An explainable predictive model of direct pulp capping in carious mature permanent teeth.

OBJECTIVE: To introduce a novel approach for predicting the personalized probability of success of DPC treatment in carious mature permanent teeth using explainable machine learning (ML) models. METHODS: Clinical data were obtained from our previous single-center retrospective study, comprising 393 carious mature permanent teeth from 372 patients who underwent DPC and attended 1-year follow-up between January 2015 and February 2021. Six ML models were derived based on 80 % cases of the cohort, with the remaining 20 % cases used for validation. Shapley additive explanation (SHAP) values were utilized to assess feature importance and the clinical relevance of prediction models. RESULTS: Within the cohort, 9.67 % (38 out of 393) of teeth experienced failure at the 1-year follow-up after DPC treatment. Among the six evaluated ML models, the XGBoost model exhibited the highest discriminative ability. By prioritizing features based on their importance, streamlined and interpretable XGBoost model with 11 features were developed for 1-year prognostication post-DPC. The model demonstrated predictive accuracy with area under the curve (AUC) scores of 0.86 for the 1-year prediction. The final model has been translated into a web application to facilitate clinical decision-making. CONCLUSION: By incorporating demographic and clinical examination data, the XGBoost model offered a user-friendly tool for dentists to predict personalized probability of success, thereby improving personalized dental care and patient counseling. The utilization of SHAP for model interpretation provided transparent insights into the decision-making process.

Biological properties of a novel solution based on silver nanoclusters for arresting dentin caries.

Objectives: To test the biological properties of a novel non-restorative treatment method for arresting dentin caries based on silver nanoclusters (AgNCls) synthesized in polymethacrylic acid (PMAA). Methods: Synthesis of AgNCls was performed by photoreduction of AgNO3 in PMAA with 355 nm/wavelength light. AgNCls/PMAA was characterized by absorption/fluorescence spectroscopy and optical and atomic force microscopy. The stability of the clusters in an aerated PMAA solution was evaluated by means of fluorescence spectroscopy. Cytotoxicity was assessed using the MTT assay and antibacterial effect was determined for minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) and colony forming (CFU) of Streptococcus mutans (S. mutans) and Lactobacillus acidophilus (L. acidophilus). 38% Silver Diammine Fluoride (SDF) was used for the control groups. Results: Chemical and structural identity of the clusters did not change within 9 months; Cell viability of 92%-89% was found after 24-48 h respectively. MIC and MBC were determined from 1:16 and 1:8 dilutions, respectively. Log CFU counts of S. mutans, and L. acidophilus treated with AgNCls/PMAA (3.4 ppm of silver) were significantly lower than in the control groups and even lower than when the same bacterial strains were treated with SDF (15,525 ppm of silver). Conclusions: AgNCls/PMAA presented chemical stability, acceptable cytotoxicity, and a potential antibacterial effect for strains associated with caries lesions at very low concentrations of silver.

Should we be concerned about the use of non-fluoride toothpaste? A survey study in two European countries.

BACKGROUND: Toothpastes available in Europe contain a range of fluoride concentrations, with some meeting the recommended level for caries prevention (>1000 ppm fluoride (ppm)) and others containing low or no fluoride. This study evaluated toothpaste fluoride concentrations in Latvia and Lithuania to inform targeted public health strategies in regions with a high prevalence of dental caries. METHODS: This cross-sectional study was conducted from May 2019 to May 2020, using a validated questionnaire in Latvia and Lithuania. Nationally representative samples (1309 families and 5436 members) provided data through a mixed-mode survey (paper and online) on sociodemographic information, toothpaste type, brand, and type. Descriptive statistics and chi-square tests (p < 0.05) were used for analysis. RESULTS: Fifteen percent of families used non-fluoridated toothpaste and 12% used <1000 part per million (ppm) fluoride. In Latvia, 56.8% of preschoolers and 28.7% of schoolchildren used <1000 ppm or non-fluoride toothpaste, whereas in Lithuania, 47.2% of preschoolers and 29.1% of schoolchildren used <1000 ppm or non-fluoride toothpaste; 63% of adolescents and 73% of adults used toothpaste with optimal fluoride content (≥1000 ppm). Of the 228 registered toothpaste types, 62% contained more than 1000 ppm, which is optimal for caries prevention; 29% of Latvian and 24% of Lithuanian families used at least one non-fluoridated toothpaste. CONCLUSION: This study revealed significant gaps in the use of fluoride toothpaste among families in Latvia and Lithuania, especially among children. To effectively prevent dental caries, targeted interventions, and education must promote optimal fluoride toothpaste use, particularly among vulnerable populations.

