and carious teeth were analyzed. Noncarious teeth showed no mineral loss and showed an electrical conductance score of 0.0 µA. In carious teeth, this score ranged from 0.3 to 3.0. A significant (p < 0.001) correlation coefficient (r) of 0.914 was obtained. Electrical conductance versus biopsy resulted in high values for sensitivity (100%) and specificity (93%). It showed a positive predictive value (PPV) of 96% and a negative predictive value (NPV) of 100% for electrical conductance versus biopsy. CONCLUSIONS: Subject to in vivo clinical support, the Ortek ECD is likely to prove to be the best method for detection and evaluation of early occlusal caries.

Early-life sugar consumption and breastfeeding practices: a multicenter initiative in Latin America.

The aim of this multicenter study was to explore the early-life sugar consumption and dietary practices in Latin America as well as to investigate the association between breastfeeding duration and the age at which foods and beverages with added sugars are introduced. A cross-sectional study was conducted with 805 1- to 3-year-old children from 10 Latin American countries, as a complementary study to the Research Observatory for Dental Caries of the Latin American Region (OICAL). A Food Frequency Questionnaire previously tested in different countries was applied to children's mothers and data on breastfeeding and age at introduction of sugary foods and beverages was collected. Statistical analysis included the Kruskal-Wallis test and Poisson regression with robust variance, with the calculation of crude and adjusted mean ratios (MR) and 95% of confidence intervals (CI). The average age at introduction of sugary foods and beverages was 10.1 months (95%CI 9.7-10.4) and 9.6 (95%CI 9.2-9.9) months, respectively, with a significant variation between countries (p < 0.001). The average daily frequency of sugary foods-beverages was 3.3 times per day (95%CI 3.1-3.5) and varied significantly between countries (p = 0.004). Breastfeeding duration of over six months was associated with an increase in the age of introduction of sweet drinks (16%; MR 1.16; 95%CI 1.05-1.28) and foods (21%; MR 1.21; 95%CI 1.10-1.33). In conclusion, most children from vulnerable settings in Latin America start consuming sugary products in the first year of life and a high frequency of consumption was reported through early childhood. Additionally, breastfeeding contributes to a delay in the introduction of sugary products.

Situational diagnosis of policies in Latin American and Caribbean countries for the use of fluoride and reduction of sugar consumption.

Policy evaluation and guidance on fluoride use and sugar consumption in Latin American and Caribbean countries (LACC) may provide a scientific evidence basis for policymakers, dental professionals, civil society organizations and individuals committed to improving public oral health. A cross-sectional study was conducted to evaluate the extent of implementation of policies/guidelines on fluoride use, and sugar consumption in LACC. The study had two stages. First a questionnaire covering four major areas was developed: fluoridation of public water supplies; salt fluoridation; fluoride dentifrices, and sugar consumption. Then, the questionnaire was applied to collect data among representative participants in public oral health from LACC. Ninety-six participants from 18 LACC answered the questionnaire. One-hundred seventy documents were attached, and 285 links of websites were provided by the respondents. Implementation of policies and guidelines on water and table salt fluoridation and processed and ultra-processed food consumption were found in most countries, with some issues in the consensus and coverage. Thus, differences were identified in the extent of implementation of public oral health strategies on sugar consumption and fluoridation among the countries. There is no consensus on the policies in LACC to reduce sugar consumption and for the use of fluoride. A few policies and guidelines were applied in isolated countries, with a variety of strategies and standards. For future actions, it will be important to encourage the development of strategies and public policies within countries, and to evaluate the effectiveness of existing policies in reducing dental caries and in improving oral health in LACC.

Caries experience and associated risk factors in Venezuelan 6-12-year-old schoolchildren.

This research aims to provide updated information on caries experience and associated risk factors in children 6-12 years old. A cross-sectional and descriptive study design was carried out with a non-probabilistic, convenient sample of 209 children male and female. Clinical examinations were performed by calibrated dental students following WHO detection criteria. Caries indices dmft and DMFT were calculated. Caries Risk Assessment data was collected using an adapted CAMBRA instrument; following the International Caries Care guidelines. Descriptive statistics were performed to analyze the results and Chi-square test, Contingency Coefficient (C) and Corrected Typified Residues were calculated to determine the association between variables. 58% of the total population had dental caries lesions in its more severe stages (cavitation) and 42% were apparently healthy (AHS) without any cavitated lesions. The mean dmft index was 1.34 ± 1.93, and the mean DMFT index was 0.63 ± 1.22. Lesion severity remained between 1-2 teeth affected on both dentitions. A statistically significant association (p = 0.035) between the health condition and toothbrushing was stablished with a degree of dependence of C = 0.144. A positive standardized residual of 2.1 was evident for schoolchildren that experience caries lesion that never brush their teeth and AHS that brushed their teeth more than once. No association (p = 0.081) was found between health condition and intake of sugary snacks and beverages. A severe dental caries experience with a statistically significant association between the health condition and toothbrushing with fluoridated toothpaste 1450 ppm > 1 a day and a positive correlation in schoolchildren that experience caries lesion that never brush their teeth.

