Caries lesion transition patterns of schoolchildren in a fluoridated community in Brazil.

OBJECTIVE: To describe the caries lesion transition pattern in permanent tooth surfaces over 2 years among a convenience sample of children in a fluoridated (0.8 ppm F) low-socioeconomic community of Brazil. MATERIAL AND METHODS: One hundred forty-nine schoolchildren (7-12 years) were examined for caries using Nyvad criteria at baseline and after 2 years. Descriptive analysis was used to evaluate caries lesion transition patterns. RESULTS: Less than 1% of sound surfaces and non-cavitated caries lesions at baseline progressed to cavitation stage within 2 years. 12.7% of the active non-cavitated (ANC) lesions became inactive, 34.7% regressed to sound, 48.0% remained active, and 4.6% progressed to cavitated/filled stages at follow-up. Similarly, 55.2% of the inactive non-cavitated (INC) lesions at baseline remained inactive, 33.3% regressed to sound, 8.0% progressed to cavitated/filled lesions, while only 3.5% progressed to ANC lesions. CONCLUSION: The caries lesion transition pattern in this child population exposed to water fluoride and fluoride toothpaste showed that a low proportion of sound surfaces and non-cavitated lesions progressed to cavitation within the 2-year follow-up. Caries arrest was mainly ascribed to a high proportion of active non-cavitated lesions regressing to sound or inactive lesions. CLINICAL RELEVANCE: Caries activity can be controlled by regular exposure to fluoridated water and fluoridated toothpaste.

Reliability and validity of a new classification of MIH based on severity.

OBJECTIVES: To describe a new molar-incisor hypomineralization (MIH) severity scoring system (MIH-SSS) that focuses on the defects' severity and to assess the system's validity and reliability over 3 years. MATERIALS AND METHODS: One hundred eighty-one children diagnosed with MIH were examined by MIH-SSS. For reliability assessment, 15-20 children were examined twice, and analyses were performed at the tooth level at four different cutoff points. Follow-up examinations were performed over 36 months. Only teeth presenting MIH opacities at baseline were assessed. Odds ratios were calculated to evaluate the chance of post-eruptive breakdown (PEB) occurrence related to the colors of MIH defects. Survival curves were created for different types of teeth (molars and incisors) based on white and yellow opacities. The Kaplan-Meier method was used with PEB as the outcome. RESULTS: According to the MIH-SSS, kappa values ranged from 0.82 to 0.88. Regarding the longitudinal evaluation, for molars and incisors, yellow/brown opacities had a significantly higher chance to evolve to dentin breakdown compared with white/creamy opacities (OR = 2.54, OR = 10.58, respectively). Survival analysis showed that the occurrence of PEB was more frequent in the first evaluation period (12 months). CONCLUSION: MIH-SSS, which provides detailed information about MIH severity, is a valid instrument presenting high reliability. Yellow/brown opacities progressed more than did white/creamy opacities. CLINICAL RELEVANCE: It is of paramount importance to detect any surface breakdown as early as possible to be able to avoid pain and caries progression. Moreover, this is the first paper that shows survival curves for MIH enamel breakdown over time.

Dental caries lesions in primary teeth without obvious cavitation: Treatment decision-making process.

BACKGROUND: Dental caries diagnosis and management have changed over time. AIM: To identify the treatment decision-making process performed by paediatric dentists, after caries detection using CAST instrument (Caries Assessment Spectrum and Treatment), for enamel (CAST 3) and non-cavitated dentin caries lesions (CAST 4) before and after analysing radiographic images. DESIGN: Seventy-four paediatric dentists were invited to participate. Twelve clinical cases were presented online, and treatment decisions before and after the analysis of bitewing radiographs were evaluated. RESULTS: Sixty-one specialists answered the questionnaire. The necessity for radiographs was significantly associated with the presence and depth of the caries lesion (P < 0.0001). CAST 3 lesions were preferentially monitored before and after the radiographic assessment. For CAST 4 lesions limited to the outer half of dentin, treatments indicated before and after radiographic analysis were sealant (33%) and restoration (40%). For the lesions in the inner half of dentin, restoration was the most cited before (45%) and after (84%) radiographs. The radiographic depth was the only significant independent variable when "change in the treatment option" was analysed by the regression model (P < 0.001). CONCLUSIONS: Enamel lesions were treated through less invasive treatments. Radiographs influenced the decision, especially for the lesions that involved the inner half of dentin.