The short-term impact of comprehensive caries treatment on the supragingival microbiome of severe early childhood caries.

BACKGROUND: Children affected by severe early childhood caries (S-ECC) usually need comprehensive caries treatment due to the extensive of caries. How the oral microbiome changes after caries therapy within the short-term warrant further study. AIM: This study aimed to investigate the short-term impact of comprehensive caries treatment on the supragingival plaque microbiome of S-ECC children. DESIGN: Thirty-three children aged 2-4 years with severe caries (dt > 7) were recruited. Comprehensive caries treatment was performed under general anesthesia in one session and included restoration, pulp treatment, extraction, and fluoride application. Supragingival plaque was sampled pre- and 1-month posttreatment. The genomic DNA of the supragingival plaque was extracted, and bacterial 16S ribosomal RNA gene sequencing was performed. RESULTS: Our data showed that the microbial community evenness significantly decreased posttreatment. Furthermore, comprehensive caries treatment led to more diverse microbial structures among the subjects. The interbacterial interactions reflected by the microbial community's co-occurrence network tended to be less complex posttreatment. Caries treatment increased the relative abundance of Corynebacterium matruchotii, Corynebacterium durum, Actinomyces naeslundii, and Saccharibacteria HMT-347, as well as Aggregatibacter HMT-458 and Haemophilus influenzae. Meanwhile, the relative abundance of Streptococcus mutans, three species from Leptotrichia, Neisseria bacilliformis, and Provotella pallens significantly decreased posttreatment. CONCLUSION: Our results suggested that comprehensive caries treatment may contribute to the reconstruction of a healthier supragingival microbiome.

An Alternative Technique for Topical Application of Acidulated Phosphate Fluoride (APF) Gel: A Two-Years Double-Blind Randomization Clinical Trial (RCT).

Background and Objectives: Dental caries is still a dramatic public health problem. The effectiveness of an alternative technique using acidulated phosphate fluoride (APF) gel pH 3.5 was evaluated and compared with conventional treatments in reducing dental caries incidence. Materials and Methods: A double-blind randomized controlled trial was conducted, involving 180 children aged 4-11 years. Three groups were formed: NaF varnish (NaFV), APF in tray (APFt), and APF in toothbrush (APFtbru). Clinical examinations were performed using standardized criteria and the ICDAS Index was assessed. The Caries Treatment Needs Index (CTNI) was calculated. Dental examinations were conducted at baseline, 12 months, and 24 months. Results: At baseline, 16,719 dental surfaces were included, with 15,434 surfaces being sound. After 24 months, the Kaplan-Meier analysis showed significant differences between the APFtbru group and the other two groups (p = 0.03). Cox regression analysis revealed that the surfaces treated with NaF varnish had the lowest survival rates (HR = 0.51 95%CI = 0.33/0.81). Occlusal surfaces had the lowest cumulative survival, while other tooth surfaces showed similar performance. Conclusions: The alternative technique of APF gel application with a toothbrush resulted in maintaining dental health over 24 months. This technique can be cost-effective and may offer advantages over traditional fluoride varnish application.

Integrating patient-centered caries management in dental education-A practical approach.

Caries management is undergoing an evolution in dental education. This is part of a larger change in thinking focused on the person/patient as well as procedures to bring health to people. This perspective attempts to tell the story of the dental education culture regarding caries management from perspectives of evidence-based care; caries as a disease of a person, not only a tooth; and the management of high-risk and low-risk individuals. Culturally and organizationally, the integration of basic, procedural, behavioral, and demographic perspectives for dental caries has happened at different rates for some decades. The involvement of students, teaching faculty, course directors, and administration is essential in this process.

