Anticaries properties of natural berries: systematic literature review.

CONTEXT: Anticariogenic properties have been ascribed to polyphenolic compounds present in high concentrations in numerous fruits. Berries, in particular, have been reported as potentially having an inhibitory effect on the dental biofilm and subsequently on caries, but the evidence is unclear. OBJECTIVE: The objective of this review was to explore the literature and summarize the evidence for berries having an inhibitory effect on the dental biofilm and an anticariogenic effect. DATA SOURCES: Following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, the PubMed, Web of Science, and SCOPUS databases were scanned using predefined and accessible terms, with a search strategy based on a structured PICO question. DATA EXTRACTION: After article selection, 23 studies met the inclusion criteria, most of them being in vitro studies. A risk assessment was performed, and data were extracted and presented in a table for qualitative analysis. DATA ANALYSIS: Meta-analyses were conducted using standardized mean differences (SMDs) with a 95% confidence interval (CI) by Review manager 5.4. RESULTS: Only 3 types of berries were found to have a reported anticaries effect: grape seed extract (GSE), cranberry, and sour cherry. Nine studies that fulfilled the eligibility criteria were subjected to quantitative analysis. Meta-analyses showed GSE was associated with enhanced remineralization of dental enamel (SMD = .96 95% CI [.45, 1.46], P < .0002) and of dentin (SMD = .65 95% CI [.13, 1.17], P = .01). Cranberry extracts positively influenced the cariogenic dental biofilm by decreasing the biofilm biomass (SMD = -2.23 95% CI [-4.40, -.05], P = .04), and biovolume (SMD = -2.86 95% CI [-4.34, -1.37], P = .0002), and increasing the biofilm pH (SMD = 7.9 95% CI [3.49, 12.31], P < .0004). CONCLUSION: Within the limitations of this systematic review and metaanalysis, GSE and cranberries or their active compounds could represent an alternative for caries management. Further clinical trials are needed to verify this effect in a clinical setting. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42020223579.

Core curriculum in cariology for dentistry degrees in the Republic of Argentina / Contenidos Mínimos de Cariología en el Currículo de las Carreras de Odontología en la República Argentina

ABSTRACT Aim To prepare a consensus document of the cariology contents and competences included in the curriculum for the dentistry degree at Argentine dental faculties/schools Materials and Method Planning the process in stages: Stage 1- Diagnosis of the situation (Google Form) and invitation to participate extended to the 20 academic units that offer dentistry degrees. Stage 2- Assessment process of Content (C) and Competences (I) agreements in the five domains: D1 Basic Sciences, D2 Risk and diagnosis of dental caries, D3 Decision-making for non-invasive treatments, D4 Decision-making for invasive treatment, and D5 Evidence-based cariology at community level. Stage 3- Consensus. Stages 2 and 3 were held in Workshop format in virtual mode (W) Results Stage 1- Of the total 20 Google forms sent to the AU, 13 responses were received: 7 from National Universities and 6 from Private Universities. All participants agreed to be part of the consensus. Stage 2- W: 20 representatives from 10 AU participated. It began with a contextualizing conference, after which the representatives were divided into 5 groups to assess the agreements of each D. Stage 3- The Cariology Curriculum document was organized into 5 Domains, and 23 C and 31 I of clinical application were defined for teaching cariology. The contents and competences for each domain were agreed upon. The final document was sent to all W participants for their approval and dissemination in each AU involved Conclusion Cariology contents were defined for dentistry students at Universities in the Argentine Republic.

RESUMEN Objetivo Elaborar un documento de consenso de los contenidos y competencias de cariología en el currículo para las facultades/escuelas de odontología argentinas, a nivel del grado Materiales y Método El proceso de creación se efectuó en etapas: 1- Diagnóstico de situación (Formulario electrónico) e invitación a participar a las 20 unidades académicas (UA) donde se imparte la carrera de odontología. 2- Proceso de valoración de acuerdos de Contenidos (C) y Competencias (I) en los cinco dominios (D): D1: Ciencias Básicas; D2: Riesgo y diagnóstico de caries dental; D3: Toma de decisiones tratamientos no invasivos; D4: Toma de decisiones para el tratamiento invasivo y D5: Cariología basada en la evidencia a nivel comunitario. 3- Etapa de consenso. Las etapas 2 y 3 se efectuaron en formato de Workshop en modalidad virtual (W) Resultados Etapa 1: Del total de 20 formularios enviados a las UA se recibieron 13 respuestas (65%), 7 (53,8%) de Universidades Nacionales y 6 (46,1%) de gestión Privada. El 100% de los participantes estuvieron de acuerdo en formar parte del consenso. Etapa 2: W: Participaron 20 representantes de 10 UA. El proceso se inició con una conferencia contextualizadora, posteriormente los representantes fueron divididos en 5 grupos para la valoración de acuerdos de cada D. Etapa 3: El documento de658. 658.l Currículo en Cariología se organizó en 5 Dominios. Se definieron 23 C y 31 I de aplicación clínica para la enseñanza de la Cariología. Se consensuaron los contenidos y las competencias para cada uno de los dominios. El documento final fue enviado a todos los participantes del W para su aprobación y difusión en cada una de las UA involucradas Conclusión En base al trabajo realizado se determinó un consenso de competencias y contenidos en cariología para estudiantes de grado de Odontología, de las Universidades de la República Argentina.

