Recommendations on Topical Fluoride Usage for Caries Management in East Asia.

Dental caries is a widespread oral health issue in Asia, affecting an estimated 30% to 90% of children and adults. Many caries cases remain untreated, resulting in pain and infection. In response, the Asian Academy of Preventive Dentistry (AAPD) emphasises comprehensive caries management and organised a fluoride workshop at the 15th International Conference of the AAPD in 2023. The AAPD invited a group of experts to form a fluoride working group to review existing literature and develop fluoride recommendations for stakeholders across Asian countries and regions. The working group assessed caries risk and identified commonly used topical fluoride products for home care, professional, and community settings in Asia. The working group concluded that fluoride is a safe and highly effective strategy to reduce caries prevalence and incidence. The working group provided key recommendations based on successful regional caries management practices: (1) use topical fluoride for prevention and control of dental caries; (2) encourage the use of fluoride toothpaste with a concentration of at least 1,000 ppm for effective caries reduction; (3) advise a 0.05% fluoride mouth rinse as soon as children can spit it out to prevent early childhood caries; (4) deliver professionally administered fluoride, such as 5% sodium fluoride varnish, 2% fluoride gel, or 1.23% acidulated phosphate fluoride preparations, to decrease dental caries in at-risk individuals; and (5) apply 38% silver diamine fluoride to arrest cavitated caries. These recommendations aim to help practitioners, health care providers, and parents/caregivers make informed decisions about fluoride use as part of comprehensive oral health care in the region.

Longitudinal Study on Dental Status, Caries Risk Assessment, and Oral Health-Related Quality of Life in 3-6-Year-Old Children Receiving Nitrous Oxide Inhalational Sedation.

Introduction Dental caries prevention in early childhood is crucial, necessitating timely assessments by dental professionals and parents. The oral health of children during their early years can significantly impact both the children themselves and their parents' quality of life. This study seeks to assess the changes in oral health-related quality of life after treatment under nitrous oxide sedation in anxious preschool children, for whom treatment otherwise is quite difficult chairside. Aim The aim of this study is to assess the association between dental caries status, risk assessment, and oral health-related quality of life (OHRQoL) in 3-6-year-old children, before and after undergoing treatment under nitrous oxide inhalation sedation. Materials and methods Eighty children were assessed for caries risk and dental status using the caries risk assessment for treatment (CRAFT) tool. Nitrous oxide sedation was employed for dental treatment, and assessments were conducted pre-treatment and post-treatment. Statistical analyses performed were paired t-tests, correlation analyses, and Chi-Square tests. Results The study revealed a mean age of 4.033 ± 0.96, with a balanced gender distribution (47.5% boys, 52.5% girls). Post-treatment, significant negative correlations were observed between OHRQoL and treatment outcomes, emphasizing improved oral health-related quality of life. Associations were found between OHRQoL, pufa index, and caries risk post-treatment. Conclusion The current research suggests that treatment done under nitrous oxide sedation could improve the OHRQoL in preschool children. Integrating risk assessment and OHRQoL enhances understanding, facilitating targeted prevention and treatment strategies. Addressing untreated dental caries is imperative for optimizing the overall well-being of children in this age group.

Oral Health Status of Workers in Acid Exposure Environments in Japan: A Cross-sectional Study.

Although the working environment may play a role in dental acid erosion, few studies have been conducted on this in Japanese workers in recent years. The purpose of this study was to investigate oral health status, including dental erosion, in workers who may have been exposed to an acidic environment. The study participants were recruited by an online research company. Oral examinations and questionnaire surveys were conducted on this cohort in January 2023. A total of 144 participants were finally included. Workers exposed to an acidic environment showed more use of protective equipment and underwent more dental examinations at the workplace (p<0.001). Possible dental erosion was observed in only 3 out of the total of 144 participants (2.1%), however. No significant difference was observed in the number of teeth, caries experience, or dental erosion according to the number of years of acid exposure in the workplace. The results of this study suggest that acid exposure exerts a relatively small effect on the oral health status of workers in Japan.