[Study on the sterilization effect of plasma jet and plasma activated water on Streptococcus mutans].

To explore the effects of plasma jet (PJ) and plasma activated water (PAW) on the sterilization of Streptococcus mutans ( S. mutans) and compare the advantages and disadvantages of the two methods, so as to provide a basis for plasma treatment of dental caries and to enrich the treatment means of dental caries, an atmospheric pressure plasma excitation system was built, and the effects of PJ and PAW on the sterilization rate of S. mutans and the changes of temperature and pH during treatment were studied under different excitation voltage ( U e ) and different excitation time ( t e ). The results showed that in the PJ treatment, the difference in the survival rate of S. mutans between the treatment group and the control group was statistically significant ( P = 0.007, d=2.66) when U e = 7 kV and t e = 60 s, and complete sterilization was achieved at U e = 8 kV and t e = 120 s in the PJ treatment. In contrast, in the PAW treatment, the difference in the survival rate of S. mutans between the treatment group and the control group was statistically significant ( P = 0.029, d = 1.71) when U e = 7 kV and t e = 30 s, and complete sterilization was achieved with PAW treatment when U e = 9 kV and t e = 60 s. Results of the monitoring of temperature and pH showed that the maximum temperature rise during PJ and PAW treatment did not exceed 4.3 °C, while the pH value after PAW treatment would drop to a minimum of 3.02. In summary, the optimal sterilization parameters for PJ were U e =8 kV and 90 s < t e ≤ 120 s, while the optimal sterilization parameters for PAW were U e = 9 kV and 30 s< t e ≤ 60 s. Both treatment methods achieved non-thermal sterilization of S. mutans, where PJ required only a smaller U e to achieve complete sterilization, while at pH < 4.7, PAW only required a shorter t e to achieve complete sterilization, but its acidic environment could cause some chemical damage to the teeth. This study can provide some reference value for plasma treatment of dental caries.

Anaesthesia and Caries Treatment by Dental Hygienists: A Worldwide Review.

OBJECTIVES: This study aimed to summarise the competencies and legal position of the dental hygienist (DH) regarding local anaesthesia and caries treatment through a worldwide review. METHODS: A structured and peer-reviewed online questionnaire consisting of 27 questions was developed and emailed to all DH associations that are members of the International Federation of Dental Hygienists or European Dental Hygienists Federation. After obtaining the data, all responding associations were contacted to confirm that the data were summarised in the correct order and were asked to provide further clarification of answers if necessary. A descriptive analysis was performed to summarise the data. RESULTS: Thirty-one countries were approached and 26 responded, resulting in a response rate of 84%. In 62% of the countries, the DH can administer local anaesthesia via infiltration and/or block anaesthesia. In 23% of the countries, the DH can indicate the placement of a caries restoration. In 15% of the countries, the DH can place caries restorations. In 81% of the countries, the DH can apply sealants. CONCLUSIONS: Considerable variation exists amongst countries regarding the extended scope of DH practice. Overall, independently administering local anaesthesia appears to be more accepted as being within the scope of DH practice than caries removal and the placement of restorations.

Study on the sterilization effect of plasma jet and plasma activated water on Streptococcus mutans / 生物医学工程学杂志

