Ação clareadora e microbiológica do enxaguante bucal com peróxido de hidrogênio: ensaio clínico / Whitening and microbiological action of mouthwash with hydrogen peroxide: clinical trial

Introdução: os enxaguantes bucais clareadores tem sido muito utilizados, porém sua eficiência e efeitos colaterais trazem questionamentos. Objetivo: este ensaio clínico teve como objetivo avaliar se o enxaguante bucal clareador, contendo peróxido de hidrogênio a 1,5%, apresenta ação clareadora e se há algum efeito secundário na cavidade bucal. Metodologia: foram selecionados 10 voluntários com idade média de 21,5 anos, submetidos a avaliação da cor dos dentes com auxílio do espectrômetro em 3 momentos: inicial; com 15 e com 30 dias de uso do enxaguante. A avaliação dos efeitos colaterais foi realizada a partir da coleta de saliva estimulada em 4 momentos: antes e depois ao primeiro uso do produto, com 15 e com 30 dias, e realizadas as análises laboratoriais: fluxo salivar; pH; quantidade de Streptococcus mutans e de Lactobacillus. A normalidade dos dados foi verificada pelo teste de Shapiro-Wilk, comparação de cor pelo teste t dependente, comparação dos microrganismos pelos testes ANOVA de medidas repetida e Tukey. Resultados: as análises de cor dos dentes não evidenciaram nenhuma alteração significativa em nenhum dos tempos investigados. No fluxo salivar, pH e Lactobacillus não houveram alterações significativas. Na quantidade de Streptococcus mutans notou-se um aumento significativo quando comparado os valores após o primeiro uso e com 30 dias. Conclusão: a solução de enxague bucal contendo peróxido de hidrogênio a 1,5% não apresentou alteração significativa na coloração dos dentes e nenhum efeito colateral significativo na atividade cariogênica de acordo com os testes e períodos avaliados.

Introduction: whitening mouthwashes have been widely used, but their efficiency and side effects raise questions. Objective: this clinical trial aimed to assess whether the bleaching mouthwash, containing 1.5% hydrogen peroxide, has a bleaching action and whether there are any side effects in the oral cavity. Methods: 10 volunteers were selected, with a mean age of 21.5 years, who underwent tooth color evaluation with the aid of a spectrometer in 3 moments: initial; with 15 and 30 days of using the washes. The evaluation of side effects was performed from the collection of stimulated saliva in 4 moments: before and after the first use of the product, at 15 and 30 days, and laboratory analyzes were carried out: salivary flow; pH; the number of Streptococcus mutans and Lactobacillus. Normal distribution was verified with Shapiro-Wilk test, comparisons of color were performed with t-test, comparisons of the microorganisms were performed with repeated measures ANOVA and Tukey tests. Results: the analysis did not show any significant changes in any of the investigated times. There were no significant changes in the salivary flow, pH and Lactobacillus. The number of Streptococcus mutans, was noted a significant increase when comparing the values after the first use and with 30 days. Conclusion: the mouthwash containing 1.5% hydrogen peroxide was not shown any significant alterations in the color teeth. There were not significant collateral effects on the cariogenic activity according to the tests and periods evaluated.

The diagnostic efficacy of quantitative light-induced fluorescence in detection of dental caries of primary teeth.

OBJECTIVES: To evaluate a quantitative light-induced fluorescence (QLF) caries detection method using a portable device under clinical conditions and present a QLF scoring index (QS-index) for primary teeth. METHODS: A total of 878 tooth surfaces (proximal and occlusal) of 44 children were studied. After visual inspection and radiographic examination, images of dental caries captured with the QLF device were classified according to caries progression stages and analyzed with a specialized software. Cut-off values, sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) were calculated for the QLF parameters: fluorescence loss (ΔF) and bacterial activity (ΔR). The reliability of logistic regression model to combine ΔF and ΔR was evaluated by the AUROC. RESULTS: QLF parameters showed a good sensitivity (0.72-0.91), specificity (0.74-0.96), and AUROC (0.861-0.940). The AUROC of logistic regression model (0.90-0.957) was higher than ΔF or ΔR average alone in all types of carious lesions. Every level of the QS-index was properly defined to represent the progression of dental caries with corresponding statistical significance. CONCLUSIONS: The reliability of QLF for dental caries detection in primary teeth was similar to or slightly higher than that of the traditional diagnostic methods of visual inspection or radiographic examination in clinical conditions. CLINICAL SIGNIFICANCE: The results of QLF were reliable in detecting all types of dental caries in primary teeth. The QLF method can provide visual images as well as quantitatively analyze the carious lesion.