Mechanical and optical properties of conventional restorative glass-ionomer cements - a systematic review.

OBJECTIVES: To perform a systematic review of test methodologies on conventional restorative glass-ionomer cement (GIC) materials for mechanical and optical properties to compare the results between different GICs. MATERIAL AND METHODS: Screening of titles and abstracts, data extraction, and quality assessments of full-texts were conducted in search for in vitro studies on conventional GICs that follow the relevant specifications of ISO standards regarding the following mechanical and optical properties: compressive strength, flexural strength, color, opacity and radiopacity. SOURCES: The Latin American and Caribbean Health Sciences (LILACS), Brazilian Bibliography of Dentistry (BBO) databases from Latin-American and Caribbean System on Health Sciences Information (BIREME) and PubMed/Medline (US National Library of Medicine - National Institutes of Health) databases were searched regardless of language. Altogether, 1146 in vitro studies were selected. Two reviewers independently selected and assessed the articles according to pre-established inclusion/exclusion criteria. Among all the properties investigated, only one study was classified as being of fair quality that tested compressive strength and was included. It was observed that many authors had not strictly followed ISO recommendations and that, for some properties (diametral tensile strength and microhardness), there are no guidelines provided. CONCLUSIONS: It was not possible to compare the results for the mechanical and optical properties of conventional restorative GICs due to the lack of standardization of studies.

Mechanical and optical properties of conventional restorative glass-ionomer cements - a systematic review

Abstract Objectives To perform a systematic review of test methodologies on conventional restorative glass-ionomer cement (GIC) materials for mechanical and optical properties to compare the results between different GICs. Material and Methods Screening of titles and abstracts, data extraction, and quality assessments of full-texts were conducted in search for in vitro studies on conventional GICs that follow the relevant specifications of ISO standards regarding the following mechanical and optical properties: compressive strength, flexural strength, color, opacity and radiopacity. Sources The Latin American and Caribbean Health Sciences (LILACS), Brazilian Bibliography of Dentistry (BBO) databases from Latin-American and Caribbean System on Health Sciences Information (BIREME) and PubMed/Medline (US National Library of Medicine - National Institutes of Health) databases were searched regardless of language. Altogether, 1146 in vitro studies were selected. Two reviewers independently selected and assessed the articles according to pre-established inclusion/exclusion criteria. Among all the properties investigated, only one study was classified as being of fair quality that tested compressive strength and was included. It was observed that many authors had not strictly followed ISO recommendations and that, for some properties (diametral tensile strength and microhardness), there are no guidelines provided. Conclusions It was not possible to compare the results for the mechanical and optical properties of conventional restorative GICs due to the lack of standardization of studies.

Glass hybrid restorations as an alternative for restoring hypomineralized molars in the ART model.

BACKGROUND: This study aimed to evaluate the survival rate of glass hybrid restorations placed under the atraumatic restorative treatment (ART) technique in first permanent molars affected by molar incisor hypomineralization (MIH). METHODS: Sixty teeth with severe MIH associated to carious dentin lesions without pulp involvement were included. Treatments were performed by one trained dentist using the ART approach and restored with a glass hybrid restorative system (Equia Forte, GC®) on school premises. Treatments were evaluated after 6 and 12 months by an independent examiner using the modified ART criterion. Data analysis involved descriptive statistics and actuarial success analysis. RESULTS: The sample comprised 24 (54.54%) girls and 20 (45.45%) boys with a mean age of 10.55 (±1.25) years. In regard to the number of surfaces involved in the restorations, 29 (48.3%) comprised one surface and 31 (51.7%) two or more surfaces. Considering cavity extent, 25 (41%) presented dentin cavitation without cusp weakness, 23 (37.7%) with large dentin cavitation with cusp weakness and 13 (21.3%) with large dentin cavitation with the breakdown of one or more cusps. Only 4 teeth required local anesthesia. A success rate of 98.3% after 6 and 12 months was observed, as only one restoration failed. The only failure occurred in a restoration involving three or more sur-faces presenting the breakdown of all cusps. CONCLUSION: Restorations using a glass hybrid restorative system and performed in the field with the ART technique proved, after 12 months of evaluation, to be an effective approach to preserving first permanent molars affected by MIH. TRIAL REGISTRATION: REBEC-RBR-8drccq (17/06/15).

