Appropriateness and imaging outcomes of ultrasound, CT, and MR in the emergency department: a retrospective analysis from an urban academic center.

PURPOSE: To evaluate the appropriateness and outcomes of ultrasound (US), computed tomography (CT), and magnetic resonance (MR) orders in the ED. METHODS: We retrospectively reviewed consecutive US, CT, and MR orders for adult ED patients at a tertiary care urban academic center from January to March 2019. The American College of Radiology Appropriateness Criteria (ACRAC) guidelines were primarily used to classify imaging orders as "appropriate" or "inappropriate". Two radiologists in consensus judged specific clinical scenarios that were unavailable in the ACRAC. Final imaging reports were compared with the initial clinical suspicion for imaging and categorized into "normal", "compatible with initial diagnosis", "alternative diagnosis", or "inconclusive". The sample was powered to show a prevalence of inappropriate orders of 30% with a margin of error of 5%. RESULTS: The rate of inappropriate orders was 59.4% for US, 29.1% for CT, and 33.3% for MR. The most commonly imaged systems for each modality were neuro (130/330) and gastrointestinal (95/330) for CT, genitourinary (132/330) and gastrointestinal (121/330) for US, neuro (273/330) and gastrointestinal (37/330) for MR. Compared to inappropriately ordered tests, the final reports of appropriate orders were nearly three times more likely to demonstrate findings compatible with the initial diagnosis for all modalities: US (45.5 vs. 14.3%, p < 0.001), CT (46.6 vs. 14.6%, p < 0.001), and MR (56.3 vs. 21.8%, p < 0.001). Inappropriate orders were more likely to show no abnormalities compared to appropriate orders: US (65.8 vs. 38.8%, p < 0.001), CT (62.5 vs. 34.2%, p < 0.001), and MR (61.8 vs. 38.7%, p < 0.001). CONCLUSION: The prevalence of inappropriate imaging orders in the ED was 59.4% for US, 29.1% for CT, and 33.3% for MR. Appropriately ordered imaging was three times more likely to yield findings compatible with the initial diagnosis across all modalities.

Middle- and long-term results after iris-fixated phakic intraocular lens implantation in myopic and hyperopic patients: a meta-analysis.

The iris-fixated phakic intraocular lens (pIOL) has been available for over 25 years. To provide a clear picture of outcomes and risks, for this systematic review and meta-analysis, the literature was searched for reports on middle- and long-term effects. The iris-fixated phakic intraocular lens (pIOL) has been available for over 25 years. To provide a clear picture of outcomes and risks, for this systematic review and meta-analysis, the literature was searched for reports on middle- and long-term effects of iris-fixated pIOLs on myopic and hyperopic eyes with a follow-up of at least 2 to 4 years. Visual and refractive results after implantation for correction of myopia are positive and the complication rate is low. Endothelial cell loss appears to be at an acceptable rate, although the range of endothelial cell change is too wide to draw firm conclusions. Care should be taken when considering an iris-fixated pIOL for hyperopic eyes because complication rates, particularly pigment dispersion, might be higher than those in myopic eyes. More well-designed, long-term studies are needed, especially in hyperopic eyes. The authors advocate for standardized reporting of refractive surgery data. Initiatives proposed by journal authors and editors to achieve uniformity should be supported.

Correlations between ocular biometrics and refractive error: A systematic review and meta-analysis.

The understanding of correlations between different biometric parameters is essential for personalized eye care in the field of cataract and refractive surgery. This systematic review offers a clear overview of the previous literature assessing these correlations including a meta-analysis. The review is focused on the following five correlations: (1) axial length and refractive error; (2) anterior chamber depth and refractive error; (3) axial length and anterior chamber depth; (4) corneal power and refractive error; (5) corneal power and axial length. An expected strong correlation between axial length and refractive error was found. Correlations including corneal power were weak and might be clinically insignificant.

Prevalence of Bluetongue virus serotype 4 in cattle in the State of Sao Paulo, Brazil.

Bluetongue (BT) is considered endemic in several regions of Brazil. The State of Sao Paulo was divided into 7 cattle production regions (circuits) according the different systems of breeding, operational and logistical capacity of the state veterinary service. At least 1 animal from each property (a total of 1,716 farms) was tested by competitive ELISA for the presence of antibodies against BTV. Sero­positive sera were subsequently also tested by virus neutralization tests (VNT) using serial dilutions from 1:10 (cutoff) up to 1:640 (in MEM). BTV­4 neutralizing antibodies were detected in 86% (1,483/1,716) of the animals tested. These results show that BTV­4 is endemic and widespread in the State of San Paulo and indirectly confirm that in the State there are favourable conditions for the multiplication of competent vectors. However, as no clinical signs have ever been reported in cattle in the region, BTV­4 infection is likely to occur silently in the State of Sao Paulo.

