J.E.F.M. Frencken

Caries-inhibiting effect of preventive measures during orthodontic treatment with fixed appliances: A systematic review

A systematic review was performed of published data on the caries-inhibiting effect of preventive measures during orthodontic treatment with fixed appliances. The purpose was to develop evidence-based recommendations about the most effective means of preventing white spot lesions in orthodontic patients. The 15 studies included were divided into four groups based on comparable preventive measures: fluoride, chlorhexidine, sealants and bonding materials. The caries-inhibiting effect of the preventive measures was expressed by the prevented fraction (PF). The overall PF of the fluoride-releasing bonding materials was 20% (SEM 0.09). This effect was, however, not statistically significant. It was impossible to calculate an overall PF for the other preventive measures, but the tendency of their caries-inhibiting effect has been described. The use of toothpaste and gel with a high fluoride concentration of 1,500–5,000 ppm or of complementary chlorhexidine during orthodontic treatment showed a demineralisation-inhibiting tendency. The use of a polymeric tooth coating on the tooth surface around the brackets showed almost no demineralisation-inhibiting effect. Many publications had to be excluded from this systematic review because of improper research designs. Future clinical trials are needed to give evidence- based advice on the optimal caries-prevention strategy.

Prevalence, distribution and background variables of smooth-bordered tooth wear in teenagers in the hague, the Netherlands.

The purposes of the study were: (1) to assess the prevalence and distribution of smooth-bordered tooth wear in teenagers, and (2) to investigate the relationship between smooth-bordered tooth wear and social background, dietary pattern, drinking habits, oral hygiene practices and caries prevalence. In The Hague, The Netherlands, a sample of 345 10- to 13-year-olds and 400 15- and 16-year-olds was clinically examined. The criteria for the assessment of smooth-bordered tooth wear (‘smooth wear’) were in line with the diagnostic criteria for erosion developed by Lussi (1996). In the age group 10–13 years, the percentage of subjects with visible smooth wear (SW1 threshold) was 3% and in 1 subject (0.3%), deep smooth enamel wear was found. Due to the low prevalence, the results for this age group were not analysed further. In the age group 15–16 years, the proportion of subjects with visible smooth wear (SW1 threshold) was 30% and that with at least deep smooth enamel wear (SW2 threshold) 11%. Smooth wear into dentine was found in 1 subject. First molars and upper anterior teeth were affected predominantly. A significant effect on visible smooth wear (SW1 threshold) was found for gender and social background. At mouth level, no significant influence was found for dietary patterns, drinking habits or oral hygiene practices. The caries prevalence was similar in subjects with and without smooth wear.

Six-Year Success Rates of Occlusal Amalgam and Glass-Ionomer Restorations Placed Using Three Minimal Intervention Approaches

The present randomised clinical trial was aimed at comparing three minimally invasive restorative treatment approaches for managing dental caries in occlusal surfaces using a non-gamma-2 amalgam and a low-viscosity glass-ionomer as the restorative material. The treatment approaches tested in parallel groups were: conventional in a university setting, modified-conventional and ultraconservative (Atraumatic Restorative Treatment, ART) approaches in a field setting. A split-mouth design was used in which the two restorative materials were randomly placed in 430 matched contralateral pairs of permanent molar teeth. A total of 152 children from five primary schools were recruited and treated by a dental therapist. The restorations were evaluated after 6 years by 2 calibrated independent examiners. The 6-year successes for all occlusal amalgam and glass-ionomer restorations were 72.6 and 72.3%, respectively. There were no statistically significant differences observed between the successes for both amalgam and glass-ionomer restorations placed either by the ART (68.6%, with 95% CI = 61–76%) approach or by the conventional (74.5%, with 95% CI = 65–82%) and the modified-conventional (75.8%, with 95% CI = 67–83%) approaches after 6 years. There was also no statistically significant difference observed between the successes of occlusal ART restorations with glass-ionomer (67.1%, with 95% CI = 56–77%) and occlusal conventional restorations with amalgam (74%, with 95% CI = 61–85%) after 6 years. ‘Restoration fracture/marginal defects’ and ‘loss of material’ were the most common causes for failure. The former was more often recorded in amalgam restorations and the latter in glass-ionomer restorations. Secondary caries was observed for 2% of glass-ionomer and for 10% of amalgam restorations. This difference was statistically significant (p = 0.001). The ART approach using glass-ionomer performed equally well as conventional restorative approaches using electrically driven equipment and amalgam for treating dentinal lesions in occlusal surfaces after 6 years.

