Remineralization of initial carious lesions in deciduous enamel after application of dentifrices of different fluoride concentrations

The aim of the present study was to evaluate the remineralization potential of five dentifrices with different fluoride concentrations. Initial caries lesions were created in 72 cylindrical enamel blocks from deciduous teeth. The specimens were randomly distributed among six experimental groups corresponding to six experimental periods. Each of the six volunteers carried two deciduous enamel specimens fixed in an intraoral appliance for a period of 4 weeks. They brushed their teeth and the enamel blocks at least two times a day with dentifrices containing 0 ppm (period 1), 250 ppm (period 2), and 500 ppm fluoride (period 3), respectively. A second group of volunteers (n = 6) used dentifrices with a fluoride content of 0 ppm (period 4), 1,000 ppm (period 5), or 1,500 ppm (period 6). At the end of the respective period, the mineral content was determined by transversal microradiography (TMR). The use of dentifrices containing 500 ppm fluoride (38% MR), 1,000 ppm fluoride (42% MR), and 1,500 ppm fluoride (42% MR) resulted in a statistically significant higher mineral recovery compared to the control group (0 ppm fluoride). Mineral recovery was similar after use of dentifrices containing 0 and 250 ppm fluoride (24%; 25%). It is concluded that it is possible to remineralize initial carious lesions in deciduous enamel in a similar way as it has been described for enamel of permanent teeth.

Treating open carious lesions in anxious children with ozone. A prospective controlled clinical study

PURPOSE: To determine whether the treatment of dental caries with ozone was possible in apprehensive children and to ascertain whether ozone reverses caries in open single-surface lesions. Further, the influence of ozone on laser fluorescence was investigated. METHODS: 82 lesions in 28 children with at least two open single-surface lesions were assessed. The children were anxious and were judged by the referring dentist as non-treatable. For each test lesion, which was treated with ozone, a control lesion was left without ozone treatment. Hardness and laser fluorescence values were assessed and the changes for hardness and laser fluorescence values in the test lesion were compared with the values in the control lesion after 2, 4, 6, and 8 months. RESULTS: 94 percent of the children were treatable and 93% lost their dental anxiety. The hardness values improved significantly in the ozone-treated test lesions after 4, 6, and 8 months (P< 0.05) compared with baseline while the control lesions had no significant change in hardness at any recall interval. Comparing the differences between test and control teeth over time, the laser fluorescence values improved, however the improvement was not statistically significant (P> 0.05). The use of ozone resulted in an average reduction of 13% of the laser fluorescence values immediately after the ozone treatment.

Effects of various forms of calcium added to chewing gum on initial enamel carious lesions in situ

The purpose of this randomized, cross-over in situ study was to determine the effects of 4 chewing gums on artificial caries-like subsurface lesions. Two chewing gums (1 with zinc citrate and 1 without) contained dicalcium phosphate (3.9%), calcium gluconate (1.8%) and calcium lactate (0.45%), 1 chewing gum contained casein phosphopeptide-amorphous calcium phosphate nanocomplexes (0.7%), and another one contained no calcium. Fifteen subjects without current caries activity (7 male, 8 female; mean age: 27.5 +/- 2.5 years) wore removable buccal appliances in the lower jaw with 4 bovine enamel slabs with subsurface lesions. The appliances were inserted immediately before gum chewing for 20 min and then retained for an additional 20 min. This was performed 4 times per day. Every subject chewed 4 different chewing gums over 4 periods of 14 days each. During a fifth period (control) the subjects only wore the appliances without chewing gum. At completion of each period the enamel slabs were embedded, sectioned and subjected to transversal microradiography. With regard to change of mineral loss and of lesion depth no significant differences could be found between chewing gums containing calcium and calcium-free chewing gums. Moreover, the chewing gum groups and the control group did not differ significantly if adjustments were made for baseline values (p > 0.05; ANCOVA). Under the conditions of the present study it may be concluded that the use of chewing gum offers no additional remineralizing benefit to buccal tooth surfaces, even if the chewing gum contains calcium compounds.

