Visible Occlusal Plaque Index Predicting Caries Lesion Activity.

This study was undertaken to appraise the predictive validity of the Visible Occlusal Plaque Index (VOPI) in assessing occlusal caries lesion activity in adolescents. A total of 618 adolescents aged 10 to 15 y were examined at the beginning of the trial and 511 (82.7%) at the 2-y follow-up. Adolescents and parents answered questionnaires about demographics, oral health behavior, and family sociodemographic variables. The VOPI has a 4-point ordinal scale ranging from no plaque to heavy plaque. Molar teeth were assigned to group VOPI 0-1 (no/thin plaque; n = 2,539) and group VOPI 2-3 (thick/heavy plaque; n = 843). At baseline examination, occlusal surfaces at risk of transition (n = 3,382) were either sound (55%), inactive noncavitated lesions (21%), inactive cavitated lesions (1%), active noncavitated lesions (15%), or active cavitated lesions (7%). The relative risk (RR) for caries lesion transition was estimated. Sound occlusal surfaces with no or thin plaque were significantly more likely to remain sound (RR = 1.3; 95% confidence interval [CI]: 1.1-1.4) than those harboring thick or heavy plaque. Inactive noncavitated occlusal lesions presenting no or thin plaque were significantly less likely to progress to active noncavitated lesions (RR = 0.1; CI: 0.0-0.8) than their counterparts with thick or heavy plaque. Active noncavitated lesions harboring thick and heavy plaque had a significantly lowest chance of becoming sound (RR = 0.7; CI: 0.5-0.9) and a highest risk of remaining active (RR = 1.5; CI: 1.1-1.9). Stepwise logistic regression analyses were run according to surface status at baseline and showed that none of the nonclinical predictors were significant for the outcome. The presence of thick and heavy plaque on occlusal surfaces was a predictor for caries lesion development, progression and activity (P < 0.0001). In conclusion, besides being an additional clinical tool for oral hygiene assessment, the VOPI is a predictor for development, progression, and activity of occlusal caries lesion. This is of particular interest for assessment of occlusal lesions undergoing health-promoting transitions.

Early diagnosis and daily practice management of erosive tooth wear lesions.

This paper explores some of the most relevant questions faced by dental practitioners when diagnosing early erosive tooth wear (ETW) and implementing non-operative management of this condition over time. It focuses on the identification of clinical signs and common locations of ETW lesions, the assessment of individual risk and the implementation of non-operative management strategies, aiming to arrest and/or reduce the rate of ETW progression and avoid its advance to pathological stages. To this end, we present a novel and comprehensive approach that considers the whole dentition of patients rather than individual groups of teeth or dental surfaces only, illustrating it with a series of clinical photographs. Dental practitioners may find this approach particularly helpful as it closely simulates the clinical examinations of patients of all age groups carried out in daily practice. The clinical signs of early ETW lesions are subtle and often not perceived as relevant by unaware clinicians. However, the early diagnosis and implementation of non-operative management strategies, especially at younger ages, is fundamental for the proper control of ETW over time.

Partial caries removal in deep caries lesions: a 5-year multicenter randomized controlled trial.

OBJECTIVE: This multicenter randomized controlled clinical trial aimed to compare the outcomes of stepwise excavation (SW) and partial caries removal (PCR) regarding the maintenance of pulp vitality in deep caries lesions over 5 years. METHODS: At baseline, 299 permanent molars with deep caries lesions were randomly assigned to control or test groups. The control group received the stepwise excavation treatment (SW), while the test group received partial caries removal from the pulpal wall followed by restoration in a single session (PCR). Treatments were conducted in two centers located in the cities of Porto Alegre (South Brazil) and Brasília (Midwest Brazil). Survival analysis was performed to compare PCR and SW over time (Weibull regression models). The primary outcome of this study was pulp vitality, determined by the combination of the following characteristics: positive response to cold test, negative response to percussion, absence of spontaneous pain, and absence of periapical lesion (radiographic examination). RESULTS: This 5-year study includes data pertaining to 229 teeth: 121 teeth actually examined at the 5-year appointment, and 108 teeth contributed with data collected in previous follow-ups (18 months or 3 years). Survival analysis showed success rates of 80% in PCR group and 56% in SW group (p < 0.001). Failure was significantly associated with treatment [PCR, HR=0.38; 95%CI=0.23-0.63)] and region [South, HR=2.22; 95%CI=1.21-4.08]. CONCLUSION: PCR significantly reduced the occurrence of pulp necrosis when compared with SW. CLINICAL RELEVANCE: This study supports the PCR as a single-visit technique to manage deep caries lesions in permanent teeth.

Validation of the Visible Occlusal Plaque Index (VOPI) in estimating caries lesion activity.