Untreated Cavitated Dentine Lesions: Impact on Children’s Quality of Life

The aim of the present investigation was to assess the impact of dental caries prevalence and the consequences of untreated cavitated dentine lesions on quality of life of 6- and 7-year-old Brazilian children. A total of 826 schoolchildren were assessed using ICDAS and pufa (to score consequences of dental caries on soft tissues) indices. History of extraction and toothache was recorded. Oral health-related quality of life was assessed using the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS). A multiple logistic regression model was used to analyze the relationship between the prevalence of dentine carious lesions, pufa, history of extraction and toothache with the B-ECOHIS scores. A total of 587 questionnaires were analyzed. The prevalence of cavitated dentine lesions and pufa was 74.8 and 26.2%, respectively. Some 21.8% of children reported toothache and 9.2% had had at least one tooth extraction. The chance (OR) for children with cavitated dentine lesions, pufa ≥1, history of extraction and toothache of having higher B-ECOHIS scores than those not affected was 1.90 (95% CI: 1.18–3.06), 6.26 (95% CI: 3.63–10.83), 6.87 (95% CI: 2.75–17.16) and 3.68 (95% CI: 2.12–6.39), respectively. Children’s quality of life was negatively influenced by untreated cavitated dentine lesions and their consequences.

Caries-Preventive Effect of a One-Time Application of Composite Resin and Glass Ionomer Sealants after 5 Years

The aim of the present trial was to (1) compare the caries-preventive effect of glass ionomer sealants, placed according to the atraumatic restorative treatment (ART) procedure, with composite resin sealants over time and (2) investigate the caries-preventive effect after complete disappearance of sealant material. Forty-six boys and 57 girls, mean age 7.8 years, were randomly divided into two treatment groups in a parallel-group study design. A light-polymerized composite resin sealant material and a high-viscosity glass ionomer were each placed in 180 fully erupted first molars in their respective treatment groups. Evaluation took place annually for 5 years by calibrated examiners. After 5 years, 86% composite resin and 88% glass ionomer sealants did not survive. Three categories of re-exposure periods for caries development in pits and fissures after complete loss of sealants were distinguished: 0–1, 1–2 and 2–3 years. In the 2- to 3-year group, 13 and 3% of pits and fissures previously sealed with composite resin and glass ionomer, respectively, were diagnosed as having developed a dentine lesion. The relative risks (95% CI) of dentine lesion development in surfaces sealed with glass ionomer compared to those sealed with composite resin after 3, 4 and 5 years were 0.22 (0.06–0.82), 0.32 (0.14–0.73) and 0.28 (0.13–0.61), respectively. The relative risks of dentine lesion development in pits and fissures previously sealed with glass ionomer compared with composite resin over re-exposure periods of 1–2 and 2–3 years were 0.26 (0.14–0.48) and 0.25 (0.09–0.68), respectively. We conclude that the caries-preventive effect of high-viscosity glass ionomer sealants, placed using the ART procedure, was between 3.1 and 4.5 times higher than that of composite resin sealants after 3–5 years. Furthermore, high-viscosity (ART) glass ionomer sealants appear to have a four times higher chance of preventing caries development in re-exposed pits and fissures of occlusal surfaces in first molars than light-cured composite resin sealant material over a 1- to 3-year period. A well-designed clinical trial using different types of oral health personnel should be implemented to confirm these initial results.