Usefulness and limitations of polymerase chain reaction in the etiologic diagnosis of neurotoxoplasmosis in immunocompromised patients.

The objective of the present study was to assess the performance and the best indication of the polymerase chain reaction (PCR) for the detection of Toxoplasmosis gondii DNA in cerebrospinal fluid (CSF) from patients with suspected neurotoxoplasmosis. CSF samples were collected from 79 patients for amplification of the T. gondii genome (gene B1) by two PCR techniques (nested and real time). Twenty-seven of the 79 patients were classified as probable cases of neurotoxoplasmosis on the basis of clinical criteria, neuroimaging and therapeutic response. PCR showed high sensitivity (86.6%) when performed in CSF samples which were collected up to the seventh day of specific toxoplasmosis treatment. There was no positive test after 1 week of treatment. These results suggest the usefulness of PCR for the diagnosis of cerebral toxoplasmosis, and support the first week as the window for the best performance of toxoplasmosis PCR in CSF.

Multicentric caries prevention program: Mechanical control of dental plaque through periodic professional oral prophylaxis. A 10 years follow up

AIM: To verify the incidence of dental caries in a multicentric prevention program applied in pediatric dentistry clinics from different regions of Brazil for 10 years, and compare with results obtained by previous studies. MATERIAL AND METHODS: 697 children of both genders, ranging from 30 months to 15 years, were included in a primary preventive strategy program for mechanical control of dental plaque through professional prophylaxis (sodium bicarbonate jet on a monthly schedule). Diagnosis of carious lesions was assessed by monthly clinical examinations and annual radiographs. This procedure aimed to provide a biological equilibrium without producing undesirable side effects. RESULTS: The average age of children at beginning of the program was 81.71 months. Before entering the program the children presented an average of 2.66 lesions/surface, while during the program the average was 0.20 lesions/surface; the incidence rate of caries per year before starting the program was on average 0.62 lesions/surface while during the program it was 0.05 lesions/surface; the time of permanence in the program was on average 44.15 months and the absence rate was 0.14 per year. CONCLUSION: The results confirm the effectiveness of the program, even when applied by different professionals and in different groups of children, turning it into an indispensible method for the control of dental caries.

When and Why Parents Seek Dental Care for Children under 36 Months.

BACKGROUND: The aim was to analyze an infant preventive program determining at what age parents take their children for their first dental visit and the reasons why they do it. MATERIALS & METHODS: A total of 844 children aged from 0 to 36 months, enrolled in the program of oral health maintenance of the Baby Clinic, participated in this study. During the first dental visit, the parents were inquired about the reasons that led them to enroll their children in the program. One trained investigator identified this reasons on the records and classified them according to the following scores: orientation/prevention, caries treatment, malpositioned teeth, dental trauma, tooth color alterations and others. RESULTS: Orientation/prevention was the most prevalent reason from 0-6 months to 25-30 months of age, and at the age 30-36 months, the reason caries/treatment overcame orientation/prevention, becoming the most prevalent reason in that age group. The third place was occupied by dental trauma. The mean age parents seek for dental care to their children was 14, 92 months. CONCLUSION: This study showed a preferentially preventive/educational profile for the children. However, lots of parents still take children to the dentist preferentially for curative instead of preventive treatment. How to cite this article: Volpato LE, Palti DG, Lima JE, Machado MA, Aranha AM, Bandeca MC, Pedro FL, Borges AH. When and Why Parents Seek Dental Care for Children under 36 Months. J Int Oral Health 2013; 5(4):21-25.

