RESUMEN
OBJECTIVE: A two-year study assessed the benefit of an enhanced oral health promotion program combined with a closely supervised tooth brushing program in schools, using toothpaste containing 1,450 ppm F- and 1.5% arginine, on oral health and dental caries. METHODS: 15 southern Thailand schools and 3,706 pre-school children were recruited: 8 schools with 1,766 children as controls; 7 schools with 1,940 children in the intervention groups. Of the intervention schools five were classified as cooperative school and two as non-cooperative schools, based on the criteria of 80% participation in the prescribed tooth brushing activities. RESULTS: The DMFT and DMFS increments ("enamel and dentine") were 1.19 and 1.91 for the control group and 1.04 and 1.59 for the intervention groups. These represent 12.6% and 16.8% reductions in caries respectively. The DMFT and DMFS increments ("dentine threshold") were 0.26 and 0.44 for the control group and 0.19 and 0.29 for the intervention group, representing 26.9%, and 34.1% reductions in caries incidence respectively. For the more cooperative schools the benefits were greater: up to a 40.9% reduction in caries for DMFS ("dentine threshold"). At the 24 month examination there were significant improvements in dental plaque scores with greater improvements seen in the intervention group, greater still in the cooperative schools. CONCLUSIONS: This study documents the positive effect from use of fluoridated toothpaste (1,450 ppm F- and 1.5% arginine) administered by schoolteachers and undertaken via an enhanced school oral health program. Optimising oral health interventions for young children in Thai schools may have a significant impact on caries incidence resulting in reductions of up to 34% reductions in caries for all schools included in the study and up to 41% for the most cooperative.
Asunto(s)
Promoción de la Salud/métodos , Salud Bucal , Higiene Bucal/educación , Servicios de Odontología Escolar/métodos , Cepillado Dental/métodos , Arginina/uso terapéutico , Carbonato de Calcio/uso terapéutico , Cariostáticos/uso terapéutico , Niño , Preescolar , Índice CPO , Caries Dental/prevención & control , Esmalte Dental/patología , Placa Dental/prevención & control , Índice de Placa Dental , Dentina/patología , Femenino , Fluoruros/uso terapéutico , Estudios de Seguimiento , Educación en Salud Dental/métodos , Humanos , Masculino , Fosfatos/uso terapéutico , Método Simple Ciego , Tailandia , Pastas de Dientes/uso terapéuticoRESUMEN
BACKGROUND: Measurement of initial enamel erosion is currently limited to in vitro methods. Optical coherence tomography (OCT) and quantitative light-induced fluorescence (QLF) have been used clinically to study advanced erosion. Little is known about their potential on initial enamel erosion. OBJECTIVES: To evaluate the sensitivity of QLF and OCT in detecting initial dental erosion in vitro. METHODS: 12 human incisors were embedded in resin except for a window on the buccal surface. Bonding agent was applied to half of the window, creating an exposed and non-exposed area. Baseline measurements were taken with QLF, OCT and surface microhardness. Samples were immersed in orange juice for 60 min and measurements taken stepwise every 10 min. QLF was used to compare the loss of fluorescence between the two areas. The OCT system, OCS1300SS (Thorlabs Ltd.), was used to record the intensity of backscattered light of both areas. Multiple linear regression and paired t test were used to compare the change of the outcome measures. RESULTS: All 3 instruments demonstrated significant dose responses with the erosive challenge interval (p < 0.05) and a detection threshold of 10 min from baseline. Thereafter, surface microhardness demonstrated significant changes after every 10 min of erosion, QLF at 4 erosive intervals (20, 40, 50 and 60 min) while OCT at only 2 (50 and 60 min). CONCLUSION: It can be concluded that OCT and QLF were able to detect demineralization after 10 min of erosive challenge and could be used to monitor the progression of demineralization of initial enamel erosion in vitro.
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Esmalte Dental/patología , Tomografía de Coherencia Óptica/métodos , Erosión de los Dientes/diagnóstico , Bebidas/efectos adversos , Citrus sinensis , Progresión de la Enfermedad , Fluorescencia , Dureza , Humanos , Concentración de Iones de Hidrógeno , Procesamiento de Imagen Asistido por Computador/métodos , Técnicas In Vitro , Luz , Dispersión de Radiación , Factores de Tiempo , Desmineralización Dental/diagnóstico , Desmineralización Dental/patología , Erosión de los Dientes/patologíaRESUMEN
UNLABELLED: The aim of this study was to compare the ability of quantitative light-induced fluorescence (QLF) and surface microhardness (SMH) to measure the remineralization of enamel subsurface lesions, using a pH-cycling model including treatment with 0-ppm, 550-ppm or 1,100-ppm sodium fluoride (NaF) dentifrices. METHODS: Subsurface lesions were created in human enamel specimens (n = 36) and exposed to a remineralization pH-cycling model for 14 days. The pH-cycling model was performed in an automated system where specimens were subjected to a demineralizing solution for 20 min and treatment for 1 min and were then remineralized for 7 h 39 min, 3 times daily. The treatments consisted of 3 NaF, silica-containing dentifrices (0 ppm F; 550 ppm F; 1,100 ppm F). The outcome variables were: change from baseline in surface hardness and percentage change from baseline in fluorescence. An ANCOVA explored differences between different treatment groups (at the p < 0.05 level). Associations between QLF and SMH were evaluated using Spearman's correlation coefficient. RESULTS: The percentage SMH changes were 14.9 ± 2.1%, 56.6 ± 9.6% and 103.9 ± 14.6% for the 0-, 550- and 1,100-ppm F dentifrices, respectively. The percentage fluorescence changes were 15.6 ± 7.1%, 59.8 ± 11.9% and 85 ± 13.2%, respectively. The differences between all pairwise comparisons were statistically significant for both methods (p = 0.001). QLF correlated with SMH (r = 0.67). CONCLUSIONS: Both the SMH and QLF methods demonstrated a significant F dose response for toothpaste in this in vitro remineralization model, and both methods were able to distinguish treatments with different F levels.
