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Statistical models for mouthlevel caries data

One major restriction of the Poisson regression model is that its mean is equal to its variance. For dental caries data, however, it is not uncommon for the variance to be much greater than the mean. For such data, a negative binomial regression model has been advocated as an alternative to Poisson regression models. It is typically used when the variability in the data cannot be properly captured by Poisson regression models. The negative binomial model is a conjugate mixture distribution for count data (Agresti, 2002). It is entirely specified by two parameters, its mean and the overdispersion parameter. Similarly to the Poisson regression model, the mean is related to potential explanatory variables using a log link function. However, the probability mass function of Y is given by where the success probability is related to covariates as nx a+xp, with a and p being the intercept and the regression parameter vector associated with X. One should note however that Poisson and negative...

Evaluation of the performance of caries detection methods

The performance of caries detection methods should be assessed considering two important parameters reproducibility and validity. A reproducible method is the one that presents similar results and shows an agreement between two exams performed in different Concerning methods' validity and calculation of sensitivity and specificity values it is necessary to establish limits to define what disease and healthy mean considering the gold standard. These limits can also be called cut-off points, which are combined according to the criteria used for the gold standard classification. For example, caries lesions can be classified in (0) caries free, (1) caries extending up to halfway through the enamel, (2) caries extending into the inner half of enamel, (3) caries in dentin and (4) deep dentin caries. Therefore, cut-off points can be defined as follow D1 all caries lesions are considered disease (1, 2, 3 and 4) D2 only caries lesions from the inner half of enamel are considered disease (2, 3...

LED technology Midwest Caries ID

Recently, another device for caries detection was developed on LED technology - Midwest Caries I.D. - (DENTSPLY Professional, York, PA, USA) (Figure 9). The handheld device emits a soft light emitting diode (LED) between 635 nm and 880 nm and analyzes the reflectance and refraction of the emitted light from the tooth surface, which is captured by fiber optics and is converted to electrical signals for analysis. The microprocessor of the device contains a computer-based algorithm that identifies the different optical signature (changes in optical translucency and opacity) between healthy and demineralized tooth (Strassler and Sensi, 2008). Fig. 9. Midwest Caries I.D. device and the standard for calibration procedure. The demineralization leads to a change in the LED from green to red with a simultaneous audible signal, which is directly related to the severity of caries lesions. According to the manufacturer, when there is a change in the optical translucency and opacity of the dental...

Electrical caries monitor ECM

Over the last decades, the relationship between the extent of caries in teeth and electrical resistance has been investigated. It is possible to assess caries lesions considering the various parameters affecting the electrical measurements of teeth, such as porosity, surface area of the contact electrode, the thickness of the enamel and dentin tissues, hydration of the enamel, temperature, ionic content of the dental tissue fluids, and the maturation time of the tooth in the oral environment (Neuhaus et al., 2009). The studies on electrical caries monitor device (ECM) (Figure 12) have assessed these parameters in a site-specific or surface specific mode. This method has shown different results of reproducibility and validity (Huysmans et al., 2005 Kuhnisch et al., 2006). Some in vitro studies indicated that the presence of stain is a confounder for ECM measurements. Besides, the different cut-off limits for enamel and dentin caries lesions may be needed for stained teeth (Cortes et...

Caries probing CP or tactile examination

Until recently, probe exploration formed part of the diagnostic routine in occlusal caries. Probe entrapment in the grooves and fissures helped in establishing the diagnosis. Although this technique is now contraindicated, some professionals continue to use caries probing (CP). The exploration probe has been evaluated as a diagnostic tool in many studies (Lussi, 1991 Lussi & Francescut, 2003). The sensitivity of CP in the detection of occlusal caries is 0.5-0.6 (Hamilton, 2005), though with high specificity values (Bader et al., 2002). The tip of the probe is unable to reach the bottom of the fissures, because of its thickness and the anatomy of the fissures. The probe tip size varies depending on the manufacturer. This lack of standardization of the tip size can make exploration difficult (Lussi, 1993). In addition, a number of studies (Lussi, 1991 Hibst et al., 2001 Hamilton, 2005) have demonstrated that a sharp-tipped probe can cause damage to recently erupted teeth and produce...

Inhibition Ofdental Caries

Cocoa contains substances that protect against dental caries (Palenik et al 1977, s'Gravenmade et al 1977) and in vitro experiments have shown that monomeric polyphenols and tannins from cocoa may interfere with glucosyltransferase activity of Streptococcus mutans and reduce plaque formation (Kashket etal 1985). Similar results were reported in hamsters, with a marked caries-inhibitive effect found with a water-extract of cocoa (Stralfors 1966). Cocoa bean husk, while not used in cocoa or chocolate, demonstrates antibacterial properties attributed to its unsaturated fatty acids and antiglucosyltransferase activities attributed to epicatechin polymers, as well as being shown both in vitro and in vivo to possess significant antiplaque activity (Matsumoto et al 2004).

Electronic caries monitorization ECM

Electronic caries monitorization (ECM) is based on the high electrical conduction resistance of the hard dental tissues. Enamel is a poor electrical conductor though caried enamel shows increased conductance versus intact enamel (Loesche et al., 1979). Demineralized enamel becomes more porous, fills with ion-containing fluid and minerals from saliva, and therefore exhibits increased electrical conductance (McComb & Tam, 2001). Two devices have been developed, with tips designed for application to the occlusal surface and for measuring electrical conductance in pits or fissures (Zandona & Zero, 2006). The Electronic Caries Monitor (LODE, Groningen, the Netherlands), in the same way as its predecessor (Vanguard, Electronic Caries Detector, Massachusetts Manufacturing Cooperation Cambridge, MA, USA), was developed for diagnosing occlusal surface caries, and allows the identification of early-stage demineralization lesions. The sensitivity performance in application to permanent...

Protection from and Prevention of Dental Caries

These factors may provide a reasonable explanation for many of the differences in caries experience observed between individuals and populations and between different locations within an individual's dentition. They do not explain the dramatic reduction in caries prevalence seen throughout the developed world in the last 30 years. There is no doubt that this improvement has been caused by the introduction of fluoride toothpaste.

Probiotics and oral health

Several authors have suggested that probiotic bacteria could also be beneficial to oral health. Species of Lactobacillus and Bifidobacteria may exert beneficial effects in the oral cavity by inhibiting cariogenic Streptococci and Candida spp (Bhardwaj, 2010). Table 3. Possible mechanisms of a probiotic in oral health 4.4 Probiotics and dental caries From a view point, probiotics (lactobacilli) could hydrolyse proteins, stimulate growth of streptococci the streptococci are acidogenic bacteria and produce low pH conditions in the oral environment (Robinson and Tamine, 1981). Also untreated caries cavities should also be questioned at this point. On the other hand, in recent studies, it was stated that probiotic might decrease the risk of the highest level of Streptococcus mutans (Ahola et al, 2002) or might increases salivary counts of lactobacilli while S. mutans levels were not modified (Montalto et al, 2004). To have a beneficial effect in limiting or preventing dental caries, a...

Dental caries determination

Images were evaluated by trained investigators using a scoring system specifically adapted for use with photographed images (International Caries Detection and Assessment System II Ismail, 2005). Visible labial surfaces examined included maxillary and mandibular central and lateral incisors, canines, first and second premolars, and first molars. The evaluators scored each visible labial tooth surface before and after orthodontic treatment. The scores were combined to determine the labial caries incidence for each patient. Teeth were examined and scored from first molar to first molar, maxilla and mandible (Fig. 2).

Trends in dental caries

Caries epidemiology continues to be an important issue in both oral health surveillance and research into refined methods for caries diagnosis (Marthaler, 2004). The changing on caries disease patterns throughout the world are closely linked to number of public health measures, including effective use of fluorides, together with changing living conditions, lifestyles and improved self- care practices (Petersen, et al., 2005). In Europe and specifically in Western Europe the decline in caries prevalence has been very substantial. It has not received much attention until recently but is now often taken for granted. However, caries prevalence is still very different when looking at various parts of Europe, and may undergo unexpected changes due to various factors. Increasing immigration has been identified as a new factor, leading to increases of the overall dental caries prevalence in Switzerland (20 non-Swiss residents), the Netherlands and Germany (Marthaler, 2004). Furthermore, there...

Dental programs for caries prevention

Oral Health is fundamental to general health and well-being. A healthy mouth enables and individual to speak, eat and socialize without experiencing active disease, discomfort or embarrassments. Children who suffer from poor oral health are 12 times more likely to have restricted-activity days than those who do not. More than 50 million school hours are lost annually because of oral health problems which affect children's performance at school and success in later life (Kawan, et al., 2005). Basically, erupting teeth are healthy. The first carious lesion and the first restoration in a tooth means the start of series of treatments that during the tooth's lifetime will end up in more and more complicated restorations or treatments if the caries process is not controlled. Today there is enough scientific knowledge about factors that might interfere in this process in order to develop preventive strategies. Operative treatment per se will never control caries. (Koch & Poulsen, 2006)....

Early Childhood Caries ECC

Dental caries is a complex, multi-factorial disease and is a significant health and social problem which affects people of all ages and is responsible for a vast amount of pain, misery and economic loss. It is a major problem in young children. Caries of the primary teeth Early Childhood Caries or ECC is one of the most prevalent health problems in infants and toddlers (Mayanagi et al, 1995). It can be considered an epidemic in lower-income families and in under developed parts of the world (Ismail & Sohn 1999). ECC is one of the major causes of hospitalization in young children, who often need to receive general anaesthesia for extraction or tooth restoration (Sheller et al, 1996).