How combining different caries lesions characteristics may be helpful in short-term caries progression prediction: model development on occlusal surfaces of primary teeth.

BACKGROUND: Few studies have addressed the clinical parameters' predictive power related to caries lesion associated with their progression. This study assessed the predictive validity and proposed simplified models to predict short-term caries progression using clinical parameters related to caries lesion activity status. METHODS: The occlusal surfaces of primary molars, presenting no frank cavitation, were examined according to the following clinical predictors: colour, luster, cavitation, texture, and clinical depth. After one year, children were re-evaluated using the International Caries Detection and Assessment System to assess caries lesion progression. Progression was set as the outcome to be predicted. Univariate multilevel Poisson models were fitted to test each of the independent variables (clinical features) as predictors of short-term caries progression. The multimodel inference was made based on the Akaike Information Criteria and C statistic. Afterwards, plausible interactions among some of the variables were tested in the models to evaluate the benefit of combining these variables when assessing caries lesions. RESULTS: 205 children (750 surfaces) presented no frank cavitations at the baseline. After one year, 147 children were reassessed (70%). Finally, 128 children (733 surfaces) presented complete baseline data and had included primary teeth to be reassessed. Approximately 9% of the reassessed surfaces showed caries progression. Among the univariate models created with each one of these variables, the model containing the surface integrity as a predictor had the lowest AIC (364.5). Univariate predictive models tended to present better goodness-of-fit (AICs < 388) and discrimination (C:0.959-0.966) than those combining parameters (AIC:365-393, C:0.958-0.961). When only non-cavitated surfaces were considered, roughness compounded the model that better predicted the lesions' progression (AIC = 217.7, C:0.91). CONCLUSIONS: Univariate model fitted considering the presence of cavitation show the best predictive goodness-of-fit and discrimination. For non-cavitated lesions, the simplest way to predict those lesions that tend to progress is by assessing enamel roughness. In general, the evaluation of other conjoint parameters seems unnecessary for all non-frankly cavitated lesions.

Free Sugars Intake among Chinese Adolescents and Its Association with Dental Caries: A Cross-Sectional Study.

This study aims to estimate the free sugars intake, identify the primary food sources of free sugars, and explore the relationship between free sugars intake and dental caries among Chinese adolescents. This cross-sectional study included 1517 middle-school students aged 12-14 years in Changsha city, China. Adolescents completed a 12-item Food Frequency Questionnaire (FFQ) and oral health assessment. The students' dental caries experience was available as DMFT score (number of decayed, missing, and filled permanent teeth). Statistical analyses included the Mann-Whitney test, Kruskal-Wallis test, Chi-square test, and binary logistic regression model. The average intake of free sugars was 53.1 g/d in adolescents, and 43.2% of the students consumed more than 50 g of free sugars daily. The primary contributor to free sugars was sugar-sweetened beverages (SSBs). Age, boarders, and high family income were risk factors for excessive free sugars intake (p < 0.05), and increased free sugars intake was a risk factor for dental caries (odds ratio, OR = 1.446, 95% confidence interval: 1.138-1.839). Both the free sugars intake and dental caries prevalence in Chinese adolescents were high. Targeted interventions are urgently needed to address the excessive consumption of free sugars and improve Chinese adolescents' oral health.

