Association between sociodemographic factors and noncavitated and cavitated caries lesions in 8- to 12-year-old Mexican schoolchildren.

ABSTRACT: The aim of this study was to evaluate the association between sociodemographic factors and noncavitated and cavitated caries lesions in Mexican schoolchildren.This cross-sectional study was conducted in 2020 on 8-to-12-year-old schoolchildren of different socioeconomic status (SES). The caries was evaluated using ICDAS II, SES was evaluated using three categories---a high, middle, or low-income level---of the CONAPO. Multinomial logistic regression analyses were performed in order to ascertain the associations between socioeconomic factors and noncavitated and cavitated caries lesions.The prevalence of noncavitated lesions was 38.0% and cavitated lesions was 43.4% in permanent dentition. In all the samples, 50.6% of schoolchildren had poor oral hygiene. About 52.5% of the mothers and 64.7% of the fathers had less than 9 years of education. Schoolchildren with a low-income level have more cavitated lesions (ICDAS II 4-6) than schoolchildren with high-income level (56.3% vs 15.8%, P = .009). The multinomial logistic regression models showed that mother's level of education <9 years and low-income level were significantly associated with cavitated caries lesions (ICDAS II 4-6), [odds ratio = 1.79 (1.17 - 2.75); P = .007], [OR = 2.21 (1.23 - 3.97); P = .008], respectively. The socioeconomic level was not associated with noncavitated caries lesions (ICDAS II 1-3).An association was found between the presence of cavitated caries lesions and the subject's mother's level of education and a low-income level. Socioeconomic factors were found to be associated with inequalities in caries distribution in the age group studied.

Efficacy of Lasers Treatment of Exposed Pulps to Stimulate Healing: A Systematic Review and Meta-Analysis

Abstract Objective: The present systematic review and meta-analysis aimed at evaluating the efficacy of laser's treatment of exposed pulps to stimulate healing. Material and Methods: MEDLINE, PubMed, Cochrane Library, Embase, ISI, Google Scholar have been searched as the electronic databases for performing systematic literature between 2005 to 2019. Searches were performed with MESH terms. The quality of the studies included was assessed using the Critical Appraisal Skills Program checklist. For Data extraction, two reviewers blind and independently extracted data from the abstract and full text of the studies included. Moreover, the fixed-effect model's odds ratio for a 95% confidence interval (CI) was calculated. Random effects were used to deal with potential heterogeneity, and I2 showed heterogeneity. The meta-analysis and forest plots have been evaluated using the Comprehensive Meta-Analysis Stata. Results: Five studies (3 RCTs and 2 animal studies) were included in this study. The Odds Ratio was 1.90 (95% CI 1.39-2.42; p=0.00); there was a statistically significant difference between the laser and the control groups (p=0.00). Conclusion: The success rate of laser treatment for exposed pulps is higher than mineral trioxide aggregate, resin, calcium hydroxide and resin-modified glass-ionomer cement. The exact mechanism of this effect has not yet been determined; further research on lasers' impact on exposed pulps treatment is required.

Dental disorders in brown howler monkeys (Alouatta guariba clamitans) maintained in captivity.

BACKGROUND: The aim of this study was to investigate dental disorders of brown howler monkeys maintained in captivity. The hypothesis is that the identification and diagnosis of the lesions may contribute to control and prevention. METHODS: Sixteen intact brown howler monkeys (Alouatta guariba clamitans), eight females and eight males, weighing from 3.9 to 6.8 kg, were studied. Under general anesthesia, the teeth were evaluated by visual inspection, probing, palpation, and intra-oral radiographic exam. The findings were registered on a dental chart specific for primates. RESULT: Of the 16 monkeys evaluated in the present study, 94% (n = 15) had some type of dental disorder. The lesions observed were dental calculus (88%), dental wear (81%), missing teeth (38%), gingivitis (19%), gingival recession (6%), dental fracture (19%), pulp exposure (19%), and dental staining (25%). CONCLUSIONS: Alouatta guariba clamitans maintained in captivity have a high rate of dental problems.

Laser-induced fluorescence in the diagnosis of pulp exposure and the influence of residual dentin thickness: An in vivo study.