Impact on oral health-quality of life in infants: Multicenter study in Latin American countries.

To assess the impact of oral conditions on oral health-related quality of life (OHRQoL) in infants in ten Latin America countries (LAC). A cross-sectional study was conducted with 930 pairs of 1-to-3-year-old children/parents from 10 LAC, as a complementary study of the Research Observatory for Dental Caries of the Latin American Region. The scale ECOHIS, previously tested and valid in ten countries, was applied to parents/caregivers of children to measure OHRQoL. Statistical analysis included descriptive data analysis and one-way analysis of variance (ANOVA-One-Way) were performed to compare age groups with OHRQoL. Bootstrapping procedures (1000 re-samplings; 95%CI Bca) were performed. The mean scores of the 'Child Impact' section in the LAC was 4.0(±8.3), in the 'Family Impact' section was 2.0(±4.0), and in overall ECOHIS score was 6.0(±12.0). In the 'Child Impact' section, Argentina 10.0(+2.4) and Venezuela 17.8(±17.5) demonstrated mean scores higher than the LAC total data. In the 'Family Impact' section, the countries with higher mean scores were Argentina 4.9(±2.0), Ecuador 2.1(±3.1) and Venezuela 7.9(±7.8). In the overall ECOHIS score, Argentina 15.1 (±4.1) and Venezuela 25.7(±25.2) has higher mean scores than the values of LAC. There is an association between children's age and parents' report of impact on the OHRQoL (p<0.001). Three-year-olds had a higher mean when compared to one- and two-year-olds, both in the Impact on the Child and Impact on the Family (p<0.001) sections, as well as in the overall ECOHIS (p<0.001). In conclusion, there are differences in OHRQoL among Latin American countries, impacting older children more significantly.

Management of dental caries lesions in Latin American and Caribbean countries.

Caries management at the lesion level is dependent on the lesion activity, the presence of a cavitation (either cleanable or non-cleanable), and lesion depth as evaluated via radiographic examination. A variety of non-invasive, micro-invasive, and minimally invasive treatment (with or without restoration) options are available for primary and permanent teeth. Non-invasive strategies include oral hygiene instructions, dietary counseling, and personal as well as professional use of fluoridated products that reduce demineralization and increase re-mineralization. Micro-invasive procedures include the use of occlusal resin sealants and resin infiltrants, while minimally invasive strategies comprise those related to selective removal of caries tissues and placement of restorations. Deep caries management includes indirect pulp capping, while exposed pulp may be treated using direct pulp capping and partial or complete pulpotomy. The aim of the present study was to review available evidence on recommended preventive and restorative strategies for caries lesions in Latin American/Caribbean countries, and subsequently develop evidence-based recommendations for treatment options that take into consideration material availability, emphasize ways to adapt available treatments to the local context, and suggest ways in which dentists and health systems can adopt these treatments.

Clinical evaluation of the ability of CaviStat in a mint confection to inhibit the development of dental caries in children.

OBJECTIVE: The aim of the present study was to determine if a sugarless mint containing CaviStat (an arginine bicarbonate calcium carbonate complex) is capable of preventing the development of dental caries in the primary molars and first permanent molars of 10 1/2- to 11-year-old Venezuelan children. METHODS: Two-hundred children were entered into this one-year study who showed the following: (i) age between 10 1/2 and 11 years; (ii) first and second primary molars still present; (iii) sound primary molars or early caries lesions in any of these teeth; and (iv) at least some caries in the primary or permanent teeth as evidence of caries activity. Out of the 200 children initially selected, 195 finished and provided complete data. Children entered into the study were examined and then randomly divided into two groups (A and B), with distribution performed on the basis of the DMFS levels of the first permanent molars. All subjects were examined visually by a single examiner using good artificial light, mirror, and probe. Group A received a sugarless confection containing CaviStat (BasicMints); Group B received a sugarless mint control that contained all ingredients except for the CaviStat. Packaging and appearance of both types of mints were identical, except for their A and B designations. RESULTS: Mean differences in DMFS, defs, and DMFS + defs scores between Groups A and B were determined. In the first permanent molars and some early erupting premolars and second molars, the data showed 75.6% fewer caries in Group A than in Group B children after six months, and 50.7% fewer after 12 months. Corresponding defs scores showed reduced development of dental caries in deciduous molars of 76.7% after six months and 131.3% after 12 months. Combined DMFS and defs scores showed 76.2 and 74.8% fewer caries lesions at six and 12 months, respectively. As exfoliation of primary molars occurred during the study period (approximately equal in the two groups), a proportion correction was made to allow for caries score reductions due to lesions lost because of such exfoliation. When this was done, the results at the end of the study still showed larger caries reductions in Group A than in the Group B subjects, and statistical analyses showed these differences were still highly significant (p < 0.001). Noncavitated caries lesions in the first permanent molars were also determined. These showed once again less caries development in Group A than in Group B subjects, and did so at both six and twelve months (57.0 and 52.4%, respectively). Levels of statistical significance at these times were p = 0.013 and 0.005. CONCLUSION: It was evident from this clinical trial that mint confections containing CaviStat are able to inhibit both caries onset and caries progression. As a result, one can conclude that CaviStat mint confection technology is a simple and economical means for reducing substantially one of the most prevalent diseases in these children.