Sensitivity and Specificity of Different Diagnostic Methods in Occlusal Caries Detection of Permanent Teeth Among Paediatric Patients

ABSTRACT@#Dental caries is a commonly progressive disease that proceeds through various degrees of severity that a dentist can detect. The aims of the in vivo study were to assess the accuracy of the individual model (near-infrared light transillumination [NILT] device, visual and radiographic examinations) in detecting occlusal caries, and to evaluate the performance of visual and NILT device combination for occlusal caries detection in deciding the treatment options. Fifty-two non-cavitated occlusal surfaces from 16 patients were assessed with three different diagnostic devices in random order. Identified lesions were prepared and validated. Logistic regression analysis was performed for each method. The sensitivity and specificity values for each method and the combined models were statistically measured using RStudio version 0.97.551. At the enamel level, visual detection was the most sensitive method (0.88), while NILT was the most specific (0.93). NILT scored the highest for sensitivity (0.93) at the dentine level and visual detection scored the highest for specificity (0.88). Visual detection + NILT model was significantly better (p = 0.04) compared to visual detection or NILT alone (df = 1). The visual-NILT combination is a superior model in detecting occlusal caries on permanent teeth. The model provided surplus value in caries detection hence improving the treatment decision-making in occlusal surfaces.

Cárie Dentária: considerações clínicas e radiográficas para seu diagnóstico / Dental Caries: clinical and radiographic considerations for diagnosis

Introdução: O diagnóstico correto da cárie dentária é fundamental para o estabelecimento do seu tratamento. Ele pode ser realizado por diferentes métodos, os mais comuns são por meio da inspeção visual e do exame radiográfico. Objetivo: Discutir, a partir de uma revi-são de literatura, o diagnóstico clínico-radiográficoda doença cárie e a sua importância na instituição do tratamento correto para tal doença. Materiais e métodos: oi realizada uma revisão da literatura nas bases de dados eletrônicos: PubMed, BVS e Scielo, através do ras-treio de artigos relevantes publicados no período de Janeiro de 2015 à Junho 2020. Foram incluídos ainda na bibliografia selecionada 2 livros e 1 tese de doutorado, que fazem consi-derações relevantes sobre o assunto estudado. Resultados: Na inspeção visual, a apresen-tação da superfície dentária é bastante importante na determinação da atividade da lesão de cárie, devem ser considerados o aspecto, o brilho e a coloração da superfície dental para tal determinação. A radiografia é um complemento usado para auxiliar no diagnóstico forne-cendo mais visibilidade e detecção das lesões cariosas permitindo melhor visualização das superfícies proximais em dentes posteriores, auxiliando no diagnóstico das lesões nessas superfícies. Conclusão: O diagnóstico correto exige bastante conhecimento do examina-dor, pois manchas opacas presentes no esmalte nem sempre são lesões cariosas e podem refletir uma perda de mineral na estrutura desse tecido que se desenvolveu por diferentes causas, sendo elas pré ou pós-eruptivas. O diagnóstico precoce e preciso da cárie dentária é fundamental, pois essa doença ainda é a principal causa de perda dentária.

Introduction:The correct diagnosis of dental caries is fundamental for the establishment of its treatment. It can be carried out by different methods and the most common is through visual inspection and radiographic examination.Objective:to discuss, based on a litera-ture review, the clinical and radiographic diagnosis of caries disease and its importance in establishing the correct treatment for this disease.Materials and methods:a literature review was carried out on the electronic databases: PubMed, BVS and Scielo, by a search of relevant articles published from January 2015 to June 2020. Also, 2 books and 1 PhD thesis were included in the selected bibliography, since they bring relevant considerations on the subject studied.Results:In the visual inspection, the presentation of the dental sur-face is very important in determining the activity of the caries lesion, the aspect, the bri-ghtness, and the coloring of the dental surface must be considered for such determination. Radiography is a complement used to assist in diagnosis by providing more visibility and detection of carious lesions, allowing a better visualization of proximal surfaces in poste-rior teeth, helping in the diagnosis of lesions on these surfaces.Conclusion:The correct diagnosis requires a lot of knowledge from the examiner because opaque stains present in the enamel are not always carious lesions and can reflect a loss of mineral in the structure of this tissue that has developed for different causes, whether pre- or post-eruptive. Early and accurate diagnosis of tooth decay is essential, as this disease is still the main cause of tooth loss.