Current status of geriatric dentistry education in selected dental schools in Latin America and the Caribbean.

OBJECTIVE: Latin American and Carribean (LAC) are currently experiencing a rapid aging of their population, coupled with a significant burden of oral diseases. Despites this, there is a scarcity of evidence regarding the manner in wich geriatric dentistry is being taught in dental schools across LAC. So, the objective of this study is to investigate the current status of geriatric dentistry education at undergraduate and postgraduate levels in selected LAC dental schools. METHODS: An electronic questionnaire was developed and emailed to all 539 dental schools in 19 LAC countries. The questionnaire recorded activity levels, contents and methodology of geriatric dentistry education as part of dental degree programmes. Reminders by email and telephone calls were used to encourage non-responders to complete the questionnaire. RESULTS: In total, 317 schools from 17 countries responded to the questionnaire (response rate: 58.8%). Geriatric dentistry was taught in 54.6% of the schools at the undergraduate level and in 6.9% at the postgraduate level. Thirty two percent of the schools had a programme director trained in geriatric dentistry. Geriatric dentistry was taught as an independent course in 14.5% of the schools. Dry mouth, periodontal disease, denture-related conditions and prosthodontic management, oral mucosal disease and age-related changes of the orofacial complex were the most frequently covered topics. Clinical teaching of geriatric dentistry was reported by 26.5% of the schools, with 38.0% providing clinical training in outreach facilities. CONCLUSIONS: Geriatric dentistry education remains incipient in LAC, with only one in every four dental school offering it as a standalone course. There is an urgent need to further develop geriatric dentistry education in the continent, including further research to develop a minimum geriatric dentistry curriculum.

¿Cómo Intervenir el Proceso de Caries en Personas Mayores? Adaptación del Consenso de ORCA/EFCD/DGZ / How to Intervene the Caries Process in Older Persons? Adaptation of the ORCA/EFCD/DGZ Consensus

Los cambios demográficos y epidemiológicos actuales determinarán un aumento en la prevalencia e incidencia de caries, específicamente lesiones de caries radicular (RCLs, por sus siglas en inglés) en personas mayores, por lo que la necesidad de tratamiento de mayor cobertura y efectividad será también cada vez mayor. Este artículo resume en español la evidencia actual disponible acerca de las recomendaciones clínicas para las intervenciones preventivas, no invasivas, micro o mínimamente invasivas e invasivas para el manejo de la caries dental en personas mayores, con especial énfasis en RCLs. La presente publicación se basa en un taller de consenso, seguido de un proceso de consenso e-Delphi, realizado por un panel de expertos nominados por la Organización Europea para la Investigación en Caries (ORCA), la Federación Europea de Odontología Conservadora (EFCD) y la Federación Alemana de Odontología Conservadora (DGZ). El propósito de este artículo es presentar las principales conclusiones alcanzadas en el consenso de ORCA/EFCD/DGZ para permitir una mejor difusión del conocimiento y la aplicación de estos conceptos en la práctica clínica, orientando la correcta toma de decisiones en el manejo de la enfermedad y RCLs en las personas mayores.

Current demographic and epidemiological changes will condition increased caries prevalence and incidence, specifically root caries lesions (RCLs) in the elderly. There will be a need, therefore, for therapeutic approaches with greater coverage and effectiveness. This article summarizes, in Spanish, the current available evidence leading to clinical recommendations for preventive, non-invasive, micro or minimally invasive and invasive interventions for the management of dental caries in older people, with special emphasis on RCLs. This publication is based on a consensus workshop, followed by an e-Delphi consensus process, conducted by a panel of experts nominated by the European Organization for Caries Research (ORCA), the European Federation of Conservative Dentistry (EFCD) and the German Federation of Conservative Dentistry (DGZ). The purpose of this article is to present the main conclusions reached in the ORCA/EFCD/DGZ consensus to allow a better dissemination of knowledge and the application of these concepts in clinical practice, guiding the correct decision-making for the disease management and the RCLs in the elderly.

Saliva Decreases Sucrose-Induced Cariogenicity in an Experimental Biological Caries Model.

OBJECTIVE: Whether a minimum quantity of saliva inhibit the caries process remains uncertain. This study aimed to investigate the impact of saliva dilutions on an in vitro caries model using Streptococcus mutans (S. mutans) biofilms. METHODS: S. mutans biofilms were cultivated on enamel and root dentin slabs, in culture media containing different proportions of saliva (v/v): 0%, 5%, 10%, 25%, 50%, 75%, and 100% saliva, and exposed to a 10% sucrose solution (5 min, 3x/day), with appropriate controls. After 5 (enamel) and 4 (dentin) days, demineralization, biomass, viable bacteria, and polysaccharide formation were analyzed. The acidogenicity of the spent media was monitored overtime. Each assay was performed in triplicate across two independent experiments (n = 6). RESULTS: In both enamel and dentin, an inverse relationship was observed between acidogenicity, demineralization, and the proportion of saliva. Even small quantities of saliva incorporated into the media led to a noticeable reduction in enamel and dentin demineralization. Saliva presence resulted in significant reductions in biomass, viable S. mutans cells, and polysaccharides, with the effects being concentration-dependent for both tissues. CONCLUSIONS: High quantities of saliva can almost completely inhibit sucrose-induced cariogenicity, while even small amounts exhibit a dose-dependent caries-protective effect.