To explore the effects of plasma jet (PJ) and plasma activated water (PAW) on the sterilization of Streptococcus mutans ( S. mutans) and compare the advantages and disadvantages of the two methods, so as to provide a basis for plasma treatment of dental caries and to enrich the treatment means of dental caries, an atmospheric pressure plasma excitation system was built, and the effects of PJ and PAW on the sterilization rate of S. mutans and the changes of temperature and pH during treatment were studied under different excitation voltage ( U e ) and different excitation time ( t e ). The results showed that in the PJ treatment, the difference in the survival rate of S. mutans between the treatment group and the control group was statistically significant ( P = 0.007, d=2.66) when U e = 7 kV and t e = 60 s, and complete sterilization was achieved at U e = 8 kV and t e = 120 s in the PJ treatment. In contrast, in the PAW treatment, the difference in the survival rate of S. mutans between the treatment group and the control group was statistically significant ( P = 0.029, d = 1.71) when U e = 7 kV and t e = 30 s, and complete sterilization was achieved with PAW treatment when U e = 9 kV and t e = 60 s. Results of the monitoring of temperature and pH showed that the maximum temperature rise during PJ and PAW treatment did not exceed 4.3 °C, while the pH value after PAW treatment would drop to a minimum of 3.02. In summary, the optimal sterilization parameters for PJ were U e =8 kV and 90 s < t e ≤ 120 s, while the optimal sterilization parameters for PAW were U e = 9 kV and 30 s< t e ≤ 60 s. Both treatment methods achieved non-thermal sterilization of S. mutans, where PJ required only a smaller U e to achieve complete sterilization, while at pH < 4.7, PAW only required a shorter t e to achieve complete sterilization, but its acidic environment could cause some chemical damage to the teeth. This study can provide some reference value for plasma treatment of dental caries.

Novel strategy for dental caries by physiologic dentin regeneration with CPNE7 peptide.

OBJECTIVE: CPNE7-derived functional peptide (CPNE7-DP) has been introduced as a bioactive therapeutics for dentin diseases. CPNE7-DP regenerates tubular dentin on the pulpal side and occlude dentinal tubules. CPNE7-DP was capable to treat dentin hypersensitivity typically associated with dentinal wear at the neck of the tooth. However, the role of CPNE7-DP in another common dentin disease, dental caries, remains uninvestigated. In this study, we evaluated the potential application of CPNE7-DP in dentin caries using an experimental dentin caries model in rats. DESIGN: The stability of CPNE7-DP in caries-like environments including pathologic bacteria of caries or low pH was tested. We established a nutrition-time/hyposalivation-based dental caries rat model by inoculating caries-inducing bacteria and diet for sufficient time. Glycopyrrolate has been treated to induce reversible hyposalivation for accelerating caries progression. Then the tubular dentin regeneration was investigated with histologic methods. Also, modulation of inflammation or autophagy by CPNE7-DP was investigated with marker gene expression in human dental pulp cells (hDPCs) and immunohistochemistry. RESULTS: CPNE7-DP was stable with caries-inducing bacteria and low pH. Establishment of dentin caries was confirmed with radiographic and histologic evaluation. CPNE7-DP regenerated a substantial amount of tubular tertiary dentin and alleviated the pulp inflammation of dentin caries. Under inflammatory conditions, CPNE7-DP reduced the expression of inflammatory cytokines. These phenomena could be the consequence of the modulation of autophagy by CPNE7-DP, which reactivates inflamed odontoblasts. CONCLUSIONS: Overall, CPNE7-DP, which repairs caries through physiological dentin regeneration, might help overcoming the limitations of current restorative caries treatments.

Investigating changes in salivary microbiota due to dental treatment: A metagenomic analysis study for forensic purposes.

The advent of next generation sequencing techniques as well as the existing traditional culture methods has enabled metagenomic studies on the usability of microbiomes for the forensic identification of individuals to gain momentum. However, before the utilization of microbiomes as a potential technique for real forensic case resolutions, it is necessary to understand the stability of the microbiota compositions in an individual's biological samples and the factors responsible for their variations. In the present study, we compared the microbiota compositions present in the saliva of individuals with active dental caries before and after treatment from a forensic and clinical perspective using an approach based on the sequencing of all the variable regions (V1-V9) of the bacterial 16 S rRNA gene. For this purpose, 10 individuals were included in the study comprising of 8 individuals between the ages of 18-50 years with at least 3 deep dentin caries as patients and 2 healthy individuals without any dental or gingival diseases as controls. Saliva samples were collected from the patients at two timepoints, before and after treatment, as well as from the healthy individuals (before and after control) at an interval of 1 month. The collected 20 saliva samples were subjected to metagenomic analysis using the MinION device, which was developed by Oxford Nanopore Technologies (ONT Oxford, UK). Bioinformatic analyses were performed on the obtained data and the results were evaluated using statistical comparison methods and alpha/beta diversity analyses within the scope of the study objective. On evaluation using the distance metrics, it was observed that the microbial compositions in the saliva of individuals with active caries remained relatively stable after treatment. However, the relative abundance levels of bacteria of 28 genera and species showed statistically significant differences before and after treatment (p < 0.05). As a result, although the composition of salivary microbiome remained relatively stable after caries treatment, there were significant changes in many types of bacteria, especially at the species level, between the BT and AT samples. Our results provide a framework for further forensic and clinical investigations regarding the factors that affect human salivary microbiome diversity.