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Esmalte Dental/patología , Remineralización Dental/métodos , Ácido Acético/efectos adversos , Resinas Acrílicas/uso terapéutico , Cariostáticos/administración & dosificación , Esmalte Dental/efectos de los fármacos , Dentífricos/administración & dosificación , Relación Dosis-Respuesta a Droga , Durapatita/uso terapéutico , Fluorescencia , Dureza , Humanos , Concentración de Iones de Hidrógeno , Luz , Fluoruro de Sodio/administración & dosificación , Factores de TiempoRESUMEN
OBJECTIVE: To assess the impact of patient risk status on Colombian dentists' caries related treatment decisions for early to intermediate caries lesions (ICDAS code 2 to 4). METHODS: A web-based questionnaire assessed dentists' views on the management of early/intermediate lesions. The questionnaire included questions on demographic characteristics, five clinical scenarios with randomised levels of caries risk, and two questions on different clinical and radiographic sets of images with different thresholds of caries. RESULTS: Questionnaires were completed by 439 dentists. For the two scenarios describing occlusal lesions ICDAS code 2, dentists chose to provide a preventive option in 63% and 60% of the cases. For the approximal lesion ICDAS code 2, 81% of the dentists chose to restore. The main findings of the binary logistic regression analysis for the clinical scenarios suggest that for the ICDAS code 2 occlusal lesions, the odds of a high caries risk patient having restorations is higher than for a low caries risk patient. For the questions describing different clinical thresholds of caries, most dentists would restore at ICDAS code 2 (55%) and for the question showing different radiographic thresholds images, 65% of dentists would intervene operatively at the inner half of enamel. No significant differences with respect to risk were found for these questions with the logistic regression. CONCLUSION: The results of this study indicate that Colombian dentists have not yet fully adopted non-invasive treatment for early caries lesions.
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Actitud del Personal de Salud , Toma de Decisiones , Caries Dental/terapia , Odontólogos/psicología , Cariostáticos/uso terapéutico , Colombia , Resinas Compuestas/química , Estudios Transversales , Amalgama Dental/química , Caries Dental/diagnóstico por imagen , Caries Dental/prevención & control , Susceptibilidad a Caries Dentarias , Esmalte Dental/patología , Restauración Dental Permanente/métodos , Dentina/patología , Femenino , Fluoruros Tópicos/uso terapéutico , Estudios de Seguimiento , Odontología General , Humanos , Masculino , Higiene Bucal/educación , Fotografía Dental , Selladores de Fosas y Fisuras/uso terapéutico , Radiografía , Medición de Riesgo , Encuestas y CuestionariosRESUMEN
Root caries is prevalent in elderly disabled nursing home residents in Denmark. This study aimed to compare the effectiveness of tooth brushing with 5,000 versus 1,450 ppm of fluoridated toothpaste (F-toothpaste) for controlling root caries in nursing home residents. The duration of the study was 8 months. Elderly disabled residents (n = 176) in 6 nursing homes in the Copenhagen area consented to take part in the study. They were randomly assigned to use one of the two toothpastes. Both groups had their teeth brushed twice a day by the nursing staff. A total of 125 residents completed the study. Baseline and follow-up clinical examinations were performed by one calibrated examiner. Texture, contour, location and colour of root caries lesions were used to evaluate lesion activity. No differences (p values >0.16) were noted in the baseline examination with regards to age, mouth dryness, wearing of partial or full dentures in one of the jaws, occurrence of plaque and active (2.61 vs. 2.67; SD, 1.7 vs.1.8) or arrested lesions (0.62 vs. 0.63; SD, 1.7 vs. 1.7) between the 5,000 and the 1,450 ppm fluoride groups, respectively. Mean numbers of active root caries lesions at the follow-up examination were 1.05 (2.76) versus 2.55 (1.91) and mean numbers of arrested caries lesions were 2.13 (1.68) versus 0.61 (1.76) in the 5,000 and the 1,450 ppm fluoride groups, respectively (p < 0.001). To conclude, 5,000 ppm F-toothpaste is significantly more effective for controlling root caries lesion progression and promoting remineralization compared to 1,450 ppm F-toothpaste.
