Influence of the ICDAS e-learning program for occlusal caries detection on dental students

The aim of this study was to evaluate the influence of ICDAS training in a group of dental students for occlusal caries detection in permanent teeth. Premolars and molars (N=104) with occlusal surfaces varying from ICDAS scores 0 to 6 were cleaned, one occlusal site per tooth was selected, and a photograph taken to identify the site. Eight senior dental students examined the teeth twice with a one-week interval between examinations during each of two phases: before and after the ICDAS e-learning program. Teeth were histologically assessed for caries extension. Intraclass correlation coefficients for intra- and interexaminer repeatability were high, both before (0.75 and 0.72, respectively) and after e-learning (0.82 and 0.78, respectively). The ICDAS scores decreased significantly from before to after e-learning (p=0.0001). Correlation between ICDAS scores and histology scores was moderate (0.57 before e-learning and 0.61 after). Although the ROC curve shows an improvement in the use of the ICDAS scoring after e-learning, the difference was not significant (p=0.10). Specificity of the ICDAS scores significantly improved after e-learning (77 percent vs. 36 percent), and sensitivity was reduced slightly after e-learning (87 percent vs. 92 percent). The ICDAS e-learning program improved the performance of the diagnostic skills of the investigated students for the detection of occlusal caries lesions.

Dental caries experience in children attending an infant oral health program

Aim: To investigate: a) caries experience in 5 year-old children and its relationship to the caries risk evaluation made before 1 year of age; b) compliance of parents to an infant oral health program as well as the abandonment reasons. Methods: Group A (GA) - 242 children (60-71 months old) who stayed in the program and had been enrolled since their first year of life underwent a clinical examination according to the WHO's criteria; their parents/caregivers were interviewed to ascertain their compliance to the program. Group B (GB) - parents of 60 children, who had dropped out of the program, were interviewed to check the reasons of withdrawing. The caries risk classification was based on the file at the first appointment. Chi-square test was used (α=0.05) for statistical analyses. Results: Most of the children were free of caries (71.1%). Caries risk evaluation showed low sensibility (34.3%, 95% CI = 22.4-46.1) and high specificity (74.4%, 95% CI = 67.6-81.2) to caries experience. Sixty-two mothers (25.6%) reported difficulty to follow the guidelines. The main reason for dropping out was changing to similar health services (40.0%). Conclusions: Caries risk in the first year of life was not efficient to predict dental caries experience at 5 years of age. Educational practice should be improved to increase the compliance of the parents to the program.

Effect of an acid diet allied to sonic toothbrushing on root dentin permeability: An in vitro study

This study quantified alterations in root dentin permeability after exposure to different acid beverages. Twenty-five third molars were sectioned below the cementoenamel junction, the root segment was collected, and the pulp tissue was removed. The root segments were connected to a hydraulic pressure apparatus to measure the permeability of root dentin after the following sequential steps, with 5 specimens in each: 1) phosphoric acid etching for 30 s (maximum permeability), 2) root planning to create new smear layer, 3) exposure to different acid substances for 5 min (orange, cola drink, vinegar, white wine, lemon juice), 4) toothbrushing with sonic toothbrush for 3 min, 5) toothbrushing with sonic toothbrush plus dentifrice for 3 min. Considering step I as 100%, the data were converted into percentage and each specimen was its own control. Data were analyzed statistically by Kruskal-Wallis and Dunn's post test at 5% significance level. All acidic substances increased dentin permeability significantly after scraping (p<0.05). Toothbrushing after exposure to acid substances decreased dentin permeability and the association with dentifrice accentuated the decrease (p<0.05), except for the specimens treated with cola drink. Thus, it may be concluded that all tested acid fruit juices increased dentin permeability, and toothbrushing with or without dentifrice can decrease root dentin permeability after dentin exposure to acid diet.

