Is there an association between maternal factors and the development of early childhood caries?

OBJECTIVE: To assess the possible associations between the following characteristics/behavior of the mother: oral health, oral hygiene, smoking habits, diet, food insecurity, stress, employment, marital status, household income and size and insurance status, with the development of dental caries in their children up to 3 years old. METHODS: Pregnant women aged 18 years or more who delivered at term and whose children had regular dental check-ups were enrolled in a longitudinal study. Oral health status of participants was assessed at enrollment, 2 months and annually thereafter. Sociodemographic characteristics and mothers' behaviors were collected through face-to-face and telephone interviews. RESULTS: By the three-year visit, 6% of the children had 1 or more cavitated dentine caries lesions. Maternal education and state of residence increased the chances of the child presenting with a caries lesion by the age of three, in addition to influencing the magnitude of the associations detected with other variables. Mothers' prior pregnancies, maternal cigarette smoking, household income and untreated dental decay were also significantly related to childhood caries. CONCLUSIONS: Sociodemographic variables were shown to have an important influence on the development of early childhood caries, highlighting the need of addressing structural problems that limit the availability of dental care and healthy foods.

Global Oral Health Policies and Guidelines: Using Silver Diamine Fluoride for Caries Control.

Silver diamine fluoride (SDF) was developed in Japan in the 1960s. It is a clear solution containing silver and fluoride ions. Because of its anti-bacterial and remineralizing effect, silver diamine fluoride has been used in managing dental caries for decades worldwide. This paper aims to summarize and discuss the global policies, guidelines, and relevant information on utilizing SDF for caries management. SDF can be used for treating dental caries in most countries. However, it is not permitted to be used in mainland China. Several manufacturers, mainly in Australia, Brazil, India, Japan, and the United States, produce SDF at different concentrations that are commercially available around the world. The prices differ between contents and brands. Different government organizations and dental associations have developed guidelines for clinical use of SDF. Dental professionals can refer to the specific guidelines in their own countries or territories. Training for using SDF is part of undergraduate and/or postgraduate curriculums in almost all countries. However, real utilization of SDF of dentists, especially in the private sector, remains unclear in most places because little research has been conducted. There are at least two ongoing regional-wide large-scale oral health programs, using SDF as one of the components to manage dental caries in young children (one in Hong Kong and one in Mongolia). Because SDF treatment does not require caries removal, and it is simple, non-invasive, and inexpensive, SDF is a valuable strategy for caries management in young children, elderly people, and patients with special needs. In addition, to reduce the risk of bacteria or virus transmission in dental settings, using SDF as a non-aerosol producing procedure should be emphasized under the COVID-19 outbreak.

Impact of proximal cavities and primary molar absence on space in the dental arches.

BACKGROUND: A recently proposed treatment protocol for dental caries in primary teeth, called Ultra Conservative Treatment (UCT), keeps medium to large cavities open so that children can keep them clean with tooth brushing and fluoride toothpaste. However, carious lesions have been related to malocclusion and decrease of space for the eruption of the permanent successor. METHODS: This cross-sectional study evaluated dental casts of 235 schoolchildren, aged 6-7 years old of six public schools in deprived suburban areas, and with at least two cavitated dentin carious lesions. The casts were grouped according to the location of cavitated dentin lesions into non-proximal cavity (NPC), proximal cavity with buccal or lingual surface contact point to adjacent tooth (PCCP) and proximal cavity without contact to adjacent tooth (PCWC), as well as the absence of primary molars due carious lesions (PMA). The relationship between location of cavitated dentin lesions or absence of primary molars with C+D+E and D+E space was analyzed. RESULTS: Children with absence of primary molars exhibited the smallest C+D+E and D+E space in the maxilla (P < 0.001) and mandible (P < 0.001), followed by proximal cavity without buccal or lingual surface contact. No significant difference was observed between NPC and PCCP groups in upper and lower arches. DISCUSSION: PCWC are associated with minor (less than the leeway space) C+D+E and D+E space loss in both arches, and additional space loss is noted when primary molars are prematurely lost. These results may have implications for orthodontic and restorative dental care decisions in children.

The effect of silver diamine fluoride and cleaning methods on bond strength of glass-ionomer cements to caries-affected dentin.

