The Usefulness of Caries Frequency, Depth, and Location in Determining Cariogenicity and Past Subsistence: A Test on Early and Later Agriculturalists From the Peruvian Coast

Dental markers have been used to unravel particularities of paleodiet, subsistence, social structure, and health. This article aims to compare oral pathology among four pre-Columbian groups with different degrees of agricultural and socio-cultural development but comparable ecological conditions who lived on the coastal desert of Peru. Three of these groups are assigned to distinct phases of the Formative Period (2500-1 BC), a time critical for our understanding of the development of agriculture and social complexity. The fourth group corresponds to the Late Intermediate Period (1000-1470 AD), when agriculture had its apogee and society was highly stratified. In this study we test whether there is an increase (1) in the frequency of carious lesions and (2) in caries depth, and (3) if there is a shift from occlusal to extra-occlusal caries locations with the development of agriculture. Therefore, we analyze the frequencies of carious lesions and antemortem tooth loss (AMTL), the caries distributions by age, sex, and type of tooth, as well as the tissues affected by, and the location of the carious lesions. Since there are no significant differences in the frequencies of carious lesions and AMTL between the groups, we reject hypothesis 1. In contrast, caries depth does increase, and caries location changes from occlusal to extra-occlusal sites with agricultural development. However, we can only corroborate hypothesis 2 and 3 when taking into consideration dental wear. Thus, we recommend that caries depth and locations should be used with evaluations of dental wear to reconstruct subsistence in ancient populations. Am J Phys Anthropol 143:75-91, 2010. (C) 2010 Wiley-Liss, Inc.

Penetration ability and microleakage of a fissure sealant applied on artificial and natural enamel fissure caries

OBJECTIVES AND METHODS: This study investigated the sealing ability of a current available unfilled fissure sealant applied over sound (n=80), artificially created (n=80) and naturally carious fissures (n=80) under different humidity conditions (90+/-2 and 45+/-2% relative humidity) and etching times (40 and 60s). All samples were submitted to 5000 thermal cycles and examined by light microscopy after sectioning. Microleakage, penetration ability, fissure type, fissure entrance angle, sealant occlusal length, caries location and caries depth were assessed. RESULTS: The significantly longer sealant occlusal length and larger entrance angle exhibited by shallow fissures, contributed to their higher microleakage and smaller amounts of unfilled areas compared to deep fissures. Sealant microleakage was significantly influenced by the condition of the enamel (sound, artificial and natural caries) and the caries location in the fissures, but not by enamel caries depth (D1 and D2), etching time, or humidity condition. Natural caries exhibited significantly higher microleakage than sound or artificially created carious fissures. CONCLUSIONS: Based on the results of this study, it can be concluded that location of caries in the fissure rather than its depth should be taken into account when applying a fissure sealant. When the borders of the fissure sealant are on carious enamel, a significantly higher microleakage must be expected. The artificial caries model was not a suitable method to assess the behavior of natural fissure caries.