OBJECTIVE: The present study appraises the construct validity of the Visible Occlusal Plaque Index (VOPI) along with its sub-types, convergent and discriminant validity. METHODS: 618 10-15year old Brazilian adolescents were included. The VOPI has a four-point ordinal scale ranging from no plaque to heavy plaque. VOPI scores and caries status on permanent molars were mapped and recorded at individual anatomical sites of the groove-fossa-system and at surface level. Outcomes were presence of sound site/surface and site/surface with active or inactive caries lesions (non-cavitated or cavitated). RESULTS: Construct validity was assumed based on qualitative assessment as no plaque (score 0) and thin plaque (score 1) reflected the theoretical knowledge that a regular disorganization of the dental biofilm either maintains the caries process at sub-clinical levels or inactivate it clinically. The VOPI also showed convergent validity since the likelihood that anatomical sites with no or thin plaque had inactive lesions simultaneously with sites with thick plaque (score 2) or heavy plaque (score 3) having active lesions were overall significant (RR=1.0-7.8). At surface level, discriminant validity of the VOPI was evidenced with multivariable analysis (GEE), by its ability to discriminate between the groups of adolescents with different oral hygiene status; negative association between adolescents with thick and heavy plaque and those with sound occlusal surfaces was found (OR=0.3, p<0.001). CONCLUSION: The VOPI has construct as well as convergent and discriminant validity and is therefore recommended as an additional clinical tool to estimate caries lesions activity and support treatment decisions. CLINICAL SIGNIFICANCE: The Visible Occlusal Plaque Index is an additional clinical tool to the assessment of oral hygiene and caries lesion activity. The VOPI is recommended to standardize and categorize information on the occlusal biofilm, thus being suitable for direct application in research and clinical settings.

Dental caries, fluorosis, oral health determinants, and quality of life in adolescents.

OBJECTIVE: This study aimed to assess the extent to which dental caries and fluorosis, in addition to sociodemographic and oral health behavior determinants, impact the oral health-related quality of life (OHRQoL) of adolescents. METHODS: All adolescents attending from sixth to eighth grades in the Region of Itapoã, Federal District of Brazil (n = 1122), were screened, and 618 10-15-year-olds were selected. Parents answered a questionnaire about their family's socioeconomic status. Adolescents answered a questionnaire about demographic and oral health behavior determinants in addition to the Child Perception Questionnaire. RESULTS: Cavitated dentine lesions and fluorosis were observed in 39.5 and 48.5 %, respectively. The outcome was a high score on OHRQoL (median split >9). The prevalence of adolescents with at least one domain being impacted "often" or "every day/almost every day" was 34.8 %. Adolescents with tooth brushing frequency ≤once per day and with moderate or severe cavitated dentine lesions reported a significant impact on their OHRQoL (p = 0.002; p = 0.001). Fluorosis did not impact daily life performances (p = 0.545). CONCLUSION: Increased impact on OHRQoL was related to the severity of cavitated dentine lesions, but fluorosis resulting from combined fluoride exposure from early ages was not of concern for the adolescents. CLINICAL RELEVANCE: Combined fluoride exposure from fluoridated drinking water, consumption of food prepared with fluoridated water, and daily twice brushing with conventional fluoride toothpaste from early ages may be recommended to control caries progression at population level without impact on OHRQoL. This information is particularly relevant for supporting oral health police for disadvantaged populations.

Dental anomalies in primary dentition and their corresponding permanent teeth.

OBJECTIVES: The objectives of this paper are to estimate the prevalence of dental anomalies in primary dentition in a sample of 2- to 5-year-old Brazilian preschool children, determine their distribution, and investigate their occurrence in the succedaneous teeth of the sample compared with a control group of children with no dental anomalies in the primary dentition. MATERIALS AND METHODS: The one-stage sample comprised 1,718 two to five-year-old children with fully erupted primary dentition clinically examined for dental anomalies. All children presenting dental anomalies underwent panoramic radiographs. Descriptive statistics were performed for the studied variables. A control group matched by sex and age was studied to compare the prevalence ratio for dental anomalies in the permanent dentition. RESULTS: The prevalence of dental anomalies in the primary dentition was 1.8 %, with no significant statistical difference between sexes. Double teeth were the most frequently observed. Dental anomalies on the succedaneous permanent teeth were diagnosed in 54.8 % of the children with affected primary dentition. The prevalence ratio (PR) for dental anomalies in the succedaneous permanent teeth was 17.1 (confidence interval (CI) 5.33-54.12) higher compared with the control group, higher in children with bilateral anomalies (PR = 31.2, CI 10.18-94.36). CONCLUSIONS: An association between anomalies of the permanent dentition and the presence of dental anomalies in primary teeth was observed, especially when they occur bilaterally. CLINICAL RELEVANCE: The results in the present study have a clinical relevance in the diagnosis of children with dental anomalies in primary dentition. Early identification of these anomalies can aid the dentist in planning dental treatment at the appropriate time.