PURPOSE: To evaluate the effect of silver diamine fluoride (SDF) application on the microshear bond strength (MBS) of glass-ionomer cements (GIC) to caries-affected dentin (Part 1) and dentin cleaning methods to reduce SDF's potential effect on MBS (Part 2). METHODS: For Part 1, 56 extracted human teeth were randomly divided into eight groups with GIC, 38% SDF application and dentin substrate. Samples of artificial caries-affected human dentin were treated or not with 38% SDF and restored with conventional or resin-modified GIC. The same procedures were performed in sound dentin tested for MBS test after 24 hours. In Part 2, different dentin cleaning agents (water, aluminum oxide, and pumice slurry) were tested after SDF application. The procedure was performed on the group that presented the worst values for MBS in Part 1. Fracture mode was evaluated under scanning electron microscope. Data were statistically analyzed by ANOVA. RESULTS: MBS was affected by the presence of caries and the type of material, with the conventional GIC the most affected (P< 0.05). Pumice slurry was superior in comparison to the other agents in cleaning SDF-treated dentin. Fracture evaluation showed more mixed failures in all the groups. CLINICAL SIGNIFICANCE: Clinicians should have caution when selecting the glass-ionomer cement (GIC) for restorations in silver diamine fluoride (SDF)-treated dentin. The mechanical properties of conventional GIC restorations were more affected than resin-modified GICs. Pumice slurry was the most effective cleaning method to minimize the negative effect of SDF on dentin.

Cavity treatment in primary molars and malocclusion: quasi-randomised clinical trial.

BACKGROUND: An innovative caries treatment protocol for primary teeth, termed Ultra-Conservative Treatment (UCT), restores small cavities through the Atraumatic Restorative Treatment (ART) protocol and cleans medium to large open cavities with toothbrush and fluoride toothpaste. However, UCT-treated primary molars were found to exfoliate earlier than amalgam (CRT) and ART-restored cavities, which may lead to unacceptable loss of space for normal eruption of permanent successors. The null-hypothesis tested was that there is no difference between the three treatment protocols and the intra-arch distances, and index of orthodontic treatment need (IOTN) after 4 years. METHODS: Dental casts were taken at baseline (T0) and four (T4) years. The space of the premolars (D + E space), arch perimeter, anterior and total arch depth were measured using a morphometric computer programme. The presence and level of malocclusion were assessed according to the IOTN index. Dependent variables were all intra-arch distances and the IOTN while the independent variable was treatment protocol (CRT, ART and UCT). Data were analysed using linear and logistic regression. RESULTS: The sample consisted of 867 pairs of casts of 272 initial 6-7-year-olds. No difference was observed between the UCT protocol and the two restorative protocols for the intra-arch variables in both maxilla and mandible over the 4 year period. There was no difference between the UCT and the CRT and ART protocols regarding the occurrence of orthodontic treatment need (malocclusion). In conclusion, the UCT treatment protocol does not differ significantly from the traditional amalgam (CRT) and ART restorative protocols with respect to intra-arch distances and malocclusion. The earlier exfoliation of UCT-treated primary molars does not lead to a worsening of the eruption pattern of permanent successors.

An assessment of three contemporary dental caries epidemiological instruments: a critical review.

Aim Dental caries epidemiological surveys produce information that may be used to assist health policy makers in the planning of preventive and curative strategies. The detection instruments used in these surveys should be able to identify the correct, true stage of the disease or medical condition. This makes it essential that valid instruments are used. This study aimed to critically review commonly used visual/tactile caries assessment instruments in epidemiological surveys with respect to their manageability, reproducibility and validity, and how results are reported.Method A Pubmed search identified the following international visual/tactile instruments for caries detection more than once between 2013 and 2018: World Health Organisation (WHO), International Caries Detection and Assessment System (ICDAS) and Caries Assessment Spectrum and Treatment (CAST).Results The review revealed that the WHO instrument can be considered a screening instrument, that the ICDAS instrument lacks sufficient validity and takes time to apply and that the CAST instrument is promising, but requires further field testing before it can be considered a fully proven caries-assessment instrument in epidemiology. It is recommended that calculating caries prevalence should be based on the presence of cavitated dentine carious lesions, that the prevalence of enamel carious lesions be reported separately and that the dmf/DMF index not be used in its current form.Conclusion Researchers/dentists should be knowledgeable of the limitations and advantages of common caries assessment instruments. Caries prevalence should not be based on the dmf/DMF index but on cavitated dentine carious lesions (d/D-component) as the M- and F-component do not refer to a disease stage.