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Cariostáticos/administración & dosificación , Personas con Discapacidad , Fluoruros/administración & dosificación , Casas de Salud , Caries Radicular/prevención & control , Pastas de Dientes/uso terapéutico , Anciano , Anciano de 80 o más Años , Cuidado Dental para Ancianos , Atención Dental para la Persona con Discapacidad , Índice de Placa Dental , Dentadura Completa , Dentadura Parcial , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Caries Radicular/patología , Remineralización Dental , Cepillado Dental/enfermería , Xerostomía/clasificaciónRESUMEN
OBJECTIVE: The purpose of this study was to assess the ability of a new dentifrice containing arginine, an insoluble calcium compound, and fluoride to arrest or reverse naturally occurring buccal caries lesions measured using Quantitative Light-induced Fluorescence (QLF). METHODS: Three study groups used dentifrices which contained 1) 1.5% arginine and 1450 ppm fluoride as sodium monofluorophosphate (experimental), 2) 1450 ppm fluoride as sodium monofluorophosphate (positive control), and 3) no fluoride (negative control). All three dentifrices were formulated in the same calcium base. The study participants were from three schools in the city of Chengdu, Sichuan Province, China. A total of 446 of 450 recruited subjects completed the study. Of these, 147 were in the experimental, 148 in the positive control, and 151 in the negative control groups. The initial age of the children was 10-12 years (mean 11.4 +/- 0.54); 47.5% were female. RESULTS: Using QLF, assessments of buccal caries lesions were made at baseline and after three and six months of product use. For AQ, representing lesion volume, the baseline mean value for the three groups was 27.30, and at the three-month examination the mean values were 16.76, 19.25, and 25.89 for the experimental, positive, and negative control dentifrices, respectively. This represents improvements from baseline of 38.6%, 29.5%, and 5.2%. At six months, the deltaQ values for the three groups were 13.46, 18.47, and 24.18, representing improvements from baseline of 50.7%, 32.3%, and 11.4%. For all QLF metrics, deltaF (loss of fluorescence), area, and deltaQ, the differences between the negative control and both the experimental and positive control groups were statistically significant (p < or = 0.01). The differences between the experimental and positive control groups attained statistical significance for deltaQ (p < or = 0.003) at the six-month examination. CONCLUSION: It is concluded that both of the fluoride-containing toothpastes are significantly better at arresting and reversing buccal caries lesions than the non-fluoride toothpaste. Furthermore, it is concluded that the new dentifrice containing arginine, an insoluble calcium compound, and fluoride provides significantly greater anticaries benefit than a dentifrice containing fluoride alone.
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Arginina/uso terapéutico , Cariostáticos/uso terapéutico , Caries Dental/prevención & control , Dentífricos/uso terapéutico , Fluoruros/uso terapéutico , Fosfatos/uso terapéutico , Calcio/uso terapéutico , Niño , Caries Dental/clasificación , Femenino , Fluorescencia , Estudios de Seguimiento , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Masculino , Fotografía Dental/métodos , Cepillado Dental/métodos , Resultado del TratamientoRESUMEN
OBJECTIVE: The purpose of this six-month study was to assess the ability of a new dentifrice containing 1.5% arginine, an insoluble calcium compound, and 1450 ppm fluoride, as sodium monofluorophosphate, to arrest and reverse primary root caries lesions in adults. METHODS: Three test groups used dentifrices which contained either: 1) 1.5% arginine and 1450 ppm fluoride as sodium monofluorophosphate in a calcium base (experimental); 2) 1450 ppm fluoride as sodium fluoride in a silica base (positive control); or 3) no fluoride in a calcium base (negative control). The study participants were residents of the city of Chengdu, Sichuan Province, China. In order to take part, subjects had to have at least one non-cavitated primary root caries lesion. A total of 412 subjects completed the study. They were aged from 50 to 70 years (mean age 64 +/- 4.1 years) and 53.6% were female. Efficacy for arresting and reversal of primary root caries was assessed by clinical hardness measures and through the use of the Electrical Caries Monitor. RESULTS: After three months of product use, clinical hardness measures showed that 27.7%, 24.6%, and 13.1% of lesions had improved in the experimental, positive, and negative control groups, respectively, and 0.7%, 4.5%, and 16.8% had become worse, respectively. The differences in the distribution of lesion change between the negative control group and both the experimental (p < 0.001) and positive control (p = 0.001) were statistically significant. The Electrical Caries Monitor was also used as an objective measure of lesion severity. The end values increased from baseline to the three-month examinations, but none of the differences between the groups attained statistical significance. After six months, clinical hardness measures showed that only one lesion (0.7%) was worse than at the baseline examination-in the experimental group compared to 9.0% and 18.2% in the positive and negative control groups, respectively. In addition, 61.7%, 56.0%, and 27.0%, respectively, showed improvement for the three groups. The differences in the distribution of lesion change scores between the negative control group and both the experimental (p < 0.001) and positive control (p < 0.001) were statistically significant, as was the difference between the experimental group and the positive control (p = 0.006). The Electrical Caries Monitor end values for the experimental, positive, and negative control groups at the six-month examination were 7.9, 1.9 mega omega(s), and 387 kilo omegas(s), respectively. The differences between the negative control group and both the experimental (p < 0.001) and positive control (p < 0.001) were statistically significant. The difference between the experimental and positive control groups was also statistically significant (p = 0.03). CONCLUSION: It is concluded that the new toothpaste containing 1.5% arginine and 1450 ppm fluoride, as sodium monofluorophosphate in a calcium base, provided greater anticaries benefits than a conventional toothpaste containing 1450 ppm fluoride. Both fluoride toothpastes demonstrated greater benefits than non-fluoride toothpaste.
