Progression of proximal caries in primary molars using the radiographic ICDAS: a retrospective cohort study.

PURPOSE: To evaluate the proximal caries progression in primary molars using the radiographic International Caries Detection and Assessment System (ICDAS). METHODS: A study was conducted on 196 children aged 3-9 years old who underwent the clinical examination and bitewing radiography during baseline and 6-month (and over) follow-up visits. The primary molars bitewing radiographs with initial enamel caries (RA1 and RA2) or outer dentine caries (RA3) of proximal surfaces were included. Caries advancement was scored using ICDAS criteria and statistical analyses with the chi-square test. Median survival time was evaluated using Kaplan-Meier survival curves and log-rank tests. RESULTS: A total of 439 surfaces of primary molars were included in this study and an averaged follow-up period of enamel and dentine caries group were 18.3 ± 9.6 months and 16.5 ± 9.5 months respectively. The progression of proximal enamel lesions significantly differed between primary maxillary and mandibular molars (p = 0.002) and among each patient's primary mandibular second molar and the others (p = 0.002). On the contrary, the outer dentine caries of each group of primary molars was not different. The median survival time of the initial enamel proximal caries (23.30 months) was non-significantly longer than that of the dentine (20.80 months). CONCLUSIONS: Progressions of the initial enamel proximal caries were significantly different among primary molars at the average 18.3-month follow-up. The median survival period of the enamel proximal caries was more extended than that of dentine but without statistical difference. These results provide essential information for dentists regarding an appropriate appointment for bitewing examinations.

Evaluation of a new 3D-printed tooth model allowing preoperative ICDAS assessment and caries removal.

INTRODUCTION: Teaching caries lesion management with operative care requires tooth models with highly realistic anatomical detail and caries lesions that can be assessed using ICDAS. This study aimed to develop and evaluate a new 3D-printed teeth model for ICDAS assessment and caries removal for pre-clinical hands-on education. METHODS: Printable tooth with different layers for enamel, dentin and carious lesions was designed and tested by 31 dental students. They were asked to visually and radiologically assess the ICDAS severity of the simulated carious lesions, establish the therapeutic strategy according to CariesCare 4D, and perform a qualitative assessment of the models based on five-point Likert scale items. RESULTS: Concerning carious lesions, the texture was realistic, and the shade was adequate for 94% and 97% of the participants. Ninety per cent of the participants found the model adequate to perform an ICDAS visual assessment. Seventy-four per cent of the students found the hardness adequate. Concerning the difference in shade and the noticeable hardness difference between enamel and dentin, participants have mixed agreement with a proportion of 61% and 55%, respectively. All the participants agreed these 3D-printed models provide a good caries simulation, are suitable for hands-on operative dentistry courses, and that learning outcomes better than the standard model. CONCLUSION: The present work shows that rapid prototyping paves the way for customized educational models capable of supporting operative but also preoperative skills. 3D printing opens up new opportunities by reducing the gap between pre-clinical training and clinical reality in caries management, which can positively impact the quality of patient care.

Assessment of dental caries based on ICDAS and WHO criteria: A comparative study.

BACKGROUND: The decayed, missing, and filled teeth (DMFT/dmft) index recommended by the World Health Organization (WHO), which measures the prevalence of caries based on the presence of cavitated caries lesions, is the most used dental caries index in epidemiological studies. Early diagnosis of noncavitated carious lesions enables preventive measures, which has the potential to prevent dental caries-related morbidity and reduce the financial burden associated with restorative or rehabilitative dental care. The International Caries Detection and Assessment System (ICDAS II) incorporates both the cavitated and noncavitated carious lesions with acceptable reliability. AIM: To compare dental caries prevalence based on ICDAS II and WHO criteria. DESIGN: A cross-sectional study was conducted among 362 children visiting People's Dental College and Hospital, Nayabazar, Kathmandu, Nepal to study dental caries prevalence based on the ICDAS II and WHO criteria. RESULTS: Among the study population, 290 (90.34%) and 169 (68.42%) children had dental caries in primary and permanent teeth according to the ICDAS II criteria, whereas according to WHO criteria, 267 (83.18%) and 107 (43.32%) had dental caries in primary and permanent teeth, respectively. The prevalence of dental caries was significantly higher (p < .001) according to ICDAS II criteria than the prevalence based on WHO criteria in both dentitions. CONCLUSION: This study showed a significant difference in dental caries prevalence between the ICDAS II and WHO methods of caries diagnosis. The presence of noncavitated carious lesions was alarming. To enable detection of early/noncavitated carious lesions, ICDAS II rather than WHO criteria of caries diagnosis may be a more a valuable tool.