Can red fluorescence be useful in diagnostic decision making of residual dentin caries?

INTRODUCTION: A diagnosis based on traditional methods can differ under the same tooth condition. Additional diagnostic tools are required to overcome this limitation. QLF technology is a viable method for detecting residual caries and is increasingly being used to detect dentin-level residual caries. In this study we used the Qraypen (AIOBIO, Seoul, Korea) to investigate the usefulness of the QLF technology for diagnosing controversial cases. CASE 1: A 31-year-old man presented with pain in the left mandibular first molar. The old restoration and severe dental caries were removed as much as possible using traditional visual and tactile senses. The area of treatment was photographed using the Qraypen. We concluded that endodontic treatment was preferable based on the Qraypen findings combined with diagnostic information. CASE 2: A 67-year-old man presented with discomfort in the first molar on the right mandible. Most of the existing restoration and carious debris were removed. Black discoloration was observed around and within the crack line, but with no red fluorescence. Based on the results of these examinations we decided that a minimally invasive dentistry approach was appropriate. CONCLUSION: Using QLF technology is more objective and accurate than other methods of determining the removal end point and detecting healthy marginal dentin for successful restoration.

Do undergraduate dental students perform well detecting and staging caries and assessing activity by visual examination? A systematic review and meta-analysis.

AIM: To assess the undergraduate students' performance in detecting and staging caries and assessing activity using visual inspection. DESIGN: Two independent reviewers searched the literature through PubMed/MEDLINE, Scopus, Lilacs databases, and OpenSINGLE. Meta-analyses summarized the results concerning reproducibility and accuracy at D1 (considering all lesions) and D3 (including only cavitated lesions or lesions into dentin) levels. For activity, we considered sound surfaces plus inactive caries lesions vs active lesions. Meta-regression assessed the effect of methodological variables on the outcomes. RESULTS: Fourteen studies were included. The mean reproducibility values were ≥0.52, except for interexaminer agreement when assessing caries activity (0.39; 95% CI 0.10-0.67). The intra-examiner reproducibility tended to be higher than the interexaminer reproducibility. Overall, undergraduate students' performance in staging caries lesions using visual examination was good (AUC>0.85 and DOR>25). The sensitivity values were moderate; however, these were associated with excellent specificity values. Despite few pooled studies, caries activity assessment revealed moderate overall performance, with lower pooled sensitivity than pooled specificity. Students' education level and background clinical experience had no influence on the accuracy and reproducibility of the visual inspection. CONCLUSION: Undergraduate students' performance in detecting and staging caries using visual inspection was good, although caries activity assessment still requires improvement.

Early caries detection methods according to the depth of the lesion: An in vitro comparison.

PURPOSE: The aims of this study were to estimate the histological and optical changes of early carious lesions according to the duration of demineralization and to compare the efficacy to detect early carious lesions of a quantitative light-induced fluorescence (QLF) system with a spectrophotometer according to the lesion depth. METHODS: Eighty-four bovine enamel specimens were immersed in demineralizing gel for six distinct days. The severities of lesions were evaluated by lesion depths (Ld) by polarized light microscopy, fluorescence loss (ΔF) using QLF, and brightness (ΔL*) by spectrophotometry. The relationships between Ld, ΔF, and ΔL*were analyzed. RESULTS AND CONCLUSION: Ld tended to be significantly deeper according to the demineralizing period (p < 0.05). The ΔF significantly decreased (p < 0.05) and the ΔL* significantly increased with increasing the demineralizing period (p < 0.05). More shallow lesions (Ld≤200 µm) showed a strong relationship between ΔF and Ld (r = -0.898, p < 0.001), while there was a strong relationship between ΔL* and Ld in deeper lesions (Ld>200 µm) (r = 0.858, p < 0.001). Our findings show that QLF system is a more efficient device for shallow early caries detection and that the spectrophotometer is a more stable device for the detection of deeper lesions.