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Arginina/uso terapéutico , Calcio/uso terapéutico , Cariostáticos/uso terapéutico , Dentífricos/uso terapéutico , Fluoruros/uso terapéutico , Fosfatos/uso terapéutico , Caries Radicular/prevención & control , Anciano , Pruebas de Actividad de Caries Dental/instrumentación , Índice de Placa Dental , Método Doble Ciego , Impedancia Eléctrica , Femenino , Estudios de Seguimiento , Encía/patología , Dureza , Humanos , Masculino , Persona de Mediana Edad , Caries Radicular/clasificación , Dióxido de Silicio/uso terapéutico , Remineralización Dental/métodos , Cepillado Dental , Resultado del TratamientoRESUMEN
Traditionally, caries clinical trials of oral care products have focused on the prevention of caries in children and adolescents at the "cavitation" level. Because of a general reduction in caries incidence and the use of positive control comparators, studies have grown both in size and duration to improve statistical power. Currently, they tend to be of 2 to 3 years' duration, with up to 2,000 high-risk individuals per group. During the past decade, there has been a shift in emphasis from a restorative approach to the treatment of dental caries to a therapeutic approach focused on the remineralization of early caries lesions. However, caries clinical trials of oral care products have not often reflected this paradigm change. This manuscript reviews alternative caries clinical trial methods for oral care products. It is concluded that methods focused on the detection and monitoring of enamel caries and root caries, by visual approaches such as ICDAS and instrumental methods such as QLF, Diagnodent, and Electrical Caries Monitors, provide viable alternatives to traditional methods. In particular, such approaches more accurately reflect the modes of action of many therapeutic agents and formulations and may reduce the cost and duration of product innovation.
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Ensayos Clínicos como Asunto/métodos , Caries Dental/diagnóstico , Proyectos de Investigación/normas , Caries Dental/prevención & control , Caries Dental/terapia , Humanos , Proyectos de Investigación/tendenciasRESUMEN
OBJECTIVE: This study evaluated the effects of three post-brushing mouthwashes containing 0 ppm F, 225 ppm F, and 500 ppm F, respectively, on salivary fluoride retention after brushing with 1450 ppm fluoride (as NaF) toothpaste and rinsing with water immediately after brushing. METHODS: In this three-phase, randomized, cross-over study, an ion-specific electrode was used to measure salivary F levels in thirty trial participants before brushing (Time 0), and after brushing, rinsing with water, and then rinsing with one of the three mouthwashes. Time points evaluated after brushing were one, three, five, 10, 20, 30, 45, and 60 minutes. For saliva sample collections, subjects were asked to pool saliva in their mouths for 10 seconds before spitting out into a container for each of the time points. RESULTS: The AUC0-60 means for F in saliva were 554, 252, and 20 for the 500, 225, and 0 ppm F mouthwash groups, respectively. The 500 ppm F mouthwash resulted in a 2660% increase in total fluoride salivary retention over 60 minutes when compared with the 0 ppm F group, and a 120% increase when compared with the 225 ppm F group. A significant difference (p < 0.001) in the AUC0-60 means between the three groups was observed using analysis of variance (ANOVA). Paired t-tests also showed significant differences in the mean fluoride retention over 60 minutes for all three pair-wise group comparisons (p < 0.001). CONCLUSION: Use of a fluoride mouthwash containing 225 ppm F or 500 ppm F produced a significant increase in salivary fluoride retention following brushing with a 1450 ppm F toothpaste and rinsing with water compared to rinsing without fluoride. The use of the 500 ppm F mouthwash may be of particular benefit to those at high caries risk.