Initial oral microbiota and the impact of delivery mode and feeding practices in 0 to 2 month-old infants

Abstract The aim of this study was to describe the initial oral microbiota and how delivery mode and feeding practices impact its diversity in 0-2-month-old infants. This was a cross-sectional study that consisted of one collection of saliva samples from 0-2-month infants at baseline. Ten pairs of mothers and infants were selected. Medical health history, pregnancy, birth, feeding practices (breastfeeding or milk formula), and infant health status was obtained. Pooled microbial samples were obtained from the oral surfaces using a sterile cotton swab. Infants did not receive any breast milk before sampling. After collection, each swab was analyzed through microbiological culture-based procedures, using selective mediums. Cultures were analyzed for the presence of Streptococci, Lactobacillus, Staphylococcus, Enterobacterium , and Candida albicans . Twenty percent of the samples were serially diluted (10-2) to assess the number of bacteria expressed as CFU. Bacillota was the leading phylogenetic group in the infant's pooled microbial sample. The most prevalent genera were Streptococcus, Lactobacillus , and Staphylococcus . Two participants had a positive growth of Candida albicans . The association between genus group, type of delivery, and feeding practices was not statistically significant (p > 0.05). Lactobacillus genus was frequently present in the cesarean delivery group but with slightly higher counts in a vaginal delivery study subject. Exclusively breastfed infants showed presence of Streptococcus, Lactobacillus, Staphylococcus . The oral microbiome in infants (0-2 month-old) is highly heterogeneous and dynamic. Microbiota composition seems to be impacted by mode of delivery, with slight differences among groups. Breastmilk appears as an essential factor in maintaining the oral microbiome's stability and diversity.

Situational diagnosis of policies in Latin American and Caribbean countries for the use of fluoride and reduction of sugar consumption

Abstract Policy evaluation and guidance on fluoride use and sugar consumption in Latin American and Caribbean countries (LACC) may provide a scientific evidence basis for policymakers, dental professionals, civil society organizations and individuals committed to improving public oral health. A cross-sectional study was conducted to evaluate the extent of implementation of policies/guidelines on fluoride use, and sugar consumption in LACC. The study had two stages. First a questionnaire covering four major areas was developed: fluoridation of public water supplies; salt fluoridation; fluoride dentifrices, and sugar consumption. Then, the questionnaire was applied to collect data among representative participants in public oral health from LACC. Ninety-six participants from 18 LACC answered the questionnaire. One-hundred seventy documents were attached, and 285 links of websites were provided by the respondents. Implementation of policies and guidelines on water and table salt fluoridation and processed and ultra-processed food consumption were found in most countries, with some issues in the consensus and coverage. Thus, differences were identified in the extent of implementation of public oral health strategies on sugar consumption and fluoridation among the countries. There is no consensus on the policies in LACC to reduce sugar consumption and for the use of fluoride. A few policies and guidelines were applied in isolated countries, with a variety of strategies and standards. For future actions, it will be important to encourage the development of strategies and public policies within countries, and to evaluate the effectiveness of existing policies in reducing dental caries and in improving oral health in LACC.

