Bennett T. Amaechi

Global oral health inequalities: dental caries task group--research agenda.

The IADR Global Oral Health Inequalities Task Group on Dental Caries has synthesized current evidence and opinion to identify a five-year implementation and research agenda which should lead to improvements in global oral health, with particular reference to the implementation of current best evidence as well as integrated action to reduce caries and health inequalities between and within countries. The Group determined that research should: integrate health and oral health wherever possible, using common risk factors; be able to respond to and influence international developments in health, healthcare, and health payment systems as well as dental prevention and materials; and exploit the potential for novel funding partnerships with industry and foundations. More effective communication between and among the basic science, clinical science, and health promotion/public health research communities is needed. Translation of research into policy and practice should be a priority for all. Both community and individual interventions need tailoring to achieve a more equal and person-centered preventive focus and reduce any social gradient in health. Recommendations are made for both clinical and public health implementation of existing research and for caries-related research agendas in clinical science, health promotion/public health, and basic science.

Correlation of quantitative light-induced fluorescence and optical coherence tomography applied for detection and quantification of early dental caries

Fluorescence loss in enamel following demineralization has been correlated with the amount of mineral lost during the demineralization. The correlation between fluorescence loss measured by quantitative light-induced fluorescence (QLF) and the reflectivity loss measured by a versatile en face optical coherence tomography (OCT) system was investigated in a demineralization process to produce artificial dental caries. We used an OCT system that can collect A-scans (reflectivity versus depth), B-scans (longitudinal images), and C-scans (en face images). The power to the sample was 250 microW, the wavelength lambda = 850 nm, and the depth resolution in air 16 microm. A-scans, which show the profile of the reflectivity versus the depth of penetration into the tooth tissue, were used for quantitative analysis of the reflectivity loss. The results have shown that both the fluorescence radiance and reflectivity of the enamel decrease with increasing de- mineralization time. A linear correlation was observed between the percentage of fluorescence loss measured by QLF and the percentage of reflectivity loss measured by OCT. It was concluded that the decrease in reflectivity of the enamel during demineralization, measured by OCT, could be related to the amount of mineral lost during the de- mineralization process.

Quantitative light-induced fluorescence: A potential tool for general dental assessment

Current dental diagnostic methods can detect caries but cannot quantify the mineral status of a lesion. Quantitative light-induced fluorescence (QLF) measures the percentage of fluorescence change of demineralized enamel with respect to surrounding sound enamel, and relates it directly to the amount of mineral lost during demineralization. Development of caries-like lesions and subsequent remineralization of the lesions were monitored by QLF. The results showed that the percentage of fluorescence change (Delta Q) increased linearly with the demineralization time and decreased with increased remineralization time. Stained teeth were whitened with a bleaching agent and the change in stain intensity (Delta E) was quantified using QLF. The results showed that Delta E decreased linearly as the tooth regained its natural color. Factors that might affect the use of QLF to detect and quantify caries were also examined. It was concluded that QLF could be used to detect and longitudinally monitor the progression or remineralization of incipient caries, however lesion detection may be limited by the presence of saliva or plaque and enhanced by staining. The change in shade of discolored teeth by whitening agents could be quantitatively measured by QLF.

Thermophotonic radar imaging: An emissivity-normalized modality with advantages over phase lock-in thermography

One major problem of frequency-domain photothermal radiometry, or alternatively in two-dimensional lock-in thermography, is the compromise one has to make between dynamic range (probing depth) and depth resolution. The thermal-wave radar incorporates chirped excitation through matched filtering to maintain good resolution and depth range inside a sample. This letter experimentally demonstrates the advantages of chirped modulation and introduces a thermophotonic modality of thermal-wave radar based on an emissivity-normalized, higher-dynamic-range contrast parameter known as cross-correlation phase. Finally, comparisons made on a biological (dental) sample show potential applications of the method.

In vitro and in situ erosion models for evaluating tooth substance loss

Because of the difficulties in measuring erosion in vivo, a number of in vitro and in situ models have been developed and validated. These models are flexible and informative, allowing single as well as multiple variables to be examined under specific conditions using accurate measurement techniques over defined timelines, thus yielding useful data without harmful effects on individuals. This information, together with clinical findings, is essential for clinicians advising susceptible patients appropriately regarding the management of their condition. Little guidance is available, however, on the standardisation of in vitro and in situ protocols for erosive tooth wear studies, so it is difficult to make meaningful comparisons between investigations as experimental variables differ widely from study to study. The aim of this review was to collate the available data on models designed to assess erosive challenges which are severe enough to cause tissue loss as opposed to just softening of the surface structure. The different types of models, with their merits and pitfalls, are documented. Test substrates, disinfecting regimens and ethical considerations are discussed. The aims of this paper are to give guidance to the researcher on evidence-based in vitro and in situ erosive tooth wear methodology and to suggest best practice given current knowledge.

Antimicrobial activity of nanoemulsion on cariogenic Streptococcus mutans

OBJECTIVE To assess antimicrobial activities of nanoemulsion (NE) to control the adhesion and biofilm formation by Streptococcus mutans by in vitro. DESIGN In vitro antimicrobial susceptibility of nanoemulsion was determined as per National Committee for Clinical Laboratory Standards guidelines and agar diffusion, serial dilution technique for the determination of minimum inhibitory concentration and minimum bactericidal concentration (MIC/MBC). Efficacy was tested by kinetics of killing, biofilm assay and scanning electron microscopy. RESULTS : NE concentrations ranging from 1:100 to 1:10,000 dilutions were effective against S. mutans as shown through MIC/MBC assays. NE showed antimicrobial activity against planktonic cells at high dilutions, confirmed by time kill studies. 4-day-old S. mutans biofilms were treated with NE; subsequent reductions of bacterial cell counts were noticed with decreasing dilutions. Staining of NE-treated biofilms with LIVE/DEAD BacLight resulted in dead cell areas of up to 48% in 1 min, 84% at 1h and significant (<0.05) increases in dead cell counts at all time points. Damage to cell membranes and cell walls of S. mutans by NE was demonstrated using scanning electron microscopy (SEM). CONCLUSION These results suggest that nanoemulsion has effective antibacterial activity against S. mutans and may be a useful medication in the prevention of dental caries.