Retention rates and caries-preventive effects of two different sealant materials: a randomised clinical trial.

OBJECTIVES: The aim of this study was to compare the caries-preventive effect and the retention rates of sealants prepared with a new modified and a high-viscosity glass-ionomer cement (GIC) in recently erupted first permanent molars.  MATERIALS AND METHODS: Fifty-six children (224 teeth) were included in a split-mouth randomised clinical trial. All children had their four first permanent molars sealed with either Clinpro XT Varnish (CXT) or Fuji IX GP FAST (FJ). FJ sealants were placed according to the ART protocol. Retention rates and caries-preventive effect of both materials were assessed clinically after 24 months, and survival curves were created according to the Kaplan-Meier method. For sealant retention rates, analyses were performed according to both the traditional method and modified sealant retention categorisation. RESULTS: FJ sealants were retained longer in comparison to CXT sealants (p < 0.05), regardless of the categorisation used. In relation to the caries-preventive effect, no statistically significant differences were observed between materials (p = 0.99). Sealants prepared with the high-viscosity GIC according to the ART protocol survived longer than those prepared with the modified GIC, but both materials were equally effective in preventing cavitated dentine lesions over 24 months. CONCLUSION: We concluded that GIC-based sealants are effective in preventing dentine caries lesions.

Caries Experience in Children with and without Molar-Incisor Hypomineralisation: A Case-Control Study.

AIM: The aim of this study was to compare the caries experience of children with and without molar-incisor hypomineralisation (MIH). METHODS: A case-control study was designed in which 130 children aged between 7 and 13 years with MIH (cases) were matched with 130 children without the condition (controls) according to age, sex, and school. Dental caries and MIH were assessed using the Caries Assessment Spectrum and Treatment (CAST) and European Academy of Paediatric Dentistry (EAPD) criteria, respectively, by three examiners. CAST was converted into DMFT/dmft; the Kruskal-Wallis test was performed to analyse whether dmft/DMFT was influenced by the severity of MIH. Associations between MIH and dental caries were analysed at child and tooth levels: between and within subjects, respectively. To correlate MIH severity and the occurrence of dental caries, the Cochran-Armitage test was used. RESULTS: The mean age of the children was 9.63 ± 1.29 years. The mean dmft for cases was 1.23 ± 1.99 and for controls 1.71 ± 2.22 (p > 0.05). For the DMFT, the mean scores for cases and controls were 0.45 ± 0.90 and 0.07 ± 0.25, respectively (p < 0.001). The between-subject analysis showed no difference in relation to enamel carious lesions; however, the prevalence of dentine carious lesions was significantly higher in children with MIH than in those without the condition. The same pattern was seen for the within-subject analysis. It was observed that the increase in MIH severity resulted in more teeth being affected by dentine carious lesions (p = 0.0003). CONCLUSION: Children with MIH presented a higher experience of caries in the permanent dentition than those without the condition. MIH was considered a risk factor for caries development.

Are Hypomineralized Primary Molars and Canines Associated with Molar-Incisor Hypomineralization?