Early-life sugar consumption and breastfeeding practices: a multicenter initiative in Latin America

Abstract The aim of this multicenter study was to explore the early-life sugar consumption and dietary practices in Latin America as well as to investigate the association between breastfeeding duration and the age at which foods and beverages with added sugars are introduced. A cross-sectional study was conducted with 805 1- to 3-year-old children from 10 Latin American countries, as a complementary study to the Research Observatory for Dental Caries of the Latin American Region (OICAL). A Food Frequency Questionnaire previously tested in different countries was applied to children's mothers and data on breastfeeding and age at introduction of sugary foods and beverages was collected. Statistical analysis included the Kruskal-Wallis test and Poisson regression with robust variance, with the calculation of crude and adjusted mean ratios (MR) and 95% of confidence intervals (CI). The average age at introduction of sugary foods and beverages was 10.1 months (95%CI 9.7-10.4) and 9.6 (95%CI 9.2-9.9) months, respectively, with a significant variation between countries (p < 0.001). The average daily frequency of sugary foods-beverages was 3.3 times per day (95%CI 3.1-3.5) and varied significantly between countries (p = 0.004). Breastfeeding duration of over six months was associated with an increase in the age of introduction of sweet drinks (16%; MR 1.16; 95%CI 1.05-1.28) and foods (21%; MR 1.21; 95%CI 1.10-1.33). In conclusion, most children from vulnerable settings in Latin America start consuming sugary products in the first year of life and a high frequency of consumption was reported through early childhood. Additionally, breastfeeding contributes to a delay in the introduction of sugary products.

[Dental caries and fluorosis in children consuming water with different fluoride concentrations in Maiquetia, Vargas State, Venezuela]. / Experiencia de caries y fluorosis dental en escolares que consumen agua con diferentes concentraciones de fluoruro en Maiquetía, Estado Vargas, Venezuela.

The objective of this study was to determine the experience of fluorosis and dental caries in 8- 12 year old children that drink water with different fluoride concentrations, from Maiquetía, Vargas State. Four hundred and twenty-one children were evaluated and divided in groups of 84 children each, according with their age (8-9-10-11) but 85 for the age 12. This evaluation was developed by a calibrated dentist using Dean's Index for dental fluorosis examining only the six upper anterior teeth and DMFT/dmft index to determine dental caries, following the criteria established by the WHO. In addition, a social status questionnaire was given to the subjects and samples of water and salt from the communities were collected. Thirty-three per cent of the children in this study were males and 67% were females. Results indicated that the mean DMFT and dmft were 0.91 and 1.88, respectively, showing a total of 2.17 teeth with dental caries being the decayed component, the highest component observed in both dentitions. The mean prevalence of dental fluorosis for the studied population was 16.6%, where the very mild category (8.5%) predominated. Maria May was the most affected school with dental fluorosis (41.5%) and the fluoride concentration in drinking water after analyses was 1.58%. The results of this study indicate the presence of an inverse relationship between fluoride concentrations in the water collected at the schools and the prevalence of dental fluorosis in the permanent dentition of school children, but not in the primary dentition.

Examination of three different methods of dental caries scoring during eruption of the premolar and second molar teeth in 10- to 13-year-old children using cross-sectional data.

OBJECTIVE: Premolars and second permanent molars mainly erupt in children between 10 and 13 years of age. This age range provides a relatively large number of caries-free or near caries-free tooth surfaces at a baseline measurement that can become carious during such trials. Since traditional DMFS scoring does not take the addition of new surfaces into account, the aim of this study was to compare that scoring system to two methods where sound surfaces are included in the scoring. METHODOLOGY: The comparison was done in a cross-sectional caries prevalence study so that caries progression and tooth eruptions (as occurs in a longitudinal investigation) would not confound the methods assessments. A total of 729 children between 10 and 13 years of age were recruited from four public schools in Venezuela and assigned to age groups 10, 11, 12, and 13. Decayed, missing, and filled surfaces (DMFS) of their respective premolar and second molar teeth were scored by one calibrated examiner (CM) using a mirror and probe and the criteria reported by Radike, but with one major modification; that was, avoidance of any forceful probing of suspected non-cavitated pits and fissures for caries lesions. In each subject, traditional DMFS were determined in which sound surfaces were not considered. These scores were compared to the scoring of DMFS plus sound surfaces (DMFSS) as described by Katz, et al. and Huntington. RESULTS: Mean traditional DMFS scores (+/- SEM) obtained for the permanent premolars and second molars of 10-, 11-, 12-, and 13-year-old children were 3.06 +/- 0.27, 3.32 +/- 0.27, 3.44 +/- 0.27, and 5.69 +/- 0.37, respectively. A large difference in these scores was observed between the 12- and 13-year-old children, in contrast to smaller differences between the 10- and 11-, and the 11- and 12-year-olds. Eruption of premolar and second molar teeth examined at the same time showed per cent eruptions as follows: 27.2% at age 10; 60.8% at age 11; 84.9% at age 12; and 95.5% by age 13. Most eruption was observed in the 10- to 12-year-olds, in contrast to the largest DMFS differences appearing between children 12 and 13 years of age. Looked at longitudinally, the incongruence of prior eruption and resulting caries reaching detection levels was about one to two years. All three methods of scoring showed the sharp increment in their respective caries scores between ages 12 and 13, whereas smaller and directionally opposite score changes occurred between years 11 and 12. With the Katz, et al. and Huntington DMFSS methods, the scores between 11 and 12 years decreased, whereas traditional DMFS scoring showed an increase. Although these differences were not large, the pattern of traditional DMFS scoring differed significantly from the other two methods (p < 0.001). CONCLUSION: Traditional DMFS scoring in children between 10 and 13 years of age will not detect the new surfaces, and the resulting extra caries increments that would arise in a clinical trial. With the Katz, et al. or Huntington scoring methods, where these new surfaces are counted, adjustment is made for any such caries rate error. In caries remineralization studies, this could be of significance.