Caries Experience in Elderly People Consuming a Milk-Based Drink Nutritional Supplement: A Cross-Sectional Study.

Nutritional supplements have been recommended to cope with malnutrition in elderly persons. In Chile, the Supplementary Nutrition Program for the Elderly (PACAM, for its Spanish acronym) consists in a monthly distribution of a low-fat-milk-based drink that contains 8% sucrose. The aim of this study was to determine whether older persons consuming the milk-based drink have a higher caries experience when compared to those not receiving the supplement. A cross-sectional study was conducted in the Maule Region in Chile. The representative sample comprised two groups: (a) PACAM consumers (CS) (n = 60) and (b) nonconsumers (NCS) (n = 60). Participants received intraoral examination and coronal (DMFT/DMFS) and root caries (RCI index) experience were recorded. Additionally, questionnaires regarding acceptability and consumption habits of PACAM and a 24-h diet recall were applied. The influence of predictors was calculated using binary logistic regression for a dichotomized DMFS and Poisson Regression for root caries lesions. A p value <0.05 was considered significant. No differences were detected in food consumption patterns between study groups (p > 0.05). CS participants had increased dairy product consumption. Higher DMFS mean value was observed in the CS (85.35 ± 39.0) compared with NCS (77.28 ± 28.9) (p = 0.043). The multivariate analysis showed nonconsumers of the milk-based product (ß = -0.41, p = 0.02) are less likely to have root surfaces affected by caries. Additionally, CS show higher RCI, compared to nonconsumers (ß = -0.17, p = 0.02). Daily consumption of a PACAM's milk-based drink supplement seems to increase coronal and root caries risk. Based on these results, composition modification of milk-based drinks with added sucrose appears mandatory.

Effect of Casein Phosphopeptide-Amorphous Calcium Phosphate Added to Milk, Chewing Gum, and Candy on Dental Caries: A Systematic Review.

Casein is one of the most studied proteins with activity against dental caries. In particular, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) has shown promising remineralizing properties. In vivo evidence on the anticaries potential of CPP-ACP added to foodstuffs is elusive, nonetheless. Hence, this systematic review aimed at determining whether the use of CPP-ACP added to foodstuffs has a remineralizing or inhibitory action on dental demineralization either in vivo or in situ. The review protocol followed the PRISMA-P criteria and was registered in PROSPERO. PubMed, Scopus, and Web of Science databases were searched using predefined criteria, based on the PICO question: Is there an effect on dental caries upon adding CPP-ACP to milk, chewing gums, or candies? No year or language limits were applied. Article selection and data extraction were carried out independently by 2 investigators. Two hundred ten titles were examined, 23 were selected for full-text review, and 16 studies were included (2 in vivo and 14 in situ). CPP-ACP was added to candy in 2 studies, to milk in 2 studies, and to chewing gum in 12 studies. The main outcomes included enamel remineralization and activity against dental biofilm. The overall quality of the evidence was classified as moderate. The available evidence suggests that CPP-ACP added to milk, chewing gum, or candy has a potential remineralizing activity on tooth enamel, with some additional antibacterial activity on the dental biofilm. Further clinical studies are needed to verify if this effect is clinically significant in reducing the caries lesion incidence or to revert the demineralizing process.

Core curriculum in cariology for dentistry degrees in the Republic of Argentina.

Aim: To prepare a consensus document of the cariology contents and competences included in the curriculum for the dentistry degree at Argentine dental faculties/schools. Materials and Method: Planning the process in stages: Stage 1- Diagnosis of the situation (Google Form) and invitation to participate extended to the 20 academic units (AU) that offer dentistry degrees. Stage 2- Assessment process of Content (C) and Competences (I) agreements in the five domains: D1 Basic Sciences, D2 Risk and diagnosis of dental caries, D3 Decision-making for non-invasive treatments, D4 Decision-making for invasive treatment, and D5 Evidence-based cariology at community level. Stage 3- Consensus. Stages 2 and 3 were held in Workshop format in virtual mode (W). Results: Stage 1- Of the total 20 Google forms sent to the AU, 13 responses were received: 7 from National Universities and 6 from Private Universities. All participants agreed to be part of the consensus. Stage 2- W: 20 representatives from 10 AU participated. It began with a contextualizing conference, after which the representatives were divided into 5 groups to assess the agreements of each D. Stage 3- The Cariology Curriculum document was organized into 5 Domains, and 23 C and 31 I of clinical application were defined for teaching cariology. The contents and competences for each domain were agreed upon. The final document was sent to all W participants for their approval and dissemination in each AU involved. Conclusion: Cariology contents were defined for dentistry students at Universities in the Argentine Republic.