Diagnosis of secondary caries 21 Histology of secondary caries

In the 1970s, Hals et al. did a comprehensive investigation of the secondary caries lesions around various restorative materials both in vitro and in vivo, and natural secondary caries on the extracted restored human teeth Hals, 1975a, 1975b Hals et al., 1974 Hals and Nernaes, 1971 Hals and Norderval, 1973 Hals and Simonsen1972 . According to their studies, whatever the restorative material type is, the secondary carious lesion displayed histologically the same basic pattern (Fig. 1) 1) an outer lesion, which is caused by the a new primary attack on the outer surface of the tooth 2) a wall lesion, might be the consequence of the diffusion of bacteria, fluids or hydrogen ions between the restorations and the cavity wall. It is also supposed in their study that the fluoride released from the silicate material would be taken by both the cavity wall and the tooth surface around the restoration, which might reduce glycolysis and induce the remineralization Hals, 1975a . Thus, the...

Frequency and location of diagnosed secondary caries

Since the early days of restorative dentistry, the phenomenon of secondary caries has been known and considered as the basis for the extension-for-prevention concept, the well-known principles of cavity preparation established by G.V. Black in the last century Black, 1908 . The clinical diagnosed secondary caries has been shown to be principal cause for the replacement of all types of restorations both in permanent and primary teeth, 50 -60 of restorations are replaced as a result of the diagnosis of secondary caries Mjor and Toffenetti, 2000 . As the development of restorative materials, some literatures regarding secondary caries indicated that the prevalence of secondary caries is associated with the restorative material type, although it may occur with all restorative materials Burke et al., 1999b Forss and Widstrom E, 2004 Mjor, 1997 Mjor and Jokstadt, 1993 . Some published researches showed that compared to amalgam restorations, resin-based composite restorations represented a...

Treatment of secondary caries

Restoration replacement has been invariably deemed as the sequela of clinically diagnosed secondary caries. Although practitioners are suggested should pay attention to the differentiation between secondary caries and discoloration, defective margin and residual caries, generally, a localized surface defect adjacent to restoration features clinically diagnosed secondary carious lesion Mjor, 2005 . However, Some dental teaching programs related to localized defects on restorations including secondary caries , indicate that repair, rather than replacement, of the restoration is adopted frequently as an alternative to total replacement Mjor and Gordan, 2002 Blum et al., 2002 Blum et al., 2003 Gordan et al., 2003 . Moreover, the modern conservative dentistry and minimal intervention dentistry call for repairing and refurbishing any localized defects at restoration margins, clinically diagnosed secondary caries rather than total replacement of restoration Ericson et al., 2003 . Despite of...

Public health aspects of dental caries

Despite improvements in the oral health of children in recent decades, early childhood caries (ECC) remains a serious threat to child welfare. ECC is manifested by severe decay of primary teeth. This can be a debilitating condition that can not only affect the children but also their families and the communities in which they live. Toothache leads to school absence, which is a ready indicator of children's health. In the USA, where caries is lower than elsewhere, visits or dental problems accounted for 117 000 hours of school lost per 100 000 children (Gift et al, 1992). Because most school dental services work mainly during school hours, loss of schooling among the poor, who have higher caries rates, is high. Other manifestations of ECC include pain, infection, abscesses, chewing difficulty, malnutrition, gastrointestinal disorders, and low self-esteem (Ripa, 1988). ECC might also lead to malocclusion and poor speech articulation, and is associated with caries in the permanent...

Caries detection methods

The detection of carious lesions has been primarily a visual process, based principally on clinical-tactile inspection and radiographic examination. Caries detection methods should be capable of detecting lesions at an early stage, when progression can be arrested or reserved, avoiding premature tooth treatment by restorations. However, none of the conventional methods fulfill this requirement and are highly subjective. The development of some alternative non-invasive detection methods, such as laser fluorescence devices (DIAGNOdent and DIAGNOdent pen), quantitative light-induced fluorescence (QLF), fluorescence camera (VistaProof), LED technology (Midwest Caries I.D.), fiber-optic transillumination (FOTI), digital imaging fiber-optic transillumination (DIFOTI) and electrical caries monitor (ECM), can offer objectives assessments, where traditional methods could be supplemented by quantitative measurements. Visual changes of the dental structure resulting from the demineralization...

Relationship between root caries and alveolar bone loss in Yayoi people

Above mentioned, the people of the Yayoi had carious lesions that were most frequently located on the root surfaces of their teeth. Root surface exposure is a prerequisite for this type of decay, and alveolar bone loss is the main cause of such exposure. Therefore, we identify the factors associated with root caries, and examine the relationship between root caries and alveolar bone loss in the people of the Yayoi period. As shown in Table 2, the prevalence of root caries was significantly higher (78.7 ) among those with a mean CEJ-AC distance > 3.4 mm than among those with a distance < 3.3 mm (54.1 ). In addition, significant differences in the mean number of teeth with root caries were observed according to age, presence of coronal caries, and the mean CEJ-AC distanceper person. The prevalence of root caries and the mean number of teeth with root caries per person were significantly associated with the mean CEJ-AC distance per person. Root caries p -value1 Mean number of teeth...

The antiquity of caries Evidences of caries in hominines and early humans

Caries is a very old disease and it is not exclusive of the human species. Evidences of dental lesions compatible with caries have been observed in creatures as old as Paleozoic fishes (570-250 million years), Mesozoic herbivores dinosaurs (245-65 million years), pre-hominines of the Eocene (60-25 million years), and Miocenic (25-5 million years), Pliocenic (5-1.6 million years), and Pleistocenic animals (1.6-0.01 million years - Clement, 1958 Kear, 2001 Kemp, 2003 Sala et al., 2004). Caries has also been detected in bears and other wild animals (Pinto & Exteberria, 2001 Palamra et al., 1981), and it is common in domestic animals (Gorrel, 2006 Shklair, 1981 Wiggs & Lobprise, 1997). In humans, caries is one of the most widely spread diseases and its presence takes place into our species origins. Paleodietary reconstructions have provided a high amount of data on the presence of caries in ancestral lineages. An approximal groove located in the cementum-enamel junction (CEJ) of...

Key factors related to caries prevalence in human populations Physiological or cultural factors

Much of the studies carried out in hunter-gatherers and farmers from different latitudes and temporal periods have stated a particular trend women show higher caries prevalences than men (Larsen et al., 1991 Lukacs, 1992, 1996, 2008, 2011 Luckacs & Largaespada, 2006 Milner, 1984 Rodriguez, 2003 Walker & Hewlett, 1990). This phenomenon suggests two possible, not necessarily excluding, explanations a) there is a major constitutional predisposition in females to caries b) the differences are culturally regulated. Clinical researches of the last decades have revealed that physiological differences between sexes have an important indirect impact on oral ecology. The saliva's chemical composition and flow are modified in various manners according to hormonal fluctuations associated with puberty, menstruation, and pregnancy. These processes lead to a much more cariogenic oral environment in females than in males. Estrogen levels are positively correlated with caries rates whereas...

The new research agenda on the historical relation between caries and food

The main objective of the study of caries and other dental diseases from the anthropological point of view is to recognize long term dietary changes related to historical events, with the purpose of understanding the rise of civilization as an integrated process that articulates not only new subsistence patterns and technologies but also new forms of relationship among human beings. Bioanthropological literature offers several comparative studies of caries among groups with known subsistence patterns and social organization that indicates that dental diseases are less frequent or do not appear in hunter-gatherers, whereas they are more frequent and variable in farmers (Table 2). However, there is not simple or universal explanation for patterns of changes in caries frequencies during human history (Tayles et al., 2000, 2009). The relationship between caries and agriculture is based on the assumption of an increase of carbohydrate in the diet and the supposition that all these...

Anti Dental Caries Introduction

Dental caries and periodontal disease are major public health problems that bother all countries in the world. Dental carie is an infectious, communicable disease that acid-forming bacteria of dental plaque can destroy tooth structure in the presence of fermentable carbohydrates such as sucrose, fructose, and glucose. The mineral content of teeth is sensitive to increases in acidity from the production of lactic acid. So, the infection results in loss of tooth minerals from the outer surface of the tooth and can progress through the dentin to the pulp, finally compromising the tooth vitality. Industrialized nations have controlled the problem with fluoride enriched water and personal hygiene products since early in the 1960s, but cariogenicity remains a crisis that economically burdens the health care system. Dental disease remains a silent epidemic in the world that threatens children and adults. The oral streptococci especially mutans Streptococci are related with the development of...

Future prospects of functional foods for the prevention of dental caries

In Japan, various types of functional foods have been developed and widely consumed for health promortion. Some of them have been advanced for prevention of dental caries. GTase inhibitors and sugar substitutes that are not the direct cause of dental caries are actively developed and utilized as preventive foods for dental caries. Recently, functional materials which enhance the defence system of host on dental caries are further added to those foods. For example, there are functional materials that promote re-mineralization of tooth and stimulate saliva excretion to block oral pH decline. The probiotics which improves oral bacterial flora may also be expected to be one of these functions. If functional materials that have different types of preventive effect for dental caries are combined in a functional food, the potential of functional foods may expand the food market for health promotion. It is important that intraoral pH does not decline for prevention of dental caries among...

Conclusion For Dental Caries

According to 1999-2004 survey in the United States, the mean dfs for children 2-8 years was 3.7, although for 6-11 years of age was 4.30 and 1.84 for dft. The same study reported 51.17 caries prevalence in primary dentition for 6-11 years old children. However, caries experience for permanent teeth was 21 while DFS index was 0.65. Additionally, a prevalence of 10.16 , 0.19 DFT and 0.29 DFS were reported in children from 6 to 8 years old (Dye, et al., 2010 National Institute of Dental and Craniofacial Research, 2011). Reports from Varmland, Sweden indicate that 76 of 6 years-old children are caries free in primary dentition, while 7,8,9 and 10 years old children were 98 , 96 , 94 and 92 caries free for permanent dentition, respectively. (Axelson, 2004). In Europe, some reports have indicated a 79-93 dmfs or DMFS, or equal to zero (Marthaler, et al., 2004) In 2001, caries prevalence in Chinese children aged 5-6 years was 78 -86 , and dmft was 4.8 - 7.0. A lower prevalence of caries was...