Tooth decay detection using a fiber optic sensor / Detección de caries dental usando un sensor de fibra óptica

ABSTRACT Introduction: tooth decay has become one of the most prevalent diseases worldwide, but ironically it is one of the most neglected. Currently, adequate and effective caries treatment is based on early diagnosis and procedures such as sealants, crowns, and root canal treatment. Methods: This study examined the behavior of carious and non-carious areas of critical dental units (premolars and molars) subjecting them to a wavelength of 830 nm in adult humans who agreed to a dental exam and had at least one tooth affected by dental caries. Underage persons and patients in medical treatment were excluded. After finding a behavior that helped differentiate decayed tissue from healthy areas, the used experimental system was characterized and tested in volunteers. The implemented system contains a fiber optic sensor comprised of a trifurcated fiber and a photodetector to perform optical power measurements. Results: This sensor detected 100% of dental caries samples on premolar and molar occlusal surfaces. It also showed the ability to diagnose buccal cavities. Conclusions: The results showed that caries can be identified in dental units by means of a fiber optic sensor and infrared light at 830 nm.

RESUMEN. Introducción: la caries se ha manifestado como una de las enfermedades con mayor prevalencia mundial, pero paradójicamente es una de las más desatendidas. En la actualidad, el tratamiento adecuado y eficaz contra la caries se basa en el diagnóstico temprano y en procedimientos como obturaciones, coronas y tratamiento de conductos. Métodos: esta investigación se centró en examinar el comportamiento de zonas cariadas y no cariadas de piezas dentales vitales (premolares y molares) al someterlas a una longitud de onda de 830 nm en seres humanos mayores de edad que aceptasen una revisión odontológica y que presentaran al menos un caso de caries dental. Fueron excluidos menores de edad y personas bajo tratamientos médicos. Tras encontrar un comportamiento que permitió diferenciar entre zonas cariadas y sanas, se caracterizó el sistema experimental usado y se probó en voluntarios. El sistema implementado se basa en un sensor de fibra óptica compuesto por una fibra trifurcada y un fotodetector para realizar mediciones de potencia óptica. Resultados: este sensor detectó el 100% de las muestras de caries dental en superficies oclusales de premolares y molares. Asimismo, exhibió indicios de la capacidad de diagnosticar caries vestibulares. Conclusiones: los resultados mostraron que se puede establecer la presencia de caries en piezas dentales mediante la implementación de un sensor de fibra óptica y luz infrarroja de 830 nm.

A survey of cariology teaching in Australia and New Zealand.

BACKGROUND: The Australian and New Zealand chapter of the Alliance for a Cavity Free Future was launched in 2013 and one of its primary aims was to conduct a survey of the local learning and teaching of cariology in dentistry and oral health therapy programs. METHODS: A questionnaire was developed using the framework of the European Organisation for Caries Research (ORCA)/Association of Dental Education in Europe (ADEE) cariology survey conducted in Europe in 2009. The questionnaire was comprised of multiple choice and open-ended questions exploring many aspects of the cariology teaching. The survey was distributed to the cariology curriculum coordinator of each of the 21 programs across Australia and New Zealand via Survey Monkey in January 2015. Simple analysis of results was carried out with frequencies and average numbers of hours collated and open-ended responses collected and compiled into tables. RESULTS: Seventeen responses from a total of 21 programs had been received including 7 Dentistry and 10 Oral Health programs. Key findings from the survey were - one quarter of respondents indicated that cariology was identified as a specific discipline with their course and 41% had a cariology curriculum in written format. With regard to lesion detection and caries diagnosis, all of the program coordinators who responded indicated that visual/tactile methods and radiographic interpretation were recommended with ICDAS also being used by over half them. Despite all respondents teaching early caries lesion management centred on prevention and remineralisation, many taught operative intervention at an earlier stage of lesion depth than current evidence supports. Findings showed over 40% of respondents still teach operative intervention for lesions confined to enamel. CONCLUSION: Despite modern theoretical concepts of cariology being taught in Australia and New Zealand, they do not appear to be fully translated into clinical teaching at the present time.

Validation of fluorescence devices for evaluation of white spot lesions in orthodontic patients.