The association between caries and periodontal diseases

Objectifs: Le but de cette étude clinique était de comparer un groupe d’adultes ayant un parodonte sain avec un groupe d’adultes atteints de parodontite chronique en terme de risque carieux et mesures cliniques et microbiologiques de la carie. Méthodes: Quatre-vingt-seize individus ont été divisés en deux groupes en fonction de leur état de santé parodontal et ont été appariés pour l'âge, le sexe et l'origine ethnique. Trente-huit sujets étaient atteints de parodontite chronique définie comme ayant au moins quatre dents avec ≥ 1 site avec une profondeur de sondage ≥ 4 mm et une perte d'attache clinique ≥ 2 mm, et 58 sujets présentaient un parodonte sain. Par la suite, les groupes ont été subdivisés en deux groupes en fonction de leur statut carieux : les participants ayant au moins une lésion carieuse non traitée sur une surface dentaire et ceux n’ayant pas de lésion carieuse non traitée. Les données ont été recueillies par le biais d’un questionnaire, un examen clinique et des échantillons de plaque supra- et sous-gingivale. L’évaluation de la charge buccale de Streptococcus mutans et de six agents pathogènes parodontaux a été réalisée par la technique d'amplification de la réaction en chaine de la polymérase (PCR). Les données ont été analysées à l'aide d’analyses statistiques descriptives et bivariées. Résultats: Les individus atteints de parodontite chronique étaient 3,5 fois plus susceptibles d'avoir des caries que les individus en bonne santé (OR 3,5 ; IC: 1,5 - 8,3 ; P = 0,006). Les sujets à la fois atteints de parodontite chronique et de caries dentaires ont eu un niveau d’éducation significativement plus faible que les sujets ayant un parodonte sain et sans caries dentaires (OR 6,0 ; IC: 1,7 à 21,7 ; P = 0,04). La proportion de sujets ayant une charge buccale élevée de Porphyromonas gingivalis (P. g.) et Treponema denticola (T. d.) était significativement plus élevée chez les patients atteints de parodontite chronique et de carie que chez les patients sains présentant des caries (P. g.: OR 8,6 ; IC: 2,4 - 30,3 ; P = 0,004 et T. d.: OR 10,0 ; CI: 2,6 - 38.1 ; P = 0,003). Conclusions: Les résultats de cette étude suggèrent que, chez les sujets adultes atteints de la parodontite chronique, la fréquence des caries est plus élevée que chez les sujets ayant un parodonte sain. De plus, le faible niveau d'éducation influence négativement le statut parodontal des individus.

Relationship between DIAGNOdent values and sealant penetration depth on occlusal fissures

The aim of this in vitro study was to evaluate the relationship between laser fluorescence values and sealant penetration depth on occlusal fissures. One hundred and sixty-six permanent molars were selected and divided into four groups, which were each treated using a different sealant (two clear and two opaque). The teeth were independently measured twice by two experienced dentists using two laser fluorescence devices-DIAGNOdent (LF and LFpen)-before and after sealing, and then thermoclycled. After measuring, the teeth were histologically prepared and assessed for caries extension. Digital photographs of the cut sealed sites were assessed, and the sealant penetration depth was measured. All 166 sites were measured by one of the examiners taking as limits the outer and inner surface of the sealant into the fissure. For each device (LF and LFpen) and each group, the difference between the values at baseline and after sealing was plotted against the sealant penetration depth and scatter plots were provided. It could be observed that most of the points were concentrated around the zero line, for both LF and LFpen in the four groups. In conclusion, there is no relation between changes in DIAGNOdent values and increasing of depth sealant penetration within the occlusal fissures.

Artificial methods of dentine caries induction: A hardness and morphological comparative study

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Comparison of direct digital and conventional imaging with Ekta Speed Plus and INSIGHT films for the detection of approximal caries

Purpose: To evaluate the accuracy of approximal caries detection comparing enhanced and unenhanced Sidexis CCD-based digital image with Ektaspeed Plus and INSIGHT films. Methods: Fifty-two extracted premolars were imaged under identical standardized geometric and exposure conditions. Four observers, using five points confidence scale, rated 104 approximal surfaces for the presence or absence of carious lesions by means of four image modalities: (1) observer enhanced; (2) unenhanced Sidexis displays; (3) E speed films and (4) F speed film. Histologic sections served as validating criterion for the presence and depth of carious lesions. Diagnostic accuracy was measured as the area beneath the ROC curve. Results: Mean ROC (receiver operating characteristic) curve areas for approximal surfaces were 0.865 (E speed), 0.856 (F speed), 0.816 (unenhanced Sidexis) and 0.776 (observer enhanced). There were no significant differences between unenhanced digital Sidexis and films. Observer enhanced Sidexis images exhibited a statistically significant lower diagnostic accuracy than the film images for two of the observers.