Objetivo: Elaborar un documento de consenso de los contenidos y competencias de cariología en el currículo para las facultades/escuelas de odontología argentinas, a nivel del grado. Materiales y Método: El proceso de creación se efectuó en etapas: 1- Diagnóstico de situación (Formulario electrónico) e invitación a participar a las 20 unidades académicas (UA) donde se imparte la carrera de odontología. 2- Proceso de valoración de acuerdos de Contenidos (C) y Competencias (I) en los cinco dominios (D): D1: Ciencias Básicas; D2: Riesgo y diagnóstico de caries dental; D3: Toma de decisiones tratamientos no invasivos; D4: Toma de decisiones para el tratamiento invasivo y D5: Cariología basada en la evidencia a nivel comunitario. 3- Etapa de consenso. Las etapas 2 y 3 se efectuaron en formato de Workshop en modalidad virtual (W). Resultados: Etapa 1: Del total de 20 formularios enviados a las UA se recibieron 13 respuestas (65%), 7 (53,8%) de Universidades Nacionales y 6 (46,1%) de gestión Privada. El 100% de los participantes estuvieron de acuerdo en formar parte del consenso. Etapa 2: W: Participaron 20 representantes de 10 UA. El proceso se inició con una conferencia contextualizadora, posteriormente los representantes fueron divididos en 5 grupos para la valoración de acuerdos de cada D. Etapa 3: El documento de658. 658.l Currículo en Cariología se organizó en 5 Dominios. Se definieron 23 C y 31 I de aplicación clínica para la enseñanza de la Cariología. Se consensuaron los contenidos y las competencias para cada uno de los dominios. El documento final fue enviado a todos los participantes del W para su aprobación y difusión en cada una de las UA involucradas. Conclusión: En base al trabajo realizado se determinó un consenso de competencias y contenidos en cariología para estudiantes de grado de Odontología, de las Universidades de la República Argentina.

Understanding dental caries as a non-communicable and behavioral disease: Management implications.

New paradigms in caries conceptualization have emerged during the last decades, leading to intense debate and discussion on how to approach the disease, both from a preventive and a therapeutic perspective. Among many new ideas, research discoveries and technologies, one major concept can be highlighted that created a deep frontier between the old and the new paradigm in caries conceptualization; the non-communicable nature of the disease, firmly associated with behaviors and lifestyles. This article synthetizes the conceptual construction of dental caries as a non-communicable disease (NCD) based on the current evidence and discusses the appropriate management of the disease in this context. Dental caries has shifted from being considered transmissible and infectious to an ecological and non-communicable disease. Environmental factors such as frequent sugars intake, disrupt the symbiosis of the dental biofilm leading to a dysbiosis, which favors caries lesion initiation and progression. As an NCD, dental caries shares characteristics with other NCDs such as cardiovascular and chronic respiratory diseases, cancer and diabetes, including long duration and slow progression, not being transmissible from person-to-person, being strongly related to modifiable behavioral risk factors, and affecting preferentially disadvantaged populations with a strong inequality gradient. Given the high prevalence of dental caries, and its consequences on people's health and quality of life, a recognizable conceptual view of caries as a NCD is required to target an effective management. Current understanding of dental caries supports prevention through acting on the modifiable risk factors (behaviors) and involves management based on an interdisciplinary approach. Communicating these modern concepts among researchers, clinicians and policymakers is needed to decrease the global high burden of the disease.

Effect of liners on composite resin microleakage after selective carious lesion removal: an experimental study / Efecto de los recubrimiento en la microfiltración de resina compuesta después de la eliminación selectiva de lesiones cariosas: un estudio experimental

Objetive: To evaluate microleakage of composite resins (CR) placed over different cavitary liners after managing deep caries lesions through selective removal of soft carious tissue to soft dentin (SRCT-S). Material and Methods: Fifty four human teeth were collected for microleakage testing. Each assay comprised ICDAS 5 or ICDAS 6 carious lesions and sound teeth for controls. Sound teeth were prepared with cavities that mirrored the carious teeth cavities, which were prepared with SRCT-S. Sound and carious teeth were further randomly assigned to one of the three experimental groups: Group A: universal adhesive (UA) + CR, Group B: glass ionomer cement liner + UA + CR, and Group C: calcium hydroxide + UA+ CR. Occlusal microleakage (OM) and cervical microleakage (CM) was classified within one of 5 depth categories. ANOVA and Chi-square tests were computed (p<0.05). Results: OM and CM were similarly distributed across subgroups (p>0.05). All Group C samples with carious lesions presented some degree of microleakage. However, no statistically significant differences were observed between groups and within each group (p>0.05). Conclusion: Teeth restored with CR after SRCT-S using calcium hydroxide as a liner material seem to exhibit higher microleakage than those restored using glass ionomer or UA alone. Further clinical research is needed to deepen these findings. Clinical significance: The application of calcium hydroxide as a liner under a composite resin may reduce the longevity of a restoration after performing selective or partial removal of carious tissues. Clinicians should rethink the need of using calcium hydroxide for this application, albeit the lack of clinical evidence.

