Hidden caries: a critical review

Hidden caries is a type of lesion visualized in dentin, mainly by means of bitewing radiographs, in which, clinically, the occlusal enamel appears healthy or minimally demineralized and radiographically presents progressive demineralization in dentin, which may progress and compromise the pulp-dentin complex. Although the etiology of hidden caries is unknown, many theories have been studied, including structural and anatomical defects of enamel, their specific microbiota and the use of fluoride, which is most accepted theory. Considering the clinical concern, since these lesions have a silent progression and often are not detected on routine clinical examinations, this study aims to conduct a critical discussion of the etiology, prevalence, diagnostic methods and treatment decision for lesions of hidden caries, alerting professionals about the importance of routine use of bitewing radiographs even in patients considered “cariesfree” or low risk of caries, for more effective diagnosis.

Individual and contextual factors related to dental caries in underprivileged Brazilian adolescents

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Influence of the addition of chlorhexidine diacetate on bond strength of a high-viscosity glass ionomer cement to sound and artificial caries-affected dentin

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Different bacterial models for in vitro induction of non-cavitated enamel caries-like lesions: microhardness and polarized light miscroscopy analyses

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effect of toothpaste with nano-sized trimetaphosphate on dental caries: In situ study

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Effect of method of caries induction on aged resin-dentin bond of primary teeth

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Individual and contextual factors related to dental caries in underprivileged Brazilian adolescents

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Histopathology of the pulp of primary molars with active and arrested dentinal caries

The purpose of this study was to compare the histological appearance of the pulp of human primary molars with active and arrested lesions. The sample consisted of 36 primary molars (18 with active lesions and 18 with arrested lesions) extracted from 35 children between 5 to 9 years of age. The histological diagnosis was classified in normal pulp, transitional stage, partial pulpitis, total pulpitis and total necrosis, and then subdivided in three subgroups: treatable, untreatable and questionable. Results showed that normal pulp or transitional stage (treatable category) was diagnosed in 50% of teeth with arrested lesions, compared to 11.1% of teeth with active lesions. Partial pulpitis (questionable category) was present in 38.8% with arrested lesions compared to 22.2% with active lesions. Total pulpitis and total necrosis (untreatable category) was diagnosed in 11.2% with arrested lesions compared to 66.7% with active lesions. The observed frequencies of histological categories between both groups were statistically significant (P < 0.05). Histologically, pulp reaction under active and arrested lesions in primary molars revealed the formation of a basophilic calcio-traumatic line at the junction of the primary and reparative dentin, formation of reparative dentin and a regular odontoblastic layer in 60% of the cases. Results indicated that the type of lesion (active or arrested) is a good indicator of the histological status of the pulp.

Risk factors in the mother-child relationship that predispose to the development of early childhood caries

This study focused on the risk factors in mother-child relationship that predispose babies to the development of dental caries. A prospective cohort study with 80 mother-child pairs was conducted. The mothers responded at 12, 18 and 30 months after their children's birth, to questions about variables related to diet, sucking habits, and oral care. Children were clinically examined to verify caries lesions (white spot lesions or cavitation). Data were analysed using Chi squared or Fisher's exact tests. The significance level was set at 5 %. Of the total, 3.75 % showed cavitated lesions after 18 months; 6.25 and 45 % had spot white lesions, respectively, at 18 and 30 months. The cariogenic diet was high at 12 (63.75 %) and 30 (88.75 %) months. Good oral hygiene was present in a minority of children at 12 months (46.25 %), but increased at 30 months (65 %), helping to prevent cavities and white spot lesions over this period (p = 0.0005). The variables of the blocks sucking habits and diet were not associated with caries. The lack of oral care in children was a risk factor for dental caries development.

Proximal caries lesion detection in primary teeth: does this justify the association of diagnostic methods?

The aim of this clinical study was to evaluate and compare the performance of visual exam with use of the Nyvad criteria (visual examination - (VE)), interproximal radiography (BW), laser fluorescence device (DIAGNOdent Pen-DDPen), and their association in the diagnosis of proximal lesions in primary teeth. For this purpose, 45 children (n = 59 surfaces) of both sexes, aged between 5 and 9 years were selected, who presented healthy primary molars or primary molars with signs suggestive of the presence of caries lesions. The surfaces were clinically evaluated and coded according to the Nyvad criteria and immediately afterwards with the DDPen. Radiographic exam was performed only on the surfaces coded with Nyvad scores 2, 3, 5, or 6. Active caries lesions and/or those with discontinuous surfaces were restored, considering the depth of lesion as reference standard. Sensitivity, specificity, accuracy, and area under ROC curve were calculated for each technique and its associations. Visual exam with Nyvad criteria presented the highest specificity, accuracy, and area under ROC curve values. The DDPen presented the highest sensitivity values. Association with one or more methods resulted in an increase in specificity. The performance of visual, radiographic, and DDpen exams and their associations were good; however, the clinical examination with the Nyvad criteria was sufficient for the diagnosis of interproximal lesions in primary teeth.

A dental caries preventive program applied to children aged 5 to 8 years attending since the first year of age at the Baby Clinic of the Araçatuba Dental School, Brazil

Objective: Tooth decay is one of the more common diseases of childhood. Several studies recommend that early preventive measures must be implemented since the first years of life and continue throughout childhood and adolescence. The aim of the this study was to present results of a preventive dental program considering oral health maintenance, dental caries experience and the prevalence of dental caries relation with follow-up compliance visits. Material end method: Intraoral and interproximal radiographic exams were performed on 171 patients participants of a preventive dental program. Data regarding age, gender, previous caries experience and the frequency at which the patients attended return visits were obtained from the records. The data were analyzed statistically by the McNemar test, with the level of significance set at 1%. Result: Clinical and radiographic examination revealed that most children participating in the program had sound teeth (77.2 and 84.8%, respectively). The past dental history of the dental caries from patients included in this study showed statistical relevance when associated with the present dental caries experience and a statistical relationship was found from the absence of compliance to clinical visits and the dental caries presence. Conclusion: The preventive strategy had a positive influence on oral health maintenance in the children examined. Previous caries experience and the lack of compliance with return visits influenced the clinical oral condition of the children during participation in the preventive program.