Partial removal of carious dentine: a multicenter randomized controlled trial and 18-month follow-up results.

AIM: The aim of this study was to evaluate the effectiveness of partial removal of carious dentine and restoration in a single session (PDR) and stepwise excavation (SW), both of which are treatments for deep carious lesions, in Public Health Services in Brazil. INCLUSION CRITERIA: patients ≥6 years old, permanent molars with deep caries lesions (having a radiolucency halfway or more into dentine) and pulp vitality but absence of spontaneous pain, positive percussion test, and periapical alterations. The subjects received either PDR (test group) or SW (control group). The radiological and clinical exams were performed after a mean time of 18 months. OUTCOMES: success was defined as pulp sensitivity to cold test and absence of periapical alterations. RESULTS: Of the 299 treatments performed, 146 were SW and 153 were PDR; 122 were amalgam restorations and 168 resin-composite restorations. There were no differences between the groups regarding the baseline characteristics (i.e. age, gender and family income). After 18 months, 212 evaluations were performed, which indicated 99 and 86% success rates in the PDR and SW groups, respectively (p = 0.016). Reasons for failure were: PDR - 1 pulpitis; SW - 8 pulpitis; 1 osteitis; 4 necrosis; 1 endodontic treatment. None of the baseline variables were significantly associated with the outcomes. CONCLUSION: The retention of carious dentine does not interfere in pulp vitality. Data from this 18-month study suggest that the procedure of reopening the cavity to remove the residual infected dentine is not necessary.

Randomized trial of partial vs. stepwise caries removal: 3-year follow-up.

This randomized, multicenter clinical trial evaluated the effectiveness of 2 treatments for deep caries lesions - partial caries removal (PCR) and stepwise excavation (SW) - with respect to the primary outcome of pulp vitality for a 3-year follow-up period. Inclusion criteria were as follows: patients with permanent molars presenting deep caries lesions (lesion affecting ≥ 1/2 of the dentin on radiographic examination), positive response to a cold test, absence of spontaneous pain, negative sensitivity to percussion, and absence of periapical lesions (radiographic examination). Teeth randomly assigned to PCR (test) received incomplete caries removal and filling in a single session. Outcome success was evaluated by assessment of pulp vitality, determined by pulp sensitivity to a cold test and the absence of periapical lesions. Data were analyzed by a Weibull regression model with shared frailty term (survival analysis). At baseline, 299 treatments were executed: PCR, 152 and SW, 147. By the end of the 3-year follow-up period, 213 teeth had been evaluated. Adjusted survival rates were 91% for PCR and 69% for SW (p = 0.004). These results suggest that there is no need to re-open a cavity and perform a second excavation for pulp vitality to be preserved (Clinical trials registration NCT00887952).

Impact of enamel defects on early caries development in preschool children.

Quantitative defects of the enamel are considered risk factors for caries development at the cavitated level. Since caries risk assessment and control should be implemented as early as possible in order to prevent operative treatment, it seemed interesting to investigate the relationship between enamel defects and caries development in the stages of progression that precede cavitation. The impact of enamel defects and selected child-mother indicators on early caries development was investigated in a cohort of Brazilian preschool children. The null hypothesis that developmental defects of the enamel and dental caries are independent and that an association between them occurs by chance was tested. The sample (n = 1,718) was made up of 2- to 5-year-olds. Developmental defects of enamel and caries on buccal surfaces were identified in 48 and 26% of the children, respectively. Bivariate analyses at the surface level showed neither an association between demarcated/diffuse opacity and caries experience (p ≥ 0.64, GLM), nor between the presence of hypoplastic surfaces and non-cavitated lesions (p = 0.29, GLM). The multivariate analyses indicated that in the mouths of individual children, hypoplastic surfaces were more likely to present filled surfaces and non-cavitated/cavitated lesions than non-hypoplastic surfaces (within-child p = 0.03, GEE). However, children having teeth with hypoplastic surfaces were not at higher caries risk than those children who did not present hypoplastic surfaces (between-child p = 0.23, GEE). The null hypothesis could not be accepted for quantitative defects such as hypoplasia, since they had a significant impact on the within-child prevalence of filled surfaces and non-cavitated/cavitated lesions.

Clinical report on plaque formation, distribution and maturation within the primary, mixed and permanent dentitions.