AIM: To clinically validate the fluorescence devices, DIAGNOdent Pen™ and Vista Proof™ for the evaluation of non-cavitated white spot lesions (WSL) in orthodontic patients and using direct visual examination after the brackets removal, as the gold standard. METHODS: The sample consisted of 31 patients, 13-28 years old, under fixed appliance orthodontic treatment. Teeth (N = 619) were evaluated with the brackets on, after cleaning and air drying, by direct, indirect visual examination and using the DIAGNOdent Pen™ device. After debonding with direct visual examination and the Vista Proof™ device. WSL were scored with the Gorelick Index for visual examination. The fluorescence devices were validated by calculating sensitivity, specificity and accuracy while ROC curves and area under the curve were used for comparison among the examination methods. RESULTS: Among the different diagnostic methods, visual examination recorded the highest degree of accuracy. The performance of the fluorescence devices was poor compared with that of the visual methods for mild WSL, while for more extended lesions no difference was found. A comparison between the validity of the two devices' showed no statistically significant difference. CONCLUSIONS: The validity of DIAGNOdent Pen™ and Vista Proof™ for the chairside diagnosis and quantification of non-cavitated WSL in orthodontic patients was moderate, and no better as compared to the visual diagnostic methods. The fluorescence devices performed similarly to the visual examination for more extended WSL and poorer for milder ones. Validity between the two devices did not differ.

Determining Caries Activity Using Oratest Among 12-to 15-year-old Children.

PURPOSE: Dental caries is the primary pathological cause of early tooth loss in children, which may lead to malnutrition and other health problems. Identification of patients with active carious lesions and at high risk for caries can help to dramatically decrease the disease prevalence. Thus, recognising the importance of early diagnosis of caries, the present study was carried out to correlate caries with oral microflora using Oratest among 12- to 15-year-old schoolchildren. MATERIALS AND METHODS: A total of 100 children were divided into control and test groups (n = 50) according to their DMFT scores. The test group was further divided into subgroup 1 (DMFT = 1-3) and subgroup 2 (DMFT > 3). Oratest, a caries activity test, was performed on all the children. Comparison among the variables was done using ANOVA and the independent sample t-test. RESULTS: Boys had lower DMFT values (1.35 ± 0.2) than did girls (1.67 ± 0.2) (p = 0.38), and the Oratest time was higher among boys (132.8 ± 0.5 min) than girls (126.4 ± 0.5 min) (p = 0.53). The control group had the highest mean Oratest time (172.7 ± 0.3 min), followed by subgroup 1 (97.8 ± 0.2 min), and subgroup 2 had the lowest Oratest time (68.5 ± 14.8 min). A statistically significant negative correlation (r = -0.893) was found between the mean DMFT and the Oratest time (p < 0.001), ie, they were inversely related to each other. CONCLUSION: An inverse relationship exists between Oratest and DMFT score.

Diagnostic Accuracy of a Bioluminescence System for the Assessment of Caries Activity on Occlusal Surfaces.

OBJECTIVE: Assessment of caries lesion activity is usually performed using visual-tactile criteria. A new approach is to use a system consisting of a photoprotein, which is specific for free calcium ions, along with an integrated camera that visualizes the elevated calcium ions on the lesion as a light signal (bioluminescence). This study aimed to evaluate the reproducibility and diagnostic accuracy of a newly developed bioluminescence system to assess caries lesion activity on occlusal surfaces in vitro. MATERIALS AND METHODS: Ninety-four extracted permanent teeth with sound surfaces and both active and inactive caries lesions were included. The extent and activity of the investigation sites were classified visually according to the International Caries Detection and Assessment System. Digital images of the teeth were produced by the bioluminescence system and the images were analyzed for the presence of caries activity (the bioluminescent areas at the investigation sites). The images were reanalyzed after 4 weeks. Teeth were hemisected and methyl red dye was applied on the sections to validate lesion activity histologically. RESULTS: Agreement between the bioluminescence readings was shown by κ values of 0.802-0.917. A significant positive correlation (p < 0.001) was found across all methods (rs 0.618-0.811). Sensitivity and specificity for activity assessment using histology as the gold standard (cut-off: active/inactive) were, respectively, 83.6 and 85.0% for the visual assessment, and 92.5 and 90.0% for the bioluminescence method. Comparison of areas under the receiver-operating characteristic curves showed no significant difference between the visual and bioluminescence systems (p = 0.094). CONCLUSION: The bioluminescence system demonstrated high in vitro reproducibility and good diagnostic accuracy for activity assessment of caries lesions on occlusal surfaces which were not significantly different from the values obtained in the visual assessment.

