Airton O. Arruda

Incidence of caries lesions among patients treated with comprehensive orthodontics.

INTRODUCTION Dental caries, specifically decalcified white-spot lesions (WSL), is a well-known side-effect of orthodontic treatment. The incidence of labial incipient caries lesions and its relationship with various patient and treatment variables was investigated in patients treated with comprehensive orthodontics. METHODS Randomly selected orthodontic patient records (n = 350) were examined to determine incipient caries lesion development. Labial surfaces on pretreatment and posttreatment photographs were scored with a standardized scoring system. Independent variables were collected by chart abstraction. RESULTS The incidence of patients who developed at least 1 new WSL during treatment was 72.9%, and this incidence was 2.3% for cavitated lesions. Treatment duration was significantly associated with new WSL development (P = 0.03). Development of WSL and cavitated lesions increased (both, P <0.00) despite increased attention to oral hygiene during treatment. Sex, age, extraction therapy, and various fluoridation sources were not associated with WSL development, but initial oral-hygiene score was moderately associated (P <0.06). CONCLUSIONS The incidence of WSL in patients treated with comprehensive orthodontics was significantly high, and the preventive therapy provided appeared to be ineffective. This widespread problem is alarming and warrants significant attention from both patients and providers that should result in greatly increased emphasis on effective caries prevention.

In-vitro evaluation of various treatments to prevent demineralization next to orthodontic brackets

INTRODUCTION One common negative side effect of orthodontic treatment with fixed appliances is the development of incipient caries lesions around brackets, particularly in patients with poor oral hygiene. Bio-available minerals from cement containing amorphous calcium phosphate (ACP) might facilitate remineralization and inhibit lesion development. Our objective was to compare the potential of ACP-containing resin cement, fluoride varnish, resin sealer, and MI Paste (GC America, Alsip, Ill) under similar in-vitro conditions to prevent incipient caries lesions next to brackets on teeth. METHODS One hundred extracted premolars were randomly allocated to 5 groups (n = 20). Brackets were bonded with ACP cement (Aegis-Ortho, Bosworth, Skokie, Ill), resin (Transbond XT [3M Unitek, Monrovia, Calif], control), or resin followed by application of fluoride varnish (Vanish, 3M, St Paul, Minn), resin sealer (Pro-seal, Reliance Orthodontic Products, Itasca, Ill), or casein phosphopeptide-ACP paste (MI Paste). All groups were cycled for 15 days in demineralization solution for 8 hours a day, rinsed, placed in artificial saliva (30 minutes), brushed, and stored overnight in artificial saliva. The extent of demineralization in each group was assessed by using quantitative light-induced fluorescence and confocal laser scanning microscopy. RESULTS Only the Pro-seal and Vanish groups showed significantly smaller lesions than the controls (Kruskal-Wallis test, P <0.05) for both quantitative light-induced fluorescence and confocal laser scanning microscopy measurements. Fluorescence loss of Aegis-Ortho was similar to Vanish; Aegis-Ortho, MI Paste, and the controls were not different from each other. CONCLUSIONS Both light-cured filled resin (Pro-seal) and fluoride varnish (Vanish) might prevent enamel demineralization next to orthodontic brackets exposed to cariogenic conditions, but the observed positive effects of Aegis-Ortho and MI Paste were not significant.

Effect of 5% fluoride varnish application on caries among school children in rural Brazil: a randomized controlled trial

OBJECTIVES To determine the efficacy of 5% sodium fluoride (NaF) varnish application in reducing caries increments in the permanent dentition of rural Brazilian school children over the course of 12 months. METHODS A double-blind, randomized, placebo-controlled trial was conducted with 379 children aged 7-14 years who attended three schools in Brazil between January 2006 and December 2007. During this period, each school was visited four times at 6-month interval for recruitment, dental examinations, and fluoride varnish applications. Recruited children were randomly assigned to either a treatment (5% NaF varnish, n = 198) or a control group (placebo, n = 181). Trained interviewers collected data on oral health habits and sociodemographic characteristics from the children. Information on the childs diet was collected through a 7-day food frequency diary. Caries examinations were conducted using the International Caries Detection and Assessment System (ICDAS). The efficacy of fluoride varnish application on caries prevention was reported as a preventive fraction (PF). Crude caries increments of decayed and filled surfaces (DFS) were compared between fluoride varnish and placebo groups. A generalized linear model (GLM) was constructed to test the differences in DFS increments between the groups after accounting for confounding factors. RESULTS Of the total sample (N = 379), 210 (55.4%) children had completed 12 months of follow-up including one or two applications of fluoride varnish or placebo. At the baseline examination, the children in the treatment and control groups presented on average 6.2 and 5.6 DFS, respectively (P < 0.001). After 12 months of follow-up, the children in the varnish group showed significantly lower DFS increments than did children in the control group (10.8 versus 13.3; P < 0.007), with PF of 40% (95% CI: 34.3-45.7%; P < 0.0001). CONCLUSIONS The results of this study suggest that applications of 5% NaF varnish can be recommended as a public health measure for reducing caries incidence in this high-caries-risk population.

Occlusal indexes as judged by subjective opinions

INTRODUCTION An orthodontic index is validated by comparing its scores with a gold standard, commonly the consensus opinion of a group of experienced orthodontists. The purpose of this investigation was to evaluate contemporary occlusal indexes against the subjective opinions of people with varying levels of dental knowledge. METHODS Randomly selected orthodontic study models (n = 25) with full permanent dentitions were scored according to the peer assessment rating (PAR) index, the index of complexity, outcome, and need (ICON), and the occlusal index (OI). The models were also scored according to the subjective opinion of orthodontists (n = 10), general dentists (n = 10), and social workers (n = 10) by using a Q-sort assessment. RESULTS High correlation coefficients were found between the panelists and the occlusal indexes. The average correlation was about 0.8. CONCLUSIONS Regardless of background and clinical experience, people with various levels of dental knowledge have similar opinions when quantifying relationships of teeth and dental arches.

White-Spot Lesions in Orthodontics: Incidence and Prevention

The most common negative effect of orthodontic treatment with fixed appliances is the development of incipient carious lesions around brackets. The objectives of this chapter are to present some of the results of two studies aiming: 1) to evaluate patients treated with comprehensive orthodontics to determine the incidence of new carious lesions during treatment; and 2) to investigate the potential of ACP-containing resin cement and other treatments (fluoride varnish, resin sealer, MI Paste) to prevent incipient carious lesions on bracketed teeth. In the first study, 350 orthodontic patients were selected randomly. The preand post-treatment photographs of the patients were examined to determine lesion development. The labial surface of each tooth was scored with a standardized system based on the International Caries Determination and Assessment System II. The independent variables were collected by chart abstraction. In the second study, 100 extracted human premolars were allocated randomly to five groups (N = 20). Brackets were bonded with ACP-cement (Aegis-Ortho), Transbond