National Trends in Caries Prevalence

Data on the prevalence of dental caries within populations are nowadays very reliable as they are collected to internationally recognized standards. Surveys of 12-year-old children are carried out in most countries, and the data are collated by the World Health Organization (see Table 1). In contrast, data for adults are scarcer. The general picture emerging from the repetition of these national surveys is clear. In many countries the prevalence of caries is falling, often dramatically. In poorer countries this is unlikely to be the case, and, even within the richest countries, the dental-health experience of the economically disadvantaged Table 1 Prevalence of caries by region the table shows the mean number of teeth with decay experience in 12-year-old children Data obtained from the WHO Oral Health Country Profile Programme, WHO Collaborating Centre (website http www.whocollab. odont.lu.se index.html). Attempts to account for these trends are hampered by the unreliability of data...

Prevention and treatment of secondary caries 41 Prevention of secondary caries

As secondary caries is one of the major reasons for restoration replacement, a large number of clinical dentists and scientists have placed great emphasis on preventing or slowing down the procession of secondary caries lesion from many aspects, so as to increase clinical restoration durability. Secondary caries, the same as other types of dental caries, is determined by the dynamic balance between pathological factors that lead to demineralization and protective factors that lead to remineralization. It is also considered that bacteria are an important etiologic factor leading to demineralization for secondary caries. Generally, the rationales of all the modification of restorative material or prevention of secondary caries normally include two fundamental points one is the decrease of demineralization and or increase of remineralization of the hard tooth tissues the other is to interfere the metabolism of caries-related bacteria and or to decrease the amount of bacteria inhibit...

Statistical models for intraoral caries data

Although many dental studies provide detailed tooth-level data on caries activity, most analyses still rely on aggregated scores such as the DMF index. These scores summarize at mouth level caries information for each individual typically recorded at the tooth level or tooth-surface level. They have therefore been instrumental in evaluating and comparing the risks for dental caries among population groups. Despite these advances in the etiology of dental caries, there are still some fundamental questions regarding the spatial distribution of dental caries in the mouth that remain unanswered. The intra-oral spatial distribution of dental caries can help answer questions on whether the disease develops symmetrically in the mouth, and whether different types of teeth (Incisors, Canines and Molars) and tooth surfaces (Facial, Lingual, occlusal, Mesial, Distal, and incisal surfaces) are equally susceptible to dental caries. It is well recognized that the different morphology of the...

Adhesion to caries affected dentine

Carious lesions have different characteristics depending on diverse factors such as host, diet, period of time and injury severity. Controversial results can be observed in the literature of adhesion to caries-affected dentine. While some studies claim that the bond strength obtained in caries affected dentine is similar to the attained in sound tissue (Mobarak et al., 2010 Zanchi et al., 2011 Zawaideh et al., 2011), other researchers detected lower bond strength when adhesives were applied on caries affected dentine (Kunawarote et al., 2011 Marquesan et al., 2009 Perdigao, 2010). Basically, these diverse results can be due to the use of natural carious human molars to compose the sample. Although some studies use artificial caries affected dentine (Zanchi et al., 2011) results are still controversial. Also, using natural carious substrate in experimental studies can induce results with high variability consequently, they do not allow direct comparison between studies. Bonding to...

The relevance of microleakage to secondary caries

Microleakage refers to the clinically undetectable leakage between the cavity wall and the filling Kidd, 1976 . Irie et al. found that a gap of 6-10 m formed immediately even after applying an acid etch and a bonding agent Irie et al., 2002 . Iwami et al. have confirmed that any restorative material can completely eliminate the microleakage between restoration and the cavity wall Iwami et al., 2005 , supported by other researches Irie and Suzuki, 1999 Huang et al., 2002 Piwowarczyk et al, 2005 . A study in vitro showed that there was no significant difference in the degree of microleakage between conventional caries removal and chemo-mechanical removal Mousavinenasab and Jafary, 2004 . Those above all show us that microleakage is inevitable. The microspace between the restoration wall and tooth can allow salivary pellicle accumulation and bacterial invasion Gonz lez-Cabezas et al., 1999 Gonz lez-Cabezas et al., 2002 Splieth et al., 2003 . In a sense, it provides a favorable...

Clinical and histological aspects of caries lesions on occlusal approximal and smooth surfaces

The occlusal surface is characterized by the pit and fissure systems, a favorable biofilm stagnation area where the bacterial accumulations receive the best protection against functional mechanical wear (mastication, attrition, abrasion from brushing, flossing or toothpicks). Those aspects contribute to the high prevalence of caries on occlusal surfaces both in the primary and permanent dentition (Kidd & Fejerskov, 2004). The complex anatomy of the occlusal surfaces requires professional special attention and deep understanding of how lesions develop on this surface. It is known that the deepest part of the fissure usually harbors non-vital bacteria or calculus (Ekstrand & Bj0rndal, 1997). An enamel caries lesion begins along the pits and fissures through acids diffusion from bacterial metabolism in the biofilm. This diffusion occurs through the side walls of the pits and Caries lesion on approximal surfaces in primary teeth presents a rapid rate of progression due to the...

Management Of Dental Caries

A seminal study showed that for individuals who have compromised salivary function, excellent oral hygiene alone is insufficient to prevent rapidly progressive dental decay.12 The use of topical fluoride and diet counseling was critical for caries prevention. Caries is an oral disease that can be exacerbated by salivary dysfunction. Therefore, treatment of this oral disease should address prevention and management. Important to this process are Caries risk assessment Early detection and prevention of caries Caries risk assessment can be determined from the oral examination looking for clinical signs of hyposalivation, measurement of salivary production, presence and number of active caries lesions, amount of plaque, quality of diet, frequency of ingestion and duration of exposure to sugar and fermentable carbohydrates, use of xeros-tomic medication, and clinical judgment. Specific protocols have been developed for caries risk assessment (Caries Management by Risk Assessment,...

Distribution of dental caries in Yayoi people

The distribution and site characteristics of dental caries previously identified in a Yayoi population using the aforementioned procedure. We examined 5010 teeth, 941 teeth were classified as antemortem teeth, and 998 teeth were classified as postmortal loss (Otani et al., 2009) (Table 1). The number of teeth in each individual ranged from a minimum of 2 to a maximum of 32, with an average of 19.5. The total number of carious teeth was 883, for a cares ratio of 17.6 . The percent of individuals with caries was 79.1 , and the percent of individuals with root caries was 65.8 Our analyses indicated that among the Yayoi people, most caries occurred in the root area, particularly on the approximal surface of the tooth root (Haraga, 2006). Moreover, Figure 3 shows the distribution of caries by tooth surface. When categorized into 3 groups, namely occlusal, , the occlusal surface percentage was 10.4 , the crown and root were compared, the crown ratio was 37.4 and the root ratio was 52.2 ....

Etiology of secondary caries 31 Microbiology of secondary caries

Dental caries is determined by the dynamic balance between pathological factors that lead to demineralization and protective factors that lead to remineralization Featherstone, 2004 . As a major pathological factor, oral bacteria, especially acidogenic bacteria, can dissolve the tooth mineral. Those acidogenic bacteria are also aciduric and can live preferentially under acid conditions Loesche, 1986 . Hitherto, it is unclear about the microbiology of secondary caries yet. Although secondary caries is described alike primary caries in histopathology, whether the etiology of secondary caries is the same as that of primary caries is a matter in dispute. Kidd et al. found no significant differences between the microflora in samples from cavity walls involving primary and secondary caries next to the amalgam Kidd et al., 1993 . However, Thomas et al. investigated bacterial composition in relation to primary and secondary caries via an in situ model, and found a phenomenon of higher...

Other Factors Affecting the Epidemiology of Caries

The influence of other factors that might be expected to have a bearing on caries experience has proved difficult to establish for practical reasons. These include the susceptibility of particular sites within the dentition or in an individual's mouth and local salivary flow rates. Both of these factors are known to be strongly influenced by genetic inheritance. The morphology of the teeth and, especially, the depth and shape of the fissures on the surfaces of the molar teeth are strongly heritable. It is generally difficult to predict, in advance of caries developing, which sites will be particularly susceptible. But one successful preven-tative approach has been to identify children with deep fissures in their molar teeth at an early age and offer prophylactic treatment in the form of sealants. This addresses the most common site of early childhood caries (the molars) and targets those children most at risk because of unfavorable tooth morphology. The rate of salivary flow, both at...

Experimental Models of the Caries Process

Because direct manipulation of the caries process in human subjects is impossible for ethical reasons, a number of techniques have been developed that provide insights without risking clinical damage to the teeth of experimental subjects. Much of the earlier work relied on measurements of the change in plaque pH that followed a single consumption episode of a food or drink containing a source of fermentable carbohydrate. This approach provides an indication of the potential cariogenic challenge of these exposures and addresses the fundamental question of whether pH falls to a level that is expected to give rise to demineralization of the tooth enamel. Plaque pH measurements have thus been used to assess whether a food or drink may be considered safe for teeth. But this technique does not provide any information on the influence of the repair processes that follow exposure to a demineralizing challenge. These models have provided useful information not only on the relative cariogenic...