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Cariostáticos/administración & dosificación , Cariostáticos/farmacocinética , Fluoruros/administración & dosificación , Fluoruros/farmacocinética , Antisépticos Bucales/farmacocinética , Saliva/química , Adolescente , Adulto , Análisis de Varianza , Área Bajo la Curva , Disponibilidad Biológica , Estudios Cruzados , Método Doble Ciego , Femenino , Humanos , Electrodos de Iones Selectos , Modelos Lineales , Masculino , Persona de Mediana Edad , Antisépticos Bucales/química , Saliva/metabolismo , Fluoruro de Sodio/administración & dosificación , Cepillado Dental , Pastas de Dientes/química , Adulto JovenRESUMEN
We define erosion as a partial demineralisation of enamel or dentine by intrinsic or extrinsic acids and erosive tooth wear as the accelerated loss of dental hard tissue through the combined effect of erosion and mechanical wear (abrasion and attrition) on the tooth surface. Most experts believe that during the last decade there has been a significant increase in the prevalence and severity of erosive tooth wear, particularly in adolescents. Even when erosive wear occurs in its milder forms, this is a matter of concern, as it may compromise the integrity of an otherwise healthy dentition in later life. The erosive wear process is complicated and modified by many chemical, behavioural and associated processes in the mouth. If interventions are to be developed it is therefore important that in vivo methods are developed to assess the outcomes of the erosion and erosive wear processes and the effects of interventions upon them. This paper discusses potential methods of investigating erosion and erosive wear in vivo and the difficulties associated with clinical studies.
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Erosión de los Dientes/fisiopatología , Ensayos Clínicos como Asunto , Esmalte Dental/patología , Dentina/patología , Humanos , Proyectos de Investigación , Sujetos de Investigación , Abrasión de los Dientes/fisiopatología , Atrición Dental/fisiopatología , Desmineralización Dental/diagnóstico , Desmineralización Dental/fisiopatología , Erosión de los Dientes/diagnósticoRESUMEN
This study used an emerging brain imaging technique, functional near-infrared spectroscopy (fNIRS), to investigate functional brain activation and connectivity that modulates sometimes traumatic pain experience in a clinical setting. Hemodynamic responses were recorded at bilateral somatosensory (S1) and prefrontal cortices (PFCs) from 12 patients with dentin hypersensitivity in a dental chair before, during, and after clinical pain. Clinical dental pain was triggered with 20 consecutive descending cold stimulations (32° to 0°C) to the affected teeth. We used a partial least squares path modeling framework to link patients' clinical pain experience with recorded hemodynamic responses at sequential stages and baseline resting-state functional connectivity (RSFC). Hemodynamic responses at PFC/S1 were sequentially elicited by expectation, cold detection, and pain perception at a high-level coefficient (coefficients: 0.92, 0.98, and 0.99, P < 0.05). We found that the pain ratings were positively affected only at a moderate level of coefficients by such sequence of functional activation (coefficient: 0.52, P < 0.05) and the baseline PFC-S1 RSFC (coefficient: 0.59, P < 0.05). Furthermore, when the dental pain had finally subsided, the PFC increased its functional connection with the affected S1 orofacial region contralateral to the pain stimulus and, in contrast, decreased with the ipsilateral homuncular S1 regions ( P < 0.05). Our study indicated for the first time that patients' clinical pain experience in the dental chair can be predicted concomitantly by their baseline functional connectivity between S1 and PFC, as well as their sequence of ongoing hemodynamic responses. In addition, this linked cascade of events had immediate after-effects on the patients' brain connectivity, even when clinical pain had already ceased. Our findings offer a better understating of the ongoing impact of affective and sensory experience in the brain before, during, and after clinical dental pain.
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Encéfalo/fisiopatología , Neuroimagen Funcional , Dolor/diagnóstico por imagen , Adulto , Encéfalo/irrigación sanguínea , Encéfalo/diagnóstico por imagen , Frío/efectos adversos , Femenino , Humanos , Masculino , Acoplamiento Neurovascular , Dolor/fisiopatología , Corteza Prefrontal/diagnóstico por imagen , Corteza Prefrontal/fisiopatología , Corteza Somatosensorial/diagnóstico por imagen , Corteza Somatosensorial/fisiopatología , Espectroscopía Infrarroja Corta , Adulto JovenRESUMEN
Images captured using light-induced fluorescence systems are generally analysed using proprietary software. The purpose of this study was to determine if such images could be scored visually and to compare these data with those metrics produced by the software. A total of 171 lesions were selected from a pool of images to provide a range of lesions which were reported as having remained static, increased or decreased in fluorescence using the QLF analysis software. The baseline and 6-month images were then assessed side by side on a computer screen by 10 examiners who were asked to rate the lesions to determine if the lesion had become better or worse, or had stayed the same. There was generally poor correlation between clinical visual image assessments and all QLF analysis outcomes for all examiners. The agreement amongst the visual image assessments for the 10 examiners compared to the average score ranged from kappa 0.22 to 0.59 and the rank correlations from -0.01 to 0.73. This study suggests that the visual assessment of lesion images by the examiners in this study was based upon different characteristics of lesion change than those utilised by the QLF analysis software. A clearer understanding of lesion characteristics that are indicative of positive and negative changes may be required before this technology can be exploited to its full potential.