Caries experience and associated risk factors in Venezuelan 6-12-year-old schoolchildren

Abstract: This research aims to provide updated information on caries experience and associated risk factors in children 6-12 years old. A cross-sectional and descriptive study design was carried out with a non-probabilistic, convenient sample of 209 children male and female. Clinical examinations were performed by calibrated dental students following WHO detection criteria. Caries indices dmft and DMFT were calculated. Caries Risk Assessment data was collected using an adapted CAMBRA instrument; following the International Caries Care guidelines. Descriptive statistics were performed to analyze the results and Chi-square test, Contingency Coefficient (C) and Corrected Typified Residues were calculated to determine the association between variables. 58% of the total population had dental caries lesions in its more severe stages (cavitation) and 42% were apparently healthy (AHS) without any cavitated lesions. The mean dmft index was 1.34 ± 1.93, and the mean DMFT index was 0.63 ± 1.22. Lesion severity remained between 1-2 teeth affected on both dentitions. A statistically significant association (p = 0.035) between the health condition and toothbrushing was stablished with a degree of dependence of C = 0.144. A positive standardized residual of 2.1 was evident for schoolchildren that experience caries lesion that never brush their teeth and AHS that brushed their teeth more than once. No association (p = 0.081) was found between health condition and intake of sugary snacks and beverages. A severe dental caries experience with a statistically significant association between the health condition and toothbrushing with fluoridated toothpaste 1450 ppm > 1 a day and a positive correlation in schoolchildren that experience caries lesion that never brush their teeth.

Impact on oral health-quality of life in infants: Multicenter study in Latin American countries

Abstract To assess the impact of oral conditions on oral health-related quality of life (OHRQoL) in infants in ten Latin America countries (LAC). A cross-sectional study was conducted with 930 pairs of 1-to-3-year-old children/parents from 10 LAC, as a complementary study of the Research Observatory for Dental Caries of the Latin American Region. The scale ECOHIS, previously tested and valid in ten countries, was applied to parents/caregivers of children to measure OHRQoL. Statistical analysis included descriptive data analysis and one-way analysis of variance (ANOVA-One-Way) were performed to compare age groups with OHRQoL. Bootstrapping procedures (1000 re-samplings; 95%CI Bca) were performed. The mean scores of the 'Child Impact' section in the LAC was 4.0(±8.3), in the 'Family Impact' section was 2.0(±4.0), and in overall ECOHIS score was 6.0(±12.0). In the 'Child Impact' section, Argentina 10.0(+2.4) and Venezuela 17.8(±17.5) demonstrated mean scores higher than the LAC total data. In the 'Family Impact' section, the countries with higher mean scores were Argentina 4.9(±2.0), Ecuador 2.1(±3.1) and Venezuela 7.9(±7.8). In the overall ECOHIS score, Argentina 15.1 (±4.1) and Venezuela 25.7(±25.2) has higher mean scores than the values of LAC. There is an association between children's age and parents' report of impact on the OHRQoL (p<0.001). Three-year-olds had a higher mean when compared to one- and two-year-olds, both in the Impact on the Child and Impact on the Family (p<0.001) sections, as well as in the overall ECOHIS (p<0.001). In conclusion, there are differences in OHRQoL among Latin American countries, impacting older children more significantly.