Caries Causing Bacteria

6 months of age) and continues throughout life. There is evidence to suggest that the initial colonization of a baby's teeth with cariogenic bacteria may arise by infection from the mother's mouth. The common practice of sampling the food in a baby's dish, to check that it is not too hot, using the same spoon that is to be used to feed the baby may be a particularly effective way of transferring bacteria from carer to baby. Brushing the teeth with a toothbrush will remove part, but not all, of this film and its accompanying bacterial population. Many of the bacteria present are harmless, but a number of species are capable both of metabolically converting carbohydrates to acids (acidogenic bacteria) and of continuing to be metabolically active when the local pH has become too acid for most bacteria to tolerate. It is these bacteria that cause caries.

Practical Approach to the Prevention of Caries

The success of fluoridated toothpaste in preventing dental caries has resulted in a change in professional approaches to prevention. Instead of focusing simply on attempts to reverse the main causative factors, attention is now centered on exploiting protective influences. The interaction of the three main causative factors is illustrated in Figure 1. Numerous attempts to change the impact of any of these influences on caries have proved ineffective, except, perhaps, under the most extreme situations, such as during war time. Figure 2 A new model to explain and guide caries prevention. The local factors - insufficient use of fluorides, insufficient oral hygiene, and protection from saliva - form a 'window of risk' through which the circle of cariogenic food (shown dashed) can be seen in the background. (A) In this example it is clear that it would be impossible to reduce the food circle to such an extent that the window is not completely filled (less caries risk). (B) If oral hygiene...

Dental Caries

Sugars play an important role in dental caries development (Walker and Cleaton-Jones, 1992). Sugars provide a favorable environment for bac- teria in the mouth, and the presence of these sugars increases the rate and volume of plaque formation (Depaola et al., 1999). However, because development of caries involves other factors such as fluoride intake, oral hygiene, food composition, and frequency of meals and snacks, sugar intake alone is not the only cause of caries.

Enamel caries

According to some studies (Pretty, 2006), laser fluorescence is able to establish differences between the readings corresponding to active and inactive enamel caries in permanent molars. In this sense, LF would be able to serve in monitoring the lesion. However, other studies (Toraman et al., 2008) consider that the technique does not register the changes that occur during remineralization and caries development arrest, and cannot serve for monitorization purposes.

Dentin caries

Enamel aperture with a diamond drill, followed by elimination of the caried dentin with adequate instruments, is indicated in the case of dentin caries. Filling with resin composites or silver amalgam should follow. Ceramic incrustations may be considered in the case of important tooth involvement.

Etiology of Caries

The causes of dental caries and factors influencing their formation have been the subject of research for more than 100 years. The importance of oral bacteria was discovered well before the specific influence of sugars derived from the diet became known in around 1950. While the protective effect of fluoride has also been known for more than 50 years, the mechanism of this effect is still a subject of debate. Different approaches have been used to try to understand the caries process. Experimental studies have either induced clinically apparent caries or attempted to model the early stages of caries. Ethical limitations on studies that might cause caries in humans and increasing resistance to animal experimentation have stimulated a great deal of imaginative recent work with laboratory modelling. Direct studies of caries induction are rarely conducted nowadays. But, in the past, important evidence in this field has come from experiments in which caries were induced in laboratory...

Caries

The most common causes of the tooth lost are caries and periodontal disease, following a tooth fracture (Jacobsen, 2008). Data suggests that in most industrialized countries 60-90 of school aged children and almost 100 of adult population are affected by tooth decay (Petersen et al., 2005), with the prevalence, which is more higher in female than male (Lukacs & Largaespada, 2006 Ferraro & Vieira, 2010). Tooth decay or dental caries is defined as chronic, multifactoral disease characterised by localized destruction of hard tooth tissues. It attacks on the mineralized tissues resulting in demineralization and in some cases destruction of the matrix (Jacobsen, 2008) . By some authors dental caries starts as small subclinical demineralised subsurface, which following a periods of remineralization and demineralization, may progress or arrest (Walmsley et al., 2002). There is an opinion that approximatelly 50 different factors subdivided into a three groups are in correlation with...

Caries and lifestyle

3.1 Dietary changes and the raise of caries experience in past human societies In fact, the history of dental caries is associated with the rise of civilization, and more recently with dietary changes that occurred since the Mercantilism and Industrial Revolution. Several archaeological and historical works have confirmed the relationship between high caries frequencies and prevalences and the increase of carbohydrates intake in human populations from the advent of agriculture6 (Larsen, 1997 Saunders et al., 1997 Turner, 1979). Generally hunter-gatherers show low caries frequencies whereas peoples based on mixed economies, gardening, and farming, show increasingly higher caries rates (Hillson, 2001 Lukacs, 1992 Powell, 1985 Turner, 1979). For instance, in the North American Southeast the number of carious teeth in farmers is three times the number of carious teeth in foragers of prior epochs (Powell, 1985). In several populations from Eastern Woodlands of North America the changes are...

Toothaches

Often an indication of tooth decay, a toothache may also be a symptom of infection such as gum disease, an abscess (a pus-filled sac surrounding the root of a tooth), or sinusitis (seepage 226). The pain may be sharp and shooting or dull and throbbing it may be continuous, come in waves, or occur only when a decayed tooth comes into contact with sweet foods, or very hot or very cold foods. CAUTION If a toothache is accompanied by fever and swelling of the gums or face, or if a tooth feels loose, see a dentist within 12 hours. If a tooth is sensitive to hot or cold, and to sweet foods and drinks, or if there is pain on biting, see a dentist within 48 hours. Toothache with severe, shooting pain Toothache with unbearable pain Toothache with throbbing pain

Effect of pH values of the bleaching agents on mineral loss of enamel

The physical and chemically soundness of the enamel depends on the pH and the saliva consisting of calcium phosphate and fluoride. Caries lesions develop with the fermentation of carbohydrates by bacteria's, the formation of organic acids and the pH decrease. The critical pH value for the enamel is pH 5.5 and when the oral pH decreases below this value, the bands between the fibrils and apatite of the enamel dissolve and the inorganic structure is affected (Axellson, 2000). In a study (Mcgucking et al., 1992) the enamel surface of bleached teeth were examined with a scanning electron microscope and a profilometer. The results showed that the enamel surface was affected by different concentrated bleaching agents, but these differences were not related with the pH values of the agents. When Tezel et al (Tezel et al., 2011 Tezel et al., 2007) measured the pH values of the bleaching agents used in their study with a pH meter it had been found that the pH was approximately 8 for each...

Lightemitting devices

Other method used for caries detection is based on optical properties from sound and carious dental tissues. Fluorescence is a phenomenon where the light is absorbed in a specific wavelength and then emitted in a higher wavelength. This characteristic has been observed in the dental tissues, since the pattern of light absorption and reemission (spectrum of fluorescence) of the dental tissues varies according to the excitation light wavelength (Benedict, 1928). Thus, light absorption and reemission is different in the enamel, dentin and cementum, as well as in sound and carious tissues. For this reason, fluorescence can be used for the detection and subsequent diagnosis of dental caries. The natural fluorescence of hard dental tissues has been studied since long time ago. It is well known that as the enamel as the dentin shows an auto-fluorescence. In this way, caries lesions, dental plaque and microorganisms also show fluorescent components. It has been observed that the difference...

Laser fluorescence devices DIAGNOdent and DIAGNOdent pen

The emitted light reaches the dental tissues through a flexible tip. As the mature enamel is more transparent, this light passes through this tissue without being deflected. In contact with affected enamel, this light will be diffracted and dispersed. The later is able to excite either the hard dental tissue, resulting in the tissue autofluorescence, or fluorophores present in the caries lesions. These fluorophores derived from the products of the bacterial metabolism and has been identified as porphyrins (Hibst et al., 2001). The emitted fluorescence by the porphyrins is collected by nine concentric fibers and translated into numeric values, which can vary from 0 to 99. Two optical tips are available tip A for occlusal surfaces, and tip B for smooth surfaces. This device has shown good results in the detection of occlusal caries, however, it might not be used as the only method for treatment decision-making process (Bader & Shugars, 2006 Rodrigues et al., 2008). Fig. 5. DIAGNOdent...

Visual inspection with magnification VIM

Visual inspection with magnification (VIM) involves all the criteria and arguments defined for visual inspection (VI) without magnification. In the same way as with VI, the reported sensitivity data differ greatly, and can be as low as 0.20 (Lussi, 1993) - though accompanied by high specificity in most studies (Lussi, 1991). Magnification can improve the diagnostic performance of the test (Ekstrand et al., 1998 Lussi & Francescut, 2003). In this context, different studies have compared both methods (Lussi, 1993 Lussi, 1991 Lussi & Francescut, 2003), with the observation of superior sensitivity and specificity for VIM, though without reaching statistically significant differences versus VI. We obtained similar results, with a sensitivity rating for VIM (x2.6 magnification) of 0.76, versus 0.71 for VI (Guerrero, 2011). Our observed specificity (Guerrero, 2011) in turn is high, with a value of 0.84. In line with these results, Lussi (Lussi & Francescut, 2003) reported moderate...

Enamel monitorization

In this case the doubt is whether enamel caries exists or not. Bacterial plaque control is indicated in these situations, based on oral and dental hygiene measures and topical fluor application. If the suspicion of caries results from high LF readings with normal VI findings, monitorization fundamentally should be carried out with LF. The detection of positive VI signs or increased LF readings during follow-up, potentially indicative of lesion progression, requires fissure aperture. If caries is suspected on the basis of the VI findings, with normal LF results, the subsequent controls should be centered on VI. The detection of an increase in positive VI signs or

Hygienicdietary habits

There is little doubt that the change in lifestyle of civilization was resulting in an increase in the prevalence of dental caries, referring mainly to the increase of the diet of soft foods that contain carbohydrates. But also, there are certain foods that can protect against the formation of dental caries by the substances that they contain in their structure, either because they are fibrous, fatty or protein, etc. which reduces their cariogenic potential, and when mixed with sugary foods, reduce the potential of the latter, these are called protective foods, among which we mention the cheese. It has been shown to finish a meal with cheese for dessert, reduces the acidity of the plaque and therefore tooth decay (cariostatic). In recent years, has also increased the use of sweeteners and sugar substitutes investigations have focused mainly on sugar alcohols (sorbitol, mannitol, maltitol and xylitol), starch hydrolysates (Lycasin), protein (Monellina) and synthetic chemicals...