Effectiveness of Three Minimal Intervention Approaches for Managing Dental Caries: Survival of Restorations after 2 Years

The present study was aimed at comparing the effectiveness of three minimally invasive restorative treatment approaches for dentinal lesions in occlusal surfaces. The approaches tested comprised a conventional and a modified–conventional treatment and a modified Atraumatic Restorative Treatment (ART). The conventional approach was performed in a university dental clinic whilst the modified–conventional, employing portable equipment, and the modified ART, using hand instruments and a caries removal solution (Caridex®), were carried out in the field. Using the split–mouth design, 430 matched contralateral pairs of occlusal cavities were restored with amalgam or glass–ionomers in permanent molars of 152 school children by one dental therapist. The restorations were assessed using a modified USPHS–Ryge criteria. After 2 years, the cumulative survival percentages for occlusal amalgam and glass–ionomer restorations were 92 and 96%, respectively. The survival of all restorations in the conventional, modified–conventional and the modified ART group was 96, 96 and 91%, respectively. The survival of occlusal amalgam and glass–ionomer restorations per treatment group was as follows: 94 and 99%, respectively (conventional group); 95 and 97%, respectively (modified–conventional group), and 89 and 93%, respectively (modified ART group). The differences in survival percentage between restorations with amalgam and glass–ionomer, and between the three restorative treatment approaches were not statistically significant. In countries facing scarcity in resources for dental care, ART seems a promising restorative approach to occlusal caries in posterior teeth. However, a longer clinical observation period is required to substantiate this initial conclusion.

Caries-preventive effect of sealants produced with altered glass-ionomer materials, after 2 years

OBJECTIVES The aim of the present study was to investigate the caries-preventive effect of sealants produced with a high-viscosity glass-ionomer with an elevated powder-liquid ratio (ART), of having energy added to this glass-ionomer, and that of glass-carbomer, in comparison to that of resin composite sealants. METHODS The randomized controlled trial covered 407 children, with a mean age of 8 years. At a school compound three dentists placed sealants in pits and fissures of high caries-risk children. Evaluation by two independent evaluators was conducted after 0.5, 1 and 2 years. The Kaplan-Meier survival method, ANOVA and t-test were used in analyzing the data. RESULTS 1352 first permanent molars were sealed. 6.6% of children and 6.8% of sealants dropped out within 2 years. 27 re-exposed pits and fissures, 20 in occlusal and 7 in smooth surfaces, in 25 children, developed a dentin carious lesion. The cumulative survival of dentin carious lesion-free pits and fissures in the glass-carbomer sealant group was statistically significantly lower (97.4%) than those in the high-viscosity glass-ionomer with energy supplied (99%) and the resin-composite (98.9%) sealant groups. There was no statistically significant difference in the cumulative survival of dentin carious lesion-free pits and fissures, between the high-viscosity glass-ionomer with (99%) and without (98.3%) energy supplied sealant groups, after 2 years. SIGNIFICANCE The survival of dentin carious lesion-free pits and fissures was high in all sealant types. More dentin carious lesions were observed in the glass-carbomer sealant group.

Prevalence and severity of clinical consequences of untreated dentine carious lesions in children from a deprived area of Brazil.

