Juliana Jobim Jardim

Randomized Trial of Partial vs. Stepwise Caries Removal 3-year Follow-up

This randomized, multicenter clinical trial evaluated the effectiveness of 2 treatments for deep caries lesions — partial caries removal (PCR) and stepwise excavation (SW) — with respect to the primary outcome of pulp vitality for a 3-year follow-up period. Inclusion criteria were as follows: patients with permanent molars presenting deep caries lesions (lesion affecting ≥ 1/2 of the dentin on radiographic examination), positive response to a cold test, absence of spontaneous pain, negative sensitivity to percussion, and absence of periapical lesions (radiographic examination). Teeth randomly assigned to PCR (test) received incomplete caries removal and filling in a single session. Outcome success was evaluated by assessment of pulp vitality, determined by pulp sensitivity to a cold test and the absence of periapical lesions. Data were analyzed by a Weibull regression model with shared frailty term (survival analysis). At baseline, 299 treatments were executed: PCR, 152 and SW, 147. By the end of the 3-year follow-up period, 213 teeth had been evaluated. Adjusted survival rates were 91% for PCR and 69% for SW (p = 0.004). These results suggest that there is no need to re-open a cavity and perform a second excavation for pulp vitality to be preserved (Clinical trials registration NCT00887952).

Health promotion and dental caries

The central idea of the Brazilian health system is to prevent the establishment of disease or detect it as early as possible. Prevention and treatment of dental caries are related to behavioral factors, including dietary and oral hygiene habits, which are related to many chronic diseases. Dental health promotion therefore should be fully integrated into broadly based health-promoting strategies and actions such as food and health policies, and general hygiene (including oral hygiene), among others. For decades, a linear relationship between sugar consumption and caries has been observed. Recent data has indicated that this relationship is not as strong as it used to be before the widespread use of fluoride. However, diet is still a key factor acting in the carious process. Oral hygiene is a major aspect when it comes to caries, since dental biofilm is its etiological factor. Oral hygiene procedures are effective in controlling dental caries, especially if plaque removal is performed adequately and associated with fluoride. An alternative to a more efficient biofilm control in occlusal areas is the use of dental sealants, which are only indicated for caries-active individuals. If a cavity is formed as a consequence of the metabolic activity of the biofilm, a restorative material or a sealant can be placed to block access of the biofilm to the oral environment in order to prevent caries progress. The prevention of dental caries based on common risk-factor strategies (diet and hygiene) should be supplemented by more disease-specific policies such as rational use of fluoride, and evidence-based dental health care.

Artificial enamel dental caries treated with different topical fluoride regimes: An in situ study

OBJECTIVES To evaluate whether the topical fluoride application (acidulated phosphate fluoride, APF) at high concentration has an additional effect on the control of enamel lesions compared to fluoride dentifrice (FD; low concentration). The frequency of APF treatment on the arrestment of caries lesions and the amount of fluoride deposited on enamel after application of high and low fluoride concentrations were also evaluated. METHODS Five subjects wore partial dentures with in vitro demineralized blocks during 35 days. All specimens (5p/subject) were brushed three times daily for 1 min with FD (1100 ppmF). Besides the FD treatment, four specimens were submitted to APF gel topical applications (12,300 ppmF) on weekly intervals (one to four applications). The enamel blocks were analyzed at baseline, after demineralization and after intraoral procedures regarding: surface roughness (SR), clinical aspects (brightness and texture), surface microhardness (SMH) and enamel fluoride content. Friedmans test was used to compare SMH and SR among the treatments. Analysis of variance, followed by Tukeys studentized range test, was used to evaluate fluoride content and SR among the groups. The significance level used was 5%. RESULTS Changes in surface brightness, texture and SR were not detected. FD+3 APF and FD+4 APF were the only treatments capable of increasing SMH values and fluoride content compared to demineralized blocks (p < 0.001), although no differences could be observed within the treatments. CONCLUSIONS This study showed that > or = 3 APF in addition to FD enhance enamel rehardening and produce a larger reservoir of fluoride.

Partial removal of carious dentine: a multicenter randomized controlled trial and 18-month follow-up results.