The role of antimicrobials in the future

A better understanding of bacterial communities found in biofilms, such as its diversity and interactions among cells, provides opportunities for new methods to control biofilm formation (Wade, 2010). It has been shown that blocking communication mechanisms between cells in biofilms (quorum-sensing) can partially restore their susceptibility to antimicrobial agents (Bjarnsholt et al., 2005). Other benefits may include reduction of pathogenic microorganisms due to reduction in the virulence mechanism in the microorganism of interest. In the particular case of dental caries, blocking or reducing the activity of glycosyltransferase in S. mutans would be interesting, since these enzymes are implicated in the ability of this cariogenic bacterium.

Evaluation of inhibitory effects on glucan production by GTase

Water-insoluble and water-soluble a-linked glucans produced from sucrose due to the action of GTases adhere to the surfaces of teeth and promote the development of dental caries. GTase inhibitors disturb the production of these glucans and prevent the development of dental caries. The inhibitory effect of test substances on GTase has been evaluated by partially purified GTase from mutans streptococci, particularly Streptococcus mutans and Streptococcus sobrinus, which are considered to be the primary causative agents of dental caries in humans. Partially purified GTase can be conveniently used to evaluate the inhibitory effects of test substances on glucan production because it is stable and readily administered after preparation. If S. mutans and S. sobrinus are directly used to evaluate the inhibitory effects of test substances on glucan production, the assay is complicated and additional effort is required

Animals and diets to evaluate anticariogenic effects

Fifteen-day-old specific pathogen-free Sprague-Dawley (SD) rats are suitable for caries studies. The first and second molars are coming through at this age. Mutans streptococci are inoculated to animals during this period. If inoculation lags behind, the prevalence of dental caries is reduced (Ooshima et al, 1994). The number of mutans streptococci that must be inoculated to definitely cause dental caries is very important. The breeding period after inoculation with mutans streptococci is about 55 days. Diet 2000 is a popular diet in animal experiments on caries (Keyes and Jordan, 1964) and contains 56 sucrose. If the percentage of sucrose is reduced, the prevalence of dental caries is also reduced. Phytochemicals are commonly added to the diet to evaluate anticariogenic effects. After breeding, the molar is removed and the degree of dental caries is scored. The details of the experimental protocol have been described (Ooshima et al, 1981 Tsunehiro et al, 1997). The typical procedure...

Amount of mutans streptococci

If oral infection by mutans streptococci is not sufficient, dental caries is not induced in the experimental animal despite feeding with a caries-inducing diet. The amount of mutans streptococci adhered on teeth also influences the development of caries. Accordingly, the amount of mutans streptococci in the oral cavity should be measured periodically until the end of the experimental schedule. According to several studies, dental caries is definitely induced if the amount of mutans streptococci is > 105 colony-forming units (CFU) mL (Ooshima et al, 1993 Tsunehiro et al, 1997).

Amount of sucrose intake and texture of diets

Dental caries is positively correlated with the amount of sucrose intake (Sreebny, 1982). Therefore, the amount of diet that the animals ingest needs to be equal among feeding groups. Furthermore, the Vipeholm Dental Caries Study clarified that the texture of food containing sucrose influences the occurrence of dental caries (Gustafsson et al, 1954). In that study, subjects ate several foods (e.g., bread, chocolate, caramel) containing sucrose. The incidence of caries was higher in the group consuming gooey foods between meals than in the control group. Namely, the ingestion of sucrose that causes the adhesion to the teeth surface becomes a high risk of dental caries induction. Therefore, the texture and configuration of test materials containing phytochemicals added to the animal experimental diet are important to get significance. If the texture and taste of test substances are unique and likely to influence intake and adhesion, the method to reduce these factors should be...

Safty aspects of probiotics

Although probiotics can affect most important caries pathogens, lactobacilli may correlate with caries development. Some strains of Lactobacillus spp., together with S. mutans, play a key role in development of dental caries. The production of organic acids from dietary carbohydrates is also a main factor in dental caries progression. If lactobacilli taken orally are able to adhere or temporarily establish themselves in the oral environment, their metabolism and acid production should not support caries induction. Studies addressing sugar fermentation has shown a strain dependent It has been also observed that caries free subjects are colonized by lactobacilli that possess a significantly increased potential to suppress the growth of mutans streptococci compared with caries active or arrested subjects (Stamatova & Meurman, 2009). Finally, it can be concluded that the lactobacilli effect on caries prevention seems favorable when probiotic strains are well selected.

Crystalline calcium phosphate remineralizing systems

Brushite has been added to products such as dentifrices (Zhang et al., 1995 Sullivan et al., 1997) in an attempt to enhance the remineralization of enamel subsurface lesions. Brushite is one of the more soluble crystalline calcium phosphate phases however, remineralization of subsurface lesions in vivo and slowing of caries progression in clinical trials have not been shown.

Unstabilized amorphous calcium phosphate systems

Published papers suggest that the unstabilized ACP ACFP technology may have efficacy in preventing caries progression. The unstabilized ACP ACFP may transform to poorly soluble phases in the mouth, and, in so doing, may act to promote dental calculus. The formation of fluoride-containing apatite intra-orally would sequester available fluoride ions, thereby reducing their ability to promote remineralization of subsurface enamel lesions. It is likely, though, that some of the ACP ACFP phases that are produced intra-orally may be stabilized by the phosphoproteins in saliva, pellicle, and plaque that are not at full stabilization capacity. This may explain the bioavailability of these technologies in the presence of saliva and the positive in situ model results (Reynolds, 2008). However, long-term randomized controlled caries clinical trials of the unstabilized ACP ACFP technologies need to be conducted to demonstrate efficacy in preventing caries and safety by the lack of dental calculus...

Casein phosphopeptides

Dairy products are the most recognized anticaries active food group (Reynolds. 1998). Using in vitro, animal and in situ caries models, the components largely responsible for this anticariogenic activity have been identified as casein, calcium and phosphate (Reynolds & Black. 1989) The bovine milk phosphoprotein, casein, which is known to interact with calcium and phosphate (Reeves & Latour.1958) and is a natural food component, is an obvious candidate for an anticariogenic food and toothpaste additive, however this is precluded by organoleptic properties and the very high levels required for activity. Using a human intraoral caries model, Reynolds (1987) showed that digestion of caseinate with trypsin did not destroy the protein's ability to prevent enamel sub-surface demineralization. Tryptic peptides of casein were found incorporated into the intra-oral appliance plaque and were associated with a substantial increase in the plaque's content of calcium and phosphate. It was...

Scientific evidence for remineralization by Cppacp and Cppacfp

The CPP-ACP literature has been reviewed by several authors (Reynolds, 1998 Llena et al., 2009 Azarpazhooh, et al 2008 Neuhaus, et al 2009, Yengopal & Mickenautsch, 2009). Yengopal and Mickenautsch (2009), in a systematic review, concludes that, within the limitations of the systematic review with meta-analysis, results of the clinical in situ trials indicate a short-term remineralization effect of CPP-ACP. Additionally, the promising in vivo randomized controlled trials results suggest a caries-preventing effect for long-term clinical CPP-ACP use. Further randomized control trials are needed in order to confirm these initial results in vivo. One randomized, controlled caries clinical trial of CPP-ACP assessed the impact of CPP-ACP in sugar-free gum relative to a control sugar-free gum. This trial demonstrated that the CPP-ACP gum significantly slowed progression and enhanced regression of caries compared with the control sugar-free gum (Morgan et al., 2008).

Laser interaction with dental hard tissues

Depending on laser wavelength and tissue characteristics, laser irradiation can be absorbed, scattered, reflected or transmitted into dental tissues (Ana et al., 2006 Featherstone, 2000 Niemz, 2004 Seka et al., 1996). These effects must be well known by professionals to help them choose the best equipment for a specific clinical application and to avoid thermal and mechanical damages to the target and surrounding tissues. Depending on the clinical situation, dentists need different laser wavelengths and irradiation parameters to obtain distinct effects on the same tissue. Considering the applications in restorative dentistry, the conventional high-intensity infrared lasers can be well-suited for caries removal (Neves et al., 2010 Tachibana et al., 2008 White et al., 1993), cavity preparation (De Moor & Delme, 2010 Moldes et al., 2009 Obeidi et al., 2009 ) and tissue conditioning (Botta et al., 2009 Dundar & Gunzel, 2011). For that, continuous emission lasers or pulsed laser...

The use of Ultra Short Pulse Lasers USPLs in dentistry

The ablation of dental hard tissues with USPLs were investigated by Niemz et al. (1995), using a system with pulse length of 30 ps. These authors reported enamel cavities with good precision and absence of thermal damages when compared with cavities performed by lasers operating with pulse length of s and ns. Further researches confirmed that the application of USPLs with pulse length of few femtoseconds almost completely avoids thermal damages and the formation of microcracks on irradiated tissues and on surrounding ones (Kruger et al., 1999 Freitas et al., 2010). It must be pointed out that lasers that operate with pulse length of s can generate the formation of microcracks on irradiated tissue depending on the energy density, and these thermal damages can be responsible for the development of secondary caries (Apel et al., 2005). Concerning the removal of dental caries, literature studies reported that the threshold fluence for carious dentin is lower than that for sound dentin,...