[Assessment of carious dental lesions and treatment options: comparison of the knowledge of dental students and orthodontic assistants]. / Einschätzung von kariösen Zahnläsionen und Therapieoptionen: Vergleich der Kenntnisse von Studierenden der Zahnmedizin und AssistenzzahnärztInnen für Kieferorthopädie.

In order to optimize dental education, established procedures for caries diagnosis and therapy, such as the International Caries Classification and Management System (ICCMS), should be integrated into the curriculum. In preparation, the level of knowledge of dental students on caries detection and management was surveyed in order to specifically address deficits in dental teaching. In addition, the data were compared with the knowledge of clinically experienced dentists. The results are presented in this report and possible consequences for dental teaching are discussed.Twenty-six sixth semester dental students and six assistant dentists at the Department of Orthodontics (Philipps University of Marburg, Germany) were available for the written survey during the winter semester 2018/2019. For 12 anonymized orthodontic patient cases, the clinical findings, caries risk, and adequate treatment were to be determined for each defined tooth. The consensus decision of two experienced dentists served as the reference value. As a result, agreement with the reference ranged from 40.7% to 51.3% for students and from 56.9% to 75.0% for assistant dentists. The extent of caries and the resulting necessary treatment were mostly underestimated.In addition to theoretical knowledge, clinical experience is another prerequisite for adequate caries diagnosis and its management. The underestimation of caries extent and necessary treatment should be taken into account when teaching content. Procedures such as the ICCMS should be integrated into the dental curriculum at an early stage, so that orthodontic patients can also receive effective care.

Assessment of early childhood caries using ICDAS and Snyder caries activity test among preschool children: a cross-sectional study.

The aim of the present study was to elucidate the correlation between the International Caries Detection and Assessment System (ICDAS) and the Snyder caries activity test (SCAT) for the assessment of early dental caries in preschool children. Dental health status of 153 children aged 3-5 years was evaluated by oral examination. The ICDAS stage (enamel opacity stage to cavitated dentine caries stage (stages 1-6)) was assigned based on the evaluation of each tooth surface by a trained dentist based on the number of decayed (d) and filled teeth (ft). In this study, scores of d3-6t (t, teeth), d3-6s (s, tooth surface), d3-6ft and d3-6fs were the cut-off points for enamel caries, set to ICDAS code 3 (d3). SCAT score was assigned based on the acid production level of lactic acid bacteria in plaque (scores: 1-4). Linear correlation analysis was used to determine the correlation between ICDAS and SCAT scores. The proportion of children for each of the dental caries status were as follows: d0, 46.4%; d1-2, 28.1%; d3-4, 9.8%; d5-6, 15.7%. Regarding SCAT scores, 30%, 30.1%, 26.8% and 12.4% children had no, mild, moderate and severe caries activity, respectively. The d3-6t, d3-6s, d3-6ft and d3-6fs indices increased with age and were 0.56, 0.82, 2.03 and 5.05, respectively. Children with a higher SCAT score had higher ICDAS scores (p < 0.05). Our findings suggest that a combination of ICDAS and SCAT scores is beneficial for diagnosing caries progression and highly active caries. Early childhood caries should be managed early to prevent the enamel opacity stage to progress to cavitation.

Sensitivity and specificity of the ICDAS II system and bitewing radiographs for detecting occlusal caries using the Spectra™ caries detection system as the reference test in children.