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Pruebas de Actividad de Caries Dental/métodos , Caries Dental/patología , Diagnóstico por Computador , Análisis de Varianza , Fluorescencia , Humanos , Luz , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Estudios Retrospectivos , Programas Informáticos , Estadísticas no ParamétricasRESUMEN
The aim of this study was to determine the impact of analysis patch border inclusion or exclusion on the reliability of quantitative laser fluorescence (QLF) analyses of lesions close to the gingival margin. Ninety-three lesions on the maxillary anterior teeth were imaged using a fluorescent capturing system. All the lesions were located on the gingival third of the teeth. One examiner undertook two analyses of the images 1 week apart and another examiner undertook a single analysis. Analyses were undertaken using QLF 2.00 g with four patch borders. Each border was assessed as active or inactive. QLF metrics DeltaF, DeltaQ and area were exported. Kappa statistics were used to measure the agreement of border inclusion between all three analyses, and intra-class correlation coefficients (ICCs) were used to determine the intra- and inter-examiner reliability of the QLF metrics. Agreement on border exclusion was poor; with intra-examiner kappa of 0.48 and inter-examiner at 0.20. However, despite the inconsistencies in border exclusions the ICCs for each QLF metric were high; intra-examiner DeltaQ 0.91, DeltaF 0.80 and area 0.92; inter-examiner DeltaQ 0.86, DeltaF 0.68, area 0.88. Lesions adjacent to the gingival margin will often require a patch analysis border to be excluded in order to ensure a satisfactory reconstruction and thus accurate analysis. The decision to include or exclude a border and, if excluded, which border to select appears to be highly variable between examiners. Nevertheless, the QLF metrics appear to be robust as demonstrated by the high ICCs noted in this study.
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Pruebas de Actividad de Caries Dental , Caries Dental/diagnóstico , Diagnóstico por Computador , Rayos Láser , Niño , Femenino , Fluorescencia , Humanos , Masculino , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Cuello del DienteRESUMEN
The purpose of the study was to determine if longitudinal measurements of enamel autofluorescence (quantitative light-induced fluorescence, QLF) could detect differences in remineralization of early enamel caries on buccal surfaces of anterior teeth following supervised daily brushing with either sodium fluoride (NaF; 1,450 ppm F), sodium monofluorophosphate (MFP; 1,450 ppm F) dentifrices or a herbal, non-fluoride placebo dentifrice. The study was a pragmatic cluster-randomized controlled trial with schools as the unit of randomization. Twenty-one schools in Chengdu, China, comprised the clusters; 296 children with at least 1 visible white-spot lesion were examined using QLF at baseline and after 3 and 6 months. Each of the 21 clusters was randomly assigned 1 of the 3 dentifrices, and the children brushed under supervision once per day for 2 min. The primary outcome measure was deltaQ (product of fluorescence loss and area) at a 5% threshold after 6 months of product use. A multi-level model was fitted to the data at the site level, taking into account the hierarchical structure with baseline deltaQ, age and sex as covariates. After 3 months there was a significant difference between the MFP group and placebo (p = 0.02) and after 6 months between the NaF group (p = 0.002), MFP group (p < 0.001) and the placebo. QLF methodology could detect, within 3- and 6-month periods of supervised brushing, a difference in remineralization between fluoride-containing and non-fluoride-containing dentifrices. Typically lesions in all 3 treatment groups demonstrated improvement. Groups receiving fluoride experienced a more rapid and more substantial remineralization than those in the placebo group.
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Cariostáticos/farmacología , Dentífricos/farmacología , Fluoruros/farmacología , Fosfatos/farmacología , Fluoruro de Sodio/farmacología , Remineralización Dental/métodos , Niño , Caries Dental/tratamiento farmacológico , Esmalte Dental/química , Esmalte Dental/efectos de los fármacos , Dentífricos/química , Métodos Epidemiológicos , Femenino , Fluorescencia , Humanos , Masculino , Factores de TiempoRESUMEN
OBJECTIVE: To compare the scoring of dental fluorosis by experienced examiners from digital photographs using the TF index. BASIC RESEARCH DESIGN: 120 images were selected from 703 photographs obtained during a clinical trial (Tavener et al., 2004). The selection process was stratified so that the full range of defects seen in the main study was included. The children, aged 8-10 years, were from deprived areas of Manchester, England with fluoride levels in the drinking water of less the 0.1 ppm F. The photographs of the upper and lower anterior sextants were taken after cleaning and drying the teeth. The examiners were identified by searching Medline for individuals who had previously used the TF index or had experience of scoring dental fluorosis. Of the 12 examiners identified, 10 agreed to take part. Each examiner was provided with identical CDs containing a PowerPoint presentation of the images. Twelve images were duplicated and interspersed amongst the 120 images to assess intra examiner agreement. Each examiner was also supplied with a table listing the criteria and illustrations for each of the TF index scores (Fejerskov et al., 1988). RESULTS: The prevalence of fluorosis (TF > 0) amongst the 10 examiners ranged from 43% to 70% and from 2% to 13% for the more severe scores (TF 3 or 4). Paired agreements amongst subject scores for the 10 examiners, measured using a weighted Kappa score, ranged from 0.40 to 0.71. CONCLUSION: It is concluded that although the criteria for the TF index are well defined, it is possible that examiners may interpret the criteria in different ways and conditions in which images are viewed may need to be standardised. This study may explain some of the differences in the prevalence and severity of fluorosis reported in different studies. There is a need to standardise the methods used to score dental fluorosis.