Improvements in appropriate placement of dental sealants after implementation of a clinical decision support system.

BACKGROUND: Dental sealants are effective for the prevention of caries in children at elevated risk levels, and increasing the proportion of children and adolescents who have dental sealants on 1 or more molars is a Healthy People 2030 objective. Electronic health record (EHR)-based clinical decision support systems (CDSSs) have the ability to improve patient care. A dental quality measure related to dental sealant placement for children at elevated risk of caries was targeted for improvement using a CDSS. METHODS: A validated dental quality measure was adapted to assess a patient's need for dental sealant placement. A CDSS was implemented to advise care team members whether a child was at elevated risk of developing caries and had sealant-eligible first or second molars. Data on dental sealant placement at examination visits during a 5-year period were analyzed, including 32 months before CDSS implementation and 28 months after CDSS implementation. RESULTS: From January 1, 2018, through December 31, 2022, the authors assessed 59,047 examination visits for children at elevated risk of developing caries and with sealant-eligible teeth. With the implementation of a CDSS and training to support the clinical care team members in September 2020, the appropriate placement of dental sealants at examination visits increased from 27% through 60% (P < .00001). CONCLUSIONS: Integration of a CDSS into the EHR as part of a quality improvement program was effective in increasing the delivery of sealants in eligible first and second molars of children aged 5 through 15 years and considered at high risk of developing caries. PRACTICAL IMPLICATIONS: An EHR-based CDSS can be implemented to improve standardization and provide timely and appropriate patient care in dental practices.

Caries in orphan children: prevalence and determinants-a systematic review and meta-analysis.

BACKGROUND: Orphan children represent a category of children who lost their family support. Their health status is poorer when compared to their parented counterparts. As the most prevalent disease in the world, dental caries is expected to affect orphans greatly. Being vulnerable, health status of orphan children must be monitored and studied; so that health improvement plans would be formulated. Therefore, this systematic review focuses on the extent of the dental caries problem among institutionalized orphan children and its determinants. METHODS: The review has two outcomes: comparing caries experience of institutionalized children to their parented counterparts, and reviewing the determinants of caries in the exposure group. Two systematic searches (one for each outcome) were run on MedLine via PubMed, Cochrane library, LILACS, Egyptian knowledge bank (EKB) and Google Scholar; beside hand search and searching grey literature. RESULTS: The searches yielded 17,760, followed by 16,242 records for the first and second outcomes respectively. The full text was screened for 33 and 103 records for the two outcomes respectively; after translating non-English reports. Finally, the review included 9 records to address the first outcome and 21 records for the second. The pooled results showed that the exposure group may show slightly poorer caries experience regarding permanent teeth (pooled mean difference of DMF = 0.09 (-0.36, 0.55)); but they have a much poorer caries experience regarding primary teeth health (pooled mean difference of dmf = (0.64 (-0.74, 2.01)). Meta-analysis of the caries determinants showed that institutionalization increases the risk of caries by 19%. Gender showed slight effect on caries risk with males being more affected; while primary teeth revealed higher risk of caries when compared to permanent teeth. CONCLUSION: Limited by the heterogeneity and risk of bias of the included studies, meta-analyses concluded that institutionalized orphan children have higher risk of caries. Yet, the institutionalization circumstances were not well-documented in all the included studies. So, the complete picture of the children's condition was not possibly sketched. TRIAL REGISTRATION: Protocol has been registered online on the PROSPERO database with an ID CRD42023443582 on 24/07/2023.

Evaluation of Risk Factors associated with Caries Development after Full-mouth Rehabilitation for Early Childhood Caries Under General Anesthesia.