Are standardised caries risk assessment models effective?

Data sourcesPubMed, Scopus and Embase were searched from 2000 to 2016.Study selectionA search strategy was developed to identify randomised clinical trials, cross-sectional studies, cohort studies, comparative studies, validation studies and evaluation studies that tested standardised caries risk assessment (CRA) models. There was no restriction with respect to patients' age, but caries data should have been recorded using the Decayed, Missing, Filled Tooth/Surface (DMFT/S) or the International Caries Detection and Assessment System (ICDAS) indices.Data extraction and synthesisTwo authors independently assessed the papers for inclusion, carried out data extraction and the papers' methodological quality using a customised quality assessment tool developed by the National Heart, Lung and Blood Institute and Research Triangle Institute International for Observational Cohort and Cross-Sectional Studies. For comparison between studies, the caries values were organised in two-by-two tables from which sensitivity, specificity values and their 95% confidence intervals were calculated.ResultsA total of 1239 papers were retrieved of which 32 were included. The most frequent CRA model investigated was the Cariogram. Sixteen studies were carried out on children and 12 on adults. The results showed an association between the risk determined by the model and the actual caries status and/or the development of new carious lesions, this association being statistically significant. With respect to the quality of the studies included in the review, 19 were classified as of good quality, while eight and five were judged as of fair and poor, respectively. On the basis of seven studies, it was observed that Cariogram sensibility varied from 41.0 to 75.0, while its specificity ranged from 65.8 to 88.0.ConclusionsThere is insufficient evidence to assert that CRA models are effective in determining patients' actual caries risk or in predicting their probability of developing new carious lesions. Moreover, the validity of standardised CRA models is still limited.

Caries assessment spectrum treatment: the severity score.

OBJECTIVES: To appraise the feasibility of the caries assessment spectrum and treatment (CAST) severity score according to the formula (F) recommended in the CAST manual. METHODS: Data from an epidemiological survey of 680 schoolchildren (mean age ± standard deviation: 7.45 ± 0.91 years), living in a low-income area in Brasília, were used. The CAST instrument was used for assessing enamel carious lesions (CAST code = 3), dentine carious lesions (CAST codes = 4-7) and tooth loss from caries (CAST code = 8). RESULTS: The prevalence of carious lesions including enamel and dentine in both deciduous and permanent dentitions was 49.41% and 69.12%, respectively. Calculating the CAST severity score per child using F was unsatisfactory because of the undiscriminating weight given for each CAST code. Modification of weights according to the accepted levels of disease severity for individual CAST codes resulted in a new formula (F1), in which the weight given to cavitated dentine lesions was quadrupled in relation to that given to enamel carious lesions; this was different from F, in which the weight given to such lesions was twofold. F1 was able to categorise satisfactorily the study children into one of three levels of dental caries severity: mild (34.1%); moderate (29.5%); or severe (36.4%). CONCLUSION: According to the outcomes of the present appraisal, it was concluded that the numerical score provided by the CAST severity scores allows an overview of the severity of caries disease and the classification of individuals into mild, moderate or severe levels of dental caries when the new formula (F1) is used.

Treating High-Caries Risk Occlusal Surfaces in First Permanent Molars through Sealants and Supervised Toothbrushing: A 3-Year Cost-Effective Analysis.