Caries progression and inhibition in human and bovine root dentine in situ

Since the use of bovine instead of human dentine to evaluate cariogenic and anticariogenic substances is not well established, this in situ study was conducted. Eleven volunteers wore palatal acrylic devices containing 4 dentine slabs (2 human and 2 bovine). Sucrose solution (20%) was dripped over all slabs 4 times a day, simulating a cariogenic challenge. Dentifrice slurries, fluoridated or not, were dripped over specified dentine slabs 3 times a day to evaluate caries reduction. After 14 days, the biofilm formed on the dentine slabs was collected for microbiological analysis. In dentine, mineral loss (DeltaZ) and lesion depth (LD) were determined by cross-sectional microhardness and by polarized light microscopy, respectively. The total streptococci and mutans streptococci counts in the biofilm formed either on human or on bovine slabs, whether treated or not with fluoride dentifrice, were not statistically different. The DeltaZ and the LID values of dentine treated with fluoride dentifrice were significantly lower than the values of dentine treated with non-fluoride dentifrice. The differences in the DeltaZ and LD values between the human and bovine dentine were not statistically significant. The results suggest that bovine dentine can be used instead of human to evaluate caries development and inhibition. Copyright (C) 2003 S. Karger AG, Basel.

Accuracy of radiographic examination in determining the depth of approximal carious lesions in primary molars

The purpose of this study was to evaluate the accuracy of the depth of carious lesions on bitewing radiographs. Methods Recently extracted primary molars had their proximal surfaces evaluated visually (EC) and classified as healthy surface (0), signs that suggest the presence of carious lesions in enamel (1), signs of a superficial lesion in dentin (2) and carious lesions in deep dentin (3). Results The results were obtained by consensus between the investigators. The gold standard was determined by histological analysis. The values of sensitivity, specificity, accuracy and area under the ROC (Receiver Operating Characteristic) curve were evaluated. There was equilibrium between sensitivity (76.92% EC and 88.46% ER) and specificity (95.83% EC and 95.83% ER). Accuracy was 86.01% (EC) and 88.46% (ER). The Spearman correlation test was used to prove the correlation between clinical and radiographic examinations (0.886), for clinical and histological (0.736) and for radiographic and histological analysis (0.843).

Influence of professional experience on detection and treatment decision of occlusal caries lesions in primary teeth

To evaluate the influence of examiner's clinical experience on detection and treatment decision of caries lesions in primary molars. Design Three experienced dentists (Group A) and three undergraduate students (Group B) used the International Caries Detection and Assessment System (ICDAS) criteria and bitewing radiographs (BW) to perform examinations twice in 77 primary molars that presented a sound or carious occlusal surface. For the treatment decision (TD), the examiners attributed scores, analyzing the teeth in conjunction with the radiographs. The presence and the depth of lesion were validated histologically, and reproducibility was evaluated. The sensitivity, specificity, accuracy, and area under the ROC curve values were calculated for ICDAS and BW. The associations between ICDAS, BW, and TD were analyzed by means of contingency tables. Results Interexaminer agreement for ICDAS, BW, and TD were excellent for Group B and moderate for Group A. The two groups presented similar and satisfactory performance for caries lesion detection using ICDAS and BW. In the treatment decision, Group A was shown to have a less invasive approach than Group B. Conclusion The examiner's experience was not determinant for the clinical and radiographic detection of occlusal lesions in primary teeth but influenced the treatment decision of initial lesions.

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)

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.

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.

Influence of dental materials used for sealing caries lesions on laser fluorescence measurements