AIM: To evaluate the risk factors associated with caries development after full-mouth rehabilitation for early childhood caries (ECC) under general anesthesia. MATERIALS AND METHODS: A total of 100 children diagnosed with ECC requiring full-mouth rehabilitation under general anesthesia were recruited for the study. At baseline, caries status, plaque index, Streptococcus mutans count, and Lactobacillus count were evaluated. The risk assessment for caries was evaluated using a cariogram. Children were recalled after 12 months for evaluation. All children returned for the recall and data was recorded at the recall visit. Children were grouped into caries-free or caries recurrent based on the absence or presence of caries. Chi-square tests and student's t-test were used for statistical analysis using the statistical package for the social sciences (SPSS), version 23. RESULTS: All 100 children returned for follow-up. 76% of the children developed new carious lesions in a period of 1 year. A statistically significant association between caries recurrence and S. mutans count and caries risk assessment (CRA) score was found (p < 0.001). No significant associations were seen between parental education levels and the oral health practices of the child. CONCLUSION: Children treated under full-mouth rehabilitation for ECC under general anesthesia are at risk for developing new carious lesions after treatment. New carious lesions are strongly correlated with the presence of S. mutans, and high cariographic risk scores serve as an indication of future caries. Early childhood caries may be avoided if children are more diligent in practicing good dental hygiene. CLINICAL SIGNIFICANCE: Relapse of caries after full-mouth rehabilitation under general anesthesia can affect the quality of life of children. Preventive measures should be initiated and reinforced to prevent the occurrence of new carious lesions after full-mouth rehabilitation. How to cite this article: Mathew MG, Jeevanandan G, Maganur PC, et al. Evaluation of Risk Factors associated with Caries Development after Full-mouth Rehabilitation for Early Childhood Caries Under General Anesthesia. J Contemp Dent Pract 2024;25(1):85-91.

Caries risk assessment by Caries Management by Risk Assessment (CAMBRA) Protocol among the general population of Pakistan-a multicenter analytical study.

Background: Caries risk (CR) assessment tools are used to properly identify individuals with caries risk and to improve preventive procedures and programs. A tool such as CAMBRA determines the precise protective factors of caries and identifies an individual's specific therapeutic intervention. The purpose of this study was to assess the caries risk using the CAMBRA protocol among the general population of Pakistan. Methods: This multicentre analytical study was conducted in ten dental hospitals in different provinces of Pakistan and the caries risk assessment was carried out using a questionnaire that was designed using the Caries Management by Risk Assessment (CAMBRA) protocol. All 521 participants were intra-orally examined to assess oral hygiene status and the presence of disease. Multiple logistic regression test was performed for analysis. Results: A higher number of participants (61.2%) were found to be in the moderate risk category of caries risk assessment. The males are 51% less likely to have caries compared to the females (AOR = 0.49, P = 0.081). The majority of participants (71.3%) had one or more disease indicators, with white spots and visible cavities. Those with visible, heavy plaque were 13.9 times more likely to have caries compared to those without (AOR = 13.92, P < 0.001). Those using calcium and phosphate during the last 6 months were 90% less likely to have caries compared to those not using them (AOR = 0.10, P < 0.001). There was no significant interaction between all eight risk factors retained in the final model (P > 0.05), the Hosmer and Lemeshow Test P < 0.001, classification accuracy = 87.1%, and AUC = 91.2%. Conclusion: The caries risk among the general population of Pakistan is moderate, with significant variation among age groups, education levels, and socioeconomic status.

Unlocking the potential of probiotic administration in caries management: a systematic review.

BACKGROUND: The use of prebiotics and/or probiotic bacteria with the potential to modulate the oral ecosystem may play an important role in the prevention and management of dental caries. To assess the evidence of the potential of pre/probiotics both in the prevention and treatment of dental caries, we focused on the PICO question "In individuals with caries, after probiotic administration, is there an improvement in outcomes directly related to caries risk and development?". METHODS: An extensive systematic search was conducted in electronic databases PubMed, Web of Science, Scopus and Cochrane, to identify articles with relevant data. This systematic review included trials performed in Humans; published in English; including the observation of patients with caries, with clear indication of the probiotic used and measuring the outcomes directly involved with the cariogenic process, including the quantification of bacteria with cariogenic potential. To evaluate the methodological quality of the studies, the critical assessment tool from the Joanna Briggs Institute was used. RESULTS: Eight hundred and fifty articles, potentially relevant, were identified. Following PRISMA guidelines 14 articles were included in this systematic review. Outcomes such as reduction of cariogenic microorganism counts, salivary pH, buffer capacity, and caries activity were assessed. The probiotic most often referred with beneficial results in dental caries outcomes is Lacticaseibacillus rhamnosus. Regarding the most used administration vehicle, in studies with positive effects on the caries management, probiotic supplemented milk could be considered the best administration vehicle. CONCLUSIONS: Evidence suggests a beneficial effect of probiotic supplemented milk (Lacticaseibacillus rhamnosus) as an adjuvant for caries prevention and management. However, comparable evidence is scarce and better designed and comparable studies are needed.