Reabilitação bucal na primeira infância: relato de caso / Oral rehabilitation in childhood: case report

A perda precoce de dentes decíduos, com subsequente comprometimento estético, pode induzir a alterações comportamentais e de ajuste social, fatores estes que devem ser considerados no planejamento do tratamento. Este estudo apresenta uma breve revisão de literatura e um relato de caso clínico sobre a perda precoce de dentes decíduos, ocasionada pela cárie severa precoce da infância em um paciente de tenra idade com o objetivo de descrever a etiologia, as implicações clínicas e o tratamento desta condição. No caso clínico apresentado, próteses parciais removíveis superior e inferior foram necessárias para o tratamento reabilitador, além da realização da adequação do meio bucal e de exodontias. A colocação das próteses restabeleceu a estética e, consequentemente a auto-estima, além da mastigação e fonética. O diagnóstico e a intervenção no caso de perda precoce de dentes decíduos são de fundamental importância para evitar danos à saúde física e psicológica da criança

The premature loss of deciduous teeth, with subsequent aesthetic problems, may induce disturbances at the child social interactions, aspects that must be considered in the treatment planning. This study presents a brief review of the literature and a case report of the premature loss of deciduous teeth, caused by severe early childhood caries in a young child, with the objective of describing the etiology, clinical implications and treatment of this condition. In the presented case, upper and lower removable partial dentures were necessary for the rehabilitation treatment besides the adequacy of the oral environment and dental extractions. The placement of the removable partial dentures restored the aesthetic, and consequently the self-esteem, as the mastication and the phonetic. The diagnosis and early intervention are of fundamental importance to prevent physical and psychological harm of the child

Medical management of neurocysticercosis.

INTRODUCTION: Neurocysticercosis (NCC) is considered to be the most common cause of acquired epilepsy worldwide. Formerly restricted to palliative measures, therapy for NCC has advanced with the advent of two drugs that are considered to be effective: praziquantel (PZQ) and albendazole (ALB). AREAS COVERED: All available articles regarding research related to the treatment of NCC were searched. Relevant articles were then reviewed and used as sources of information for this review. EXPERT OPINION: Anticysticercal therapy has been marked by intense controversy. Recent descriptions of spontaneous resolution of parenchymal cysticercosis with benign evolution, risks of complications and reports of no long-term benefits have reinforced the debate over the usefulness and safety of anticysticercal therapy. High interindividual variability and complex pharmacological interactions will require the close monitoring of plasma concentrations of ALB and PZQ metabolites in future trials. Given the relative scarcity of clinical trials, more comparative interventional studies - especially randomized controlled trials in long-term clinical evolution - are required to clarify the controversy over the validity of parasitic therapy in patients with NCC.

Anesthetic technique for inferior alveolar nerve block: a new approach.

BACKGROUND: Effective pain control in Dentistry may be achieved by local anesthetic techniques. The success of the anesthetic technique in mandibular structures depends on the proximity of the needle tip to the mandibular foramen at the moment of anesthetic injection into the pterygomandibular region. Two techniques are available to reach the inferior alveolar nerve where it enters the mandibular canal, namely indirect and direct; these techniques differ in the number of movements required. Data demonstrate that the indirect technique is considered ineffective in 15% of cases and the direct technique in 13-29% of cases. OBJECTIVE: The aim of this study was to describe an alternative technique for inferior alveolar nerve block using several anatomical points for reference, simplifying the procedure and enabling greater success and a more rapid learning curve. MATERIAL AND METHODS: A total of 193 mandibles (146 with permanent dentition and 47 with primary dentition) from dry skulls were used to establish a relationship between the teeth and the mandibular foramen. By using two wires, the first passing through the mesiobuccal groove and middle point of the mesial slope of the distolingual cusp of the primary second molar or permanent first molar (right side), and the second following the occlusal plane (left side), a line can be achieved whose projection coincides with the left mandibular foramen. RESULTS: The obtained data showed correlation in 82.88% of cases using the permanent first molar, and in 93.62% of cases using the primary second molar. CONCLUSION: This method is potentially effective for inferior alveolar nerve block, especially in Pediatric Dentistry.