Clinical performance of fluorescence-based methods for detection of occlusal caries lesions in primary teeth.

We aimed to investigate the performance of fluorescence-based methods (FBMs), compared to visual inspection after histological validation, in detecting and assessing the activity status of occlusal carious lesions in primary teeth. One examiner evaluated 50 primary molars close to exfoliation in 24 children. Teeth were assessed using quantitative light-induced fluorescence (QLF) and pen-type laser fluorescence (LFpen). After exfoliation, histological validation was performed. Teeth were cut and sections were evaluated for lesion depth and activity status (after utilization of a pH indicator) under a stereomicroscope. Parameters related to the performance of the methods in detecting caries lesions at two thresholds (initial and dentin lesions) were calculated. Regarding the activity status, lesions were classified into sound+inactive or active, and the area under the ROC curve and the diagnostic odds ratio values of the methods were calculated and compared. Evaluation of red fluorescence using QLF presented higher sensitivity but lower specificity than visual inspection in detecting dentin caries lesions. However, QLF considering different parameters and LFpen had similar performance to that obtained with visual inspection. Regarding activity assessment, all FBMs and visual inspection also presented similar performance. In conclusion, FBMs did not prove advantageous for the detection and activity assessment of occlusal caries lesions in primary molars when compared to visual inspection.

Identifying a Potential Summary Measure for Overall Caries Level in Children Examined with the International Caries Detection and Assessment System.

OBJECTIVE: To identify a potential summative summary measure that reflects a patient's overall caries level in children examined with the International Caries Detection and Assessment System (ICDAS). SUBJECTS AND METHODS: Participants were 1- to 15-year-old children from Kuwait, Brazil, and Spain. Children's teeth were examined using the ICDAS. Multiple measures of central tendency and dentition-specific indices were considered as potential summative measures. The relationship between the summative measures and number of caries lesions was evaluated considering degrees of caries severity using Spearman's correlation analysis. The results were generated using the Kuwaiti sample and were cross-validated using the Brazilian and Spanish samples. RESULTS: A total of 2,808 children participated in the present study. Total ICDAS score and mean ICDAS score showed a strong correlation with the number of caries lesions at different caries severity levels in primary, mixed, and permanent dentitions. The total ICDAS score of 51 buccal (B), 61B, 54 occlusal (O), 55O, 64O, 65O, 74O, 75O, 84O, and 85O surfaces in primary dentition and the total ICDAS score of 14O, 16 lingual (L), 16O, 24O, 26L, 26O, 36B, 36O, 37O, 46O, 46B, and 47O surfaces in permanent dentition or mixed dentition (if present) showed strong correlations with the number of caries lesions at different caries severity levels. CONCLUSIONS: Total ICDAS and mean ICDAS scores were the best summary measures of overall caries level at different dental stages. Total ICDAS scores of selectively examined 10 surfaces in primary dentition and 12 surfaces in permanent dentition can give an excellent summary measure for a patient's overall caries level with high diagnostic accuracy.

[Preventive dentistry 6. Prevention of caries in frail older people]. / Preventieve tandheelkunde 6. Preventie van cariës bij kwetsbare ouderen.

Many older people have a bad oral health, with (root) caries a prevalent cause. Alarming results of research projects raise the question whether sufficient preventive measures are being taken to prevent the development and progress of (root) caries in frail older people. A review of the recent literature revealed that in frail older people and physically or cognitively impaired adults, daily use of a 5,000 ppm fluoride toothpaste and quarterly application of chlorhexidine or sodium fluoride can decrease by half the risk of root caries. In the Netherlands, toothpaste containing 5,000 ppm fluoride is not (yet) on the market. At the present time, only the advice brochure 'Prevention of root caries' is available. Another measure to prevent deterioration of oral health among frail older people is paying attention to frail older people who do not visit their dentist on a regular basis due to physical limitations and care dependency. When this is the case, it is necessary to intensify professional oral healthcare with instructions to personal caregivers and professional care providers in order to fight (root) caries.