Maxillofacial Morphology as a Predictive Factor for Caries Risk in Orthodontic Patients: A Cross-Sectional Study.

This cross-sectional study aimed to explore the correlation between maxillofacial morphology and caries risk, assessed using salivary tests, in orthodontic patients. Despite enhancing the oral health-related quality of life, orthodontic treatment may adversely affect oral hygiene and increase caries risk. This study included 1071 patients all of whom underwent orthodontic examinations and salivary tests before starting orthodontic treatment at a hospital. Salivary tests were performed to assess the secretion rate, pH, buffering capacity, and counts of cariogenic bacteria. The maxillofacial morphology was evaluated using cephalometric X-rays and dental models. Statistical analyses revealed significant correlations among salivary characteristics, bacterial scores, and maxillofacial morphology. Notably, the facial angle and Y-axis values were associated with salivary secretion (p < 0.001), pH (p < 0.001), buffering capacity (p < 0.05), and cariogenic bacterial scores (p < 0.01), respectably. In conclusion, assessing the maxillofacial morphology before orthodontic treatment may aid in predicting the risk of bacterial oral diseases, offering valuable insights into personalized preventive measures. These findings underscore the potential for comprehensive evaluations to enhance caries risk assessment in orthodontic patients.

Improving predoctoral education related to caries risk assessment in adults.

OBJECTIVES: This project examined patterns of adult patient management using a caries risk assessment (CRA) protocol at East Carolina University, School of Dental Medicine. Usage of the CRA protocol from 2014 to 2019 was assessed. Non-operative anti-caries treatments were measured against caries risk status (high, moderate, low, or none). Steps to improve the appropriate management of patients based on caries risk are presented to align with accreditation standards for predoctoral education programs. METHODS: The CRA protocol is based on the Caries Management by Risk Assessment approach. Risk-based patterns for two non-operative interventions were examined: (1) prescriptions for 0.12% chlorhexidine gluconate (CHX) mouth rinse and (2) prescriptions for 5000 ppm fluoride toothpaste (PreviDent 5000 [PreviDent]). Statistical analyses included chi-square tests and logistic regression. RESULTS: Over the study period only 16.4% of adult patients had completed the CRA form. Among 29,411 patients from nine community sites, treatment rates for PreviDent were 18.7% among high-risk patients, 11.6% for moderate-risk adults, and 6.4% for low-risk adults (p < 0.01). Treatment rates for CHX were 23.0%, 22.6%, and 17.1%, respectively (p < 0.05). Patients without a CRA status were least likely to receive any anti-caries treatments, indicating that CRA status affects clinical, non-operative care. CONCLUSIONS: Patterns for prescription of PreviDent and CHX are consistent with CRA status. Future efforts to improve usage of the CRA protocol using faculty calibration, tracking with quality improvement tools, and reassessment. Training in the community-based educational setting is enhanced through data-based tracking to assure evidence-based decision making.

A systematic review of caries risk in children <6 years of age.