The aim of this study was to determine the influence of thickness and aging on the intrinsic fluorescence of sealing materials and their ability to block fluorescence from the underlying surface as assessed using a laser fluorescence device. Cavities of 0.5 mm and 1 mm depth were drilled into acrylic boards which were placed over two surfaces with different fluorescence properties: a low-fluorescence surface, to assess the intrinsic fluorescence of the sealing materials, and a high-fluorescence surface, to assess the fluorescence-blocking ability of the sealing materials. Ten cavities of each depth were filled with different sealing materials: Adper Scotchbond Multi-Purpose, Adper Single Bond 2, FluroShield, Conseal f and UltraSeal XT Plus. Fluorescence was measured with a DIAGNOdent pen at five different time points: empty cavity, after polymerization, and 1 day, 1 week and 1 month after filling. The individual values after polymerization, as well as the area under the curve for the different periods were submitted to ANOVA and the Tukey test (p < 0.05). At 0.5 mm, Scotchbond, FluroShield and UltraSeal showed insignificant changes in intrinsic fluorescence with aging and lower fluorescence after polymerization than Single Bond and Conseal. At 1 mm, Scotchbond and FluroShield showed the lowest intrinsic fluorescence, but only Scotchbond showed no chagnes in fluorescence with aging. At both depths, Scotchbond blocked significantly less fluorescence. All sealing materials blocked more fluorescence when applied to a depth of 1 mm. At 0.5 mm, fissure sealants blocked more fluorescence than adhesives, and did not show significant changes with aging. Scotchbond had the least affect on the fluorescence from the underlying surface and would probably have the least affect on the monitoring of sealed dental caries by laser fluorescence.

Performance of fluorescence-based and conventional methods of occlusal caries detection in primary molars - an in vitro study

International Journal of Paediatric Dentistry 2012; 22: 459466 Aim. This in vitro study aimed to test the performance of fluorescence-based methods in detecting occlusal caries lesions in primary molars compared to conventional methods. Design. Two examiners assessed 113 sites on 77 occlusal surfaces of primary molars using three fluorescence devices: DIAGNOdent (LF), DIAGNOdent pen (LFpen), and fluorescence camera (VistaProof-FC). Visual inspection (ICDAS) and radiographic methods were also evaluated. One examiner repeated the evaluations after one month. As reference standard method, the lesion depth was determined after sectioning and evaluation in stereomicroscope. The area under the ROC curve (Az), sensitivity, specificity, and accuracy of the methods were calculated at enamel (D1) and dentine caries (D3) lesions thresholds. The intra and interexaminer reproducibility were calculated using the intraclass correlation coefficient (ICC) and kappa statistics. Results. At D1, visual inspection presented higher sensitivities (0.970.99) but lower specificities (0.180.25). At D3, all the methods demonstrated similar performance (Az values around 0.90). Visual and radiographic methods showed a slightly higher specificity (values higher than 0.96) than the fluorescence based ones (values around 0.88). In general, all methods presented high reproducibility (ICC higher than 0.79). Conclusions. Although fluorescence-based and conventional methods present similar performance in detecting occlusal caries lesions in primary teeth, visual inspection alone seems to be sufficient to be used in clinical practice.

Laboratorial training of examiners for using a visual caries detection system in epidemiological surveys

Background: In epidemiological surveys, a good reliability among the examiners regarding the caries detection method is essential. However, training and calibrating those examiners is an arduous task because it involves several patients who are examined many times. To facilitate this step, we aimed to propose a laboratory methodology to simulate the examinations performed to detect caries lesions using the International Caries Detection and Assessment System (ICDAS) in epidemiological surveys. Methods: A benchmark examiner conducted all training sessions. A total of 67 exfoliated primary teeth, varying from sound to extensive cavitated, were set in seven arch models to simulate complete mouths in primary dentition. Sixteen examiners (graduate students) evaluated all surfaces of the teeth under illumination using buccal mirrors and ball-ended probe in two occasions, using only coronal primary caries scores of the ICDAS. As reference standard, two different examiners assessed the proximal surfaces by direct visual inspection, classifying them in sound, with non-cavitated or with cavitated lesions. After, teeth were sectioned in the bucco-lingual direction, and the examiners assessed the sections in stereomicroscope, classifying the occlusal and smooth surfaces according to lesion depth. Inter-examiner reproducibility was evaluated using weighted kappa. Sensitivities and specificities were calculated at two thresholds: all lesions and advanced lesions (cavitated lesions in proximal surfaces and lesions reaching the dentine in occlusal and smooth surfaces). Conclusion: The methodology purposed for training and calibration of several examiners designated for epidemiological surveys of dental caries in preschool children using the ICDAS is feasible, permitting the assessment of reliability and accuracy of the examiners previously to the survey´s development.