We conducted a 3-year cost-effectiveness analysis on the cavitated dentine carious lesion preventive capabilities of composite resin (CR) (reference group) and atraumatic restorative treatment (ART) high-viscosity glass-ionomer cement (HVGIC) sealants compared to supervised toothbrushing (STB) in high-risk first permanent molars. School children aged 6-7 years in 6 schools (2 per group) received CR and ART/HVGIC sealants or STB daily for 180 days each school year. Data were collected prospectively and cost estimates were made for sample data and a projection of 1,000 sealants/STB high-risk permanent molars. Although STB had the best outcome, its high implementation cost (95% of cost for supervisors visiting schools 180 days/school year) affected the results. ART/HVGIC was cost-effective compared to CR for the sample data (savings of USD 37 per cavitated dentine carious lesion prevented), while CR was cost-effective compared to ART/HVGIC for the projection (savings of USD 17 per cavitated dentine carious lesion prevented), and both were cost-saving compared to STB. Two STB scenarios were tested in sensitivity analyses with variations in caries incidence and number of supervision days; results showed STB had lower costs and higher savings per cavitated dentine carious lesion prevented than CR and ART/HVGIC. A major assumption is that both scenarios have the same high effectiveness rate experienced by STB under study conditions; however, they point to the value of further research on the benefits of adopting STB as a long-term venture in a general population of school children.

Do parents and children perceive molar-incisor hypomineralization as an oral health problem?

BACKGROUND: Very little is known about how patients perceive molar-incisor hypomineralization (MIH). AIM: The aim of this study was to identify whether parents and children perceive opacities associated with MIH as an oral health problem. DESIGN: A case-control study was designed in which 131 children diagnosed with MIH were matched by age, sex, and school to 131 children without MIH. The Child and Parent Questionnaire about Tooth Appearance was used to assess reports from parents, who were interviewed by telephone, and children, who were interviewed on school premises. The Spearman correlation and Wilcoxon and Fisher's exact tests were used to assess the data. RESULTS: For the first part of the questionnaire, children avoided smiling because of the appearance of their teeth, and mothers seemed to be distressed by the appearance of their children's teeth (P < 0.05). For the second part, children showed dissatisfaction with their 'tooth alignment' and 'tooth discoloration' compared with the controls, while mothers were not satisfied with their children's tooth discoloration in comparison with controls (P < 0.05). Children and mothers were concerned about tooth discoloration (P < 0.05). CONCLUSION: Poor agreement was found between the reports of children and their mothers, but both children and mothers in the MIH group perceived MIH opacities negatively in comparison with controls.

Long-term Effect of Supervised Toothbrushing on Levels of Plaque and Gingival Bleeding Among Schoolchildren.

PURPOSE: To test the hypothesis that, in high caries-risk children, supervised toothbrushing (STB) reduces visible plaque levels and gingival bleeding to a greater extent than does unsupervised toothbrushing (USTB) in comparable children and in low caries-risk USTB children over 4 years. MATERIALS AND METHODS: High caries-risk schoolchildren, ages 6 to 7, were allocated to three oral healthcare protocols using a cluster-randomised design: 1. Ultra-Conservative Treatment (UCT): small cavities in primary molars were restored using ART, while medium and large cavities were left open and cleaned under daily supervised toothbrushing together with the remaining dentition (UCT/STB); 2. Conventional Restorative Treatment (CRT): primary molars were restored with amalgam, while high caries-risk first permanent molars received resin sealants (CRT/USTB); 3. Atraumatic Restorative Treatment (ART): primary molars were restored using ART, while high caries-risk first permanent molars received ART sealants (ART/USTB). Low caries-risk children (dmft ≤ 1) formed the no-treatment/USTB group. 273 children were examined at baseline (T0) and after 4 years (T1) according to the VPI and GBI indices. Data were analysed using linear and logistic regression. RESULTS: Mean VPI and mean GBI scores were statistically significantly lower at T1 than at T0. Reduction in mean VPI scores in UCT/STB children was statistically significantly higher than for CRT+ART/USTB children over 4 years (p = 0.03), but no difference was observed between UCT/STB and no-treatment/USTB children (p = 0.361). No statistically significant difference in the reduction of mean GBI scores was observed between UCT/STB and CRT+ART/USTB (p = 0.62) and no-treatment/USTB children (p = 0.74). CONCLUSION: In high caries-risk children, the protocol based on supervised toothbrushing presented greater reduction in visible plaque levels than did protocols based on restorations and sealants over 4 years.

Exfoliation rates of primary molars submitted to three treatment protocols after 3.5 years.