BACKGROUND: Most studies assessing the sensitivity and specificity of caries detection methods have been performed in vitro using the histological method as the gold standard showing inconsistent values. The aim of this study was to compare the sensitivity and specificity in detecting occlusal caries using the International Caries Detection and Assessment System (ICDAS II) with the radiographic method (RM), while using the Spectra™ Caries Detection System (SCDS) as the reference test. METHODS: One hundred sixty children, ages 7-12 years, participated in the study. Five zones in the occlusal surfaces of 859 primary and 632 first permanent molars were examined visually using ICDAS-II, the RM using bitewing radiographs and SCDS. The descriptive statistics of sensitivity and specificity were calculated and compared. RESULTS: For all molars combined and for primary molars only, the sensitivity of ICDAS II was higher for detecting total caries (p < 0.001), caries in enamel (p < 0.001), and caries in dentin (p = 0.016), but it was not different for detecting caries in the dentin of permanent first molars (p = 0.214), and primary second molars (p = 0.761). The specificity of RM was higher for detecting total caries, caries in enamel for all molars combined and for permanent first molars (p < 0.001). For caries in dentin, the specificity of ICDAS II was higher for all molars combined and for primary molars only (p < 0.001). For total caries in primary molars only, and caries in dentin of permanent first molars only, the specificity was not different (p = 0.156 and p = 0.181 respectively). CONCLUSIONS: The sensitivity and specificity of ICDAS II and RM changes depending on whether the carious lesion compromises the enamel or dentin, and if the caries detection is performed in the primary molars or permanent first molars.

Predictive validity of the reduced Cariogram model for caries increment in non-cavitated and cavitated lesions: cohort study.

BACKGROUND: The aim of this study is to assess the caries prediction of the reduced Cariogram by comparing baseline caries risk profiles with non-cavitated and cavitated lesions over periods of six, twelve, and 18 months. METHODS: From May 2016 to October 2017, seven schools in Bhakkar, Pakistan, participated in a cohort study. First base line examination was conducted followed by examinations at 6, 12 and 18 months. Children intraoral examinations were performed on portable dental chair with in school premises by a trained examiner. A modified ICDAS index was used to measure caries at baseline and at follow-up examinations after 6, 12, and 18-months. A receiver operating curve (ROC) analysis was performed to evaluate its effectiveness for predicting dental caries increment. RESULTS: About 40% of children had a low-risk status, 30.5% medium risk, and 29.7% high risk, at baseline risk assessment. At 18 months, 73% of high-risk children, 59% of medium-risk children, and 41% of low-risk children showed a caries increment. For the reduced Cariogram model, the area under the curve on the 6, 12 and 18 months follow-up was 0.63, 0.65 and 0.70 respectively. CONCLUSIONS: Our findings indicates that a reduced Cariogram can predict the progression of caries in both cavitated and non-cavitated lesions and model exhibits a level of discriminatory ability. While it might not achieve a very high accuracy, it suggests that the model is able to predict caries increment effectively than random guessing.

Self-assembling peptide and nano-silver fluoride in remineralizing early enamel carious lesions: randomized controlled clinical trial.

BACKGROUND: Nanoparticles and regenerative biomineralization are new caries prevention technologies. This study assessed the remineralizing effect of self-assembling peptide (P11-4), Nanosilver Fluoride (NSF) and sodium fluoride (NaF) on white spot lesions (WSLs) in permanent teeth. METHODS: Sixty six young adults with WSLs on buccal surfaces in permanent teeth and ICDAS code 1 or 2, were randomly assigned to one of three groups; P11-4, NSF or NaF. Assessment of ICDAS scores, lesion activity (Nyvad scores) and diagnodent readings of lesions were done at baseline and after 1, 3, 6 and 12 months of agents' application. Comparisons between groups were made using chi squared test and comparison within groups were made using McNemar test. Multilevel binary logistic regression was used to assess the effect of agents on change of ICDAS scores after 3, 6 and 12 months (reduction versus no reduction). RESULTS: There were 147 teeth in 66 patients; mean ± SD age = 13.46 ± 4.31 years. There were significant differences in the change of ICDAS scores among the three groups after 3 and 6 months (p = 0.005). The reduction in ICDAS score increased steadily in all groups across time with the greatest increase in the P11-4 group: 54.5% after 12 months. Lesion activity (Nyvad scores) showed significant differences among the three groups with the greatest percentage of inactive cases in the P11-4 group. Multilevel binary logistic regression showed non-significant reduction of ICDAS in P11-4 and NSF varnishes compared to NaF varnish (AOR = 2.56, 95% CI: 0.58, 8.77 and AOR = 2.12, 95% CI: 0.59, 7.64 respectively). CONCLUSION: P11-4 and NSF varnish reduced the ICDAS scores, caries activity and diagnodent readings of WSLs in permanent teeth. However, the change in ICDAS scores was not significantly different from NaF. TRIAL REGISTRATION: This trial was prospectively registered on the clinicaltrials.gov registry with ID: NCT04929509 on 18/6/2021.

