CariesCare International adapted for the pandemic in children: Caries OUT multicentre single-group interventional study protocol.

BACKGROUND: Comprehensive caries care has shown effectiveness in controlling caries progression and improving health outcomes by controlling caries risk, preventing initial-caries lesions progression, and patient satisfaction. To date, the caries-progression control effectiveness of the patient-centred risk-based CariesCare International (CCI) system, derived from ICCMS™ for the practice (2019), remains unproven. With the onset of the COVID-19 pandemic a previously planned multi-centre RCT shifted to this "Caries OUT" study, aiming to assess in a single-intervention group in children, the caries-control effectiveness of CCI adapted for the pandemic with non-aerosols generating procedures (non-AGP) and reducing in-office time. METHODS: In this 1-year multi-centre single-group interventional trial the adapted-CCI effectiveness will be assessed in one single group in terms of tooth-surface level caries progression control, and secondarily, individual-level caries progression control, children's oral-health behaviour change, parents' and dentists' process acceptability, and costs exploration. A sample size of 258 3-5 and 6-8 years old patients was calculated after removing half from the previous RCT, allowing for a 25% dropout, including generally health children (27 per centre). The single-group intervention will be the adapted-CCI 4D-cycle caries care, with non-AGP and reduced in-office appointments' time. A trained examiner per centre will conduct examinations at baseline, at 5-5.5 months (3 months after basic management), 8.5 and 12 months, assessing the child's CCI caries risk and oral-health behaviour, visually staging and assessing caries-lesions severity and activity without air-drying (ICDAS-merged Epi); fillings/sealants; missing/dental-sepsis teeth, and tooth symptoms, synthetizing together with parent and external-trained dental practitioner (DP) the patient- and tooth-surface level diagnoses and personalised care plan. DP will deliver the adapted-CCI caries care. Parents' and dentists' process acceptability will be assessed via Treatment-Evaluation-Inventory questionnaires, and costs in terms of number of appointments and activities. Twenty-one centres in 13 countries will participate. DISCUSSION: The results of Caries OUT adapted for the pandemic will provide clinical data that could help support shifting the caries care in children towards individualised oral-health behaviour improvement and tooth-preserving care, improving health outcomes, and explore if the caries progression can be controlled during the pandemic by conducting non-AGP and reducing in-office time. TRIAL REGISTRATION: Retrospectively-registered-ClinicalTrials.gov-NCT04666597-07/12/2020: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AGM4&selectaction=Edit&uid=U00019IE&ts=2&cx=uwje3h . Protocol-version 2: 27/01/2021.

Caries status and proximal lesion behaviour during a 6-year period in young adult Danes: an epidemiological investigation.

Studies have indicated that many initial proximal caries lesions progress and are eventually restored even if the patients have been under comprehensive preventive programmes. The objectives of the study were (1) to describe the 1996-year baseline caries status of male Danish conscripts and (2) to assess their early proximal lesions 6-year behaviour. In 1996, all 20-year-old conscripts at Central Barrack Birkerød (n = 115) went through an oral examination, including visual surface-level fillings' recording and a radiographic examination with bitewing radiographs that assessed the proximal-surface caries and restoration patterns. After 6 years, the behaviour of proximal lesions was studied in 73 of these subjects, and oral health habits were assessed through a questionnaire. Mean number of filled surfaces was 7.5, of which 23% were posterior proximal. Radiographically, the mean number of proximal lesions was 5.5. Over the 6-year period, there was progression of lesions into deeper radiolucencies or fillings in 57% of cases. The questionnaire showed a poor compliance with regular flossing/tooth-stick use (18%). Based on these results, more efficacious preventive measures seem to be needed for proximal surfaces.

Maloclusión clase III / Malocclusion class III

La frecuencia de la Maloclusión Clase III es del 1 al 3 en la población blanca y de un 48 en la población oriental. Se estima que un 10 de toda las moloclusiones Clase III se originan en la infancia, siendo una de las alternativas más difíciles de manejar. Dietrich en 1.970 reporta una incidencia del 35 para Maloclusiones Clases III en dentición primaria. La causa principal puede ser el resultado del prognatismo y/o macrognatismo mandibular, sin embargo estudios sugieren que en el 42 al 63 de los casos esta displasia es el resultado de una retrusión o hipoplasia maxilar. Por otro lado, la maloclusión Clase III se puede presentar como combinación entre pronagtismo y/o macronagtismo mandibular y micronagtismo o retrognatismo maxilar. En algunos casos la Maloclusión Clase III se ha asociado con síndromes tales como el sínrome de Down y enfermedades del Crouzon entre otros. Se ha aceptado como primisa, que una dentición primaria y transicional normal son necesarias para establecer una oclusión adulta funcional. Por lo tanto prevenir y/o interceptar el desarrollo de la Maloclusión debe ser objetivos prioritarios en el tratamiento de estos pacientes.