Objetivo: Evaluar la microfiltración de resinas compuestas (RC) colocadas sobre diferentes liners cavitarios después del manejo de lesiones de caries profundas mediante la remoción selectiva de tejido cariado blando hasta dentina blanda (SRCT-S). Material y Métodos: Se recolectaron 54 dientes humanos para pruebas de microfiltración. Cada ensayo comprendía lesiones cariosas ICDAS 5 o ICDAS 6 y dientes sanos para los controles. Se prepararon dientes sanos con cavidades que reflejaban las cavidades de los dientes cariados, que se prepararon con SRCT-S. Los dientes sanos y cariados se asignaron al azar a uno de los tres grupos experimentales: Grupo A: adhesivo universal (AU) + RC, Grupo B: revestimiento de cemento de ionómero de vidrio + AU + RC, y Grupo C: hidróxido de calcio + AU+ RC. La microfiltración oclusal (MO) y la microfiltración cervical (MC) se clasificaron dentro de una de las 5 categorías de profundidad. Se calcularon las pruebas ANOVA y Chi-cuadrado (p<0,05). Resultados: La MO y MC se distribuyeron de manera similar en los subgrupos (p> 0,05). Todas las muestras del Grupo C con lesiones cariosas presentaron algún grado de microfiltración. Sin embargo, no se observaron diferencias estadísticamente significativas entre grupos y dentro de cada grupo (p>0,05). Conclusión: Los dientes restaurados con RC después de SRCT-S usando hidróxido de calcio como material de revestimiento parecen exhibir una mayor microfiltración que aquellos restaurados usando ionómero de vidrio o AU solo. Se necesita más investigación clínica para profundizar estos hallazgos. Relevancia clínica: la aplicación de hidróxido de calcio como revestimiento debajo de una resina compuesta puede reducir la longevidad de una restauración después de realizar la eliminación selectiva o parcial de los tejidos cariados. Los médicos deberían reconsiderar la necesidad de usar hidróxido de calcio para esta aplicación, aunque no haya evidencia clínica.

Detection of Cavitated Proximal Carious Lesions in Permanent Teeth: A Visual and Radiographic Assessment.

Detection of proximal carious lesions involves the combination of clinical and radiographic methods, both with inherent difficulties. The present cross-sectional study is aimed at estimating the prevalence of cavitation in proximal carious lesions, based on a direct clinical assessment of previously detected radiographic lesions, in permanent molars and premolars. Proximal dental surfaces were radiographically evaluated using the ADA coding system and cavitation was determined through clinical visual examination of the surfaces after separation with elastomeric bands. One-hundred and twenty-six patients attending the dental clinics at the University of Talca were examined, comprising 508 proximal surfaces with radiographic codes ranging from E1 to D3. Two examiners were trained and calibrated for radiographic and clinical detection of proximal lesions. Most participants were females (61.9%). The age mean of participants was 28.7 (0.8) years old. A total of 22.2% of the examined surfaces were cavitated. Only few lesions coded as E1 (n = 4; 2.1%) and E2 (n = 9; 9.8%) were cavitated. Fifty D1 (35.5%) and 22 D2 (41.5%) lesions were cavitated after separation. Most lesions coded as D3 (n = 28; 84.8%) were cavitated. The multilevel binary regression model (p = 0.003) demonstrated that sex, age, jaw, tooth type, surface, and side were not associated with the likelihood of having proximal cavitation. Challenging conventional wisdom, most D1 and D2 lesions were not cavitated. Combining detection methods seems desirable to increase the accuracy in assessing approximal posterior lesions. The low proportion of cavitated lesions reinforces the idea of cautiously indicating invasive approaches for managing proximal carious lesions.

¿Cómo Intervenir el Proceso de Caries en Niños? Adaptación del Consenso de ORCA/EFCD/DGZ / How can the Caries Process in Children be intervened? Adaptation of the ORCA/EFCD/DGZ Consensus

RESUMEN: La caries dental afecta alrededor del 70% de los niños y en Latinoamérica este problema es aún más complejo, dadas las barreras socioeconómicas y culturales que dificultan el acceso a la salud bucal, con grandes inequidades. Durante el año 2019, un panel de expertos de la Organización Europea para la Investigación en Caries (ORCA), la Federación Europea de Odontología Conservadora (EFCD) y la Federación Alemana de Odontología Conservadora (DGZ) elaboraron revisiones sistemáticas de la literatura y consensuaron recomendaciones basadas en evidencia destinadas a dentistas, mediante un taller en Berlín, Alemania, seguido de un trabajo de consenso mediante metodología e-Delphi. El propósito de este artículo es presentar las principales conclusiones del consenso adaptadas idiomáticamente al español y al contexto de Latinoamérica para permitir una mejor difusión del conocimiento generado y su aplicación en la práctica clínica. El artículo proporciona evidencia y recomendaciones clínicas para las intervenciones preventivas, no invasivas, microinvasivas, mínimamente invasivas e invasivas mejor sustentadas por la ciencia para el manejo de la enfermedad de caries y de las lesiones de caries en niños, con énfasis en la caries de la infancia temprana (CIT), dientes primarios y superficies oclusales de dientes permanentes.

ABSTRACT: Dental caries remains the most prevalent chronic disease in the world, affecting around 70% of children and posing a challenge for public health. Given the socioeconomic, cultural barriers and great inequalities that hinder access to oral health, in Latin America this problem is even more complex. During 2019, a panel of experts from the European Organization for Caries Research (ORCA), the European Federation for Conservative Dentistry (EFCD) and the German Federation for Conservative Dentistry (DGZ) prepared systematic reviews of the literature to reach consensus and generate evidence-based recommendations for dentists on how to manage caries in children. In a workshop in Berlin, Germany, followed by an e-Delphi methodology the experts published the consensus. The purpose of this article is to present the main conclusions of the consensus adapted idiomatically to Spanish and to the Latin American context to allow a better dissemination of the knowledge generated and facilitate its application in clinical practice. The article provides evidence and clinical recommendations for the best science-supported preventive, non-invasive, micro-invasive, minimally invasive, and invasive interventions for the management of caries disease and caries lesions in children, with an emphasis on early childhood caries (ECC), primary teeth and occlusal surfaces of permanent teeth.