OBJECTIVE: The aim of the study was to evaluate the exfoliation pattern of primary molars treated according to three treatment protocols. The hypothesis tested was that there is no difference in the exfoliation pattern of primary molars treated according to conventional restorative treatment using amalgam (CRT), atraumatic restorative treatment using high­viscosity glass­ionomer (ART), and ultraconservative treatment (UCT). The latter consisted of restoring small cavities with ART and cleaning medium/large nonrestored cavities daily with toothpaste/toothbrush under supervision. METHODS: A sample of 302 children aged 6­7 years from a suburban area of Brasilia was followed up for 3.5 years. The numbers of treated molars were 341 (CRT), 244 (ART), and 275 (UCT). Exfoliation rates were obtained using the PHREG procedure. Differences between the three treatment protocol groups were tested using the Wald test. RESULTS: After 3.5 years, there was no difference over the exfoliation rates of all primary molars as 51.0% (CRT), 48.7% (ART), and 59.3% (UCT) had exfoliated at the overall period (P = 0.34). CONCLUSION: The three treatment protocols led to similar exfoliation patterns of all primary molars after 3.5 years.

Effectiveness of an oral health program for mothers and their infants.

BACKGROUND: The baby oral health program (bOHP) provides pregnant women and their future babies with oral care. AIM: To assess the bOHP effectiveness by comparing caries prevalence in infants enrolled and not enrolled in the oral health program (OHP). DESIGN: Mothers who had been invited to participate in the bOHP from 2006 to 2009 were contacted. Two groups were formed: 87 pairs of mothers and infants who effectively participated in the OHP (G1) and 107 pairs who did not (G2). Mothers and infants were given a dental examination. Socio-economic status (SES) and education level (EL) questionnaires were completed. t-tests and multivariate logistic regression were used in analyzing data. RESULTS: Statistically significant differences were observed in the mean age of mothers (G1 = 33.8 years; G2 = 35.6 years; P = 0.015) and mean decayed, missed and filled surface (DMFS) score (G1 = 24.71; G2 = 32.58; P < 0.001), not in SES (P = 0.758) and EL (P = 0.109). Mean age and mean dmfs scores of G1 and G2 children were 4.2 and 4.4 years (P = 0.068), and 0.25 and 4.12 (P < 0.001), respectively. The odds ratio (OR) for children in G2 to develop dentine lesions, as opposed to those in G1, was 48.56. CONCLUSION: The bOHP was effective in preventing caries in infants enrolled in the program.

Is high-viscosity glass-ionomer-cement a successor to amalgam for treating primary molars?

OBJECTIVES: To assess and compare the cumulative survival rate of amalgam and atraumatic restorative treatment (ART) restorations in primary molars over 3 years. METHODS: 280 children aged 6-7 years old were enrolled in a cluster randomized controlled clinical trial using a parallel group design covering two treatment groups: conventional restorative treatment with amalgam (CRT) and atraumatic restorative treatment (ART) using a high-viscosity glass-ionomer (HVGIC) Ketac Molar Easymix. Three pedodontists placed 750 restorations (364 amalgam and 386 ART in 126 and 154 children, respectively) which were evaluated at 0.5, 1, 2 and 3 years. The proportional hazard rate regression model with frailty correction, ANOVA and Wald tests, and the Jackknife procedure were applied in analysing the data. RESULTS: The cumulative survival rates over 3 years for all, single- and multiple-surface CRT/amalgam restorations (72.6%, 93.4%, 64.7%, respectively) were no different from those of comparable ART/HVGIC restorations (66.8%; 90.1% and 56.4%, respectively) (p=0.10). Single-surface restorations had higher survival rates than multiple-surface restorations for the both treatment procedures (p<0.0001). A higher proportion of restorations failed because of mechanical reasons (94.8%) than of secondary caries (5.2%). No difference in reasons for restoration failures between all types of amalgam and ART/HVGIC restorations were observed (p=0.24). SIGNIFICANCE: The high-viscosity glass-ionomer used in this study in conjunction with the ART is a viable option for restoring carious dentin lesions in single surfaces in vital primary molars.

The caries assessment spectrum and treatment (CAST) instrument: its reproducibility in clinical studies.