Comparison of the immediate effects of gaseous ozone and chlorhexidine gel on bacteria in cavitated carious lesions in children in vivo

Clinical application of ozone gas has been shown to arrest the progression of dentinal caries in children. In this study, we compare the immediate effects of gaseous ozone and chlorhexidine gel on bacteria in cavitated carious lesions in children. Forty children, each with at least two open occlusal carious lesions, were enrolled in the study. Two teeth were chosen randomly. In one lesion, overlying soft biological material was removed, whilst the other lesion was not excavated. Cavities were rinsed with sterile water and dried with air. A standardised sample was taken from the mesial part of each lesion. Then, gaseous ozone (HealOzone) or 1% chlorhexidine gel (Corsodyl) was applied for 30 s on both lesions of 20 children each, and a second sample was taken from the distal part of each lesion. The anaerobic microbiota was cultivated; the number of colony forming units was calculated per milligram sample. The two-sided paired t test showed no significant (P > 0.05) differences in the reduction of total bacterial counts per milligram comparing samples before and after ozone or chlorhexidine application. The tests also showed no statistically significant difference whether the superficial decayed dentine had been removed before ozone or with chlorhexidine treatment or not. It can be concluded that gaseous ozone or chlorhexidine gel application for 30 s to deep occlusal carious cavities had no significant immediate antimicrobial effects whether the superficial decayed layers dentine were removed or not.

In situ fluoride retention and remineralization of incipient carious lesions after the application of different concentrations of fluoride

Limited information is available on the time-dependent or dosage-dependent cariostatic efficacy of highly concentrated fluoride compounds. This good clinical practice-conforming, double-blind, placebo-controlled, crossover in situ study tested the hypothesis that a 1.0% amine fluoride fluid is superior to a 0.5% amine fluoride fluid regarding fluoride retention and mineral change in initial caries enamel lesions over a period of 28 d. Fluoride retention was significantly higher after application of the two fluoride fluids compared with placebo but had decreased in both groups to similar levels after only 1 wk. Mineral gain was significantly higher for both verum groups compared with placebo. The use of 1% fluoride fluid resulted in significantly higher remineralization compared with the use of 0.5% fluoride fluid. For both fluoride fluids mineral gain followed a linear relationship with time during the experimental period, indicating a possible further uptake of mineral, even after 4 wk.

Feline caries in two cats from a 13th century archeological excavation

Mandibles of two cats containing carious lesions were discovered among the previously published findings of feline dental resorptive lesions from materials examined at an archaeological museum. These lesions were too small to be noted on radiographs, and consisted of two inconspicuous enamel lesions in a mandibular left first molar tooth (309), a clinically visible white spot area containing an enamel lesion in a mandibular left fourth premolar tooth (308), and a root surface caries in the 308 of a different specimen. Histologic examination using special stains and polarized light revealed both initial and early initial stage enamel caries, as well as root surface caries. Knoop hardness measurements confirmed these findings, considered the first documented cases of feline caries.

The future of fluorides and other protective agents in erosion prevention

The effectiveness of fluoride in caries prevention has been convincingly proven. In recent years, researchers have investigated the preventive effects of different fluoride formulations on erosive tooth wear with positive results, but their action on caries and erosion prevention must be based on different requirements, because there is no sheltered area in the erosive process as there is in the subsurface carious lesions. Thus, any protective mechanism from fluoride concerning erosion is limited to the surface or the near surface layer of enamel. However, reports on other protective agents show superior preventive results. The mechanism of action of tin-containing products is related to tin deposition onto the tooth surface, as well as the incorporation of tin into the near-surface layer of enamel. These tin-rich deposits are less susceptible to dissolution and may result in enhanced protection of the underlying tooth. Titanium tetrafluoride forms a protective layer on the tooth surface. It is believed that this layer is made up of hydrated hydrogen titanium phosphate. Products containing phosphates and/or proteins may adsorb either to the pellicle, rendering it more protective against demineralization, or directly to the dental hard tissue, probably competing with H(+) at specific sites on the tooth surface. Other substances may further enhance precipitation of calcium phosphates on the enamel surface, protecting it from additional acid impacts. Hence, the future of fluoride alone in erosion prevention looks grim, but the combination of fluoride with protective agents, such as polyvalent metal ions and some polymers, has much brighter prospects.