Fluoride during orthodontic treatment rinses etc

In addition to reinforced oral hygiene instructions, orthodontists have turned to various products and preventive measures to reduce this problem. Dental professionals have employed fluoride for years to prevent caries and remineralize enamel in patients. A systematic review found a reduced level of caries and adolescents who have regular supervised rinsing with a fluoride mouthwash (Marinho, 2004). Daily fluoride rinses have shown promising results, and a significant reduction in enamel lesions can be achieved during orthodontic therapy through the daily use of a 10 mL neutral 0.05 sodium fluoride rinse. However, typical patient compliance rates with this protocol have been relatively low (Geiger et al., 1992).

Amorphous calcium phosphate ACP 431 Cppacp paste

Due to the early stages of this technology, published independent research on the ACP products like MI Paste is limited. Generally, the studies on caries prevention with CPP-ACP consist of in-situ caries models with gums, mouthrinses, or lozenges (Iijima et al., 2004 Reynolds et al., 2003). In addition, the vast majority of these studies were carried out by the same group that first isolated CPP-ACP at the University of Melbourne, Australia. For example, using topical applications of CPP-ACP via sugar-free chewing gum and mouthrinse, Reynolds et al. showed that CPP-ACP incorporated into dental plaque can significantly increase the levels of plaque calcium and phosphate ions (Reynolds et al., 2003). Conversely, an in-vitro study carried out by an American group found that while fluoride 5000 ppm paste had a statistically significant protective effect against demineralization on enamel sections, MI Paste had no effect (Pulido et al., 2008).There are two published studies that examine...

ACPcontaining bonding cement

As for ACP bonding cement products like Aegis-Ortho, there are currently no published comparative studies on its ability to prevent white spot lesions in the peer-reviewed literature. Two reports detail the questionable bond strength of ACP-containing cement. In spite of its potential benefits, frequent bond failures with ACP-cement have been reported. An in-vitro study with an earlier generation of Aegis-Ortho showed that orthodontic brackets bonded to teeth with an ACP-containing composite material failed at significantly lower forces than brackets bonded to teeth with a conventional resin-based composite orthodontic cement (Dunn, 2007). Another in-vitro study found that brackets bonded with the conventional Transbond XT had more than two times the shear bond strength in comparison to brackets bonded with Aegis-Ortho cement (Foster et al., 2008). In evaluating the current evidence base for ACP and its various products, the number of published in-vitro and in-vivo trials is clearly...

Need for investigation

Due to high caries incidence, low patient compliance, and low usage of fluoride varnish by orthodontists, there appears to be a need for a better treatment modality for patients undergoing orthodontic treatment. Regardless of the exact prevalence rate for white spot lesion development, most dental professionals would agree that it is currently far too high. While adjuncts to treatment such as fluoride rinse can potentially reduce the incidence of white spot lesions, the required compliance of high caries-risk patients is dubious. Equally troublesome, available non-compliant and proven treatments like professionally applied fluoride varnish have failed to catch the attention of practicing orthodontists. The resin sealer (Pro-seal) seems to address the patient compliance issue, but if orthodontists have neither the time nor the interest to deliver fluoride varnish, their likelihood of investing the resources and chair time to etch and light cure Pro-sea on twenty teeth is probably low....

Polarized light microscopy

Polarized light evaluations of enamel sections have been useful in describing the early caries lesion and alterations in structure upon further demineralization or remineralization. Generally, it provides information on absorption color and boundaries between minerals of differing refraction indices. Materials such as enamel act as beam splitters and divide light rays into two parts. Polarized Light microscopy (PLM) in turn exploits the interference of split light rays, as they are reunited along the same optical path to extract information about materials. Essentially, polarized light microscopy allows the visualization of areas with different porosities. The histologic features seen under a polarized light microscope allow the examiner to distinguish carious and non-carious enamel by their respective distribution of pores (Gwinnett, 1966). Polarized light examination of enamel specimens is a well-established procedure in which it is customary to view quinoline-imbibed sections...

Quantitative lightinduced fluorescence

Quantitative Light-induced Fluorescence (QLF) is one method of assessing levels of enamel demineralization. With QLF, real-time fluorescent images are captured into a computer and stored in an image database. Optional quantitative analysis tools enable the user to quantify parameters like mineral loss, lesion depth, lesion size, stain size and severity with high precision and repeatability. The QLF method is based on the auto-fluorescence of teeth. When teeth are illuminated with high intensity blue light they will start to emit light in the green part of the spectrum. When enamel demineralization takes place, minerals are replaced mainly by water from saliva, causing a decrease in the light path in the tooth substance. This results in less light absorption by enamel. Because fluorescence is a result of light absorption, the intensity of fluorescence decreases in demineralized regions of the enamel, which appear darker than sound tooth structures (de Josselin et al., 1995 al-Khateeb...

Compomers Polyacidmodified resin composites

Polyacid-modified composite resins, known trivially as compomers, are a group of aesthetic materials for the restoration of teeth damaged by dental caries. They were introduced to the profession in the early 1990s 40 , and were presented as a new class of dental material designed to combine the aesthetics of traditional composite resins with the fluoride release and adhesion of glass-ionomer cements. The trivial name was devised from the names of these two parent materials, the comp coming from composite, and omer from ionomer 60 . The term polyacid-modified composite resin was originally proposed for these materials in 1994 39 and has been widely adopted both by manufacturers and researchers since that time. However, it has been criticised on the grounds that it . . .may overemphasize a structural characteristic of no or little consequence 60 . This is a somewhat strange criticism, since to formulate these materials, manufacturers have modified them specifically by the introduction...

Composition and setting

Despite the presence of these additional components, compomers are similar to composite resins in that they are fundamentally hydrophobic, though less so than conventional composite resins. They set by a polymerization reaction, and only once set do the minority hydrophilic constituents draw in a limited amount of water to promote a secondary neutralization reaction 23 . They lack the ability to bond to tooth tissues, so require bespoke bonding agents of the type used with conventional composite resins, and their fluoride release levels are significantly lower than those of glass-ionomer cements. Such low levels of fluoride release have been shown to compromise the degree of protection afforded by these materials in in vitro experiments using an artificial caries medium 41 .

Composite resin chemistry

One of the most significant problems with current monomers used for direct composite restorative materials is the shrinkage that occurs during polymerization. Currently, all commercial dental composites are based on vinyl monomers polymerized using free radical initiators. Conversion of these monomers results in a decrease in distance between the molecules, from a Van der Waals gap to the distance of a covalent bond. Although this distance is very small for a single monomer, the distance change over a long polymer chain is significant. Inclusion of filler reduces the volume of resin and its volume change, but the amount of filler incorporation is approaching the maximum theoretical packing fraction of 74 volume for close-packed structures. The amount of shrinkage is controlled by the volume of resin, its composition, and the degree of conversion. Current commercial dental composites have a volumetric shrinkage ranging from 1.6 to 8 volume . The contraction stress developed at the...

Clinical survive probability of composites

Composites are monitored in clinical studies by using United States Public Health Service (USPHS) categories 61 of interest color matching, interfacial staining, secondary caries, anatomic form (wear), and marginal integrity 7 . Changes in restorative treatment patterns, the introduction of new and improved restorative materials and techniques, effective preventive programs, enhanced dental care, and growing interest in caries-free teeth have greatly influenced the longevity of dental restorations however, failure of restorations is a major problem in a practice treating primarily permanent teeth. Studies show that 60 of all operative work done is attributed to the replacement of restorations 44 . Composites have improved since their introduction, and their survival rates are improving. Clinical studies to evaluate the latest composite technologies have not been published therefore most of the survival data are on older composite compositions. In the 1970s, degradation or wear was...

Diet nutrition and dental health

It has been well-documented in animals that early malnutrition affects tooth development and eruption (Mellanby, 1928) and can result in increased dental caries later in life. But in humans, a causal relationship between nutritional status and dental health has not been directly demonstrated (Alvarez & Navia 1989). However two separate cross-sectional studies in Peruvian children have shown that malnutrition is associated with delayed tooth development and increased caries experience (Alvarez et al, 1988, 1990). However it has been shown beyond reasonable doubt that there is a distinct relationship between diet and dental caries (Gustafsson et al, 1954). These effects are accepted, but there are two important aspects to the relationship food choice and nutrient intake, both may affect and be affected by, poor dental health. The role of nutrition in the maintenance of health is well known. Nutritional deficiencies in the growing child, whether due to deprivation, over-indulgence, or...

Quercus infectoria gall

Quercus infectoria (Fabaceae) is a small tree, the galls arise on young branches of this tree as a result of attack by the gall-wasp, Adleria gallae-tinctoria. The plant is known as Mayaphal and Majufal in Hindi. Quercus infectoria gall extract has the potential to generate herbal metabolites. the crude extracts demonstrating anti-dental caries activity could result in the discovery of new chemical classes of antibiotics. These chemical classes of antibiotics could serve as selective agents for the maintenance of human health and provide bio-chemical tools for the study of infectious diseases (Vermani & Navneet 2009).

Epidemiological considerations about MIH 41 Diagnose of MIH

Dental Carrie Fracture

Dental diseases have a detrimental effect on quality of life both in childhood and older age. (Moynihan & Petersen, 2004) Several authors have discussed whether developmental defects of enamel (DDE) are a public health problem. (Mathu-Muju & Wright, 2006) For a condition to be considered of public health significance, several criteria need to be reviewed, particularly the prevalence its impact on an individual in terms of symptoms, functioning, psychological and social should be considerate. (Marshman et al., 2009) Besides its clinical implications in the field of public health, MIH have taken on importance as strong predictors of dental caries. This result highlights the importance of establishing priority programs of prevention and early treatment for these groups of children both for aesthetic and functional reasons, as well as to minimize the increased risk of dental caries.