Resumo Avaliar o impacto das condições bucais na qualidade de vida relacionada à saúde bucal (QVRSB) em crianças de dez países da América Latina (AL). Foi realizado um estudo transversal com 930 pares de crianças/pais de 1 a 3 anos de 10 países da AL, como estudo complementar do Research Observatory for Dental Caries of the Latin American Region. A escala ECOHIS, previamente testada e validada em dez países, foi aplicada a pais/cuidadores de crianças para mensurar a QVRSB. A análise estatística incluiu análise descritiva de dados e análise de variância unidirecional (ANOVA-One-Way) para comparar grupos etários com QVRSB. Procedimentos de bootstrapping (1000 reamostragens; 95%IC Bca) foram realizados. A pontuação média da seção 'Impacto na Criança' na AL foi 4,0 (±8,3), na seção 'Impacto na Família' foi 2,0 (±4,0) e no escore total do ECOHIS foi 6,0 (±12,0). Na seção 'Impacto na Criança', Argentina 10,0(+2,4) e Venezuela 17,8(±17,5) demonstraram pontuações médias superiores aos dados totais da AL. Na seção 'Impacto na Família', os países com pontuações médias mais altas foram Argentina 4,9(±2,0), Equador 2,1(±3,1) e Venezuela 7,9(±7,8). No escore total do ECOHIS, Argentina 15,1 (±4,1) e Venezuela 25,7(±25,2) apresentaram escores médios superiores aos valores de AL. Houve associação entre a idade das crianças e o relato dos pais de impacto na QVRSB (p<0,001). As crianças de três anos tiveram média maior quando comparadas às de um e dois anos, tanto nas seções 'Impacto na Criança' e 'Impacto na Família' (p<0,001), quanto no escore total ECOHIS (p<0,001). Em conclusão, houveram diferenças na QVRSB entre os países da América Latina, impactando de forma mais significativa as crianças mais velhas.

Management of dental caries lesions in Latin American and Caribbean countries

Abstract Caries management at the lesion level is dependent on the lesion activity, the presence of a cavitation (either cleanable or non-cleanable), and lesion depth as evaluated via radiographic examination. A variety of non-invasive, micro-invasive, and minimally invasive treatment (with or without restoration) options are available for primary and permanent teeth. Non-invasive strategies include oral hygiene instructions, dietary counseling, and personal as well as professional use of fluoridated products that reduce demineralization and increase re-mineralization. Micro-invasive procedures include the use of occlusal resin sealants and resin infiltrants, while minimally invasive strategies comprise those related to selective removal of caries tissues and placement of restorations. Deep caries management includes indirect pulp capping, while exposed pulp may be treated using direct pulp capping and partial or complete pulpotomy. The aim of the present study was to review available evidence on recommended preventive and restorative strategies for caries lesions in Latin American/Caribbean countries, and subsequently develop evidence-based recommendations for treatment options that take into consideration material availability, emphasize ways to adapt available treatments to the local context, and suggest ways in which dentists and health systems can adopt these treatments.

The inhibitory effect of an arginine bicarbonate/calcium carbonate CaviStat-containing dentifrice on the development of dental caries in Venezuelan school children.

OBJECTIVE: This study assessed the effect of an arginine bicarbonate/calcium carbonate (CaviStat)-containing dentifrice on caries development, mainly in 11- to 12-year-old Venezuelan children over a two-year period. METHODOLOGY: Children (726) with a DMFT between 3 and 6 were examined at baseline, six months, and one and two years using a mirror, probe, and DMFS scoring. Subjects who completed the study consisted of two groups; 304 test and 297 control. The test group received a CaviStat-containing dentifrice, and the controls used a commercially available 1100 ppm fluoride toothpaste. All subjects were instructed to brush three times a day for 1 minute followed by swishing for 30 seconds. RESULTS: After six months, the mean DMFS scores increased only slightly from baseline in both groups, 6.93 +/- 0.22 in the control and 6.59 +/- 0.22 in the test subjects. After one year, the mean DMFS score in the control group rose to 8.00 +/- 0.24 and leveled off at 7.92 +/- 0.30 at two years. In contrast, the mean DMFS score in the test group decreased to 5.50 +/- 0.24 after one year before rising to 6.99 +/- 0.28 at two years. DMFS difference between the two groups was highly significant (p < 0.001), but mainly due to the large difference seen at one year. Dissection of the data showed that the erupted first molars dominated the overall DMFS changes. At the beginning of this study, first molar scores started at high values and showed a pattern thereafter like that seen for the total data. In contrast, premolars/molars, which erupt 4-6 years later (and at the start of the study had a mean DMFS score slightly above zero), showed a clear rise in the DMFS score in the control group during the first year of the study, which continued to rise until the end of the investigation. In contrast, the CaviStat group showed no change in the premolar/second molar DMFS score from baseline during the first year (giving the impression of 100% inhibition at one year), but showed a delayed rise thereafter that paralleled that seen in the controls between one and two years (58.3% inhibition at two years). Reversal of the development of early dental caries lesions in the CaviStat subjects and limitations of the diagnosis of very early caries lesions with standard dental explorers was suggested for the interesting first molar, first year data. Inhibition of caries initiation and caries progression in the CaviStat group was also observed and easier to see in the premolar/second molar, second year data where the DMFS scores were very low at baseline and reversals are not a significant issue. The results were subjected to statistical analysis including analysis of covariance. Largely because of the first year and first molar data, the difference between control and experimental groups was highly significant (p < 0.001). Similar comparison with the later-erupting premolar/molar teeth showed the CaviStat effect was also significant but at a lower level (p < 0.05). The differences could not be due to examiner error since the Kappa for 10% of the subjects randomly selected and re-examined was 0.898 overall and 0.914 for the first molar data. The data also suggested CaviStat inhibition of caries progression because of a slower rate of rise of missing+filled teeth in the CaviStat vs. the control group (p < 0.05). CONCLUSION: A CaviStat-containing toothpaste was more effective both clinically and statistically in inhibiting caries initiation and progression than the fluoride toothpaste control, and manifested its effects differently in the already-erupted first molars than in the later-erupting premolars and second molars.