Effect of drying on the reproducibility of DIAGNOdent to detect caries-like lesions

The aim of this study was to verify the drying effect on the reproducibility of DIAGNOdent (Dd) devices to detect caries-like lesions. Three areas were created in each of the 34 bovine incisors: sound (S), demineralized (DE) and remineralized (RE). One examiner measured each area with two Dd devices (denominated X and Y), twice under humid, and twice under dry condition. Intra-rater agreement according each device and inter-device agreement were estimated by kappa statistics (κ). Intra-rater agreement for device Y was substantial under humid (κ DE=0.68 and κ RE+S=0.68) and dry condition (κ DE=0.64 and κ RE+S=0.67). For device X, it was substantial under humid condition (κ DE=0.57 and κ RE+S=0.49), and it was almost perfect after air drying (κ DE=1.0 and κRE+S=1.0). Inter-device agreement was slight (κ =0.17) under humid condition, and it was substantial under dry condition (κ =0.62). As reproducibility increased under dry condition, drying is advised to detect caries-like lesions on free smooth surfaces when different devices are used.

Evaluation of the dentin-pulp complex after cavity preparation with ultrasonic diamond tip

The aim of this paper was to compare the dentin-pulp complex response to cavity preparation in human teeth using ultrasonic chemical vapor deposition (CVD) diamond tip and high-speed diamond bur. Class V buccal cavities were randomly prepared in 40 premolars from 14 patients aged 11 to 15 years. The cutting time was recorded and the cavities had the axial walls protected with gutta-percha and were filled with glass ionomer cement. The teeth were extracted at intervals of 0, 5, 10 and 20 days, and were decalcified, sectioned and stained by Hematoxylin & Eosin, Masson's Trichrome and Brown & Brenn techniques. The inflammatory response and cell disorganization were blindly evaluated by two examiners. The remaining dentin thickness (RDT) was measured by a linear scale using computer software. Statistical analysis by one-way ANOVA showed no statistically significant difference (P≤0.05) among the cavities prepared with either type of instrument, with mean RDT of 1132.50 mm. Cutting time and the pulp-dentin complex responses were analyzed statistically by Kruskal-Wallis and Dunn tests (P≤0.05). The ultrasonic CVD diamond tip took 5 times longer to prepare the cavities and there were no typical inflammatory pulp responses in cavities prepared with either type of cutting instrument, only mild to moderate cell disorganization was present. Even taking longer to cut the dental substrate, the ultrasonic CVD diamond tip produced similar pulp response compared to the conventional high-speed diamond bur.

Caries experience associated to social and preventive factors in children of a pastoral community from Limeira-SP

Aim: To evaluate caries experience and prevalence associated to social and preventive factors in 3-6-year-old children of a Pastoral Community from Limeira, Brazil. Methods: A cross-sectional study was carried out through an epidemiologic research about the oral conditions of 110 children registered at the Children's Pastoral Community from the city of Limeira, SP, Brazil. Intraoral examination was performed by a trained dentist and the parents/caregivers filled out a questionnaire in order to outline the children's profile with respect to gender, parental education and oral health. Results: Differences related to gender were not detected (p= 0.3404). The most frequent periods of breastfeeding were 0 to 2 months (36.36%) and 2 to 6 months (35.45%), corresponding to 71.81% of the cases. The time bottle feeding pointed to two most frequent categories: 1) more than 12 months (35.45%) and 2) between 2 and 6 months (22.63%). Regarding parental education, the majority of the sample has not completed primary school (38.32%). It was observed a larger number of decayed teeth in male children (63.39%). Caries experience was significantly higher in children who were breastfed for only 2 months of life (41.96%). Children that did not use baby bottle or did not use a baby bottle for more than 1 year presented a smaller dmft, corresponding to 29.17% and 28.33%, respectively. Time of use of bottle and pacifier presented a significant association (p<0.05). Conclusions: The implementation of adequate strategies and actions is needed to reinforce oral health conditions in risk groups.