Aim: The aim of this study was to evaluate the effectiveness of partial removal of carious dentine and restoration in a single session (PDR) and stepwise excavation (SW), both of which are treatments for deep carious lesions, in Public Health Services in Brazil. Methods: Inclusion criteria: patients ≥6 years old, permanent molars with deep caries lesions (having a radiolucency halfway or more into dentine) and pulp vitality but absence of spontaneous pain, positive percussion test, and periapical alterations. The subjects received either PDR (test group) or SW (control group). The radiological and clinical exams were performed after a mean time of 18 months. Outcomes: success was defined as pulp sensitivity to cold test and absence of periapical alterations. Results: Of the 299 treatments performed, 146 were SW and 153 were PDR; 122 were amalgam restorations and 168 resin-composite restorations. There were no differences between the groups regarding the baseline characteristics (i.e. age, gender and family income). After 18 months, 212 evaluations were performed, which indicated 99 and 86% success rates in the PDR and SW groups, respectively (p = 0.016). Reasons for failure were: PDR – 1 pulpitis; SW – 8 pulpitis; 1 osteitis; 4 necrosis; 1 endodontic treatment. None of the baseline variables were significantly associated with the outcomes. Conclusion: The retention of carious dentine does not interfere in pulp vitality. Data from this 18-month study suggest that the procedure of reopening the cavity to remove the residual infected dentine is not necessary.

The history and global market of oral home-care products

This literature review reports the history and the current market of oral home-care products. It provides information extending from the products used by our ancestors to those currently available, as well as on the changes in the supply and consumption of these products. Although the scientific knowledge about oral diseases has improved greatly in recent years, our ancestors had already been concerned with cleaning their teeth. A variety of rudimentary products and devices were used since before recorded history, like chewing sticks, tree twigs, bird feathers, animal bones, tooth powder and home-made mouth rinses. Today, due to technological improvements of the cosmetic industry and market competition, home-use oral care products available in the marketplace offer a great variety of options. An increase in the consumption of oral care products has been observed in the last decades. Estimates show that Latin America observed a 12% increase in hygiene and beauty products sales between 2002 and 2003, whereas the observed global rate was approximately 2%. A significant increase in the per capita consumption of toothpaste, toothbrush, mouthrinse and dental floss has been estimated from 1992 to 2002, respectively at rates of 38.3%, 138.3%, 618.8% and 177.2%. Pertaining to this increased supply and consumption of oral care products, some related questions remain unanswered, like the occurrence of changes in disease behavior due to the use of new compounds, their actual efficacy and correct indications, and the extent of the benefits to oral health derived from consuming more products.

Prevalence and Risk Indicators of Dentin Hypersensitivity in Adult and Elderly Populations From Porto Alegre, Brazil

BACKGROUND Dentin hypersensitivity (DH) is a clinical condition with potential implications for patients. However, little is known about its occurrence and determinants in the general population. The aim of this study is to assess the prevalence and risk indicators of DH in Porto Alegre, Brazil. METHODS A representative multistage probability sample of 1,023 adults aged ≥ 35 years was obtained. Individuals were interviewed and clinically examined in their homes. DH was assessed dichotomously in all present teeth by a blast of air and a manual probe. Teeth restored with crowns and presenting with carious cavitation were excluded. Survey logistic regression using sampling weights was applied to assess demographics and behavioral and clinical determinants. RESULTS Overall prevalence estimates for DH diagnosed by air and probe were 33.4% and 34.2%. DH affected ≈ 1 tooth per individual, and approximately 10% of teeth with gingival recession (GR) had DH. In a multivariable model for DH diagnosed with air, females had increased chance of DH (odds ratio [OR] = 2.14; 95% confidence interval [CI] = 1.57 to 2.91). Smoking, periodontal treatment, and GR were also associated with increased DH risk. The chance of DH was lower (OR = 0.47, 95% CI = 0.29 to 0.76) among individuals ≥ 60 than among those aged 35 to 49 years. Oral hygiene practices, socioeconomic and education status, dental visits, and gingival inflammation were not associated with DH. CONCLUSIONS DH may be considered a concern in a Brazilian general population. Reduction of DH may be achieved by smoking cessation and periodontal health improvements.