Disadvantaged children suffer because tooth cavities are not being treated and their clinical consequences not being surveyed. The present study aimed to assess the prevalence and severity of clinical consequences of untreated dentine carious lesions in schoolchildren from a deprived area of Brazil and to investigate the determinants of the pufa index. A sample of 835 children aged 6–7 years, from six public schools, was examined by 3 calibrated examiners. Clinical consequences of untreated dentine carious lesions in primary teeth were diagnosed using the four codes of the pufa index: ‘p’ (pulpal involvement), ‘u’ (ulceration), ‘f’ (fistulae), ‘a’ (abscess). Effects of gender, age, school, history of extraction, and toothache on the prevalence of pufa codes were tested. The prevalence of pufa codes was 23.7%. The mean pufa score was 0.4 ± 0.9. Code ‘p’ was the most prevalent (19.5%), whereas code ‘u’ was least prevalent (0.1%). Children with a history of extracted primary teeth due to caries had a 2.7 times higher chance to have a pufa code than children with no previous extraction. Children with toothache had a 5.6 times higher chance to have a pufa code than children without toothache. The prevalence of clinical consequences of untreated dentine carious lesions was moderate and the severity was low. The pufa index is an epidemiological tool complementary to existing caries indices aimed to assess dental caries. However, there appears to be no need to include code ‘u’ nor to score codes ‘f’ and ‘a’ separately.

Effect of chlorhexidine varnish application on mutans streptococci counts in orthodontic patients

INTRODUCTION Enamel demineralization occurs frequently around orthodontic brackets. High levels of mutans streptococci (MS) increase the risk of caries. The hypotheses tested in this study were that high-frequency application of 40% chlorhexidine varnish (40%CHX) results in lower levels of MS in plaque of orthodontic patients compared with low-frequency application, and that bimonthly application of 40%CHX results in lower levels of MS in plaque compared with 1% chlorhexidine/1% thymol varnish (1%CHX). METHODS Eighty adolescent patients were randomly allocated to 4 treatment groups: monthly, bimonthly, and quarterly 40%CHX application, and bimonthly application of 1%CHX. Plaque samples were collected monthly and processed for MS counts. Twenty patients dropped out before the evaluation time at 1 month. Data from the remaining 60 adolescents were analyzed by using linear regression models with the plaque bacterial ratio (PBRx) as the dependent variable. The trial was ended after 5 months because of a high number of dropouts. RESULTS High-frequency application of 40%CHX did not provide lower mean PBRx than low-frequency application. Mean PBRx after 40%CHX application was lower than 1%CHX after 1 month (P = .002). This reduction was undiscernible 2 months after the application. CONCLUSIONS 40%CHX application results in greater reduction of MS in plaque than 1%CHX a month after application. A follow-up study with a larger study population is warranted to test the first hypothesis.

Compressive strength of two newly developed glass-ionomer materials for use with the Atraumatic Restorative Treatment (ART) approach in class II cavities

OBJECTIVES The null-hypotheses tested were that no difference in compressive strength of ART class II cavities exists between those restored with (1) glass-carbomer and a commonly used glass-ionomer; (2) KMEM and the commonly used glass-ionomer and; (3) glass-carbomer and KMEM. METHODS 100 molar teeth, stratified by size, were randomly allocated to the four test groups. Large ART class II cavities were drilled and restored with Clearfil photoposterior (negative control), Fuji IX (positive control), Glass-carbomer and Ketac Molar Easymix (KMEM) (experimental groups). Half of the samples in each test group were 5000 times thermocycled between 5 degrees C and 55 degrees C, with a 30s dwell time in each bath and a transfer time of 10s. The restorations were statically tested at the marginal ridge until failure, using a rounded rectangular testing rod at crosshead speed of 1.0mm/min. ANOVA and Students t-test were applied to test for differences between the dependent variable (compressive strength at the final breaking point) and the independent variables (thermocycling and restorative material). RESULTS Restorations of Clearfil photoposterior had a statistically significant higher mean compressive strength value at final breaking point than those of the three glass-ionomers tested (p=0.0001). No thermocycling effect was observed (p=0.19). ANOVA between the three glass-ionomer materials and mean compressive strength at final breaking point showed no statistically significant difference (p=0.09). SIGNIFICANCE Class II ART cavities restored with the newly launched Glass-carbomer and Ketac Molar Easymix were not significantly more fracture resistant than comparable restorations using the conventional glass-ionomer Fuji IX.