Current erosion indices--flawed or valid? Summary

The problem of erosive tooth wear appears increasingly to be encountered by clinicians and researchers. An adequate way of defining and recording erosive tooth wear is essential in order to assess the extent of this clinical phenomenon, both on an individual level and in the population, and for the adequate provision of preventive and therapeutic measures. Well-established erosion indices have been used in most of these studies, although in many cases modifications have been made to suit the different research aims. This use of different indices is one reason why it still cannot be claimed that there is enough current knowledge on this clinical phenomenon. This article summarises the proceedings of a workshop to discuss the topic of dental erosion indices. The result of the workshop is the proposal for a new scoring system (Basic Erosive Wear Examination, BEWE) designed for use both within the research field and for dental clinicians, with the aims of standardising assessment of erosion for international comparisons, raising awareness and providing guidelines for treatment of erosive tooth wear in dental practice.

Anti-cariogenic effect of a cetylpyridinium chloride- containing nanoemulsion

OBJECTIVES The aim of this pilot study was to investigate the anticaries activity of a nanoemulsion composed of soybean oil, water, Triton X-100 and cetylpyridinium chloride. METHODS Tooth blocks (3 mm length x 3 mm width x 2 mm thickness) were cut from smooth surfaces of selected molar teeth using a water-cooled diamond wire saw. The blocks were randomly assigned to three experimental groups: (A) nanoemulsion, (B) 0.12% chlorhexidine gluconate, and (C) no treatment. The formation of dental caries in human tooth enamel was tested using a continuous flow dual-organism (Streptococcus mutans and Lactobacillus casei), biofilm model, which acts as an artificial mouth and simulates the biological and physiological activities observed within the oral environment. Experimental groups A and B were treated with their respective solutions once daily for 30 s on each occasion, while group C received no treatment. 10% sucrose was supplied every 6 h for 6 min to simulate meals and pH cycling. The experiment lasted for 5 days, and the tooth blocks were harvested and processed for demineralization assessment using transverse microradiography (TMR). RESULTS For both lesion depth and mineral loss, statistical analysis indicated that Emulsion was significantly lower than Control and Chlorhexidine, and Chlorhexidine was significantly lower than Control. CONCLUSIONS We conclude that cetylpyridinium-containing nanoemulsions appear to present a feasible means of preventing the occurrence of early caries.

In vitro detection and quantification of enamel and root caries using infrared photothermal radiometry and modulated luminescence

Artificially created demineralized and remineralized carious lesions on the root and enamel of human teeth were examined by photothermal radiometry (PTR) and modulated luminescence (LUM). Fourteen extracted human teeth were used and a lesion was created on a 1 mmx4 mm rectangular window, spanning root to enamel, using a lactic acid-based acidified gel to demineralize the tooth surface. The lesion was then exposed to a remineralization solution. Each sample was examined with PTR/LUM on the root and enamel before and after treatment at times from 1 to 10 (5 on root) days of demineralization and 2 to 10 days of remineralization. Ten-day (5 on root) demineralized samples were remineralized. After completing all the experiments, transverse microradiography (TMR) analysis was performed to compare and correlate the PTR/LUM signals to the depth of lesions and mineral losses. The PTR and LUM amplitudes and phases showed gradual and consistent changes with treatment time. In this study, TMR showed good correlation coefficients with PTR and LUM. It was also found that the length of the treatment time did not correlate very well to any technique, PTR/LUM or TMR, which implies a significant degree of inhomogeneity of the demireralization and remineralization rates in each and every tooth.

Detection of interproximal demineralized lesions on human teeth in vitro using frequency-domain infrared photothermal radiometry and modulated luminescence

Frequency-domain photothermal radiometry (FD-PTR or PTR) is used to detect mechanical holes and demineralized enamel in the interproximal contact area of extracted human teeth. Thirty-four teeth are used in a series of experiments. Preliminary tests to detect mechanical holes created by dental burs and 37% phosphoric acid etching for 20 s on the interproximal contact points show distinct differences in the signal. Interproximal contact areas are demineralized by using a partially saturated acidic buffer system. Each sample pair is examined with PTR before and after micromachining or treating at sequential treatment periods spanning 6 h to 30 days. Dental bitewing radiographs showed no sign of demineralized lesion even for samples treated for 30 days. Microcomputer tomography (micro-CT), transverse microradiography (TMR), and scanning electron microscopy (SEM) analyses are performed. Although micro-CT and TMR measured mineral losses and lesion depths, only SEM surface images showed visible signs of treatment because of the minimal extent of the demineralization. However, the PTR amplitude increased by more than 300% after 80 h of treatment. Therefore, PTR is shown to have sufficient contrast for the detection of very early interproximal demineralized lesions. The technique further exhibits excellent signal reproducibility and consistent signal changes in the presence of interproximal demineralized lesions, attributes that could lead to PTR as a reliable probe to detect early interproximal demineralization lesions. Modulated luminescence is also measured simultaneously, but it shows a lower ability than PTR to detect these interproximal demineralized lesions.