Diagnosis of occlusal caries lesions in deciduous molars by coherent light scattering pattern speckle.

BACKGROUND: This study presents the correlation between laser speckle images and detection of incipient caries lesions from changs in the microstructure of the surface of tooth enamel. METHODS: We used 30 healthy deciduous molar teeth collected from the Biobank Human Teeth, Faculty of Dentistry, University of São Paulo who had carious lesions induced by the pH cycling method. The samples were evaluated for the diagnosis of caries by two methods ICDAS and speckle pattern of coherent light scattering after 5, 10 and 15days and the results were statistically analyzed using α=0.05 significance level. RESULTS: A significant difference was observed between the image of the speckle scattering of healthy and injured areas within the 3 study groups, but not when comparing the three groups, showing us that it is an innovative technique that needs further study, but can be used as a diagnostic method for the detection of early caries lesions. CONCLUSION: It can be concluded that the analysis of scattering speckle pattern is a diagnostic technique that provides information on the microstructure of the surface of tooth enamel which has sensitivity for detection of incipient caries lesions.

Examiner's experience and the outcome interpretation of ICDAS and Nyvad's system - a prospective in vitro study.

OBJECTIVE: To evaluate, prospectively, the influence of examiner's experience in interpreting and applying the caries detection systems ICDAS (IC) and Nyvad (NY). MATERIAL AND METHODS: Twelve second-year undergraduate dental students (UG) and 12 postgraduates (PG) MSc level analysed and codified 77 clinical dental caries photographs at three different moments: initially, without any training; after one week of receiving training through a theoretical class; and after two years. Reproducibility and correlation was evaluated; sensitivity, specificity and area under ROC curve (AUC) were dichotomized according to the presence of cavitation (IC) and in relation to disease activity (NY). RESULTS: IC presented good kappa values for the first two evaluations. Both criteria resulted in good Spearman's correlation after two years (IC = UG: 0.89; PG: 0.93/NY = UG: 0.81; PG: 0.82). Sensitivity, specificity and AUC were statistically higher in the third evaluation by UG for Nyvad. CONCLUSIONS: ICDAS criteria seem to be instinctively understood by students without clinical experience. Nyvad's concepts performed better after two years where the students deepened their theoretical knowledge and experienced clinical practice, collaborating with the identification of activity signs.

Laser fluorescence in monitoring the influence of targeted tooth brushing on remineralization of initial caries lesions on newly erupted molar teeth - RCT.

OBJECTIVE: This study aimed to monitor mineralization changes in initial caries lesions on newly erupted second molars using laser fluorescence (LF) scanning after a 1-month targeted tooth brushing intervention. METHODS: Altogether, 124 13- to 14-year-old school children were invited to participate. Of those who fulfilled the clinical criteria (at least one initial lesion with LF value >10 in second molars), 51 gave their written consent to participate. Laser fluorescence values were registered at baseline and after 1-month follow-up period. All participants were individually taught targeted tooth brushing of their second molars and randomly provided tooth paste with 0 or 1500 ppm fluoride. Brushing frequency was investigated at baseline and after the follow-up. Change in LF values was compared considering the tooth, content of fluoride in the paste and brushing frequency. RESULTS: In lesions with LF values ≤30 at baseline, change in LF values demonstrated improvement. Improvement was detected especially in upper molars. In lesions with LF values >30 at baseline, improvement was least detected. Brushing frequency increased slightly during the intervention. CONCLUSIONS: Laser fluorescence is a simple method and useful in monitoring remineralization of incipient lesions even in weeks. Targeted tooth brushing seems to induce remineralization even in weeks. Laser fluorescence could be a valuable motivating tool in promoting patients' self-care.