CLINICAL FEATURES OF THE CARIES COURSE OF TEMPORARY TEETH IN CHILDREN.

OBJECTIVE: The aim: Assess the incidence of caries of temporary teeth in children using the indices drxfm, SIC, ICDAS. PATIENTS AND METHODS: Materials and methods: A survey of 255 children 3 and 6 years old was conducted and 2 research groups were formed. We determined the prevalence, intensity of caries by the expanded formula drxfm, SIC-index and ICDAS II 1-6, as well as determined the Green-Vermilion hygienic index. RESULTS: Results: The high prevalence of caries of permanent teeth according to WHO criteria was revealed. The average value of ICDAS II 1-6 at the age of 3 years is 1.91 « 0.24 teeth, p <0.05. In 6-year-olds, this index was 3.78 « 0.32 teeth, p <0.05. In 3-year-old children, the average value of SIC was 2.64 « 0.09 teeth, which probably differed from that of 6-year-old children - 6.82 « 0.12 teeth. Regarding the Green-Vermilion index, unsatisfactory oral hygiene was found in children aged 3 and 6 years. CONCLUSION: Conclusions: Thus, the obtained high rates of prevalence and intensity of caries determine the special importance of caries prevention measures and indicate the need to find new approaches in the fight for dental health of children.

The efficacy of combined arginine and probiotics as an add-on to 1450 ppm fluoride toothpaste to prevent and control dental caries in children - A randomized controlled trial.

OBJECTIVES: To determine how daily consumption of a lozenge combining arginine and two probiotic strains affects the Relative Risk Reduction (RRR) in children regarding dental caries transitions and lesion activity at tooth surface level during 10-12 months. METHODS: A total of 21,888 tooth surfaces in 288 children were examined. The intervention group (n = 141) received a lozenge containing 2% arginine, Lacticaseibacillus rhamnosus, LGG® (DSM33156), and Lactobacillus paracasei subsp. paracasei, L. CASEI 431® (DSM33451). The placebo group (n = 147) received a placebo lozenge. Both groups received 1,450 ppm F- toothpaste. Primary canines, molars, and first permanent molars were examined clinically (ICDAS0-6) and radiographically (R0-6) at baseline and follow-up. Sealed, filled, and missing surfaces were also included. Caries activity was computed as a sum of each caries lesion's location, color, texture, cavitation, and gingival bleeding. RRRs were computed with cluster effect on surface level. ICH-GCP was followed, including external monitoring. RESULTS: A total of 19,950 surfaces were analyzed after excluding 1,938 tooth surfaces. No statistically significant differences were found between the groups. The RRRs showed less caries progression (13.6%, p = 0.20), more regression (0.3%, p = 0.44), and fewer active caries lesions (15.3%, p = 0.15) in the intervention group. CONCLUSION: Daily consumption of a lozenge combining arginine and probiotics for 10-12 months given to 5-9-years-old children characterized being with low caries risk demonstrated a marked, though not statistically significant RRR for caries progression, regression, and number of active lesions in the intervention group compared to the placebo-group. CLINICALTRIALS: gov (NCT03928587). CLINICAL SIGNIFICANCE: Since all the RRRs were in favor of the intervention group and the PF of combined arginine and probiotics is high (81.6%) compared to fluoride toothpaste (24.9%) and arginine-fluoride toothpaste alone (19.6%) the combined pre-and probiotics approach may be a future additional tool regarding caries prevention and control.

Caries Experience in Preschoolers in Three Ecuadorian Communities.