PURPOSE: To clinically (a) determine whether laser-induced fluorescence (LIF) was able to assess pulp tissue health or disease in situations of pulp exposure; (b) evaluate the influence of different pulp tissue conditions upon LIF through dentin thicknesses of ≤1 mm; and (c) explore possible differences between the diagnostic performance of quantitative (q) and qualitative (ql) LIF. METHODS: 98 healthy subjects were scheduled for the treatment of caries. Three groups were established according to pulp tissue condition: Group A (n=30 teeth) (deep caries with healthy pulp tissue); Group B (n=30 teeth) (pulp necrosis); and Group C (n=30 teeth) (irreversible symptomatic acute pulpitis). The carious lesions were eliminated, and q and ql LIF measurements were made at two levels: measurement in dentin at < 1 mm from the pulp (A-D); and direct pulp exposure measurement (A-LP). In healthy pulp tissue at level A-LP, eight teeth with accidental pulp exposure were used. The Kruskal-Wallis test was used to evaluate the statistical significance of the differences in LIF readings among the three groups. The diagnostic performance of q and ql LIF in application to pulp tissue health or disease was assessed by calculating the sensitivity and specificity of the two tests at level A-LP. RESULTS: A significant correlation was observed between acute pulpitis and an increase in the q LIF values at level A-D (P= 0.004), but with no correlation to healthy pulp. Quantitative and qualitative LIF may be useful in diagnosing pulp tissue health or disease in situations of pulp exposure (A-LP).

Pre-Eruptive Intracoronal Resorption (PEIR): Literature Review and Case Report.

Pre-eruptive intracoronal resorption (PEIR) are lesions that are often located in the occlusal portion of the crown in unerupted teeth. The etiology and pathology of these lesions remain unclear and most go undetected until later stages of development. Prognosis is dependent on early detection, and conservative treatment is recommended. This report reviews the etiology, prevalence, diagnosis and treatment of PEIR and describes a case of a permanent second molar with PEIR diagnosed in an 11-year-old patient.

Application of optical coherence tomography to identify pulp exposure during access cavity preparation using an Er:YAG laser.

OBJECTIVE: The study aimed to evaluate the ability of optical coherence tomography (OCT) to guide and identify pulp exposure using an erbium: yttrium-aluminum-garnet (Er:YAG) laser. BACKGROUND DATA: The Er:YAG laser has been proven to be effective in ablating dental hard tissue and offers advantages, as there is none of the vibration and noise you get with conventional methods, but it has limitations in relation to the tactile feedback that would aid in identification of entry into the pulp chamber. Based on depth-resolved optical reflectivity, OCT technology has been developed to provide high-resolution, cross-sectional images of the internal structure of biological tissues. MATERIALS AND METHODS: The pulp chambers of 20 human mandibular incisors were examined, and the average thickness of hard tissue covering the pulp chamber was assessed using micro-computed tomography (micro-CT) images. An Er:YAG laser was used to gradually penetrate the hard tissue over the pulp chamber under microscopic guidance. The preparation was constantly imaged using a swept-source OCT at 10 sec intervals until a pulp chamber exposure was identified using the technology. The pulp exposure was re-examined under the microscope and compared with micro-CT images for verification. RESULTS: The pulp exposures of 20 incisors were all verified microscopically and with micro-CT images. The thickness of hard tissue penetrated by the laser ranged from 0.44 to 1.69 mm. CONCLUSIONS: Swept-source OCT is a useful tool for identifying pulp exposure during access opening with the Er: YAG laser.

Quantification of incisal tooth wear in upper anterior teeth: conventional vs new method using toolmakers microscope and a three-dimensional measuring technique.

OBJECTIVES: This study aimed to quantify tooth wear in upper anterior teeth using a new CAD-CAM Laser scanning machine, tool maker microscope and conventional tooth wear index. METHODS: Fifty participants (25 males and 25 females, mean age = 25 ± 4 years) were assessed for incisal tooth wear of upper anterior teeth using Smith and Knight clinical tooth wear index (TWI) on two occasions, the study baseline and 1 year later. Stone dies for each tooth were prepared and scanned using the CAD-CAM Laser Cercon System. Scanned images were printed and examined under a toolmaker microscope to quantify tooth wear and then the dies were directly assessed under the microscope to measure tooth wear. The Wilcoxon Signed Ranks Test was used to analyze the data. RESULTS: TWI scores for incisal edges were 0-3 and were similar at both occasions. Score 4 was not detected. Wear values measured by directly assessing the dies under the toolmaker microscope (range = 113 - 150 µm, mean = 130 ± 20 µm) were significantly more than those measured from Cercon Digital Machine images (range=52-80 µm, mean = 68 ± 23 µm) and both showed significant differences between the two occasions. CONCLUSIONS: Wear progression in upper anterior teeth was effectively detected by directly measuring the dies or the images of dies under toolmaker microscope. Measuring the dies of worn dentition directly under tool maker microscope enabled detection of wear progression more accurately than measuring die images obtained with Cercon Digital Machine. Conventional method was the least sensitive for tooth wear quantification and was unable to identify wear progression in most cases.