Probioticsderived biosurfactant

As it is clear, colonization of the teeth by mutans streptococci has been associated with the etiology and pathogenesis of dental caries in humans. The ability of these organisms, particularly Streptococcus mutans, to synthesize extracellular glucans from sucrose using glucosyltransferases (Gtfs) is a major virulence factor of this bacterium. The Gtfs secreted by S. mutans (particularly GtfB and GtfC) provide specific binding sites for either bacterial colonization of the tooth surface or attachment of bacteria to each other, modulating the formation of tightly adherent biofilms, the precursor of dental caries (Koo et al. 2010 Murata et al. 2010). However, the ability of S. mutans to adhere to the tooth surface is vital for the initiation and progression of dental caries. a-(1-3)- and a-(1-6)-linked glucan polymers are encoded by the genes gtfB, gtfC, and gtfD. In vitro studies have indicated that gtfB and gtfC are essential for the sucrose-dependent attachment of S. mutans cells to...

Recent advances in antiplaque agents Chemoprophylactic agents antimicrobial peptides antiquorum sensing approach and

Control of oral biofilms is essential for maintaining oral health and preventing dental caries, gingivitis and periodontitis. However, oral biofilms are not easily controlled by mechanical means and represent difficult targets for chemical control (Socransky, 2002). With the exception of chlorhexidine and fluoride, few of the existing oral prophylactic agents have significant effects (Petersen & Scheie, 1998 Wu & Savitt, 2002 Scheie, 2003). A likely explanation for this low efficiency is due to the fact that microorganisms organized in biofilms possess characteristics that differentiate them from planktonic cells, such as higher Replacement therapy has been suggested as a strategy for replacement of pathogenic microorganisms modified to become less virulent. Some requirements for this type of approach are important, such as the replaced organism must not cause disease by itself it must persistently colonize and must possess a high degree of genetic stability. DNA technology has...

Quantitative lightinduced fluorescence QLF

Quantitative light-induced fluorescence (QLF) (QLF-clin, Inspektor Research Systems BV, Amsterdam, Netherlands) (Figure 7) was developed for use in caries detection and it is available commercially for clinical use. This device consists of a handheld intraoral color microvideo CCD camera, interfaced with a personal computer and custom software (QLFpatient, Inspektor Research Systems BV, Amsterdam, Netherlands). The software enables to capture and to analyze in vivo images of the tooth during clinical examination. Fig. 7. (A) QLF system. (B) Fluorescence image of an enamel caries lesion on the buccal surface. (C) Fluorescence image of an occlusal caries lesion. (D) Fluorescence image of a secondary caries lesion around a composite restoration Fig. 7. (A) QLF system. (B) Fluorescence image of an enamel caries lesion on the buccal surface. (C) Fluorescence image of an occlusal caries lesion. (D) Fluorescence image of a secondary caries lesion around a composite restoration To enable...

Effect of improved dentition on nutrition and growth in children

The reported association between chronic malnutrition, growth, and dental caries suggests that dental decay might contribute to poor weight gain in children (Alvarez et al, 1990). Four cases of children with early childhood caries and subsequent dental rehabilitation were published by Acs in 1998 (Acs et al, 1998). Regardless of the presumptive aetiology of the poor weight gain, all of these children demonstrated an immediate increase in weight, propelling them to higher weight percentile categories with increased adjusted 6-month increments of growth after their carious teeth had been repaired. At the end of the observation, none of these children continued to satisfy the criteria for the designation of faltering growth. These observations were consistent with the phenomenon of catch-up growth that has been observed in faltering growth children (Prader et al, 1963). The effect of dental health improvement on growth was evaluated through another study by Acs in 1999 (Acs et al, 1999)....

Laser fluorescence LF

Diagnodent

Laser fluorescence (LF) (Fig. 6) is less widely known and used by dental professionals, though it constitutes a necessary complement to the traditional methods. LF therefore deserves a more detailed description in this Chapter. Fluorescence occurs as a result of the interaction between electromagnetic radiation and tissue molecules. When light falls upon the surface of the tooth it penetrates a few millimeters into the tissue, and is reflected towards the tip of a device that measures the fluorescence by means of an electronic system. Two incremental ranges are observed in the fluorescence spectrum one at 430-450 nm, related to demineralization of the tooth, and another at 590-650 nm, related to the presence of bacteria and their metabolites (Lundberg et al., 2007). Furthermore, there are other elements of organic and inorganic origin that can emit additional fluorescence and thus lead to error in the detection of caries fluorosis, hypomineralization, bacterial plaque, calculus,...

Dental biofilm Dynamics of biofilm formation

Bacterial species are thought to play important role in the maintenance of oral health and in the etiology of oral diseases in humans (Socransky et al., 2002). Oral biofilms develop naturally and the resident plaque microflora contributes to the host defenses by preventing colonization by exogenous species (Marsh, 2003). Mechanisms contributing to colonization resistance include more effective competition for nutrients and attachment sites, production of inhibitory factors and creation of unfavorable growth conditions by the resident microflora (Marsh, 2004).

Fiberoptic transillumination FOTI and digital imaging fiberoptic transillumination DIFOTI

Steve Foti

FOTI (Figure 10) device is a practical, easy, fast and inexpensive method of imaging teeth in the presence of multiple scattering. It is based on the changes in the scattering and absorption phenomenon of light photons that increases the contrast between sound and enamel caries. In other words, results from a local decrease of transillumination owing to the characteristics of the carious lesion. The illumination is delivered via fiber-optics from a light source to a tooth surface. The light propagates from the fiber illuminator across tooth tissue to non-illuminated surfaces. The resulting images of light distribution are then used for diagnosis. Its transmission can be observed either in the opposite side or in the occlusal surfaces, when molars and premolars are analyzed. As light scattering is higher in the demineralized enamel, it is possible to see the lesion as a dark area or a shadow. Besides, carious dentin appears orange, brown or grey underneath the enamel. This can help on...

Conventional Xrays Rx

Clinical inspection is completed by radiological evaluation. Bitewing X-rays represent the technique of choice for diagnosing proximal surface caries, though they may also be useful for diagnosing occlusal dentin caries (Tran us et al., 2005 Wenzel et al., 1992). At occlusal level, the X-rays register a tooth thickness beyond the proximal zone, and the lesions are masked by the healthy tissues for a longer period of time (Wenzel et al., 1992). For this reason, from the histological perspective, the lesion is more advanced than suggested by its radiological appearance - a fact that justifies the low sensitivity of the technique. In our studies, the observed sensitivity was 0.57 (Guerrero, 2011), i.e., many existing lesions are not detected. Nevertheless, once again, the specificity is very high. These results imply that negative X-ray findings cannot be taken to rule out dentin caries, though a positive X-ray diagnosis should be taken as an indication for opening the fissure and...

Effects of Elm Es Alg53 and oolong on glucan production by GTase from S sobrinus 6715 and S mutans MT8148

Oolong has been used as a functional food to prevent dental caries. Oolong was therefore used to compare the inhibitory effects of other phytochemicals on glucan production by GTase. The inhibitory effect of phytochemicals on water-insoluble glucan synthesis by GTase from S.sobrinus 6715 is illustrated in Fig. 6A. The original ELM solution reduced the production of water-insoluble glucan to 66 of that of the control (ELM-free). ES also significantly reduced the synthesis of water-insoluble glucan. The inhibitory effect of ES was remarkable compared with that of ELM. The inhibitory effect of oolong on the production of water-insoluble glucan by GTase was stronger than that of ELM and of a similar level to that of ES. Fig. 6B shows water-insoluble glucan synthesis by GTase from S. mutans MT8148. ELM significantly inhibited the glucan production by GTase from S. mutans MT8148, and the ratio of inhibition of production of water-insoluble glucan was 64 that of the control (ELM-free). The...

Communication microbial biofilms Quorum sensing mechanisms

The gram-negative bacterium, Streptococcus mutans, a major pathogen of dental caries, performs the quorum-sensing by releasing mediator peptides of gene expression. The signaling system involves at least six gene products encoded comCDE, comAB and comX (Cvitkovitch et al., 2003). The OMCC gene encodes a precursor peptide, which when cleaved and exported release a signal peptide, 21 amino acid or stimulating competence peptide (CSP). Through the quorum-sensing, it was found that the competence-stimulating peptide (CSP) was necessary for proper formation of S. mutans biofilm in addition to its virulence characteristics (Li et al., 2001).

Demineralization protocol

Teeth were exposed to a pH cycling system to develop caries-like lesions. Each day teeth were incubated in demineralization solution (lactic acid and Carbopol pH 5.0 , 50 saturated with hydroxyapatite) for eight hours, rinsed with de-ionized water and placed in artificial saliva for 30 minutes, followed by two seconds of brushing with a powerbrush (Sonicare, Philips) and fluoridated dentifrice (NaF, 1,100 ppm F), rinsed again and placed back in artificial saliva until next demineralization period (next day). Solutions were refreshed daily during the experimental period of 15 days. On day 15, all teeth were removed from the saliva solution, rinsed under tap water and stored in 100 humidity. To assess demineralization, Quantitative Light-induced Fluorescence (QLF) and Confocal Laser Scanning Microscopy (CLSM) were used. Both procedures were carried out at the Oral Health Research Institute (IU) in Indianapolis, IN.

Healthy eating habits in preschool children

Good preschool eating patterns are important because they influence both energy and nutrient intake, and dental health. An optimum eating pattern would be regular meals and nutritious, low fat, low sugar snacks. Young children have small appetites but large nutrient needs relative to their body size, therefore regular refueling is required. An eating pattern based on distinct meals is generally beneficial and also promotes dental health. Dental caries is prevalent in preschool children and it is directly related to the amount and frequency of consumption of non-milk extrinsic sugars in the diet (Holt, 1991). Family meal patterns are inevitably affected by family routines, parents working hours and the child's appetite at different times of day. Regular meals allow opportunities for socializing and for parents to set a good example with respect to food choices and eating behavior (Graham, 1972). A suitable snack should provide nutrients other than calories and should be low in non-milk...