Anesthetic technique for inferior alveolar nerve block: a new approach

BACKGROUND: Effective pain control in Dentistry may be achieved by local anesthetic techniques. The success of the anesthetic technique in mandibular structures depends on the proximity of the needle tip to the mandibular foramen at the moment of anesthetic injection into the pterygomandibular region. Two techniques are available to reach the inferior alveolar nerve where it enters the mandibular canal, namely indirect and direct; these techniques differ in the number of movements required. Data demonstrate that the indirect technique is considered ineffective in 15 percent of cases and the direct technique in 13-29 percent of cases. OBJECTIVE: The aim of this study was to describe an alternative technique for inferior alveolar nerve block using several anatomical points for reference, simplifying the procedure and enabling greater success and a more rapid learning curve. MATERIAL AND METHODS: A total of 193 mandibles (146 with permanent dentition and 47 with primary dentition) from dry skulls were used to establish a relationship between the teeth and the mandibular foramen. By using two wires, the first passing through the mesiobuccal groove and middle point of the mesial slope of the distolingual cusp of the primary second molar or permanent first molar (right side), and the second following the oclusal plane (left side), a line can be achieved whose projection coincides with the left mandibular foramen. RESULTS: The obtained data showed correlation in 82.88 percent of cases using the permanent first molar, and in 93.62 percent of cases using the primary second molar. CONCLUSION: This method is potentially effective for inferior alveolar nerve block, especially in Pediatric Dentistry.

In situ investigation of the remineralizing effect of saliva and fluoride on enamel following prophylaxis using sodium bicarbonate.

OBJECTIVES: This in situ study evaluated the effect of saliva, associated or not with fluoride, on enamel previously submitted to prophylaxis using sodium bicarbonate. METHODS: The study was conducted on enamel blocks submitted to in vitro prophylaxis using sodium bicarbonate. The blocks were randomly divided into 2 groups (G1/G2) and mounted on intraoral appliances wore by 10 volunteers. G1 blocks were directly exposed to saliva in situ, while blocks in G2 were exposed to saliva with fluoride (rinsing with 0.2% NaF solution during the initial minute). Enamel alterations were evaluated using surface microhardness and profilometry. Enamel hardness data were analyzed by ANOVA and Tukey tests and surface wear was evaluated using paired t test (P<.05). RESULTS: No significant differences were found between G1 and G2 for enamel hardness and wear. The wear after prophylaxis was not different from the wear after the in situ stage. Baseline mean values of enamel hardness, after prophylaxis and after the in situ stage were 340±16.6, 329±35.7 and 354±37.8 for G1 and 338±15.6, 312±46.3 and 340±21.8 for G2, respectively. CONCLUSIONS: It was concluded that saliva alone exhibited a similar effect to saliva associated with fluoride; after 4h of in situ remineralization, there was no recovery in height of the enamel structure that had been lost due to the application of sodium bicarbonate.

Migraine and epilepsy: a focus on overlapping clinical, pathophysiological, molecular, and therapeutic aspects.

The association of epilepsy and migraine has been long recognized. Migraine and epilepsy are both chronic disorders with episodic attacks. Furthermore, headache may be a premonitory or postdromic symptom of seizures, and migraine headaches may cause seizures per se (migralepsy). Migraine and epilepsy are comorbid, sharing pathophysiological mechanisms and common clinical features. Several recent studies identified common genetic and molecular substrates for migraine and epilepsy, including phenotypic-genotypic correlations with mutations in the CACNA1A, ATP1A2, and SCN1A genes, as well as in syndromes due to mutations in the SLC1A3, POLG, and C10orF2 genes. Herein, we review the relationship between migraine and epilepsy, focusing on clinical aspects and some recent pathophysiological and molecular studies.

Programa preventivo da cárie dentária baseado no controle mecânico da placa bacteriana em crianças, por meio da profilaxia profissional periódica: Resultados após 25 anos de acompanhamento / Dental caries prevention program based on the mechanical control of the bacterial plaque in children, through the periodic professional prophylaxis: Results after 25 years of attendance

OBJETIVOS: o objetivo deste trabalho foi verificar a incidência de cárie dentária em um programa de prevenção aplicado durante 25 anos em clínica particular. METODOLOGIA: participaram desse programa 640 crianças de ambos os gêneros, na faixa etária de 3 a 15 anos de idade. O programa foi baseado no controle mecânico da placa bacteriana dentária por meio da profilaxia profissional com jato de bicarbonato de sódio com uma periodicidade mensal. A incidência de cárie foi verificada por meio de exames clínicos durante as sessões de atendimento e radiográficos anualmente. A média de idade das crianças ao ingressarem no programa foi de 7,8 anos. RESULTADOS: antes de ingressar no programa, as crianças apresentaram, em média, 5,3 faces cariadas, enquanto após o programa a média foi de 0,18. A incidência de cáries por ano antes do programa foi de 0,9 faces cariadas e durante o programa de 0,03. O tempo de permanência das crianças no programa foi, em média, de 52,6 meses, e a média de faltas foi de 0,5 falta por ano. Esses resultados demonstram o sucesso do programa, principalmente por ter uma filosofia que procura o equilíbrio da biodiversidade da cavidade bucal, sem o risco de produzir efeitos colaterais indesejáveis. CONCLUSÕES: conclui-se, assim, que esse parece ser o caminho mais curto para resolver o problema da cárie dentária, ou seja, o controle mecânico da placa bacteriana dentária através da profilaxia profissional mensal, pois é um método de prevenção possível de ser aplicado em qualquer criança, independentemente de suas condições psicomotoras e sociais, e que proporciona a melhor relação custo-benefício, além de estar de acordo com os conceitos mais atuais de cárie e de seus fatores etiológicos. Em função da faixa etária das crianças, o programa é de suma importância para clínicas de Odontopediatria e Ortodontia.