Diagnosis of the condition of the dental pulp: a systematic review.

The aim of this systematic review was to appraise the diagnostic accuracy of signs/symptoms and tests used to determine the condition of the pulp in teeth affected by deep caries, trauma or other types of injury. Radiographic methods were not included. The electronic literature search included the databases PubMed, EMBASE, The Cochrane Central Register of Controlled Trials and Cochrane Reviews from January 1950 to June 2011. The complete search strategy is given in an Appendix S1 (available online as Supporting Information). In addition, hand searches were made. Two reviewers independently assessed abstracts and full-text articles. An article was read in full text if at least one of the two reviewers considered an abstract to be potentially relevant. Altogether, 155 articles were read in full text. Of these, 18 studies fulfilled pre-specified inclusion criteria. The quality of included articles was assessed using the QUADAS tool. Based on studies of high or moderate quality, the quality of evidence of each diagnostic method/test was rated in four levels according to GRADE. No study reached high quality; two were of moderate quality. The overall evidence was insufficient to assess the value of toothache or abnormal reaction to heat/cold stimulation for determining the pulp condition. The same applies to methods for establishing pulp status, including electric or thermal pulp testing, or methods for measuring pulpal blood circulation. In general, there are major shortcomings in the design, conduct and reporting of studies in this domain of dental research.

DIAGNOdent laser fluorescence assessment of endodontic infection.

INTRODUCTION: Real-time assessment of the microbial status of the root canal system would be useful in clinical endodontic practice for determining endpoints of biomechanical treatment. This laboratory study used an existing laser fluorescence device, the DIAGNOdent (KaVo, Biberach, Germany), in a proof-of-concept study. METHODS: Visible laser red light (wavelength 655 nm) was used to elicit fluorescence emissions in the near-infrared range from infected and uninfected root canals. A prototype sapphire tip designed for periodontal assessment was used to analyze the pulp chamber and coronal third of the root canal system in extracted teeth. The fluorescence properties of bacterial cultures, monospecies biofilms in root canals, pulpal soft tissues, and sound dentin were also evaluated, together with 50 extracted teeth with known endodontic pathology. RESULTS: Sound dentin and healthy pulpal soft tissue gave an average fluorescence reading of 5 (on a scale of 100), whereas biofilms of Enterococcus faecalis and Streptococcus mutans established in root canals showed a progressive increase in fluorescence over time. Fluorescence readings reduced to the "healthy" threshold reading of 5 when root canals were endodontically treated, and the experimentally created bacterial biofilms were removed completely. High fluorescence readings were recorded in the root canals and pulp chambers of extracted teeth with radiographic evidence of periapical pathology and scanning electron microscopy evidence of bacterial infection. CONCLUSIONS: The use of the DIAGNOdent fluorescence approach for the assessment of the status of the pulp chamber and root canal system holds promise for clinical application; once more, flexible tips can be developed for gaining greater penetration into middle and apical thirds of the root canal.

Endodontic diagnosis. Mystery or mastery?

UNLABELLED: Review of 6 clinical distinctions: (1) Symptom: "anything under the sun." DIAGNOSIS: pulp exposure. Duplicate: clinical or radiographic pulp exposure evidence. TREATMENT: endodontics or pulp cap under strict protocol conditions. (2) Symptom: "cold." DIAGNOSIS: hyperemia. Duplicate: ice. TREATMENT: pulp protection or endodontics. (3) Symptom: "heat." DIAGNOSIS: pulpitis. Duplicate: heat. TREATMENT: pulpotomy for multirooted teeth or pulpectomy for single-rooted teeth. Schedule endodontic completion. (4) Symptom: "I recently had a toothache and now it is gone." DIAGNOSIS: necrosis. Duplicate: Electric Pulp Test and ice are negative. TREATMENT: endodontics. (5) Symptom: "I had a toothache awhile back and now it is gone." DIAGNOSIS: LEO. Duplicate: Electric Pulp Test, ice, and test cavity are negative. TREATMENT: endodontics. (6) Symptom: "It really hurts to touch my tooth." DIAGNOSIS: percussion. Duplicate: may or may not have a LEO and may or may not have cellulitis. TREATMENT: reduce occlusion, access cavity, water chew, and schedule to finish endodontics. If these tests are carefully performed, then they are objective and the doctor does not have to be in a subjective situation. A newfound sense of endodontic diagnostic mastery is experienced. Perhaps the best way to summarize the simplicity of this clinical diagnostic scheme is to quote Sherlock Holmes: "Nothing is more deceptive than the obvious."