Dental caries in the preschool population presents a significant challenge in the field of global public health, including Ecuador. Early detection of this disease is crucial for developing effective strategies for prevention and promotion of oral health, which can have a substantial impact on the quality of life of preschool-aged children. This study evaluated 600 children aged 3 to 5 years attending preschool education centers using the ICDAS II diagnostic criteria. The Student's t-test was used to analyze differences between the means of two independent groups. Additionally, an analysis of variance (ANOVA) was conducted to assess differences between the means of three or more groups. The prevalence of caries was 87%, with a dft index of 3.85 in the three provinces studied. A high treatment need was observed in 84.17% of the population. No significant differences in the DFT index were found based on gender, although both groups exhibited elevated values. No significant differences were observed in relation to province and environment. The second molar was the most affected tooth, with a caries prevalence of 58.8%. Despite the lack of significant differences among the evaluated variables, a high prevalence and experience of dental caries were found in the studied population.

Comparative evaluation of caries prevalence among group of Egyptian adolescents using DMFS and ICDASII methods: a cross-sectional study.

BACKGROUND: Limited data is available regarding the prevalence of dental caries as a chronic disease among adolescents using different caries assessment indices. The aim of this study was to compare and describe the prevalence of dental caries among group of Egyptian students using two caries assessment indices; DMFS and ICDAS II. METHODS: This descriptive, cross-sectional epidemiological study included 2760 public secondary school students with age range from 15 to 18 years with permanent dentition and good general health. Presence of; retained teeth, congenital or developmental anomalies in the permanent dentition, orthodontic treatments, systematic conditions, smoking and general health problems were considered the exclusion criteria in this study. Participants were selected randomly from 8 public secondary schools in the Great Cairo, Egypt. The examination was achieved by 6 trained and previously calibrated examiners using sets of diagnostic mirrors, compressed air, a WHO probe and cotton rolls. DMFS index and ICDAS II system were used as caries detection methods. In DMFS index; the number of decayed (D), missing (M) and filled (F) surfaces was recorded, while in the ICDAS II index, the assessment of both cavitated and non-cavitated carious, missed and filled teeth with restorations /sealants was recorded. The examiners performed the oral examination using both scoring systems in an alternating manner. The collected data were explored for normality using Kolmogorov-Smirnov and Shapiro-Wilk tests. Chi square test was used to analyze the frequencies. RESULTS: There was a statistical significant difference between the DMFS and ICDAS II methods results regarding the recorded number of caries affected teeth and cavitated teeth surfaces. The prevalence of dental caries among the investigated secondary school students was (69.56%) and (78.29%) for DMFS and ICDAS II, respectively. CONCLUSIONS: The prevalence of dental caries among Egyptian adolescent is high. ICDAS scoring system revealed higher caries prevalence values than DMFS method. ICDAS method is the best choice for the preventive goals, while DMFS is sufficient for clinical purposes.

Is oral rehydration therapy associated with early childhood caries in children resident in Ile-Ife, Osun State, Nigeria?

BACKGROUND: Oral rehydration therapy may increase the risk of early childhood caries (ECC) because of reduced pH in the oral environment. AIM: To investigate associations between the use of oral rehydration therapy and the prevalence and severity of ECC in children resident in the Ife Central Local Government Area of Osun State, Nigeria. DESIGN: This observational study assessed the prevalence and severity of caries, using the International Caries Detection and Assessment System (ICDAS) II index. The outcome variables were the prevalence and severity of ECC. The explanatory variable was the use of oral rehydration solution for the management of diarrhea in the 12 months preceding the study. A multivariable logistic regression analysis was conducted to determine associations between the explanatory and outcome variables. RESULTS: Only 217 (14%) of the 1564 children had used oral rehydration solution for the management of diarrhea. Seventy-three (4.7%) children had ECC. The use of oral rehydration solution was not significantly associated with the prevalence and severity of ECC. CONCLUSION: The study findings suggest that the use of oral rehydration therapy in the management of diarrhea may not be a risk factor for ECC in communities with low prevalence and severity of ECC and high prevalence of gastroenteritis.