PURPOSE: The purpose of this study was to evaluate the prevalence of and relationship between hypomineralized second primary molars (HSPM) and hypomineralized primary canines (HPC) with molar-incisor hypomineralization (MIH) in 1,963 schoolchildren. METHODS: The European Academy of Paediatric Dentistry (EAPD) criterion was used for scoring HSPM/HPC and MIH. Only children with four permanent first molars and eight incisors were considered in calculating MIH prevalence (n equals 858); for HSPM/HPC prevalence, only children with four primary second molars (n equals 1,590) and four primary canines (n equals 1,442) were considered. To evaluate the relationship between MIH/HSPM, only children meeting both criteria cited were considered (n equals 534), as was true of MIH/HPC (n equals 408) and HSPM/HPC (n equals 360; chi-square test and logistic regression). RESULTS: The prevalence of MIH was 14.69 percent (126 of 858 children). For HSPM and HPC, the prevalence was 6.48 percent (103 of 1,592) and 2.22 percent (32 of 1,442), respectively. A significant relationship was observed between MIH and both HSPM/HPC (P<0.001). The odds ratio for MIH based on HSPM was 6.31 (95 percent confidence interval [CI] equals 2.59 to 15.13) and for HPC was 6.02 (95 percent CI equals 1.08 to 33.05). CONCLUSION: The results led to the conclusion that both hypomineralized second primary molars and hypomineralized primary canines are associated with molar-incisor hypomineralization, because children with HSPM/HPC are six times more likely to develop MIH.

Caries risk assessment in schoolchildren--a form based on Cariogram software.

UNLABELLED: Identifying caries risk factors is an important measure which contributes to best understanding of the cariogenic profile of the patient. The Cariogram software provides this analysis, and protocols simplifying the method were suggested. OBJECTIVES: The aim of this study was to determine whether a newly developed Caries Risk Assessment (CRA) form based on the Cariogram software could classify schoolchildren according to their caries risk and to evaluate relationships between caries risk and the variables in the form. MATERIAL AND METHODS: 150 schoolchildren aged 5 to 7 years old were included in this survey. Caries prevalence was obtained according to International Caries Detection and Assessment System (ICDAS) II. Information for filling in the form based on Cariogram was collected clinically and from questionnaires sent to parents. Linear regression and a forward stepwise multiple regression model were applied to correlate the variables included in the form with the caries risk. RESULTS: Caries prevalence, in primary dentition, including enamel and dentine carious lesions was 98.6%, and 77.3% when only dentine lesions were considered. Eighty-six percent of the children were classified as at moderate caries risk. The forward stepwise multiple regression model result was significant (R2=0.904; p<0.00001), showing that the most significant factors influencing caries risk were caries experience, oral hygiene, frequency of food consumption, sugar consumption and fluoride sources. CONCLUSION: The use of the form based on the Cariogram software enabled classification of the schoolchildren at low, moderate and high caries risk. Caries experience, oral hygiene, frequency of food consumption, sugar consumption and fluoride sources are the variables that were shown to be highly correlated with caries risk.

Caries risk assessment in schoolchildren - a form based on Cariogram® software

Identifying caries risk factors is an important measure which contributes to best understanding of the cariogenic profile of the patient. The Cariogram® software provides this analysis, and protocols simplifying the method were suggested. Objectives: The aim of this study was to determine whether a newly developed Caries Risk Assessment (CRA) form based on the Cariogram® software could classify schoolchildren according to their caries risk and to evaluate relationships between caries risk and the variables in the form. Material and Methods: 150 schoolchildren aged 5 to 7 years old were included in this survey. Caries prevalence was obtained according to International Caries Detection and Assessment System (ICDAS) II. Information for filling in the form based on Cariogram® was collected clinically and from questionnaires sent to parents. Linear regression and a forward stepwise multiple regression model were applied to correlate the variables included in the form with the caries risk. Results: Caries prevalence, in primary dentition, including enamel and dentine carious lesions was 98.6%, and 77.3% when only dentine lesions were considered. Eighty-six percent of the children were classified as at moderate caries risk. The forward stepwise multiple regression model result was significant (R2=0.904; p<0.00001), showing that the most significant factors influencing caries risk were caries experience, oral hygiene, frequency of food consumption, sugar consumption and fluoride sources. Conclusion: The use of the form based on the Cariogram® software enabled classification of the schoolchildren at low, moderate and high caries risk. Caries experience, oral hygiene, frequency of food consumption, sugar consumption and fluoride sources are the variables that were shown to be highly correlated with caries risk. .