BACKGROUND: For caries risk assessment (CRA) tools for young children to be evidence-based, it is important to systematically review the literature to identify factors associated with the onset of early childhood caries (ECC). AIM: This updated systematic review aimed to identify current evidence on caries risk in young children. DESIGN: A comprehensive and systematic literature search of relevant databases was conducted to update a previous systematic review and identify risk factors associated with ECC. Potential risk factors were identified based on strength of association using odds ratios, hazard ratios, relative risk, etc. GRADE was used for rating quality evidence through consensus. RESULTS: Twenty-two studies met inclusion criteria for the search from mid-2017 to 2021. Twenty-five publications from the prior systematic review, from 1997 to mid-2017, were also included. Several socioeconomic, behavioral, and clinical variables were identified as ECC risk factors. Factors included the following: age, socioeconomic status, frequency of and supervised toothbrushing, fluoride exposure, breast- and bottle-feeding, feeding habits, absence of a dental home, past caries experience, active non-cavitated lesions, visible plaque, enamel defects, and microbiome. CONCLUSION: This study provides updated evidence of risk factors for ECC that could be included in CRA tools.

Cuestionario de autoevaluación CAMBRA como método de cribado poblacional del riesgo de caries sin métodos exploratorios: un estudio piloto observacional transversal / Modified CAMBRA questionnaire as a method for population-based caries risk screening without exploratory methods: a cross-sectional observational pilot study

Fundamentos: Caries Management by Risk Assessment (CAMBRA) es un cuestionario de diagnóstico del riesgo global de caries dental. Este estudio tuvo como objetivo presentar un cuestionario de autoevaluación basado en CAMBRA que, a diferencia del original, es cumplimentado por padres/madres/cuidadores, sin necesidad de una exploración odontológica, permitiendo establecer un diagnóstico de presunción en menores de siete años excluidos del programa de salud oral del Sistema Nacional de Salud, con el fin de instaurar recomendaciones individualizadas al riesgo de caries y su inclusión precoz en programas preventivos del Servicio Madrileño de Salud (Madrid, España). Métodos: Se llevó a cabo un estudio observacional transversal basado en las recomendaciones STROBE, empleando por primera vez un cuestionario de autoevaluación basado en CAMBRA en niños/as de tres a seis años de una escuela infantil de Madrid (España). Los resultados se analizaron mediante una estadística descriptiva y para el estudio de la relación entre variables cualitativas se utilizó el estadístico exacto de Fisher. Resultados: El cuestionario fue respondido por padres de 120 niños, de los cuales, el 40,8% presentó, a priori, un riesgo de caries bajo, el 42,5% un riesgo moderado y el 16,7% un riesgo alto de caries. Conclusiones: El presente estudio permite la identificación de pacientes en riesgo de presentar y/o desarrollar caries. No obstante, futuros estudios han de evaluar su sensibilidad y especificidad mediante su comparativa frente a un diagnóstico de confirmación tras una exploración odontológica. Pese a ello, el cuestionarioCAMBRA modificado podría ser una herramienta útil para el cribado poblacional, facilitandoel acceso de la población en riesgo de caries y en riesgo de exclusión a planes preventivos y comunitarios.(AU)

Background:Caries Management by Risk Assessment (CAMBRA) is a questionnaire used to diagnose the patient’s overall caries risk. This study aimed to present a self-assessment questionnaire based on CAMBRA which, unlike the original, is completed by parents/caregivers, without the need for a dental examination, allowing a presumptive diagnosis to be established in children under seven years of age excluded from the oral health programme of the National Health System to establish individualised recommendations for caries risk and their early inclusion in preventive programmes of the Madrid Health Service (Madrid, Spain). Methods: A cross-sectional observational study was carried out following STROBE guidelines using for the first time a self-assessment questionnaire based on CAMBRA in a population of children aged from three to six years from a nursery school in Madrid (Spain). The results were analysed using descriptive statistics and Fisher’s exact statistic was used to study the relationship between qualitative variables. Results: The questionnaire was answered by the parents of 120 children (response rate=53.1%), of whom 40.8% presented a low a priori caries risk, 42.5% a moderate risk and 16.7% a high caries risk. Conclusion: The present study allow the identification of patients at risk of presenting and/or developing caries. However, future studies should evaluate its sensitivity and specificity by comparing it with a confirmatory diagnosis after a dental examination. Nevertheless, the modified CAMBRA questionnaire could be a useful tool for population screening, facilitating the access of the population at risk of caries and risk of exclusion to preventive and community plans.(AU)

[Modified CAMBRA questionnaire as a method for population-based caries risk screening without exploratory methods: a cross-sectional observational pilot study]. / Cuestionario de autoevaluación CAMBRA como método de cribado poblacional del riesgo de caries sin métodos exploratorios: un estudio piloto observacional transversal.