Dental caries experience in schoolchildren and the impact of non-cavitated lesions on the caries index

El objetivo de este artículo fue evaluar la experiencia de caries en escolares de 11 a 13 años de edad del Municipio Sucre y el impacto de las lesiones no cavitadas en el índice de caries. Seseleccionó una muestra a conveniencia de 12 escuelas ubicadas en el Municipio Sucre, Estado Miranda, Venezuela. Previo consentimiento informado, se examinaron 1484 niños utilizandoluz artificial, espejo #5 y explorador #23; siguiendo los criterios propuestos por Radike (1972), modificados por Acevedo et al (2005). La detección de las lesiones iniciales se realizó previaprofilaxis y secado del diente durante 5 segundos (con jeringa triple). Resultados: La prevalencia de caries fue de 94,07 por ciento y el índice CPOS promedio fue de 4,35±4,21 aumentandosignificativamente a 6,45±5,01 cuando se incorporaron las lesiones iníciales (p<0,05). De acuerdo al género, seobservó un CPOS mayor en las niñas (4,51±4,45) al compararlo con los varones (4,21±3,97), sin diferencia estadísticamente significativa (p>0,05). El mismo patrón se observó cuando seincorporaron las lesiones iníciales al CPOS, 6,67±5,15 para niñas y 6,26±4,88 para varones. Las lesiones no cavitadas representaron el 33 por ciento del total de lesiones cariosas. Conclusión: Los resultados indican una alta prevalencia de caries en lapoblación estudiada, así como la importancia de incluir las lesiones no cavitadas al índice CPOS.

Métodoa convencionales y no convencionales para la detección de lesión inicial de caries: revisión bibliográfica / Conventional and unconventional methods to detect initial caries lesion: a review

El conocimiento sobre la caries como enfermedad, así como los conceptos y métodos de diagnóstico, han evolucionado desde Miller hasta Fejerskov, quien postula que la caries dental es un proceso dinámico, resultado de un desequilibrio en el mecanismo de desmineralización y remineralización como consecuencia del metabolismo microbiano y de los efectos que este proceso tiene sobre los tejidos duros del diente. De acuerdo a esta nueva visión de lo que es la caries dental, surge la inquietud de desarrollar métodos diagnósticos más sensibles y específicos para detectar la lesión desde sus estadios más tempranos con el fin de promover la remineralización de la lesión evitando la pérdida de estructura dentaria. No obstante, existen diferencias sustanciales en cuanto a cómo el odontólogo afronta el diagnóstico, prevención y manejo de la caries dental, lo que nos hace pensar que no solo es cuestión de un buen método de detección de caries, sino de la utilización de criterios que conlleven a un diagnóstico más acertado. Sin embargo, todavía no se desarrolla un método lo suficientemente sensible como para sustituir a la exploración visual-táctil, aunque éste, por su baja sensibilidad, requiera en algunos casos de la utilización de un método auxiliar que incremente la detección o confirme el resultado de la exploración, para lo cual es necesario conocer los métodos de detección de caries con los cuales contamos en la actualidad