Nonrestorative Caries Treatment: A Systematic Review Update.

Caries is the most prevalent chronic noncommunicable disease. Strategies to prevent its onset and early interventions to arrest the progression of early lesions have been emphasised throughout recent decades to avoid or delay the restorative spiral of the tooth. More individuals are retaining their natural teeth into old age, thereby necessitating ongoing restorative dentistry intervention for their maintenance. The aim of this systematic review was to update the state of the art regarding clinical studies reporting the effectiveness of different nonrestorative caries treatment options in the 5-year period from 2017 to 2022. Relevant articles were retrieved from 2 electronic databases, including randomised clinical trials (RCTs) published from January 2017 until April 2022, assessing effectiveness and secondary effects of at least one nonrestorative caries treatment option, carried out with adults and/or children with noncavitated or cavitated carious lesions on either primary or permanent teeth and diagnosed by radiographs or visual/tactile assessment. All 35 included articles presented the results of RCTs with a follow-up period ranging from 6 to 84 months. Most of these studies were considered high-quality articles with a low risk of bias. Sealants and fluoride gels and varnishes were mentioned in 12 studies as effective strategies to prevent the onset of caries lesions and to arrest them in the early stages. Resin infiltration reported high caries arresting rates in noncavitated proximal lesions in 10 publications. Silver diammine fluoride presented high caries-arresting rates in open dentin lesions, both in primary and permanent dentitions as well as in root caries lesions that were accessible for cleansing. New evidence has been published between 2017 and 2022 as the result of numerous clinical studies providing further evidence of the effectiveness of nonrestorative caries treatment options.

¿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.

Amalgam Phase-Down Part 1: UK-Based Posterior Restorative Material and Technique Use.

INTRODUCTION: A European Union amalgam phase-down has recently been implemented. Publicly funded health care predominates in the United Kingdom with the system favoring amalgam use. The current use of amalgam and its alternatives has not been fully investigated in the United Kingdom. OBJECTIVES: The study aimed to identify direct posterior restorative techniques, material use, and reported postoperative complication incidence experienced by primary care clinicians and differences between clinician groups. METHODS: A cross-sectional survey was distributed to primary care clinicians through British dentist and therapist associations (11,092 invitations). The questionnaire sought information on current provision of direct posterior restorations and perceived issues with the different materials. Descriptive statistical and hypothesis testing was performed. RESULTS: Dentists' response rate was 14% and therapists' estimated minimum response rate was 6% (total N = 1,513). The most commonly used restorative material was amalgam in molar teeth and composite in premolars. When placing a direct posterior mesio-occluso-distal restoration, clinicians booked on average 45% more time and charged 45% more when placing composite compared to amalgam (P < 0.0001). The reported incidences of food packing and sensitivity following the placement of direct restorations were much higher with composite than amalgam (P < 0.0001). Widely recommended techniques, such as sectional metal matrix use for posterior composites, were associated with reduced food packing (P < 0.0001) but increased time booked (P = 0.002). CONCLUSION: Amalgam use is currently high in the publicly funded sector of UK primary care. Composite is the most used alternative, but it takes longer to place and is more costly. Composite also has a higher reported incidence of postoperative complications than amalgam, but time-consuming techniques, such as sectional matrix use, can mitigate against food packing, but their use is low. Therefore, major changes in health service structure and funding and posterior composite education are required in the United Kingdom and other countries where amalgam use is prevalent, as the amalgam phase-down continues. KNOWLEDGE TRANSFER STATEMENT: This study presents data on the current provision of amalgam for posterior tooth restoration and its directly placed alternatives by primary care clinicians in the United Kingdom, where publicly funded health care with copayment provision predominates. The information is important to manage and plan the UK phase-down and proposed phase-out of amalgam and will be of interest to other, primarily developing countries where amalgam provision predominates in understanding some of the challenges faced.