Summary and conclusion

Good nutrition is essential for good physical health. Nutrition also plays a key role in the development and maintenance of a healthy mouth, especially the teeth and gums. The food we eat affects our teeth both before and after their eruption into the mouth. The relation of dental caries and periodontal diseases to the type and frequency of diet and to intake nutritional elements is well-known. At the same time, the health or lack of health of our teeth and gums can affect what we eat. Missing teeth are a factor in food choices and may affect individuals' ability to consume the necessary nutritional elements. Nutritional deficiencies in growing children, whether due to deprivation or mal-absorption syndromes may have significant impact on their natural development and somatic growth. The potential impact of eating disorders, chronic diseases and infection on overall health via physiologic and hormonal mechanisms has also been well established. - Early childhood caries is a chronic...

Dental plaque biofilm management

Of sugars in caries etiology and the importance of sugars as the principal dietary substrate that drives the caries process (Caglar et al., 2005 Touger et al., 2003 Loo et al., 2003). Evidences show that expression of required genes for glucan and fructan synthesis, such as gtfB, gtfC and ftf, is well-regulated after initial adhesion and results in forming dental plaque, caries and other periodontal disease (Zero, 2004) The ability of mutans Streptococci to adhere to teeth surfaces is vital for the progression of the disease. The bacterial adhesion mechanism is mediated by synthesis of both extracellular enzymes, glucosyltransferase (GTF) and fructosyltransferase (FTF). These extracellular enzymes identified in Streptococcus mutans are responsible for the synthesis of extracellular polysacharides such as glucans and fructans. These polymers are fundamental factors in dental biofilm formation. fl-(1-3) - and fl-(1-6)-linked glucan polymers through the concerted action of three secreted...

Clinical management of MIH

Therefore, a detailed study under magnification of the unerupted molar and incisor crowns on any available radiographs should be done. (William et al., 2006a) During teeth eruption, when MIH is confirmed, it should be made a diet counseling for dietary modifications to avoid dental caries, dental erosion and dental sensitivity It should be recommended a toothpaste with a fluoride or, in cases of dental sensitivity, aiming to produce a non-sensitivity and hypermineralized surface layer which provides a super saturated environment of calcium and phosphate on enamel surface, a desensitizing toothpaste with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) should be indicated. (Baroni & Marchionni, 2011) case, the adjunctive use of nitrous oxide-oxygen analgesia may alleviate anxiety and reduce dental pain. In last case, general anesthesia may be required for restorative treatment. (William et al., 2006a) The maintenance of existing tooth structure and pain relief can be...

Particularities of the orthodontic treatment

Malocclusion is the third place in the oral diseases, the occurrence of occlusal anomalies varies between 11 al 93 the complications that it brings could be psychological derived from the alteration of the dentofacial aesthetics oral function problems, including difficulties in the mobility of the jaw, pain or disorders in the temporomandibular joint and problems to chew, to swallow or to speak and finally, problems of major susceptibility to traumatism, periodontal diseases or dental decay (Proffit, 2008 Sidlauskas & Lopatiene, 2009). Lesions developed during orthodontic treatment could be radicular resorption, gingival recession and increase of caries risk and periodontal diseases. The enamel decalcification is one of the most common and undesirable complications of the orthodontic therapy. Some authors (Chang et al., 1999 Heintze, 1999 Z rate et al., 2004) show increase of decalcifications or white spot lesions in patient on treatment.

Morphology and microflora of intercusp fissures in teeth

With development of methods for intercusp fissure sealing, there has been an increased interest in microflora status in carious cavities covered with sealant (75). Because of anatomical characteristics of masticatory surfaces of teeth, sealing material is introduced on bacterial plaque accumulated on the fissure's bottom. Therefore it is critical to obtain information about sealant's impact on microflora in the fissure. The sealant's impact on microflora of fissures not affected by caries has been the subject of numerous studies. Those studies were performed on implanted fragments of masticatory surfaces of teeth. Data indicate that after sealing, microflora in carious lesions becomes suppressed. However, under the sealant a presence of microorganisms capable of growing was observed, which are believed to be etiologically connected with carious processes. It was also demonstrated that sealing materials do not constitute a fully tight barrier separating fissures from oral environment,...

Factors impacting effective sealing

Efficacy of sealing procedure is determined by retention of sealant and obtained caries reduction. Factors impacting retention of sealing materials are - individual susceptibility to caries, Varied morphology of fissures in lateral teeth makes diagnostics of caries in fissures by means of dental mirror and probe ineffective (about 25 probability of caries detection). Fissure penetration with a sharp dental probe causes iatrogenic damage of enamel surface, often affected by demineralization processes. As literature reports, a less invasive method is diagnosing with the use of (5,59) electrical conductivity measurement (ECM), quantitative light-induced fluorescence (QLF) (5) and DIAGNOdent (58,68) in order to assess sensitivity and specificity of caries detection on occlusal surfaces (5,59). ECM demonstrates high sensitivity of between 93 and 96 . However specificity of this method is relatively low -less than 80 (71-77 ). Specificity at the average level of about 75 means that 25 of...

The specific diagnostic problem and the diagnostic methods

As it was described above, while secondary caries accounts for more than half of replacing restorations regardless of the different materials in the general practice, around 50 percent, this high prevalence is not found in one controlled clinical trial in which only 2 among 2660 Class I or II restorations were replaced due to secondary caries Letzel et al., 1989 . On the contrary, in another randomized controlled clinical trial 66.7 and 87.6 of the failures that occurred in amalgam and composite restorations because of the diagnosed secondary caries, respectively Bernardo et al., 2007 . Are they correct or wrong Why are there are huge differences between these studies Are the practitioners involved in these studies poorly trained or ignorant about the criteria of secondary caries diagnosis Indeed, until now it is very difficult to explain the above questions reasonably, however, except the variation between those studies themselves, it should be acknowledged that there are some...

Clinical considerations and management of MIH 51 Dentinopulpal complex considerations and MIH

Dental pain and the severity of hypomineralisation or enamel loss in molar-incisor hypomineralisation are major determinants for the choice of treatment. (William et al., 2006a) The most conservative interventional treatment consists of bonding a tooth colored material to the tooth to protect it from further wear or sensitivity although the nature of the enamel prevents formation of an acceptable bond. (William et al., 2006b) Less conservative treatment options, but frequently necessary include use of stainless steel crowns, permanent cast crowns or extraction of affected teeth in association with the orthodontic appliance or teeth replacement with a bridge or implant.

The indirect effect of anticariogenic substances on body except for tooth

When a diet containing ELM or ES is added to Diet 2000 and given to rats, most of the rats suffer osmotic diarrhea during the experimental period and growth is slightly suppressed. ELM and ES strongly inhibit sucrase activity. Hence, a lot of sucrose of Diet 2000 is transferred to the lower intestine and may cause osmotic diarrhea. Osmotic diarrhea may reduce the immune response, and disturb anticariogenic effect of phytochemicals in experimental animals. If experimental animals catch illness except for dental caries during the experiment, the risk of dental caries infection may increase. Therefore, the properties and functional effects of test substance apart from anticariogenic effects need to be examined, and the concentration and form of test substance added to diets should be investigated carefully before carrying out animal experiments.

Conclusions of the diagnostic tests

Modern dental practice needs diagnostic methods to diagnose caries in the early stages of the disease, and research efforts must focus on satisfying this need. The traditional diagnostic techniques offer high specificity, but with the possibility of false-negative results due to dentin caries. Laser fluorescence (LF) shows high sensitivity, and is able to identify hidden dentin caries in situations where visual inspection (VI) and X-rays are unable to detect the lesions. However, because of its lesser specificity and the low current prevalence of caries in the industrialized world, LF should be used as a coadjutant to VI in diagnosing hidden dentin caries. It has been estimated that an additional 30-50 of non-cavitated occlusal caries can be detected in the early stages with LF. Bitewing X-rays represent a complement to VI, but is only able to detect the lesion once it has advanced in the dentinal tissue. As a result, different studies (Anttonen et al., 2003 Ricketts et al., 1997)...

Qualitative lightinduced fluorescence QLF

Qualitative light-induced fluorescence (QLF) is used for the detection and quantification of early-stage caries (Pretty, 2006 McComb & Tam, 2001) and for monitoring demineralization or remineralization of smooth surface lesions (Verdonschot & van der Veen, 2002 Heinrich-Weltzien et al., 2005). The tooth is illuminated by the diffuse blue-green light beam of an argon laser at a wavelength of 488 nm (Tran us et al., 2005 McComb & Tam, 2001). It can also be illuminated by a xenon microdischarge arc lamp and optic fiber system generating blue light at a wavelength of 370 nm (Pretty, 2006), with conduction by a liquid guide. The images are obtained in a dimmed environment using a portable intraoral video camera, with software processing. These images can be used to calculate lesion size, depth and volume (Tran us et al., 2005 Zandona & Zero, 2006). The demineralized areas appear as dark zones, since radiation of the carious lesion is lower than that of the healthy enamel (Tran...

Feeding pattern in children with ECC

The relationship between sugar consumption and dental caries is one of cause and effect. The evidence to support such a relationship is generally considered overwhelming (Burt, 1986). Epidemiological studies have shown that caries prevalence was highest among children who ingested a diet high in sugar (Sheiham, 1991). Surveys have also shown that high consumption of cariogenic drinks and foods at bed time by pre-school children is an important factor in risk of caries (Palmer, 1971). Holt's study in 1991 on a group of preschool children showed that children consume sweets, biscuits and sweet drinks regularly and that mean dmft increases significantly with a higher rate of sugar consumption (Holt, 1991).

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