Sinopsis de la Situación de Salud Oral en Chile - Parte IV: Traumatismo Dentoalveolar / Synopsis of the Oral Health Situation in Chile - Part IV: Traumatic Dental Injuries

RESUMEN: Objetivo: Sintetizar los resultados de estudios epidemiológicos sobre Traumatismo Dentoalveolar (TDA) en la población chilena. Material y métodos: Se realizó una revisión sistemática de la literatura para identificar estudios poblacionales a nivel nacional, regional, provincial y comunal, además de datos de servicios dentales de atención primaria y secundaria sobre TDA en Chile. Resultados: Se incluyeron 2 estudios con representatividad nacional y 8 realizados en centros de atención en salud. A nivel nacional, la prevalencia de TDA a los 6 años fue de un 2.57%, y a los 12 años, 4.97%. En los estudios realizados en centros de salud, el diagnóstico más prevalente en dentición primaria fueron las lesiones de tejidos de soporte y en dentición permanente, la fractura coronaria. Fue más frecuente la afectación de un solo diente, y los incisivos centrales superiores fueron los dientes más afectados. Conclusiones: Los estudios representativos de la población en Chile son escasos, realizados hace más de una década y representativos sólo de la población de 6 y 12 años, lo cual pone de manifiesto la necesidad de mayor información epidemiológica sobre el TDA en la población chilena.

ABSTRACT: Aim: To summarize the evidence on epidemiological studies about traumatic dental injuries (TDI) in Chile. Methods: A systematic literature review was carried out in two databases to identify population studies at national, regional, provincial and community levels, as well as reports from primary and secondary dental care services, regarding TDI in Chile. Results: Two studies with national representation and eight studies from primary and secondary healthcare centers were included in the analysis. National prevalence for 6-year-old children was 2.57%, and 4.97% for 12-year-old children. While the most frequent diagnosis in primary dentition was traumatic injury involving tooth-supporting tissues, the most commonly reported diagnosis in permanent dentition was crown fracture. Single tooth affection was more frequent, and the upper central incisors were the most affected teeth. Conclusions: Data on representative studies about TDIs in Chile are scarce. Few studies, carried out more than a decade ago and only on 6- and 12-year-old children are available. There is a need for further epidemiological information about TDIs in Chile.

¿Cómo Intervenir el Proceso de Caries en Adultos? Adaptación del Consenso de ORCA/EFCD/DGZ / How to Intervene the Caries Process in Adults? Adaptation of the ORCA/EFCD/DGZ Consensus

RESUMEN: El manejo terapéutico de lesiones de caries primarias y secundarias concentra gran parte del quehacer de los dentistas en el mundo. Recientes cambios en la concepción de la enfermedad de caries llevaron a un panel de expertos de la Organización Europea para la Investigación en Caries (ORCA), la Federación Europea de Odontología Conservadora (EFCD) y la Federación Alemana de Odontología Conservadora (DGZ) a analizar la evidencia y consensuar recomendaciones sobre manejo de caries en adultos. Mediante una reunión en Berlín, Alemania en 2019 y con metodología e-Delphi, los expertos analizaron la evidencia y propusieron recomendaciones clínicas. El propósito de este artículo es presentar una adaptación idiomática de las principales recomendaciones, que incluyen terapias no invasivas (higiene, uso de fluoruros y control de dieta), terapias microinvasiva (sellantes e infiltrantes), terapias necesariamente invasivas y la reparación de restauraciones. Todas las recomendaciones se basan en un enfoque mínimamente invasivo, con un adecuado manejo restaurador. Los dentistas de países hispanoparlantes podrán encontrar recomendaciones basadas en evidencia, provenientes de un consenso de expertos a nivel global, que orienten sus decisiones clínicas, apoyándose en los principios de la odontología de mínima intervención.

ABSTRACT: Therapeutic management of primary and secondary caries lesions concentrates much of the work of dentists throughout the world. Recent changes in caries disease conception and therapeutic management led a panel of experts from the European Organisation for Caries Research (ORCA), the European Federation for Conservative Dentistry (EFCD) and the German Federation for Conservative Dentistry (DGZ) to analyze the evidence and reach consensus on recommendations for caries management in adults. Through a meeting held in Berlin, Germany in 2019 and using an e-Delphi methodology, the experts analyzed the evidence and proposed clinical recommendations. The purpose of this article is to present an idiomatic adaptation to Spanish of the main recommendations, which include non-invasive therapies (hygiene, use of fluoride and diet control), microinvasive therapies (sealants and infiltrants), invasive therapies and repair of restorations. All recommendations are based on a minimally invasive dentistry approach, with a technically adequate restorative management. Spanish-speaking dentists may use these consensus recommendations to guide their clinical decisions, based on the most recent evidence and experts opinions, under the principles of minimal intervention dentistry.