OBJECTIVE: Caries Management by Risk Assessment (CAMBRA) is a questionnaire used to diagnose the patient's overall caries risk. This study aimed to present a self-assessment questionnaire based on CAMBRA which, unlike the original, is completed by parents/caregivers, without the need for a dental examination, allowing a presumptive diagnosis to be established in children under seven years of age excluded from the oral health programme of the National Health System to establish individualised recommendations for caries risk and their early inclusion in preventive programmes of the Madrid Health Service (Madrid, Spain). METHODS: A cross-sectional observational study was carried out following STROBE guidelines using for the first time a self-assessment questionnaire based on CAMBRA in a population of children aged from three to six years from a nursery school in Madrid (Spain). The results were analysed using descriptive statistics and Fisher's exact statistic was used to study the relationship between qualitative variables. RESULTS: The questionnaire was answered by the parents of 120 children (response rate=53.1%), of whom 40.8% presented a low a priori caries risk, 42.5% a moderate risk and 16.7% a high caries risk. CONCLUSIONS: The present study allow the identification of patients at risk of presenting and/or developing caries. However, future studies should evaluate its sensitivity and specificity by comparing it with a confirmatory diagnosis after a dental examination. Nevertheless, the modified CAMBRA questionnaire could be a useful tool for population screening, facilitating the access of the population at risk of caries and risk of exclusion to preventive and community plans.

OBJETIVO: Caries Management by Risk Assessment (CAMBRA) es un cuestionario de diagnóstico del riesgo global de caries dental. Este estudio tuvo como objetivo presentar un cuestionario de autoevaluación basado en CAMBRA que, a diferencia del original, es cumplimentado por padres/madres/cuidadores, sin necesidad de una exploración odontológica, permitiendo establecer un diagnóstico de presunción en menores de siete años excluidos del programa de salud oral del Sistema Nacional de Salud, con el fin de instaurar recomendaciones individualizadas al riesgo de caries y su inclusión precoz en programas preventivos del Servicio Madrileño de Salud (Madrid, España). METODOS: Se llevó a cabo un estudio observacional transversal basado en las recomendaciones STROBE, empleando por primera vez un cuestionario de autoevaluación basado en CAMBRA en niños/as de tres a seis años de una escuela infantil de Madrid (España). Los resultados se analizaron mediante una estadística descriptiva y para el estudio de la relación entre variables cualitativas se utilizó el estadístico exacto de Fisher. RESULTADOS: El cuestionario fue respondido por padres de 120 niños, de los cuales, el 40,8% presentó, a priori, un riesgo de caries bajo, el 42,5% un riesgo moderado y el 16,7% un riesgo alto de caries. CONCLUSIONES: El presente estudio permite la identificación de pacientes en riesgo de presentar y/o desarrollar caries. No obstante, futuros estudios han de evaluar su sensibilidad y especificidad mediante su comparativa frente a un diagnóstico de confirmación tras una exploración odontológica. Pese a ello, el cuestionario CAMBRA modificado podría ser una herramienta útil para el cribado poblacional, facilitando el acceso de la población en riesgo de caries y en riesgo de exclusión a planes preventivos y comunitarios.

[Assessment of carious dental lesions and treatment options: comparison of the knowledge of dental students and orthodontic assistants]. / Einschätzung von kariösen Zahnläsionen und Therapieoptionen: Vergleich der Kenntnisse von Studierenden der Zahnmedizin und AssistenzzahnärztInnen für Kieferorthopädie.