Amalgam Phase-Down Part 2: UK-Based Knowledge, Opinions, and Confidence in the Alternatives.

INTRODUCTION: Amalgam use has recently been phased down, and the potential for a phase-out is being investigated. OBJECTIVES: The study aimed to identify knowledge of the phase-down and opinions of a potential phase-out of amalgam by UK primary care clinicians and assess their confidence in using different materials in different situations. METHODS: An anonymized, prepiloted cross-sectional e-survey was used to assess primary care clinicians' knowledge and opinions of the amalgam phase-down and potential phase-out and their confidence in using amalgam and the alternatives in different situations. In total, 11,902 invitations were distributed through British dentist and therapist associations. Prior hypotheses were tested alongside descriptive statistics. RESULTS: Response rate was 13% (n = 1,513). Knowledge of the amalgam phase-down was low, with just 3% clinicians correctly identifying all patient groups in whom amalgam use should be avoided in the United Kingdom. Postgraduate education on posterior composite placement was high (88%), but a large majority had personal and patient-centered concerns over the suitability of the alternatives and lacked confidence when placing composite in comparison to amalgam in difficult situations (P < 0.0001). Logistic regressions revealed that the best predictors of high confidence in placing mesio-occluso-distal composites and composites in difficult situations were being a private general dentist or being primarily a composite user. CONCLUSION: Primary care clinicians have major personal and patient-centered concerns regarding the amalgam phase-down (of which they have limited knowledge) and potential phase-out. Many lack confidence in using the alternative, composite, to restore posterior teeth in difficult situations, whereas confidence in using amalgam in similar situations is high. Effective education of clinicians and understanding patients' needs, alongside policy changes, are required to enable a successful amalgam phase-down and potential phase-out. KNOWLEDGE TRANSFER STATEMENT: This study shows that UK primary care clinicians are worried about the phase-down of amalgam for themselves and their patients. Many lack confidence in the alternative, composite, when used in difficult situations, which is in stark contrast to amalgam. Knowledge of the phase-down is limited. There is a need for more effective education of clinicians, an understanding of patients' values, and policy changes to ensure the success of the phase-down and potential phase-out of amalgam.

MMP-9 Levels and NaOCl Lavage in Randomized Trial on Direct Pulp Capping.

Outcome expectations of direct pulp capping in carious teeth are obscured by a clinically unknown infiltration and breakdown of the dental pulp tissue. Histologic studies showed that this soft tissue breakdown is related to the innate immune system. We hypothesized 1) that a neutrophil biomarker could predict the outcome of direct pulp capping and 2) that using sodium hypochlorite (NaOCl) as a lavage solution to remove necrotized infected pulp tissue could improve it. In this randomized trial in mature posterior teeth causing no or mild discomfort with carious pulpal exposures, pulpal fluid was collected to assess neutrophil gelatinase (matrix metalloproteinase 9 [MMP-9]) per total protein (TP) levels as a predictive local biomarker. Subsequently, the dentin-pulp wound was randomly washed with a 2.5% NaOCl or a physiologic saline solution (1:1 allocation), capped with mineral trioxide aggregate, and the tooth was immediately restored with a resin-based composite restoration. Ninety-six patients were included, and 84 individuals could be followed up to treatment failure or clinically confirmed pulp survival after a minimum of 1 y. The entire data were fitted to a Cox proportional hazards model to assess the influence of the observational variables MMP-9/TP and discomfort with the randomized lavage treatment on pulp survival. The Kaplan-Meier pulp survival rates after 1 y were 55% for saline and 89% for NaOCl lavage. The inflammatory state of the pulp tissue as reflected by MMP-9/TP levels and NaOCl lavage had a highly significant (P < 0.001 and P = 0.004, respectively) impact on pulp survival, while mild preoperative discomfort did not. In conclusion, MMP-9/TP showed great promise as a predictive local biomarker, and NaOCl lavage considerably improved the survival time of cariously exposed and directly capped pulps.