Desigualdades en Salud Bucal para Personas Mayores en Tiempos del COVID-19. La Teleodontología y la Odontología de Mínima Intervención como Caminos de Solución / Oral Health Inequalities for the Elderly in Times of COVID-19. Teledentistry and Minimal Intervention Dentistry as Solution Paths

RESUMEN: Si bien la salud bucal de las personas mayores en Chile y el mundo ya era deficiente, es esperable que los estragos en materia sanitaria, producto de la COVID-19, acentúen este deterioro, particularmente en aquellos con limitaciones cognitivas o funcionales, perpetuando la desigualdad de acceso a la atención odontológica y con ello empeorando su condición de salud bucal y su calidad de vida. La emergente Odontogeriatría debe potenciarse y fortalecerse ante esta verdadera catástrofe sanitaria que se espera ocurra durante y post pandemia. Para ello, no se precisan nuevos desarrollos científicos o tecnológicos, sino la implementación de filosofías y aproximaciones ya disponibles, como son la adopción sistemática de la Teleodontología y de la Odontología de Mínima Intervención (MID). La atención domiciliaria también aparece como una estrategia necesaria ante este nuevo escenario. Este artículo analiza y discute la situación de salud bucal de las personas mayores durante estos complejos tiempos que vive Chile y la humanidad. La pandemia por COVID-19 es una oportunidad única de replantear tanto la práctica clínica como la educación en Odontología, introduciendo nuevos paradigmas, dándole un enfoque de curso de vida e implementando medidas destinadas a corregir las grandes desigualdades con que viven las personas mayores.

ABSTRACT: Although oral health of older people in Chile and the world was already poor, it is expected that the COVID-19 pandemic will increase oral deterioration, particularly in those with cognitive or functional limitations, perpetuating access inequality to dental care and worsening the oral condition and quality of life. Emerging geriatric dentistry should be strengthened in the context of this health catastrophe, expected to occur during and after the pandemic. To face this challenge, no new scientific or technological developments are required, but the implementation of already available philosophies and approaches, such as the systematic adoption of Teledentistry and Minimum Intervention Dentistry (MID). Home care also appears as a necessary strategy in this new scenario. This article analyzes and discusses the oral health situation of older people in these complex times experienced by Chile and the humanity. The COVID-19 pandemic is a unique opportunity to rethink both clinical practice and education in Dentistry, introducing new paradigms, giving it a life course approach and implementing measures aimed at correcting the outrageous inequalities for older people.

Competition and Caries on Enamel of a Dual-Species Biofilm Model with Streptococcus mutans and Streptococcus sanguinis.

Imbalances within the dental biofilm trigger dental caries, currently considered a dysbiosis and the most prevalent noncommunicable disease. There is still a gap in knowledge about the dynamics of enamel colonization by bacteria from the dental biofilm in caries. The aim, therefore, was to test whether the sequence of enamel colonization by a typically commensal and a cariogenic species modifies biofilm's cariogenicity. Dual-species biofilms of Streptococcus mutans and Streptococcus sanguinis on saliva-coated enamel slabs were inoculated in different sequences: S. mutans followed by S. sanguinis (Sm-Ss), S. sanguinis followed by S. mutans (Ss-Sm), S. mutans and S. sanguinis inoculated at the same time (Sm=Ss), and the single-species controls S. mutans followed by S. mutans (Sm-Sm) and S. sanguinis followed by S. sanguinis (Ss-Ss). Biofilms were exposed to 10% sucrose 3 times per day for 5 days, and the slabs/biofilms were retrieved to assess demineralization, viable cells, biomass, proteins, polysaccharides, and H2O2 production. Compared with Sm-Sm, primary inoculation with S. sanguinis reduced demineralization (P < 0.05). Both Ss-Sm and Sm=Ss sequences showed reduction in biomass, protein, and polysaccharide content (P < 0.05). The highest S. sanguinis viable count and H2O2 production level and the lowest acidogenicity were observed when S. sanguinis colonized enamel before S. mutans (P < 0.05). Initial enamel adherence with commensal biofilms seems to induce more intense competition against more typically cariogenic species, reducing cariogenicity.IMPORTANCE The concept of caries as an ecological disease implies the understanding of the intricate relationships among the populating microorganisms. Under frequent sugar exposure, some bacteria from the dental biofilm develop pathogenic traits that lead to imbalances (dysbiosis). Depending on which microorganism colonizes the dental surface first, different competition strategies may be developed. Studying the interactions in the entire dental biofilm is not an easy task. In this study, therefore, we modeled the interplay among these microorganisms using a caries-inducing species (S. mutans) and a health-associated species (S. sanguinis). Initial enamel adherence with S. sanguinis seems to induce more intense competition against typically caries-inducing species. Besides continuous exposure with sugars, early colonization of the enamel by highly cariogenic species like S. mutans appears to be needed to develop caries lesions as well. Promoting early colonization by health-associated bacteria such as S. sanguinis could help to maintain oral health, delaying dysbiosis.

Microcavitated (ICDAS 3) carious lesion arrest with resin or glass ionomer sealants in first permanent molars: A randomized controlled trial.