In order to optimize dental education, established procedures for caries diagnosis and therapy, such as the International Caries Classification and Management System (ICCMS), should be integrated into the curriculum. In preparation, the level of knowledge of dental students on caries detection and management was surveyed in order to specifically address deficits in dental teaching. In addition, the data were compared with the knowledge of clinically experienced dentists. The results are presented in this report and possible consequences for dental teaching are discussed.Twenty-six sixth semester dental students and six assistant dentists at the Department of Orthodontics (Philipps University of Marburg, Germany) were available for the written survey during the winter semester 2018/2019. For 12 anonymized orthodontic patient cases, the clinical findings, caries risk, and adequate treatment were to be determined for each defined tooth. The consensus decision of two experienced dentists served as the reference value. As a result, agreement with the reference ranged from 40.7% to 51.3% for students and from 56.9% to 75.0% for assistant dentists. The extent of caries and the resulting necessary treatment were mostly underestimated.In addition to theoretical knowledge, clinical experience is another prerequisite for adequate caries diagnosis and its management. The underestimation of caries extent and necessary treatment should be taken into account when teaching content. Procedures such as the ICCMS should be integrated into the dental curriculum at an early stage, so that orthodontic patients can also receive effective care.

Case Report: Treatment and management of a child at high risk of caries.

Introduction: Caries are at the forefront of childhood diseases. Although childhood caries is usually not life-threatening, it can affect children's dental-maxillofacial development and mental health and place significant financial and psychological burdens on parents. As the focus of childhood dental caries shifts to early diagnosis and prevention rather than restorative dentistry alone, screening children at a high risk of dental caries is urgent. Appropriate caries prevention measures and treatment sequences can effectively reduce the occurrence and development of dental caries in children. Case: We report the case of a 7-year-old boy presenting with a high risk of dental caries involving multiple primary teeth and premature eruption of the permanent teeth. We shifted the caries status of the child from high to moderate likelihood. At the 9-month post-treatment follow-up, the patient had no new dental caries, and the length and width of the dental arch were effectively maintained. Conclusion: Oral health education, dental plaque removal in a regular basis, and fluoride application contribute to caries management.

Oral health and caries risk profile assessment using the the Cariogram in thalassemia patients with or without splenectomy: A cross-sectional study.

BACKGROUND: Splenectomy is performed in ß-thalassemia cases due to the destruction of red blood cells (RBCs), and the consequent splenomegaly. OBJECTIVES: The aim of the present study was to compare oral health and the caries risk between ß-thalassemia patients with or without splenectomy, using the Cariogram. MATERIAL AND METHODS: In a cross-sectional study carried out in both the Maternity and Children Hospital and the King Fahad Hospital, Al-Madinah al-Munawwarah, Saudi Arabia, interviews, salivary sampling and oral clinical examinations were performed on 60 children and adolescents with ß-thalassemia major (mean age: 13 ±3 years; 65% with splenectomy). The Cariogram program was used to calculate the caries risk. The main outcome measures were the number of decayed, missing due to caries, and filled teeth (DMFT), plaque and gingival indices, and the caries risk. RESULTS: Of individuals with and without splenectomy, tooth brushing was reported in 49% and 57%, respectively (p > 0.05). Individuals with splenectomy had lower plaque and gingival bleeding scores (p ≤ 0.05). Salivary secretion was identical in both groups. Caries experience and the caries risk were higher in individuals without splenectomy (p > 0.05 and p ≤ 0.05, respectively). CONCLUSIONS: Within the study limitations, children and adolescents with ß-thalassemia had high plaque and gingival bleeding scores, as well as caries experience and caries risk. Those with splenectomy demonstrated lower figures than those without. Individuals with ß-thalassemia, particularly those with splenectomy, need to be educated about the oral side effects of the disease and its treatment.

Dentists' Utilization of Caries Risk Assessment and Individualized Caries Prevention Methods in Pediatric Patients in Saudi Arabia.