Erosive tooth wear and wedge-shaped defects in 1996 and 2006: cross- sectional surveys of Swiss army recruits.

The purpose of this study was to determine the prevalence and possible etiological factors of erosive tooth wear and wedge-shaped defects in Swiss Army recruits and compare the findings with those of an analogous study conducted in 1996. In 2006, 621 recruits between 18 and 25 years of age (1996: 417 recruits; ages 19 to 25) were examined for erosive tooth wear and wedge-shaped defects. Additional data was acquired using a questionnaire about personal details, education, dentitions subjective condition, oral hygiene, eating and drinking habits, medications used, and general medical problems. In 2006, 60.1% of those examined exhibited occlusal erosive tooth wear not involving the dentin (1996: 82.0%) and 23.0% involving the dentin (1996: 30.7%). Vestibular erosive tooth wear without dentin involvement was seen in 7.7% in 2006 vs. 14.4% in 1996. Vestibular erosive tooth wear with dentin involvement was rare in both years (0.5%). Oral erosive tooth wear lacking exposed dentin was also rare in those years, although more teeth were affected in 2006 (2.1%) than in 1996 (0.7%). The examinations in 2006 found one or more initial wedge-shaped lesions in 8.5% of the recruits, while 20.4% of the study participants exhibited such in 1996. In 1996, 53% consumed acidic foods and beverages more than 5 times/day; in 2006, 83.9% did so. In neither study did multivariate regression analyses show any significant correlations between occurrence and location of erosive tooth wear and wedge-shaped defects and various other parameters, e.g., eating and hygiene habits, or dentin hyper-sensitivity. Despite a significant increase in consumption of acidic products between 1996 and 2006, the latter study found both fewer erosive tooth wear and fewer wedge-shaped defects (i.e., fewer non-carious lesions.).

Clinical performance of a new laser fluorescence device for detection of occlusal caries lesions in permanent molars

OBJECTIVES: To determine the clinical performance of a laser fluorescence device (DIAGNOdent pen, KaVo) to discriminate between different occlusal caries depths (D(0)-D(1-4); D(0-2)-D(3,4)) in permanent molars. METHODS: In this prospective, randomized two-centre-study 120 sound/uncavitated carious sites in 120 patients were measured after visual and radiographic caries assessment. In cases of operative intervention (n=86), the lesion depths after caries removal were recorded (reference). In cases of preventive intervention (n=34), the sites were reassessed visually/radiographically after 12 months to verify the status assessed before (reference). The discrimination performance was determined statistically (Mann-Whitney test, Spearman's rho coefficient, and areas under the receiver operating characteristic curves (AUCs)). Sensitivities (SE) and specificities (SP) were plotted as a function of the measured values and cut-off values for the mentioned thresholds suggested. RESULTS: Sound sites (n=13) had significantly minor fluorescence values than carious sites (n=107) (P<0.0001) as had sites with no/enamel caries (n=63) compared to dentinal caries (n=57). The AUCs for the same discriminations were 0.92 and 0.78 (P<0.001). For the D(0)-D(1-4) threshold, a cut-off at a value of 12 (SE: 0.88, SP: 0.85) and for the D(0-2)-D(3,4) threshold at 25 (SE: 0.67, SP: 0.79) can be suggested. A moderate positive correlation between the measurements and the caries depths was calculated (rho=+0.57, P=0.01). CONCLUSION: Within this study, the device's discrimination performance for different caries depths was moderate to very good and it may be recommended as adjunct tool in the diagnosis of occlusal caries.

ChronOS Inject in Children with Benign Bone Lesions – Does It Increase the Healing Rate?

Benign bone lesions in children although rare, can result in a pathological fracture. Although their etiology and pathogenesis are not yet entirely clear, the phenomenon of spontaneous healing is well known. Nevertheless, some benign bone lesions are unlikely to heal spontaneously due to the patient's age or high risk of fracture and deformity due to the lesion's location or size. The following study presents our results after treatment of these bone cysts with chronOS Inject.