OBJECTIVES: Although there is some consensus that carious lesions in early stages (non-cavitated) could be treated using sealants, neither the type of materials nor their use in lesions with localized enamel breakdown (microcavitated) has been reported To compare the efficacy of resin or glass ionomer (GI) sealants in arresting microcavitated carious lesions (ICDAS 3) in first permanent molars. MATERIALS AND METHODS: A double-blinded randomized controlled clinical trial was conducted in 41 healthy 6 to 11-year-old children. At the baseline examination, each subject had at least one carious lesion classified as ICDAS 3 on the first permanent molar. One hundred fifty-one lesions were randomized into: Group 1: resin sealants (76 lesions) and Group 2: GI sealant (75 lesions). Carious lesion progression was assessed clinically and radiographically. Progression and retention failure were the outcomes used for group comparisons at p-value<0.05. RESULTS: After a two-year follow-up, only one lesion progressed to ICDAS 5, without statistically significant differences between the groups (χ2(1) = 0.90, p = 0.53). Radiographically, 100 lesions (98%) were arrested and 2 (2%) showed radiographic progression, without differences between groups (χ2(1) = 0.93, p = 0.93). At 2 years, complete retention was observed in 77% of the resin-based and in 83% of the GI sealants, without statistical differences between type of sealant (χ2(1) = 0.71, p = 0.48). The multilevel mixed model demonstrated that location and type of sealant did not affect retention rates (χ2(1) = 24,98, p < 0.001). CONCLUSION: Sealing ICDAS 3 carious lesions in permanent molars appears to be effective in arresting lesions after a two-year follow-up. Clinicaltrials.gov: RCTICDAS3/2015. CLINICAL SIGNIFICANCE: Minimally invasive approaches for carious lesion management have been promoted. Using sealants for the treatment of microcavitated lesions (ICDAS 3) appears predictable in the routine practice, without predilection for resin or glass ionomer materials. In addition to preserving tooth structure, this strategy reduces chair-time, dental fear and costs, and increases coverage to dental care.

High fluoride dentifrice for preventing and arresting root caries in community-dwelling older adults: A randomized controlled clinical trial.

OBJECTIVE: Self-administered non-invasive therapies with high-fluoride dentifrices are an attractive alternative to traditional restorative management of root carious lesions (RCLs), but the available evidence is still scarce, particularly in community-dwelling elders. The aim of this randomized controlled trial (RCT) was to compare the effectiveness of toothbrushing with 5,000 ppm versus 1,450 ppm fluoridated dentifrice (F- dentifrice) on preventing and arresting RCLs, in community-dwelling elders. METHODS: A two years double-blinded RCT was carried out with 345 independently-living older adults, with at least one tooth with RCL. Participants were instructed to brush twice per day with either high-fluoride (5,000 ppm F) or the control dentifrice (1,450 ppm F). Incidence of new and arrested existing RCLs was recorded at two years and compared with the baseline data. Linear mixed regression model with repeated measures were used to test differences between groups (p < 0.05). RESULTS: The percentage of teeth with active lesions varied significantly at two years, but in opposite directions for both groups. While the control group significantly increased the mean percentage of RCLs activity from baseline to two years, from 24.32% to 40.52%, the intervention decreased the percentage of activity from 29.74% to 3.72%. The incidence of RCL was 93.5% and 35.2% in participants of the 1,450 ppm and 5,000 ppm in the F- dentifrice groups, respectively, with a relative risk (RR) of 0.10 [CI: 0.05 - 0.19]. CONCLUSION: Non-invasive treatment with 5,000 ppm F dentifrice is more effective than conventional dentifrices in preventing and arresting RCLs in community dwelling elders. ClinicalTrials.gov NCT02647203. CLINICAL SIGNIFICANCE: RCLs can be effectively prevented and arrested with the use of 5,000 ppm F dentifrice. Oral health programs directed to community-dwelling older adults might benefit from the inclusion of high fluoride dentifrice in their portfolio.

Assessment of oral health-related quality of life as a function of non-invasive treatment with high-fluoride toothpastes for root caries lesions in community-dwelling elderly.

PURPOSE: Non-invasive treatment of root caries lesions (RCLs) may impact oral health-related quality of life (OHRQoL), but no evidence is available. The purpose of the study was to assess changes in OHRQoL among patients exposed to non-invasive treatment of RCLs with conventional or high-fluoride dentifrices. METHODS: To be eligible, subjects had to be ≥60 years of age, independently living, with at least five teeth and one RCL. The 14-item Oral Health Impact Profile for adults in Spanish (OHIP-14Sp), oral examination and sociodemographic data were documented at the beginning of the study (T0). The presence and activity of RCLs were detected and diagnosed. Subjects were randomly assigned to either the control (1,450 ppm fluoride) or the experimental (5,000 ppm fluoride) treatment group. A new set of measurements was obtained at 12 months (T1). Mean comparisons were carried out using the Student's t-test for total OHIP-14Sp scores. To determine whether T1 OHRQoL scores were different regarding sex, age, educational level and socio-economic status, mean OHIP-14Sp scores were obtained and compared with those variables at 12 months. RESULTS: An overall improvement in OHRQoL after the non-invasive treatment of RCLs was verified when T1 was compared with T0 (P < 0.0001). Regarding treatment type, no significant differences were detected between groups (P = 0.114). Subjects with higher income and more years of formal education had better OHRQoL than those with a lower salary (P < 0.0001) and with fewer years of education (P = 0.0006). CONCLUSIONS: Non-invasive treatment for RCLs in community-dwelling elders appears to cause a positive impact on OHRQoL. Better OHRQoL was associated with higher socio-economic status and educational level. No significant differences were detected regarding the fluoride concentration in the dentifrices.