AIM: This study investigated the incidence of dental caries in a prevention program applied for 25 years. METHODS: A total of 640 children of both genders aged 3 to 15 years old participated in the program, which was based on mechanical plaque control by professional prophylaxis with sodium bicarbonate jet on a monthly basis. The incidence of dental caries was investigated by clinical and radiographic examination during attendances. RESULTS: Upon inclusion in the program, the mean age of children was 7.8 years; the mean number of decayed tooth surfaces was 5.3 at the onset and 0.18 at completion of the program. The caries incidence per year was 0.9 surface before the program and 0.03 surface during the program. Children were followed-up in the program for a mean period of 52.68 months, with a mean absence of 0.5 per year. These results demonstrate the success of the program, mainly because it attempts to balance the biodiversity in the oral cavity without the risk of undesirable side effects. CONCLUSIONS: In conclusion, this seems to be the shortest way to solve the program of dental caries, i.e., mechanical plaque control by monthly professional prophylaxis, since this method may be applied to any child, regardless of the psychomotor and social conditions; it provides the better cost-benefit relationship and agrees with the newest concepts of dental caries and its etiologic factors.

Resin-modified glass ionomer cement and a resin-based material as occlusal sealants: a longitudinal clinical performance.

PURPOSE: The aim of this study was to compare retention, effectiveness in caries prevention and superficial characteristics in 2 different materials used as an occlusal sealant. METHODS: The sample consisted of 108 school children with a mean age of 7.5+/-1.25 years, in which 364 first permanent molars were divided into 6 groups: (1) group 1=Delton + rubber dam (used only for this group); (2) group 2=Delton + cotton rolls; (3) group 3=Prime & Bond 2.1 + Delton; (4) group 4=Vitremer with a 0.25:1 powder/liquid proportion; (5) group 5=Primer + Vitremer with a 0.25:1 powder/liquid proportion; and (6) group 6=Vitremer with a 1:1 powder/liquid proportion. RESULTS: After 12 months, the total retention rate for groups 6, 1, 2, 3, 4, and 5 was, respectively: 92%, 79%, 67%, 52%, 41% and 12%. For the 3 occlusal areas, retention was: 97%, 92%, 86%, 77%, 69%, and 36%. For the modified criterion, the proportion test showed a statistically significant difference (P<.05) between: groups 1 and 4; groups 6 and 2; and group 3, 4, and 5 with all others groups. Considering the total of 3 areas, there was a statistically significant difference (P<.05) between: groups 1 and 6 with groups 3 and 4; group 2 with group 4; and groups 6 and 5 with the others. CONCLUSION: The resin-modified glass ionomer cement may be a promising alternative as an occlusal sealant.

Evaluation of superficial microhardness in dental enamel with different eruptive ages.

This study evaluated the superficial microhardness of enamel in teeth at different posteruptive ages (before eruption in the oral cavity, 2-3 years after eruption, 4-10 years after eruption and more than 10 years after eruption). The study sample was composed of 134 specimens of human enamel. One fragment of each tooth was obtained from the flattest central portion of the crown to produce specimens with 3 x 3 mm. The enamel blocks were minimally flattened out and polished in order to obtain a flat surface parallel to the base, which is fundamental for microhardness testing. Microhardness was measured with a microhardness tester and a Knoop diamond indenter, under a static load of 25 g applied for 5 seconds. Comparison between the superficial microhardness obtained for the different groups was performed by analysis of Student's t test. The results demonstrated that superficial microhardness values have a tendency to increase over the years, with statistically significant difference only between unerupted enamel and that with more than 10 years after eruption. According to the present conditions and methodology, it was concluded that there were differences between the superficial micro-hardness of specimens at different eruptive ages, revealing an increasing mineralization. However, this difference was significant only between unerupted specimens and those with more than 10 years after eruption.