Mechanisms of action of fluoride for caries control

Fluoride was introduced into dentistry over 70 years ago, and it is now recognized as the main factor responsible for the dramatic decline in caries prevalence that has been observed worldwide. However, excessive fluoride intake during the period of tooth development can cause dental fluorosis. In order that the maximum benefits of fluoride for caries control can be achieved with the minimum risk of side effects, it is necessary to have a profound understanding of the mechanisms by which fluoride promotes caries control. In the 1980s, it was established that fluoride controls caries mainly through its topical effect. Fluoride present in low, sustained concentrations (sub-ppm range) in the oral fluids during an acidic challenge is able to absorb to the surface of the apatite crystals, inhibiting demineralization. When the pH is re-established, traces of fluoride in solution will make it highly supersaturated with respect to fluorhydroxyapatite, which will speed up the process of remineralization. The mineral formed under the nucleating action of the partially dissolved minerals will then preferentially include fluoride and exclude carbonate, rendering the enamel more resistant to future acidic challenges. Topical fluoride can also provide antimicrobial action. Fluoride concentrations as found in dental plaque have biological activity on critical virulence factors of S. mutans in vitro, such as acid production and glucan synthesis, but the in vivo implications of this are still not clear. Evidence also supports fluoride's systemic mechanism of caries inhibition in pit and fissure surfaces of permanent first molars when it is incorporated into these teeth pre-eruptively. © 2011 S. Karger AG, Basel.

Topical use of fluorides for caries control

Since the early findings on the protective effects of fluoride present in drinking water upon caries incidence and prevalence, intensive research has been conducted in order to determine the benefits, safety, as well as the cost-effectiveness of other modalities of fluoride delivery. The present chapter reviews the various forms of topical fluoride use - professionally and self-applied - with special emphasis on clinical efficacy and possible side effects. The most widely used forms of fluoride delivery have been subject of several systematic reviews, providing strong evidence supporting the use of dentifrices, gels, varnishes and mouth rinses for the control of caries progression. Dentifrices with fluoride concentrations of 1,000 ppm and above have been shown to be clinically effective in caries prevention when compared to a placebo treatment, but the evidence regarding formulations with 450-550 ppm is still subject of debate. Therefore, the recommendation for low-fluoride dentifrice use must take into account both risks and benefits. The evidence for the combined use of two modalities of fluoride application in comparison to a single modality is still inconsistent, implying that more studies with adequate methodology are needed to determine the real benefits of each method. Considering the currently available evidence and risk-benefit aspects, it seems justifiable to recommend the use of fluoridated dentifrices to individuals of all ages, and additional fluoride therapy should also be targeted towards individuals at high caries risk. © 2011 S. Karger AG, Basel.

Adhesion between fiber post and root dentin: evaluation of post surface conditioning for bond strength improvement.

The aim of this paper was to evaluate two surface conditioning methods associated with the application of adhesive on the post surface for improving the bond to resin cement. Sixty single-rooted bovine teeth were sectioned at 16 mm in length, prepared (9 mm depth), embedded in a PVC cylinder using acrylic resin, and allocated into 3 groups (N.=20) according to post surface treatment: cleaning with ethanol (control group); etching with hydrogen peroxide; etching with hydrofluoric acid. Ten posts for each group were silanized and other 10 posts were silanized and received an adhesive agent. The posts were cemented with self-adhesive resin cement (RelyX U100 resin cement). All teeth were sectioned perpendicularly to the long axis (2 mm thickness per slice), submitted to push out bond strength testing and the type of failure was recorded. The obtained data were submitted to two-way ANOVA and Turkey's test, with the level of significance set at 5%. Neither the hydrofluoric acid or hydrogen peroxide post surface treatment, nor the adhesive application, had an influence on bond strength values. The main type of failure was adhesive between cement and dentin. Etching and the application of an adhesive on the post surface did not presented a significant influence on the bond strength results for the fiber post resin cement-root dentin assembly. The cement appears to adhere very well to the fiber post surface rather than the dentin surface.