A comparative analysis of caries and fluorosis among cities with and without public water supply fluoridation in São Paulo State, Brazil

Purpose: This population-based, cross-sectional study aimed to record the DMFT index for 12 year-old children with dental caries and fluorosis levels in cities with and without public water supply fluoridation. Methods: From the 101 municipalities belonging to the Health Regional Department XV (DRSXV-SJRP) of the São Paulo state in the Southeast region of Brazil, 85 cities were selected after exclusion of those with incomplete data and less than ten years of fluoridation treatment in 2004. The criteria adopted for the assessment of dental caries and fluorosis levels were based on the guidelines published in the WHO Manual 4th edition. The data were analyzed using Fisher’s exact tests at a significance level of 5%. Results: The prevalence of caries in 12 year-old children had no significant association with fluoridated water, and was considered “moderate” and “high” in cities without fluoridation and “low” and “moderate” in cities with fluoridation. A significant association was found between water fluoridation and fluorosis (P=0.001), but not between water fluoridation and the DMFT index (P=0.119). Conclusion: The prevalence of fluorosis was related to water fluoridation in this study. However, fluorosis was also observed in non-fluoridated cities, which may result from fluoride intake through other sources.

Protective efficacy of psidium cattleianum (Sabine) and myracrodruon urundeuva (Allemao) leaf extracts against caries development in rats

This study evaluated the influence of Psidium cattleianum Sabine (Myrtaceae) and Myracrodruon urundeuva Allemão (Anacardiaceae) aqueous extracts on S. mutans counts and dental enamel micro-hardness of rats submitted to a cariogenic challenge. Sixty Wistar rats were distributed in three groups and received water (control) or aqueous extracts of Psidium cattleianum or Myracrodruon urundeuva as hydration solution. Initially the animals had their sublingual and submandibular salivary glands surgically removed and the parotid ducts ligated. Then the rats were inoculated with 106 CFU of Streptococcus mutans ATCC 35668 and were fed with a cariogenic diet. To detect and quantify the presence of S. mutans, oral biofilms were sampled and microbial DNA was extracted and submitted to amplification by means of real-time PCR (Polymerase Chain Reaction). After seven weeks the animals were sacrificed and enamel demineralization was analyzed by cross-sectional micro-hardness. Both extracts produced a significant reduction on S. mutans counts and decreased the enamel demineralization. It can be concluded that the extracts tested had a significant effect on S. mutans in oral biofilm of the rats, decreasing S. mutans accumulation and enamel demineralization.

Caries formation around restorative composite and glass ionomer cement

This in vitro study evaluated the demineralization around restorations class V made on the buccal and lingual surfaces of teeth when using different restorative materials. Thirty extracted teeth were randomly divided into 3 groups (n=10) according to the restorative material: Group I - Fuji II LC (GC America Inc., Alsip, Illinois, USA), Group II - Tetric (Ivoclar Vivadent AG, Schaan, Liechtenstein) and Group III - Chelon Fil (3M/ESPE., Seefeld, Germany). The teeth were submitted to a pH-cycling model associated to a thermocycling model. Sections were made and the specimens were analyzed under a polarized light microscopy as for the presence of demineralization. Measurements were performed and the results were subjected to statistical analysis using Anova and Tukey´s Test (α=0.05). Mean values of demineralization depth (µm) according to each positions showed that the demineralization was significantly reduced when Chelon Fil (Group III) was used for all depths, when compared to fluoridated resin materials. Also, it was verified that non-fluoridated resin material, composite resin Tetric, had the lowest inhibitory effect on the development of demineralization.

Ant community richness and composition across a gradient from Eucalyptus plantations to secondary Atlantic Forest

As florestas secundárias e plantações de espécies exóticas estão se expandindo nas paisagens tropicais. No entanto, nossa compreensão sobre o valor destas florestas para a conservação da biodiversidade de invertebrados ainda é incipiente. Neste trabalho, usamos a fauna de formigas de serapilheira para avaliar a diversidade desses insetos entre três florestas de Eucalyptus, sendo uma comercial (quatro anos de idade) e duas abandonadas em diferentes idades de regeneração (16 e 31 anos) e uma área de Mata Atlântica secundária. A riqueza total foi mais alta na floresta secundária e nos plantios de Eucalyptus abandonados há mais tempo. A densidade de espécies na floresta secundária foi significativamente maior quando comparado as plantações de Eucalyptus, mas não difere entre eucaliptais; análise de ordenação revelou diferenças na composição de espécies entre as plantações de Eucalyptus com subbosque ausente e com subbosque desenvolvido ou em desenvolvimento. Ainda, foi constatada uma sobreposição acentuada entre amostras de serapilheira das florestas de eucaliptos abandonadas há mais tempo e a floresta secundária. em geral, plantações de eucalipto foram caracterizadas pela presença de espécies generalistas e de ampla distribuição. Nossos resultados indicam que embora o subbosque de plantações de eucaliptos com maior idade de regeneração suporte um conjunto relativamente alto de espécies generalistas de formigas, é improvável que eucaliptais conservem a maioria das espécies de florestas primárias, especialmente predadores especializados, Dacetini e espécies nômades.