Introduction: The first step in any complete oral health care plan for a child is a thorough caries risk assessment (CRA). This study aimed to investigate whether the practice dentists in Saudi Arabia's Western province do CRA methods and offer Individualized Caries Prevention (ICP) to their pediatric patients. Material and Methods: Dentists in active clinical practice in the Western province of Saudi Arabia were the participants of this cross-sectional survey. The participants in this study were chosen using a simple random sampling technique. A self-administered, structured questionnaire was used to gather participants' responses. Results: A majority (88.2%) of the dentists agreed that it is very important to practice CRA on a regular basis among their pediatric patients. About 67% of dentists employed Individualized Caries Prevention methods. No statistically significant correlation was observed between ICP and CRA factors, indicating that interventions primarily focused on patients' financial affordability. Conclusion: Dentists should encourage parents/caregivers to establish a dental home concept at the earliest, which includes CRA, education, and anticipatory guidance on the prevention of oral diseases.

A Patient with Dementia Presents from a Nursing Home with a History of Decreased Oral Intake, Malodor, and Weight Loss.

Individuals with dementia can present with varying challenges depending on their state of disease. The individuals caring for them may be faced with resistant behaviors when trying to provide adequate oral care. A poor oral condition can lead to decreased caloric and fluid intake causing multiple comorbidities to be exasperated due to the declining oral condition. Creating a management plan and an oral disease prevention plan are key to improving the overall health outcomes of these patients.

A Study to Assess Knowledge, Attitude, and Perception of Dental Practitioners on Minimally Invasive Dentistry Concepts.

Background: Minimally invasive dentistry (MID) includes caries detection using caries risk assessment (CRA), early localization of nascent carious sores including necessary and voluntary avoidance, and remineralization of demineralized veneer and dentin when diagnosed early for these reasons. Although the dentistry curriculum prioritizes the benefits of MID in tooth protection, this research is seldom included in classroom instruction. Aim: The purpose of this research was to gauge the level of understanding that dental professionals have about MID ideas. Methods: An online questionnaire measuring MID knowledge and application was used to compile the data. The Chi-square tests were run for statistical analysis in the Statistical Package for the Social Sciences (SPSS). Results: Just 42.2% of the dentists who replied had MID training during their undergraduate or internship years, and the majority of that training came via lectures (45.2%). The majority (almost 81%) of respondents believed that CRA should be performed on all patients. Differences in knowledge and experience with atraumatic restorative therapy and the sandwich approach for treating caries in permanent teeth and high caries risk children were shown to be statistically significant (P 0.05). Conclusion: Dentists know about the benefits of MID, but their patients are not reaping those benefits since so many dentists still use the old methods of treating complete caries.

Assessing Adherence to Provider's Recommendations in Caries Risk Assessment and Management: A Retrospective Data Review.

AIM: To evaluate the distribution of caries risk category of patients at a dental institution and determine adherence to providers' recommendations. MATERIALS AND METHODS: A cross-sectional retrospective review of 1,235 patients records that included data collection on demographics, the sum of the number of decayed, missing due to caries, and filled teeth in the permanent teeth (DMFT), presence of frequent snacking, stimulated salivary flow rate, stimulated saliva pH, saliva buffering capacity, biofilm activity, caries risk category, anti-caries prescription accept/decline, and change in the caries risk category. Statistical analysis was carried out through Pearson's Chi-squared test and linear model ANOVA with a significance level of 0.05. RESULTS: Pearson's Chi-squared test showed a statistically significant difference in frequency by risk category (p < 0.001) indicating that patients were skewed toward high and extreme caries risk. Linear model ANOVA showed that higher risk categories were associated with lower salivary flow rates (p = 0.010) and higher biofilm activity (p < 0.001). About, 1 out of 3 patients were reported to have frequent snacking (N = 391, 32%). Frequent snacking patients were more likely to present with higher caries risk assessment (p < 0.001), younger age (p < 0.001), and female (p < 0.001). Despite recommendations from the dental student provider, only 27% accepted the anti-cavity prescriptions while 61% declined the recommendation. CONCLUSION: Distribution of caries risk category is not evenly distributed, but rather skewed toward high and extreme caries risk levels. Despite the identified risks, there is low adherence to the recommendations provided by healthcare providers. The results underscore the necessity for targeted interventions and initiatives aimed at fostering behavioral changes to enhance oral health outcomes. CLINICAL SIGNIFICANCE: There is a high need for targeted interventions and initiatives that promote behavioral changes to enhance oral health outcomes.