Making Cavities History: A Global Policy Consensus for Achieving a Dental Cavity-Free Future.

These global consensus recommendations on caries and cavities, as well as evidence that caries is the most prevalent noncommunicable disease (NCD) globally, should be shared throughout institutional, health care professional, industrial, civil society, and patient communities so that the recommendations can be incorporated into policies for achieving a dental cavity-free future. Appropriate inclusion within strategies and action plans globally and locally will accelerate progress toward Making Cavities History, as well as improving NCDs and wider health.

¿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.

Infiltración de resina y barniz de flúor para el tratamiento de caries interproximales no cavitadas en dentición temporal / Resin infiltration plus fluoride varnish for non-cavitated proximal caries in primary dentition

RESUMEN: Introducción: Con el fin de prevenir la progresión de la caries interproximal no cavitada en dientes temporales, se ha generalizado el uso de estrategias mínimamente invasivas como la aplicación de sellantes, barniz de flúor o la resina infiltrante, ya sea combinadas o como monoterapia. Pese a lo anterior, hay incertidumbre con relación al efecto de la infiltración de resina en combinación con el barniz de flúor en dientes temporales. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metaanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Se identificaron nueve revisiones sistemáticas que en conjunto incluyeron tres estudios primarios que corresponden a ensayos clínicos aleatorizados. Se concluye que la infiltración de resina probablemente reduce el riesgo de la progresión de la caries interproximal no cavitada en dientes temporales. No se encontraron estudios que evaluaran los eventos adversos. Palabras claves: caries, infiltración de resina, caries interproximal, barniz de flúor, tratamiento mínimamente invasivo, Epistemonikos, GRADE.

ABSTRACT: Introduction: Minimally invasive techniques are widely used in non-cavitated interproximal caries treatment in primary dentition. Sealants, fluoride varnish, or resin infiltration can be applied in conjunction or as monotherapy. There is uncertainty regarding the effect of resin infiltration in conjunction with fluoride varnish in primary dentition. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified 9 systematic reviews including three studies overall, of which all were randomized trials. We conclude that resin infiltration plus fluoride varnish probably decreases the risk of progression of non-cavitated interproximal caries in primary dentition. No studies were found that looked at adverse effects.

Evaluation of success of stainless steel crowns placed using the hall technique in children with high caries risk: A randomized clinical trial.

OBJECTIVE: This study aimed to compare the clinical efficacy and survival rates of the hall technique (HT), and conventional restoration (CR) for the management of occlusoproximal carious lesions in primary molars. MATERIALS AND METHODS: This clinical study observed 35 children (aged 4-8 years). Exclusion criteria included symptoms of pulpal or periradicular pathology or systemic conditions requiring special dental considerations. For each child, at least one tooth was treated with HT and one with CR. The primary outcome measures were minor and major clinical failure rates. Plaque and gingival scores of the teeth were also evaluated. Friedman test and Wilcoxon signed ranks test were used to compare the plaque and gingival index scores for each arm. Chi-square tests were used for comparisons of clinical outcomes, plaque-gingival index, and distribution of ICDAS categories among treatment arms (P < 0.05). RESULTS: Thirty-three of 35 (94.2%) participants returned for 1-year follow-up. HT showed statistically significantly higher treatment survival rate and fewer minor failures than CR (P = 0.040). The rate of major failures was minimal (2 of 84 teeth) and did not differ between treatments (P = 0.092). In both treatment groups, the gingival score and plaque score were significantly decreased at the 1-year follow-up (P < 0.05). CONCLUSION: HT was a more successful method for managing caries in primary molars than CR, both for symptoms of pulpal disease and longevity of the restorations. HT is a simplified method of managing carious primary molars using SSCs cemented with no local anesthesia, caries removal, or tooth preparation.