A new caries assessment instrument, the Caries Assessment Spectrum and Treatment (CAST), was developed. It covers carious lesion progression from no lesion, sealants and restorations to lesions in enamel and dentine, advanced stages in pulpal and tooth-surrounding tissues, and tooth loss owing to dental caries, in nine codes. The objective of this study was to determine the reproducibility of the CAST instrument in primary and permanent dentitions, using three age groups. Two epidemiological surveys were conducted in Brazil, covering three age groups: 2-6-year-old and 6-9-year-old children and 19-30-year-old adults. Four trained and calibrated examiners performed the examinations. Reproducibility was calculated for intra- and inter-examiner at surface and tooth levels and expressed as unweighted kappa-coefficient value (κ) and percentage of agreement (Po) for CAST codes (0-7) and for the categories healthy (0-2) versus diseased (3-7), and non-cavitated (0-3) versus cavitated (4-7) teeth. Using CAST codes (0-7) for the 2-6-year-old age group in primary dentitions, inter-examiner consistency was κ = 0.74 and Po was 98.3%. In the 6-9-year-old age group in primary dentitions, inter-examiner consistency ranged from κ = 0.68 to κ = 0.86 and Po was ≥ 93.7%. In the 19-30-year-old age group inter-examiner consistency was κ = 0.87 and Po was 94.1%. The reproducibility of the CAST instrument for use in the primary dentition of 2-6-year olds and of 6-9-year olds was 'substantial' to 'almost perfect'. The reproducibility for its use in the permanent dentition of 19-30-year olds was 'almost perfect'. The CAST instrument can reliably be applied in epidemiological studies covering these ages.

The Caries Assessment Spectrum and Treatment (CAST) instrument: construct validation.

The Caries Assessment Spectrum and Treatment (CAST) is a newly developed epidemiological instrument. The aim of this study was to investigate its construct validity. Four calibrated examiners, using CAST codes 0-6, visually examined 109 surfaces of extracted and exfoliated teeth. These teeth were then hemisectioned, photographed, and assessed histologically by two calibrated examiners using the Downer criteria. Twenty-eight of the 109 teeth were scanned using micro-computed tomography (micro-CT) and assessed by the same examiners using the same criteria. Validation was determined through calculation of the sensitivity, specificity, and Youden index for two categories of carious lesions examined visually, with histology and micro-CT as gold standards. Interexaminer consistency was κ = 0.76: SE ± 0.05 between visual and histological assessments of teeth and was κ = 0.89: SE ± 0.08 between visual and micro-CT assessments. For the category 'healthy' vs. 'diseased' (CAST codes 0-2 vs. CAST codes 3-6), sensitivity, specificity, and Youden index values of 100%, 92.9%, and 93%, respectively, for micro-CT, and 96.6%, 86%, and 83%, respectively, for histology, were obtained. For the category 'dentine' vs. 'non-dentine lesions' (CAST codes 0-3 vs. CAST codes 4-6) sensitivity, specificity, and Youden index values of 90%, 100%, and 90%, respectively, for micro-CT, and 81.4%, 100%, and 81%, respectively, for histology, were obtained. Construct validity of the CAST instrument was obtained.

Effect of different protocols for treating cavities in primary molars on the quality of life of children in Brazil--1 year follow-up.

The aim of this study was to test the hypothesis that the conventional restorative treatment (CRT) and the atraumatic restorative treatment (ART) protocols, in comparison with the ultra-conservative treatment (UCT) protocol, would increase the quality of life of children over a period of 1 year. Cavitated primary molars of 302 children 6-7 years of age were treated according to the CRT, ART and UCT protocols at the school compound. Children's parents completed the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) at baseline and one year later. Paired t-test, Chi-square test and ANOVA were applied in analysing the data. Questionnaires from 277 and 160 children were collected at baseline and after 1 year, respectively. A statistically significant difference in B-ECOHIS scores over the 1-year period was found for domains 'child symptoms' (P = 0.03) and 'child psychology' (P = 0.02). Treatment protocols did not statistically significantly influence the changes in B-ECOHIS scores over the 1-year period (P = 0.78). It can be concluded that the UCT protocol was as good as the two restorative protocols. All treatment protocols were effective in reducing children's experience of pain, their sleeping problems and their irritability and/or frustration levels over the 1-year period.