Micromechanics of dentin/adhesive interface in function of dentin depth: 3d finite element analysis

Objectives: The aim of this study was to analyze the stress distribution on dentin/adhesive interface (d/a) through a 3-D finite element analysis (FEA) varying the number and diameter of the dentin tubules orifice according to dentin depth, keeping hybrid layer (HL) thickness and TAǴs length constant. Materials and Methods: 3 models were built through the SolidWorks software: SD - specimen simulating superficial dentin (41 x 41 x 82 μm), with a 3 μm thick HL, a 17 μm length Tag, and 8 tubules with a 0.9 μm diameter restored with composite resin. MD - similar to M1 with 12 tubules with a 1.2 μm diameter, simulating medium dentin. DD - similar to M1 with 16 tubules with a 2.5 μm diameter, simulating deep dentin. Other two models were built in order to keep the diameter constant in 2.5 μm: MS - similar to SD with 8 tubules; and MM - similar to MD with 12 tubules. The boundary condition was applied to the base surface of each specimen. Tensile load (0.03N) was performed on the composite resin top surface. Stress field (maximum principal stress in tension - σMAX) was performed using Ansys Wokbench 10.0. Results: The peak of σMAX (MPa) were similar between SD (110) and MD (106), and higher for DD (134). The stress distribution pathway was similar for all models, starting from peritubular dentin to adhesive layer, intertubular dentin and hybrid layer. The peak of σMAX (MPa) for those structures was, respectively: 134 (DD), 56.9 (SD), 45.5 (DD), and 36.7 (MD). Conclusions: The number of dentin tubules had no influence in the σMAX at the dentin/adhesive interface. Peritubular and intertubular dentin showed higher stress with the bigger dentin tubules orifice condition. The σMAX in the hybrid layer and adhesive layer were going down from superficial dentin to deeper dentin. In a failure scenario, the hybrid layer in contact with peritubular dentin and adhesive layer is the first region for breaking the adhesion. © 2011 Nova Science Publishers, Inc.

Morphological alterations on human radicular dentin after exposure to different fruit juice drinks

Purpose: This in vitro study aimed to evaluate the effect of different fruit juice drinks available in the Brazilian market on smear layer removal and dentinal tubules opening, as well as to verify the effect of toothbrushing subsequently to the juices exposure. Methods: Dentin specimens were prepared and randomly distributed into the control group (distilled water) and twelve types of fruit juice drinks (cashew, orange, mandarin, apple, passion fruit, guava, strawberry, grape, mango, pear, peach, pineapple). The following treatments were applied: immersion or immersion + brushing. After preparation for SEM, photomicrographs were assessed using an index of smear layer removal. Results: No significant differences regarding smear layer removal and dentinal tubules exposure could be observed between the groups after both treatments (Kruskal-Wallis, post-hoc paired comparisons, P>0.05). The control solution and the fruit juice drinks were not able to remove smear layer and to open dentinal tubules. Significant difference between the applied treatments was detected only for the mango juice group (Mann-Whitney, P<0.05). Conclusion: Under the experimental conditions, the different fruit juice drinks did not promote significant alterations on human radicular dentin morphology regardless of the subsequent application of brushing procedures. Copyright: © 2011 Zandim et al.

Nd:YAG Laser Irradiation effect on apical intracanal dentin-a microleakage and SEM evaluation

The purpose of this in vitro study was to evaluate the effect of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser irradiation on intracanal dentin surface by SEM analysis and its interference in the apical seal of filled canals. After endodontic treatment procedures, 34 maxillary human incisors were randomly assigned to 2 groups. In the negative control group (n=17), no additional treatment was performed and teeth were filled with vertically condensed gutta-percha; in the laser-treated group (n=17), the root canals were irradiated with Nd:YAG laser (1.5 W, 100 mJ, 15 Hz) before filling as described for the control group. Two specimens of each group were prepared for SEM analysis to evaluate the presence and extent of morphological changes and removal of debris; the other specimens were immersed in 0.5% methylene blue dye (pH 7.2) for 24 h for evaluation of the linear dye leakage at the apical third. SEM analysis of the laser-treated group showed dentin fusion and resolidification without smear layer or debris. The Student's t-test showed that the laser-treated group had significantly less leakage in apical third than the control group. Within the limitations of this study, it may be concluded that the morphological changes on the apical intraradicular dentin surface caused by Nd:YAG laser resulted in less linear dye apical leakage.