Our knowledge about tooth decay as an illness as well as the concepts and diagnostic methods, have evolved from Miller to Fejerskov who postulates that caries is a dynamic process brought about by a lack of equilibrium connected to the mechanism of remineralization and demineralization. This situation is generated by the microbial metabolism and by the effect that this process has over the hard dental tissues. According to this new perspective about what dental decay is all about, we are forced to design new and more sensitive and specifics diagnostic methods which enable us to detect the lesion already in its initial stage and be able to promote remineralization not to loose the dental structure. Notwithstanding there is controversy about the dentist´s diagnostic and his decision about the best way to prevent and handle dental decay. This makes us think that there need more than a good method to detect the lesion, but the operator must be able to use criteria which enables de dentist to arrive to a better diagnostic. However, we have no developed a sensitive method yet to replace the tactil-visual exploration, this method is sensitivity, and in sometimes need an auxiliary method to increase the detection of a carious event or confirm the exploration outcomes. To attain this, is necessary to be acquainted with the commonly used today method to detect carious lesions

Teorías y factores etiológicos involucrados en la hipersensibilidad dentinaria

La hipersensibilidad dentinaria se caracteriza por un dolor breve y agudo ocasionado por la exposición de la dentina a estímulos típicamente térmicos, táctiles, osmóticos, químicos o aquellos que producen evaporación del líquido dentinario, que no puede ser atribuido a ninguna forma de patología o defecto dental. Se considera de etiología multifactorial. La teoría que mejor explica la aparición del la sensibilidad dentinaria es la hidrodinámica propuesta por Brannström. Los factores etiológicos mas relacionados a la hipersensibilidad dentinaria son: El raspado y alisado radicular, colocación de restauraciones adhesivas, la erosión dental, la abrasión, la abfracción y el blanqueamiento.

The dentinary hipersensitivity is caracterizad by ana cute and short duration pain produced by the exposition of dentine to termal, evaporatorios, tactile, osmotic or chemical stimulants, that can not be atribuited to any pathology or dental detect. It is considerated to have a multifactorial etiology. The theory that best explains the aparition of dentinary sensibility is the hydrodinamic one proponed by Brannström. The etiological factors mostly related to dentinary hypersensitivity are: root planning treatment, adhesive restorations, dental erosion, abrasion, abfraction and whitening.

Evaluación de un método de extracción de glicoproteína de glándulas submaxilares de bovino / Evaluation of an extraction method glycoprotein bovine submaxillary glands

Los métodos utilizados para la obtención de glicoproteínas de glándulas submaxilares de bovino consisten en esquemas que implican la eliminación de compuestos acuoinsolubles, aislamiento y purificación de las glicoproteínas. El propósito de este estudio fue evaluar un método de obtención de glicoproteínas (Escalona y col. 1989) a partir de glándulas de bovino para obtener un extracto mucínico destinado a la elaboración de un sustituto salival, con el fin de conocer el tipo y cantidad de proteínas presentes y su asociación con la viscosidad. Se analizaron 6 fases acuosas posteriores a la primera centrifugación. De cada una de las fases acuosas se tomó una alícuota y se determinó la cantidad de proteínas totales, y la viscosidad. La viscosidad aparente se midió con un viscosímetro Marca Brokfield modelo LVT con un eje Nº4 a una velocidad de desplazamiento a 73.42seg-1, y las proteínas se caracterizaron por electroforesis en geles de SDS-PAGE al 8 por ciento. Cada uno de los geles se escaneo y la densitometría se realizó en forma computarizada (un programa MultiAnalystTM /PC -Bio Rad- Versión 1.1). Se observó que a medida que se avanzaba en el esquema de extracción de glicoproteínas disminuía la cantidad de proteínas totales, el patrón electroforético mostró diferencias cualitativas entre las muestras evaluadas lo cual se reflejó en una disminución estadísticamente significativa (p<0,05) de la viscosidad aparente. Al expresar la viscosidad con relación al contenido proteico ésta aumentaba, lo que nos permitió inferir que a pesar que hubo una perdida de proteínas se preservaron las glicoproteínas viscosas a expensa del rendimiento proteico

For the obtainment of glycoproteins from bovine submaxillary glands methods are used that encompass the elimination of insoluble compounds, and fractionation and purification procedures. This study was designed to evaluate a particular method (Escalona et al. 1989) for the obtainment of glycoprotein to be used in the preparation of a salivary substitute, and aimed to gathering information on the type and amount of present proteins and their association with viscosity. For this purpose, the six aqueous phases following a centrifugation step in the fractionation scheme were analyzed for protein content (Lowry et al 1951), aparent viscosity (Brookfield viscometer, model LVT), and 8 percent SDS-PAGE electrophoresis with electronic processing of the densitograms (Bio-Rad/multi Analyst). The protein content, aparent viscosity (statistically significant P<0.05), and number of electrophoretic bands showed a decrease with the progress of the fractionation procedure. However, when aparent visxosity was ex pressed in terms of protein content it showed an increase, which is consonous with the relative enrichmentain of the fractions glycoprotein along the purification procedure