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Fluorosis Dental/clasificación , Fotografía Dental/métodos , Niño , Consenso , Esmalte Dental/patología , Fluorosis Dental/patología , Humanos , Incisivo/patología , Variaciones Dependientes del Observador , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVES: (a) To validate a method for acquiring reproducible radiographic images and repeatable measurements of digital images. (b) To investigate the clinical and radiographic changes following periodontal surgery and in a periodontally healthy control group. METHODS: In-vitro study. Sixteen dried human skulls had replicate intra-oral radiographs taken using an extra-oral alignment apparatus under simulated clinical conditions, and measurements were made on the images using Image Pro-Plus analysis software. In-vivo study. Seven subjects, aged 38-63 years with chronic periodontitis, were treated using replaced flap surgery. Nine patients with healthy periodontal tissues were recruited as a control group. Clinical measurements and radiographs were taken pre-surgery and 6 months afterwards, and at the same interval for untreated healthy controls using the alignment apparatus. Radiographs were analysed using Image Pro-Plus and subtraction radiography. RESULTS: Radiographs had a high degree of reliability (ICC 0.98-0.99) for the in-vitro study and intra-operator repeatability of measurements was high (ICC 0.65-0.99) for the in-vivo study. Over this interval there were both significant clinical improvements and in bone gain within infra-bony defects on radiographs. Subtracted images showed that out of 17 surgically treated sites, 13 showed evidence of bone gain, one showed no change, two showed bone loss and one could not be interpreted due to poor alignment. Overall there were no significant clinical or radiographic changes in the control group. CONCLUSIONS: Radiographic images were highly reproducible. Measurements had a high degree of repeatability. The methods used allowed accurate quantitative and qualitative measurement of change in alveolar bone. This technique would allow accurate measurement of any changes in alveolar bone levels in patients with periodontal disease.
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Proceso Alveolar/diagnóstico por imagen , Enfermedades Periodontales/diagnóstico por imagen , Programas Informáticos , Adulto , Proceso Alveolar/anatomía & histología , Análisis de Varianza , Estudios de Casos y Controles , Humanos , Persona de Mediana Edad , Enfermedades Periodontales/cirugía , Radiografía Dental/instrumentación , Reproducibilidad de los ResultadosRESUMEN
A dental appointment commonly prompts fear of a painful experience, yet we have never fully understood how our brains react to the expectation of imminent tooth pain once in a dental chair. In our study, 21 patients with hypersensitive teeth were tested using nonpainful and painful stimuli in a clinical setting. Subjects were tested in a dental chair using functional near-infrared spectroscopy to measure cortical activity during a stepwise cold stimulation of a hypersensitive tooth, as well as nonpainful control stimulation on the same tooth. Patients' sensory-discriminative and emotional-cognitive cortical regions were studied through the transition of a neutral to a painful stimulation. In the putative somatosensory cortex contralateral to the stimulus, 2 well-defined hemodynamic peaks were detected in the homuncular orofacial region: the first peak during the nonpainful phase and a second peak after the pain threshold was reached. Moreover, in the upper-left and lower-right prefrontal cortices, there was a significant active hemodynamic response in only the first phase, before the pain. Subsequently, the same prefrontal cortical areas deactivated after a painful experience had been reached. Our study indicates for the first time that pain perception and expectation elicit different hemodynamic cortical responses in a dental clinical setting.