Usefulness and satisfaction of a digital learning tool for caries detection using ICDAS / Utilidade e satisfação de uma ferramenta digital de aprendizado para detecção de cárie utilizando ICDAS

Objective: this study aimed evaluate the usefulness and satisfaction of a digital learning tool (DLT) using ICDAS (International caries detection and assessment system) created for learning and training visual detection of carious lesions in a non-controlled setting. Material and Methods: the DLT containing 60 pictures of sound and carious surfaces was distributed through social media and professional associations, aiming at both dentists and dental students. Analysis was based on data collected through a personal, professional and satisfaction questionnaire and Google Analytics. Results: a total of 2300 users accessed the DLT and 1517 completed it, filling out the questionnaires. Users required 2.29 sessions to accomplish the DLT in an average time of 15 min and 14 seconds each. The satisfaction questionnaire showed that 84.8% of users found in the DLT exactly what they expected and 91.8% found it useful. Around 88.4% of users found that the DLT helped in discussion of ICDAS with colleagues and 88.9% with superiors; 88.3% found that the DLT provided immediate learning results. The DLT was most useful to dental students (83.7% of users), and overall satisfaction was 86%. Conclusion: users found the DLT useful for learning and training visual detection of carious lesions using ICDAS, and general satisfaction was high. (AU)

Objetivo: o objetivo deste estudo foi avaliar a utilidade e a satisfação de uma ferramenta digital de aprendizado (FDA) utilizando o ICDAS (International caries detection and assessment system), criada para aprender e treinar a detecção visual desse índice de forma virtual. Material e Métodos: a FDA contendo 60 fotos de superfícies hígidas e cariadas foi distribuída por meio de mídias sociais, visando profissionais e estudantes de odontologia. A análise baseou-se nos dados recolhidos através de um questionário de satisfação da experiência e Google Analytics. Resultados: um total de 2.300 usuários acessaram a FDA e 1.517 a completaram até os questionários. Os usuários precisaram de 2,29 sessões para realizá-la em um tempo médio de 15 min e 14 segundos. O questionário de satisfação mostrou que 84,8% dos usuários encontraram exatamente o que esperavam e 91,8% a acharam útil. Cerca de 88,4% dos usuários acreditaram que a FDA ajudou na discussão do ICDAS com colegas e 88,9% com superiores; 88,3% acharam que foi fornecido resultados de aprendizagem imediatos. A FDA foi mais útil para estudantes de odontologia (83,7% dos usuários) e a satisfação geral foi de 86%. Conclusão: os usuários acharam a FDA útil para aprender e treinar a detecção visual de lesões cariosas utilizando o ICDAS. A satisfação geral alcançada foi considerada alta. (AU)

Caries dental en preescolares: estudio transversal de base poblacional en Montevideo, Uruguay

Prevalencia/extensión/severidad de caries, registrada según ICDAS, en niños de 5 años de Montevideo-Uruguay. Estudio transversal de base poblacional de 614 niños de escuelas públicas/privadas. Se evaluó la asociación entre variables predictoras, prevalencia/extensión de caries mediante regresión de Poisson. Prevalencia 70,9%(95%IC=66,40-75,50) y extensión 10,0(95%IC=8,70-11,30) superficies. La prevalencia mostró diferencias significativas entre categorías de escuelas, SEC, nivel educativo de la madre (NEM) y alimentación, y la extensión entre el tipo de escuelas, SEC, NEM, frecuencia de cepillado y de consumo de refrescos. Niños con SEC bajo/medio (RP=1,55;IC95%=1,15-2,08 y PR=1,50;IC95%=1,12-2,01 respectivamente), NEM primario (RP=1,35;IC95%=1,11-1,65), de escuela pública (RP=1,21;95%IC=1,08-1,36) y que consumían gaseosa diariamente (RP=1,20;95%IC=1,01-1,43) mostraron significancia en el modelo no-ajustado. Preescolares con SEC bajo/medio (RR=1,78;IC95%=1,01-3,11 y RR=1,66;IC95%=0,99-2,79 respectivamente), NEM primario (RR=1,86; IC95%=1,21-2,87); bajo SEC (RR=1.78;IC95%=1.01-3.11) y consumo diario de refrescos (RR=1.79;IC95%=1.20-2.68) tenían mayor probabilidad de caries en el análisis ajustado. La prevalencia/extensión de caries fue alta, asociándose con variables sociodemográficas/comportamentales.