Minimal intervention dentistry for managing dental caries - a review: report of a FDI task group.

This publication describes the history of minimal intervention dentistry (MID) for managing dental caries and presents evidence for various carious lesion detection devices, for preventive measures, for restorative and non-restorative therapies as well as for repairing rather than replacing defective restorations. It is a follow-up to the FDI World Dental Federation publication on MID, of 2000. The dental profession currently is faced with an enormous task of how to manage the high burden of consequences of the caries process amongst the world population. If it is to manage carious lesion development and its progression, it should move away from the 'surgical' care approach and fully embrace the MID approach. The chance for MID to be successful is thought to be increased tremendously if dental caries is not considered an infectious but instead a behavioural disease with a bacterial component. Controlling the two main carious lesion development related behaviours, i.e. intake and frequency of fermentable sugars, to not more than five times daily and removing/disturbing dental plaque from all tooth surfaces using an effective fluoridated toothpaste twice daily, are the ingredients for reducing the burden of dental caries in many communities in the world. FDI's policy of reducing the need for restorative therapy by placing an even greater emphasis on caries prevention than is currently done, is therefore, worth pursuing.

The Caries Assessment Spectrum and Treatment (CAST) index: face and content validation.

OBJECTIVES: The aim of this study was to establish the face and content validity of the Caries Assessment Spectrum and Treatment (CAST) index. This hierarchical epidemiological index consists of 10 codes covering the spectrum of carious lesion progression and describing conditions ranging from the absence of carious lesions to the presence of sealants and restorations, the presence of lesions in enamel and dentine, and the presence of advanced stages of carious lesion in pulpal tissue and tissue surrounding the tooth. METHODS: Using the RAND modified e-Delphi consensus method, a set of 17 statements related to the content, including the codes and descriptions used, and suitability of the CAST index were scored on a scale of 1-9 by 15 senior epidemiologists from 15 countries over three rounds of assessment. Agreement of ≥ 75% was required to indicate consensus on a statement. RESULTS: Consensus was reached on 14 statements in the first round, none in the second and on the remaining three statements in the third round. To obtain feedback on the initial validation of the index and to test its external validity, 41 epidemiologists from 24 countries were requested to assess the validated statements. Minor changes to 10 of the 17 statements' content and descriptions were suggested; this necessitated the resubmission of the modified CAST index to the original 15 epidemiologists. Consensus of ≥ 80% was reached on all 10 statements regarding codes and their descriptions. CONCLUSIONS: After a total of four rounds with the panel members and one round with the feedback group, the CAST index was approved for face and content validity. External validity was obtained. The participating epidemiologists found the RAND modified e-Delphi consensus method to be a suitable instrument for reaching consensus.

Ion concentration adjacent to glass-ionomer restorations in primary molars.

OBJECTIVES: The aim was to compare the levels of fluoride, calcium and phosphorus in enamel and dentin alongside glass-ionomer-based restorations over time. METHODS: This CCT consisted of children with cavities in the occlusal surface of primary molars that were restored with either a high-viscosity (Fuji IX GP(®)) or a resin-modified glass-ionomer (Vitremer(®)), being the test groups. Sound teeth (controls) were harvested from the children belonging to the test groups. Sampled teeth were cut in half and the ion concentration measured using EPMA. ANOVAs, and Newman-Keuls tests were performed to analyze the data. The study sample consisted of 35 children having 29 teeth per group available for analyses. RESULTS: Although statistically significantly higher, the mean ion-concentration of calcium in enamel and dentin, and that of phosphorous in dentin hardly differed between the tests and control groups. The mean fluoride concentration in enamel (0.20ppm×10(3) and 0.24ppm×10(3)) and dentin (0.71ppm×10(3) and 0.78ppm×10(3)) surrounding the Fuji IX GP(®) and Vitremer(®) restored teeth, respectively was statistically significantly higher than in enamel (0.12ppm×10(3)) and dentin (0.12ppm×10(3)) for the control teeth. SIGNIFICANCE: The present in vivo investigation showed that fluoride ions are released from high-viscosity and resin-modified glass-ionomer primary restoration into the restorations' surrounding enamel and, and in particular, dentin.