Estimates and multivariable risk assessment of gingival recession in the population of adults from Porto Alegre, Brazil

AIM To describe estimates and determine risk indicators of gingival recession in the urban population of Porto Alegre, Brazil. MATERIALS AND METHODS A representative sample of 1023 adults 35 years and older was obtained using a multistage probability sampling strategy. A structured questionnaire was applied and a clinical examination was performed at four sites of all teeth present. Complex survey commands were used for the estimation of gingival recession (GR) and during risk assessment. RESULTS GR ≥1 mm affected 99.7% of subjects. The percentage of subjects with ≥1 tooth with GR ≥3 mm and ≥5 mm was 75.4% and 40.7%, respectively. 67.6%, 27.8% and 9.5% of teeth per subject showed GR ≥1 mm, ≥3 mm and ≥5 mm, respectively. Older age, male gender, smoking exposure, poor self-reported oral hygiene, history of periodontal treatment and high percentage of calculus were significant risk indicators for GR found after multivariable risk assessment. When buccal GR was analysed separately, only gender, age, smoking and high education were significant risk indicators for GR, whereas variables related to oral hygiene were not associated. CONCLUSION GR is highly prevalent in this Brazilian population. Preventive strategies for GR may target a variety of socio-demographic, behavioural and clinical risk indicators.

Acid susceptibility of arrested enamel lesions: in situ study.

Arrested lesions are more resistant to a new cariogenic challenge, but the degree of surface rehardening needed to achieve this is unknown. The aim of this in situ study was to analyze the acid susceptibilityof newly formed and arrested enamel lesions with known arrestment period and surface microhardness. Six individuals wore an oral appliance with human enamel blocks for 3 periods: (1) 21 days of demineralization due to plaque accumulation and cariogenic challenge, 4 blocks/person (nonfluoride dentifrice); (2) 75 days of arrestment, brushing with fluoride dentifrice, 2 blocks/person; (3) 21 days of demineralization, 5 blocks/person: 1 sound block, 2 demineralized blocks and 2 demineralized and arrested blocks (nonfluoride dentifrice). After period 1, all blocks showed a dull whitish surface characteristic of active, noncavitated lesions. After arrestment, the surfaces assumed a shiny and smooth aspect. The Knoop hardness number (KHN, mean ± SD) of the sound blocks was 307.6 ± 15.0. After period 1, microhardness decreased significantly to 162.6 ± 33.5 KHN (p < 0.001). The microhardness of subsequently arrested lesions (279.8 ± 23.1 KHN) was significantly greater than after demineralization, but lower than that of sound enamel. Arrested enamel did not show a decrease in microhardness when subjected to a new cariogenic challenge and after the same cariogenic challenge showed similar microhardness to sound enamel. The results showed that, although noncavitated lesions probably take years to reach microhardness levels like sound enamel, this does not imply that special care, in addition to the ones normally given to sound tooth surfaces, is necessary.

Dental caries in individuals with Down syndrome: a systematic review

BACKGROUND Many studies have shown a lower experience of caries in people with Down syndrome compared to individuals without Down syndrome, but this issue has not been critically evaluated. AIM To conduct a systematic review of the international literature on dental caries experience in people with Down syndrome. DESIGN Three online databases (PubMed, LILACS, and Cochrane) were used to identify relevant studies on caries experience in people with Down syndrome published until May 2015. PICO (Patient/Population, Intervention, Comparison group, and Outcome) criteria were used to screen studies by title and abstract. An assessment of the methodological study quality was performed according to the modified Newcastle-Ottawa Scale. RESULTS The search resulted in 226 studies. Thirteen publications were included in the systematic review. Ten studies reported results of lower caries experience in individuals with Down syndrome in at least one age group studied. Three studies reported no differences in caries experience among the groups. All studies, however, included in this systematic review had limitations that increased the likelihood of bias in the study results. CONCLUSION There is no scientific evidence to support the hypothesis that people with Down syndrome have a lower experience of caries than non-syndromic individuals.