Reframing perceptions in operative dentistry relating evidence-based dentistry and clinical decision making: a cross-sectional study among Jordanian dentists.

BACKGROUND: The aim of the current study was to investigate current dental practice in operative dentistry in Jordan, and the relationship between evidence-based dentistry in caries research and decision making in clinical practice in operative dentistry. MATERIALS AND METHODS: This cross-sectional study was conducted through a survey of dentists in Jordan. The survey aimed to explore the degree of knowledge and practice of evidence-based dentistry in caries research the dentists possess regarding clinical decision making in operative dentistry. The sample size was composed of (5811) dentists whom registered in Jordan Dental Association database. Descriptive statistics were generated and Chi-square test was used to examine associations between the different variables and the significance level was set at P < 0.05. RESULTS: 4000 responses were collected from the web-survey, response rate (68.83%). Nearly half of the surveyed dentists focus on the chief complaint of their patients (n = 2032, 50.8%) rather than doing full mouth assessment. Nearly two-thirds of dentists (n = 2608, 65.2%) treat lesions confined to enamel with operative treatment. Half of dentists use operative treatment when asked about the routine management of radiographically detected proximal caries confined to enamel. When treating incipient lesions, the majority (n = 3220, 80.5%) use preventive treatment. Three-quarters of dentists (n = 2992, 74.8%) treat deep dentinal caries by removing just the soft infected carious dentin, and treated old failed restorations with replacement. CONCLUSION: In operative dentistry, the evidence-based research is not implemented clinically. To optimize relationship between evidence-based dentistry and clinical decision-making, dental curriculum has to be updated and modified constantly.

Three-dimensional characterization of naturally developed early caries lesions using high-resolution micro-computed tomography.

OBJECTIVES: The goal of this micro-Computed-Tomography (µCT) study was to characterize the structural parameters of natural, early proximal enamel caries lesions and correlate them with two-dimensional radiographic findings. METHODS: Extracted human premolar teeth with ICDAS score 2 proximal lesions were examined using visual-tactile, µCT and simulated bitewing radiographs (BTX). Sound enamel and caries-lesions' structural and mineral density (MD) parameters were analyzed which included surface layer (SL) status and thickness, depth of lesion, and MD. RESULTS: Thirty-six extracted premolars with 54 proximal early enamel caries lesions were analyzed. Lesions varied notably in lesion depth and MD. SL thickness ranged between 20 and 139µm. Three teeth (5.6%) had micro-cavitations upon the µCT examination despite being "clinically" non-cavitated. Cavitation status had no significant association with µCT nor BTX radiographic depth. Depth of lesions correlated weakly but statistically significantly with mineral loss (ML) at body of lesion (r=0.301, p=0.027). SL thickness also correlated negatively with ML at SL (r=-0.501, p<0.001). CONCLUSIONS: Early proximal enamel lesions with ICDAS 2 score as determined by visual-tactile examination exhibited a wide range of lesion parameters and cavitation status when examined by µCT. Visual-tactile examination may fail to detect micro-cavitations in enamel surface that are detectable by µCT. CLINICAL SIGNIFICANCE: Clinicians have direct access to early proximal enamel lesions during orthodontic separation, exfoliation, extraction or restoration of adjacent teeth. This study invites the clinician to consider more decisive management options in high risk individuals (e.g. micro-invasive techniques), given the finding of vast structural variability of such lesions.

Caries experience scores revisited for caries risk assessment using cariogram model - A cross-sectional study.

Context: The widely accepted caries risk assessment tools such as the Cariogram model needs modifications in the scoring of different factors for reliable results. Aims: The study was aimed to report the caries experience in 3-60 years of the Rajasthan population and to apply the newly derived average decayed exfoliated filled teeth/Decayed Missing Filled Teeth (deft/DMFT) scores in the Cariogram model to assess the caries risk. Settings and Design: The cross-sectional study was planned in the Department of Dentistry and a total of 500 participants were equally divided into five groups (3-6, 7-12, 13-30, 31-44, and 45-60 years) were included. Methods and Material: All participants were examined for caries detection using deft/DMFT, ICDAS, and CAST indices according to the predefined protocol. A single examiner evaluated the participants in a dental operatory and data was recorded. Statistical Analysis Used: One-Way ANOVA and Tukey's Post-Hoc tests were used to evaluate the significant difference between the groups of each caries index. Results: A statistically significant difference was observed between the mean deft/DMFT and CAST scores of 3-6, 7-12, and 13-30 age groups with the 45-60 years age group. Caries prevalence was highest (83%) in 31-44 and 45-60 year age groups and lowest (51%) in the 3-6 year age group. Conclusions: Caries experience scores increase as the age increases and the highest scores were observed in 31-44 and 45-60 year age groups and the lowest were observed in the 3-6 year age group. The average ICDAS and CAST scores were higher when compared to the deft/DMFT index.