AIM: The report described the formation distribution and maturation of dental plaque within the primary, mixed and permanent dentitions. DESIGN: Eight caries-free volunteers who were 4-6 years of age participated in the study. MATERIALS AND METHODS: The children received prophylaxis and refrained from toothbrushing for 48 hours. The occurrence and distribution of plaque in the primary dentition were assessed. One child continued the experiment from the age of 6 to 15. RESULTS: The recording of plaque was made and pictures were taken. In the primary dentition, 704 surfaces were assessed. Significant difference between plaque on buccal and other surfaces was recorded (p< 0.001). In the mixed and permanent dentition plaque scores of 128 surfaces were recorded. Plaque scores of partially erupted posterior teeth and posterior teeth in full occlusion differed significantly with limited accumulation of occlusal plaque in the latter. CONCLUSION: The report highlights that the most critical period for plaque accumulation is the time from tooth emergence to full occlusion, when the tooth has a reduced participation in the mechanical oral function. As caries is a plaque induced disease, the potential to caries development in children during tooth eruption is consequently high.

Caries trends in Brazilian non-privileged preschool children in 1996 and 2006.

The aims were to analyse caries trends in Brazilian non- privileged preschool children from 1996 to 2006 and to test the hypothesis that a decline in caries prevalence would manifest itself as a reduction in the rate of caries progression. Subjects were 1- to 5-year-old children born in and life time residents of the Federal District of Brazil (cohort 1996=1,465) and (cohort 2006=2,511). The clinical examination determined whether the tooth surfaces were sound, presented active lesions (non cavitated and cavitated), inactive lesions (non-cavitated and cavitated), fillings, were indicated for extraction or had been extracted. Intra- and inter-examiner reliability of caries scores showed kappa values ranging from 0.71-0.93. A significant increase in the percentage of children who were free from any form of untreated or treated caries was observed (p<0.05; chi(2) test). Caries prevalence decreased by almost a half from 1996 to 2006. Differences in the mean caries scores at surface level, which included non-cavitated lesions, were observed for all age groups (p<0.002; Mann-Whitney test) indicating a reduction in the rate of caries progression. In conclusion, since this population has access to fluoride and presents moderate caries prevalence, other measures to reduce the rate of caries progression are required to further improve oral health in non-privileged children.

Traumatic dental injuries in Brazilian pre-school children.

The purpose of this investigation was to estimate the prevalence of traumatic dental injuries in a sample of Brazilian pre-school children with limited access to dental care. The sample included 1,853 one-to-five-year-old children attending public nursery schools in the Federal District of Brazil. Dental injuries were clinically assessed as follows: 1) uncomplicated crown fracture, 2) complicated fracture, 3) crown discoloration, 4) intrusive luxation, 5) extrusive luxation, 6) exarticulation or extraction after trauma and 7) subluxation. The results showed that 10% (< 2 years), 12% (3-4 years) and 20% (5 years) of the children had suffered at least one type of injury clinically identified at the time of the examination. Boys and girls were similarly affected. Dental injuries were almost entirely restricted to the maxillary central incisors (88%). Single tooth injury was predominant in all age groups. In the youngest group the most common types of injuries were crown fracture (69%) and crown discoloration (18%). However, from the age of three, crown discoloration showed percentages ranging from 41% to 47%. Prematurely lost tooth accounted for 11% of the injuries in 5-year-old children. The observed increase of dental injuries with age indicates accumulated treatment needs due to the children's limited access to dental care.

Onset, development and arrest of dental caries in Brazilian pre-school children.

The aim of this study was to describe the onset, development and arrest of dental caries in Brazilian 1- to 5-year-old children with limited access to dental care. The sample represented 40% of all children in these age groups attending public nursery school in the Federal District of Brazil. A total of 1465 children who benefited from fluoridated water soon after birth were examined for caries. For all teeth and tooth surfaces, the examination recorded whether they were sound, showing active or arrested lesions (non-cavitated or cavitated), filled or indicated for extraction. The onset of dental caries was identified at an early age; 89% of children were free of caries at the age of 1 year, decreasing to 28% at the age of 5 years. Non-cavitated lesions (active and arrested) accounted for 71% (<2 years), 58% (3 years), 47% (4 years) and 40% (5 years) of the total number of surfaces showing caries experience. The corresponding values for cavities were 28%, 38%, 47% and 47%, respectively. Maxillary incisors and molars disclosed the highest caries experience in all ages. For children older than 1 year, both mean deft and defs scores not including non-cavitated lesions were significantly different from those for which non-cavitated lesions were taken into account (t-test, P < 0.0001). At the age of 5 years, defs scores were 5.5 and 8.8, respectively. This study documented that the onset and development of dental disease started at an early age in the population studied, leading to a considerable need for dental care.