Evaluation of superficial microhardness in dental enamel with different eruptive ages

This study evaluated the superficial microhardness of enamel in teeth at different posteruptive ages (before eruption in the oral cavity, 2-3 years after eruption, 4-10 years after eruption and more than 10 years after eruption). The study sample was composed of 134 specimens of human enamel. One fragment of each tooth was obtained from the flattest central portion of the crown to produce specimens with 3 x 3 mm. The enamel blocks were minimally flattened out and polished in order to obtain a flat surface parallel to the base, which is fundamental for microhardness testing. Microhardness was measured with a microhardness tester and a Knoop diamond indenter, under a static load of 25 g applied for 5 seconds. Comparison between the superficial microhardness obtained for the different groups was performed by analysis of Student's t test. The results demonstrated that superficial microhardness values have a tendency to increase over the years, with statistically significant difference only between unerupted enamel and that with more than 10 years after eruption. According to the present conditions and methodology, it was concluded that there were differences between the superficial micro-hardness of specimens at different eruptive ages, revealing an increasing mineralization. However, this difference was significant only between unerupted specimens and those with more than 10 years after eruption.

Cárie dentária: um novo conceito / Dental caries: a new concept

INTRODUÇÃO: a maneira como a cárie dentária é conceituada e seus fatores etiológicos considerados têm gerado divergências, na elaboração de estratégias preventivas, entre epidemiologistas e profissionais da saúde. As considerações e o conhecimento sobre a formação, progressão e definição da lesão de cárie devem ser aprofundados, para se estabelecer critérios que favoreçam o diagnóstico, a prevenção e o tratamento, preservando a qualidade de vida do paciente. O conceito de cárie dentária como doença infecciosa, transmissível e dieta dependente deve ser revisto, e os fatores etiológicos melhor interpretados e entendidos, para evitar estratégias de prevenção e tratamento equivocadas. É necessário um posicionamento mais conclusivo de instituições científicas e universidades, objetivando o estabelecimento definitivo desses conceitos, para que possam refletir-se em resultados práticos. OBJETIVO: o objetivo deste trabalho foi trazer uma contribuição baseada em 35 anos de exercício profissional e da vivência acadêmica no ensino e pesquisa e, também, realizar uma revisão da literatura de Cariologia, com a intenção de levar a uma interpretação dos achados científicos que permita um raciocínio lógico sobre o conceito de cárie dentária e dos fatores envolvidos em sua etiologia, podendo, com isso, chegar o mais próximo possível da verdade. RESULTADOS E CONCLUSÕES: os conhecimentos adquiridos até hoje, por meio da pesquisa científica e também a partir das conclusões deste trabalho, permitem elaborar estratégias preventivas mais eficientes em todo o planeta e a cárie dentária passará a ser, dentro de pouco tempo, um problema irrelevante ao ser humano...

INTRODUCTION: The concept of dental caries and its etiologic factors have been raising disagreement in the establishment of preventive strategies among epidemiologists and health professionals. Considerations and knowledge on the formation, progression and definition of carious lesions should be enhanced for establishment of criteria to favor the diagnosis, prevention and treatment, maintaining the life quality of patients. The concept of dental caries as an infectious, transmissible and diet-dependent disease should be revised; the etiologic factors should be better interpreted and understood to avoid mistaken approaches for prevention and treatment. A more conclusive positioning of scientific institutions and universities is required for definitive establishment of these concepts and achievement of practical outcomes. AIM: This study aimed to provide a contribution based on 35 years of professional exercise and academic experience in teaching and research, as well as to conduct a literature review on cariology for interpretation of scientific findings to allow logical conclusions on the concept of dental caries and its etiologic factors, to reach the truth as much as possible. RESULTS AND CONCLUSIONS: The information currently available by means of scientific investigation and also the conclusions of this study allow the formulation of more effective preventive strategies throughout the world allows; in the short term, dental caries will be a minor problem to mankind. Based on the present study, it is concluded that dental caries should not be considered a disease, but rather an enamel lesion due to local causes, without determinant etiologic factors, yet caused by imbalance between physiological factors pertinent to the biodiversity of mankind and specifically to the oral cavity. An objective preventive strategy should aim to achieve biological balance, taking into account the mankind quality of life.