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Encéfalo/fisiología , Sensibilidad de la Dentina/fisiopatología , Actitud Frente a la Salud , Cognición/fisiología , Frío , Ansiedad al Tratamiento Odontológico/fisiopatología , Ansiedad al Tratamiento Odontológico/psicología , Sensibilidad de la Dentina/psicología , Emociones , Potenciales Evocados/fisiología , Femenino , Hemodinámica/fisiología , Humanos , Masculino , Dimensión del Dolor/métodos , Percepción del Dolor/fisiología , Umbral del Dolor/fisiología , Percusión , Corteza Prefrontal/fisiopatología , Umbral Sensorial/fisiología , Corteza Somatosensorial/fisiopatología , Espectroscopía Infrarroja CortaRESUMEN
BACKGROUND: Many studies have shown that water fluoridation dramatically reduces dental caries, but the effect that water fluoridation has upon reducing dental health inequalities is less clear. The aim of this study is to describe the effect that water fluoridation has upon the association between material deprivation and dental caries experience in 5-year-old children. METHODS: It is an ecological descriptive study of dental caries experience using previously obtained data from the British Association for the Study of Community Dentistry's biennial surveys of 5-year-old children. This study examined the following data from seven fluoridated districts and seven comparable non-fluoridated districts in England: 1) dental caries experience using the dmft (decayed, missing, filled teeth) index; 2) the Townsend Deprivation Index of the electoral ward in which the child lived; 3) whether fluoride was present at an optimal concentration in the drinking water or not. RESULTS: A statistically significant interaction was observed between material deprivation (measured by the Townsend Deprivation Index) and water fluoridation (P < 0.001). This means that the social class gradient between material deprivation and dental caries experience is much flatter in fluoridated areas. CONCLUSION: Water fluoridation reduces dental caries experience more in materially deprived wards than in affluent wards and the introduction of water fluoridation would substantially reduce inequalities in dental health.
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Caries Dental/epidemiología , Caries Dental/prevención & control , Fluoruración , Clase Social , Preescolar , Estudios Transversales , Índice CPO , Femenino , Humanos , Incidencia , Modelos Lineales , Masculino , Medición de Riesgo , Factores de Riesgo , Factores Socioeconómicos , Reino Unido/epidemiologíaRESUMEN
This paper is directed to the question, "What are the appropriate validation criteria for the use of a new clinical trial methodology as a replacement for a conventional two- to three-year caries study?" It is important to recognize that the objective of a two- to three-year randomized, controlled caries trial is to test a precisely framed hypothesis, regarding an experimental product's efficacy relative to a control product. The external validity of conventional two- to three-year caries clinical studies in determining the efficacy and safety of anti-caries products is well-accepted. However, caries clinical trials are not without limitations and have increasingly been viewed as inefficient with respect to measuring the disease process in a holistic manner. The endpoint of a caries lesion with loss of enamel integrity (cavitation) focuses on one end of the caries progression continuum at the expense of early caries initiation and progression. Several early caries detection methods have been developed that correlate with mineral loss of the tooth surface. These diagnostics differ from conventional visual-tactile and radiographic methods in that they are capable of detecting early non-cavitated lesions, and this can generate continuous data. As diagnostic methods become accepted, they will lead to study designs that diverge from the conventional two- to three-year caries studies. Modification of the existing two- to three-year conventional caries design for assessment of product effectiveness, whether by the introduction of a new diagnostic method or by modification of the overall clinical design, must result in a clinical design that is able to differentiate known treatments on the basis of caries prevention efficacy. Given that the fluoride dose response has been characterized in the literature, this should form the basis of any validation package for new methodologies. In conclusion, a minimum expectation for acceptance as a replacement to conventional testing should be that the method or design can differentiate products of known efficacy from one another and that the efficacy relationship observed in a two- to three-year conventional study can be observed with the new method or design.
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Ensayos Clínicos como Asunto/estadística & datos numéricos , Caries Dental/diagnóstico , Cariostáticos/uso terapéutico , Caries Dental/fisiopatología , Caries Dental/prevención & control , Progresión de la Enfermedad , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Reproducibilidad de los Resultados , Proyectos de Investigación , Desmineralización Dental/diagnóstico , Desmineralización Dental/fisiopatología , Resultado del TratamientoRESUMEN
The main reasons that industry runs caries clinical trials (CCTs) are to provide proof of efficacy and to collect in vivo safety data on new products. In recent years, predominantly due to declining caries levels and the use of positive controls, the cost of performing these CCTs has escalated. It is now reaching the stage where it is becoming commercially prohibitive to conduct new studies. This is likely to stifle innovation of new anticaries products, and we now need new, more discriminatory, faster, and less expensive study designs. There are many ways in which the design of CCTs may be changed, such as improving diagnostic efficiency, improving data handling/statistical modeling, and using high-risk populations. However, it is paramount that the overriding principle behind CCT design validation must be that the results/conclusions from any new design are in line with those shown previously by 'conventional' CCTs, to ensure the maintenance of standards for both efficacy and safety. It is suggested that the validation of any new trial design must involve comparisons with regimens previously shown in conventional CCTs to have different anticaries efficacies. For example, since several clinical trials have shown convincing evidence for a monotonic dose response for fluoride at least up to levels of 2500 ppm F, one could choose two products, differing solely in their fluoride level. One aim for this workshop is to identify and agree on validation principles for new clinical trial designs. This will facilitate general international acceptance of novel smaller/faster CCTs designs both now and in the future. We recognize that any new design must not compromise the standard of proof of either efficacy or safety. In addition, any principles will need to take account of current understanding of the caries process, while recognizing the need for change to match future developments in cariology. Finally, the mechanism of action of the test product must be considered, in assessments of the acceptability of novel designs, if this differs markedly from the regimens used to validate the design.