Evaluation of Remineralization Potential of Remin Pro Forte vs Remin Pro on White Spot Lesions: A Randomized Clinical Trial.

AIM: This study was conducted to evaluate the remineralization potential of Remin Pro Forte vs Remin Pro remineralizing agents on white spot lesions (WSLs) post-orthodontic treatment. MATERIALS AND METHODS: Twenty patients with post-orthodontic WSLs were divided into the following two equal groups based on treatment (n = 10): (1) A 3-month program of hydroxyapatite, fluoride, xylitol, ginger, curcuma-containing cream (Remin Pro Forte) as intervention group; (2) A 3-month cream regimen including hydroxyapatite and fluoride, xylitol (Remin Pro) as control group. The main outcomes including caries regression (assessed by ICDAS II), mineral content (assessed by VistaCam iX camera), and color of WSLs (assessed by digital image analysis by Adobe photoshop) were measured at the time of enrollment and 1, 2, and 3 months afterward. Mann-Whitney test used to compare between tested groups. The statistical significance was set at p <0.05. RESULTS: Both Remin Pro Forte and Remin Pro elicited much better caries regression and significantly higher mineral content in WSLs over a 3-month period (p <0.05). However, the difference in mineral content of WSLs between groups did not reach statistical significance (p = 0.414). In both experimental groups, the appearance of WSLs improved significantly (p <0.05). CONCLUSION: Both Remin Pro Forte and Remin Pro were successful in reducing caries, increasing mineral content, and enhancing the appearance of demineralized enamel, indicating that both products could be suggested for post-orthodontic WSL management. CLINICAL SIGNIFICANCE: Natural herbal products could be employed as remineralizing agents and included into tooth preventive measures. It is a less harmful alternative to traditional chemical remineralization methods.

Establishing risk-based recall interval for caries management among 11-12-year-old Pakistani children.

BACKGROUND: This study aims to investigate the rate of caries increment among 11-12-year-old Pakistani children over 18 months using modified International Caries Detection and Assessment Systems II (ICDAS) and subsequently establish an appropriate dental recall interval for our targeted population according to their caries risk intensity. METHODS: A prospective longitudinal study was conducted in Bhakkar, Punjab, Pakistan. The 226 children from seven schools of Bhakkar with the highest student enrolment were conveniently selected. Caries risk assessment was performed using a computer-based reduced Cariogram program. Caries increment among cavitated lesions was measured by modified Beck's method or adjusted caries increment. Two ICDAS II cutoffs were created for the analysis of cavitated lesion (ICDAS code 3-6) and cavitated plus non-cavitated lesion (ICDAS code A-6). RESULTS: At the risk assessment stage, 39.8% of the children were classified as low risk, 30.5% as medium risk, and 29.7% as high risk. Caries increment at both cutoff points increased with caries risk at all follow-ups. The highest caries increment was recorded at the third follow-up among high-risk children at cutoff 3-6 (1.95 ± 3.18) and A-6 (4.01 ± 4.31). However, the lowest caries increment was recorded at the third follow-up among low-risk children at cutoff 3-6 (0.18 ± 1.42) and A-6 (1.11 ± 3.33). CONCLUSION: Based on the study findings for Pakistani children with cavitated lesions, the recommended risk-based recall interval for caries management is 18 months for those with low and medium caries risk and six months for those with high caries risk. On the other hand, recommendations for risk-based recall intervals for caries management in non-cavitated and cavitated lesions are six months for low-risk, moderate risk and high-risk for Pakistani 11-12-year-old children.