A comparative study of the physical properties of conventional and Grander-modified adhesive systems

Purpose: The objective of this study was to evaluate the influence of the Grander technology in reducing the surface tension and contact angle of a self-etch adhesive system. Methods: Distilled water and Xeno III self-etch adhesive system (Dentsply) were modified by physical contact with the Flexible unit Grander system to revitalize water, for 48 hours, resulting in four groups: Group 1 - Xeno III under normal conditions; Group 2 - Xeno III modified by Grander; Group 3 - distilled water under normal conditions; Group 4 - distilled water system modified by the Grander system;. Surface tension and contact angle (dentin substrate and titanium plate) of the adhesive system and water in normal and Grander-modified conditions was measured with a goniometer. Data were analyzed by ANOVA and Tukey test (5%). Results: Grander technology reduced the surface tension of water but not of the adhesive system Xeno III. The contact angle property of the adhesive ystem was not affected. Conclusion: Grander technology did not interfere with the surface tension and contact angle physical properties of the Xeno III self-etch adhesive system. Copyright: © 2011 Gonçalves et al.;.

Analysis of hybrid layer thickness, resin tag length and their correlation with microtensile bond strength using a total etch adhesive to intact dentin.

The objective of this study was to evaluate the use of a two-step total etch and rinse adhesive, the correlation between the hyybrid layer thickness (HL) and bond strength (BS), and between resin tag length (RT) and bond strength in the same teeth, and also to evaluate the fracture patterns of the tested specimens. Ten human molars were used for the restorative procedure and then sectioned in two halves (mesio-distally). The materials used were Adper Single Bond 2, 3M ESPE, Ultra etch gel, Ultradent and Filtek Z250, 3M ESPE. One half were utilized to measure the HL thickness and RT length through light microscopy analysis (400x), and the other half was subject to a microtensile test to measure the BS. The fractured surfaces were analyzed by scanning electron microscopy and fracture patterns classified. The Pearson correlation test was applied (p = 0.05). The results of the analyses of each specimen then were correlated: mean HL thickness = 4.39 (0.48) microm, mean length of RT = 9.94 (1.69) microm, mean BS = 23.98 (10.24) MPa. A statistically significant correlation between HL thickness and bond strength was found (r = 0.93). The two step etch and rinse adhesive system, showed a strong correlation between HL thickness and bond strength. The most common fractures were adhesive, followed by cohesive in resin.

Biomass production and chemical composition of essential oil of Piper callosum as affected by spacing in Manaus, Amazonas State, Brazil

The family Piperaceae contains nearly 2000 species, most of them distributed in two genera, Piper and Peperomia. In Brazil circa 170 Piper species are found, mainly in tropical areas Their use ranges from flavoring and culinary to raw material for pharmaceutical and cosmetic industry. One of these species, Piper callosum, is used in folk medicine in the Amazon area. The objective of this study was to evaluate the production of biomass (aerial parts) as well as yield and composition of the essential oil from the leaves, according to different spacing between cultivated plants at Embrapa Western Amazon, in Manaus, State of Amazonas, Brazil. The experimental design was randomized blocks, with four treatments and seven replicates with six plants. Biomass production was inversely proportional to the spatial arrangements, with the greatest biomass production (1034.93 kg/ha) in the shortest spacing (E1), although no statistical difference was verified between E3 and E4. The same response was observed for the production of essential oil. The chemical composition of the oil was not affected by spacing, and major compounds found were safrole (59.1%), beta-pinene (8.3%), alpha-pinene (6.5%), methyl eugenol (6.3%) and 1,8-cineole (4.1).