PPAR-gamma expression in peritoneal endometriotic lesions correlates with pain experienced by patients

Endometriosis is a significant gynecologic condition that can cause both pain and infertility and affects up to 15% of women during their reproductive years. In peritoneal endometriotic lesions, the expression of peroxisome proliferation-activated receptor gamma, a nuclear receptor with antiinflammatory and neuroprotective roles, is positively correlated with the pain reported by patients.

PET/CT-guided biopsies of metabolically active bone lesions: applications and clinical impact

In a minority of cases a definite diagnosis and stage grouping in cancer patients is not possible based on the imaging information of PET/CT. We report our experience with percutaneous PET/CT-guided bone biopsies to histologically verify the aetiology of hypermetabolic bone lesions.

In vivo performance of a laser fluorescence device for the approximal detection of caries in permanent molars

OBJECTIVES: The aim of this randomised clinical trial was to investigate if a laser fluorescence device is able to discriminate between sound and carious approximal sites and between enamel and dentinal lesions, as well as to find appropriate cut-off values. METHODS: One hundred and seventeen sound or uncavitated carious sites in permanent molars were visually and radiographically examined, then either opened or not, after which their laser fluorescence was measured. Forty-three lesions were opened, the caries removed and the clinically identified caries depths were registered in addition to the radiographical scoring. Seventy-four sites were radiographically deemed sound or had enamel caries and were not opened. Here, the radiographical scorings were registered. RESULTS: Taking the radiographic scoring as gold standard for all investigated approximal sites, sound sites (D(0), n=40) showed significantly lower laser fluorescence measurements than carious sites (D(1-4), n=77) (Mann-Whitney test, P<0.025) suggesting a cut-off at 7 (sensitivity=0.68, specificity=0.7). Comparing measurements of D(0-2) (n=74) and D(3,4) (n=43), the results were also different by a statistically significant amount (P<0.025) and the cut-off calculated to be 16 (sensitivity=0.6, specificity=0.84). A fair positive correlation between laser fluorescence values and radiographical scoring was found (rho=+0.47, P<0.01). Analysing the 43 opened lesions with their clinically found lesion depths as gold standard, there was a fair positive correlation to the laser fluorescence values (rho=+0.34, P=0.03) and a moderately strong correlation to the radiographic scoring (rho=+0.67, P<0.01). CONCLUSION: The device may be an adjunct tool in the approximal detection of caries along with established procedures.

Formation of caries-like lesions in vitro on the root surfaces of human teeth in solutions simulating plaque fluid

Lesion formation on root surfaces of human posterior teeth was studied in acetate/lactate buffers with a background electrolyte composition based on plaque fluid analyses. Lesion depth after 28 days at 37 degrees C was measured in relation to: the presence or absence of cementum; the concentration of undissociated buffer; the presence or absence of magnesium ions at plaque fluid concentration. Each factor was evaluated at several values of -log(ion activity product for hydroxyapatite): pI(HA). Solutions were formulated to minimize variation in pH, which varied by < or =0.03 for a given comparison (individual pI(HA)) and by 0.42-0.82 over the range of pI(HA) within experiments. Lesions on surfaces from which cementum had been ground were significantly deeper than on intact surfaces, but this is considered to be due to subsurface mechanical damage and not to a solubility difference. Neither the concentration of undissociated buffer nor the presence of magnesium ions significantly affected lesion depth. Lesion depth was strongly influenced by the correlated variations in pI(HA) and pH. At pI(HA) 54 and 55, only extremely shallow lesions formed. From pI(HA) 56, lesion depth increased with increasing pI(HA). The results confirm that the solubility of the mineral of root tissues is higher than that of hydroxyapatite, but indicate that it is probably lower than suggested by Hoppenbrouwers et al. [Arch Oral Biol 1987;32:319-322]. For calcium concentrations of 3-12 mM, the critical pH for root tissue mineral was calculated as 5.22-5.66 assuming solubility equivalent to pI(HA) 54 and 5.08-5.51 assuming pI(HA) 55.