Júlio Eduardo do Amaral Zenkner

Influence of Eruption Stage and Biofilm Accumulation on Occlusal Caries in Permanent Molars: A Generalized Estimating Equations Logistic Approach

The aim of this study was to estimate the independent effects of biofilm accumulation and eruption stage on the occurrence of active caries lesions on occlusal surfaces of permanent molars. The sample consisted of 298 schoolchildren (6–15 years) who were examined by a calibrated examiner at a dental unit, using artificial light, a dental mirror and a WHO probe. The occurrence of visible biofilm on occlusal surfaces and the eruption stage of each permanent molar were recorded. After professional prophylaxis and air drying, the occlusal surfaces were classified as sound, caries-inactive or caries-active. To evaluate the association of eruption stage and biofilm accumulation with active caries lesions, a logistic regression model was used. Since data were clustered, odds ratios were obtained using generalized estimating equations with a logistic link function. 1,779 permanent molars were examined. All eruption stages were associated with active caries lesions. After adjustment for biofilm accumulation and type of molar, molars with occlusal surfaces partially exposed to the oral cavity were 63.6 times more susceptible to caries activity than molars with full occlusion (95% CI = 22.0–183.7). After adjustment for eruption stage and type of molar, teeth with a high degree of biofilm accumulation were 14.5 times more susceptible to caries activity than those without visible biofilm accumulation (95% CI = 6.5–32.4). No association between active caries and hardly detectable biofilm was found in this population. The present study found that the eruption stage of permanent molars is strongly associated with active caries lesions, adjusted for biofilm accumulation and type of molar.

Eruption Stage of Permanent Molars and Occlusal Caries Activity/Arrest

This study assessed the association between the eruption stage of permanent second molars and occlusal caries activity among 12-year-old schoolchildren from South Brazil. A cross-sectional study was performed in Porto Alegre using a multistage probability sampling strategy to select a representative sample. Clinical examination was conducted to assess the eruption stage of permanent molars, Gingival Bleeding Index, and, after tooth cleaning and drying, caries experience (noncavitated and cavitated lesions, including caries activity assessment). Data were collected on sex, socioeconomic status, mother’s education, brushing frequency, and consumption of soft drinks. Generalized estimating equations were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Overall, 983 schoolchildren with 3,071 second molars were available for analysis. Whereas active caries was observed in 6.6% of fully erupted permanent second molars, caries affected 26.2%, 29.6%, and 18.2% of erupting molars classified as stages 1, 2, and 3, respectively: stage 1, partially erupted occlusal surface; stage 2, fully erupted occlusal surface, <1/2 crown exposed; and stage 3, fully erupted occlusal surface, >1/2 crown exposed. After adjusting for socioeconomic and behavioral variables, partially erupted molars were significantly more likely to present active caries lesions than molars in full occlusion: stage 1, OR = 4.99 (95% CI = 3.38, 7.38); stage 2, OR = 5.18 (95% CI = 3.14, 8.53); stage 3, OR = 3.20 (95% CI = 2.21, 4.64). Similar results were found when clinical variables were included in the adjusted model. In conclusion, most occlusal caries lesions tend to arrest/revert when teeth reach the occlusal plan; however, an important proportion of these lesions remains active and in need of proper management. Children at risk should be targeted with preventive and minimally invasive strategies.

Effectiveness of a standardized treatment protocol for children with active non‐cavitated occlusal lesions on erupting permanent molars

OBJECTIVE To evaluate the effectiveness of a treatment for non-cavitated occlusal lesions on erupting permanent molars and to verify whether initial eruption stage and final biofilm accumulation are associated with lesions activity after the treatment. METHODS Forty-eight patients aged from 5 to 13 years old were selected. Molars with active non-cavitated lesions on the occlusal surface were classified according to eruption stage. Patients received a treatment for 4 weeks based on oral health instructions and fluoride applications. Three weeks after the end of the treatment, 39 patients were reassessed and lesion activity status and biofilm accumulation were recorded. Odds ratios were obtained using generalized estimating equations with logistic link function. RESULTS Partially erupted molars were more prone to remain caries-active than molars in full occlusion (E1: OR = 301.1; E2: OR = 49.0 and E3: OR = 1107.3). High biofilm accumulation was associated with the presence of active lesions. CONCLUSIONS Biofilm accumulation and eruption stage strongly influenced the effectiveness of a treatment for dental caries.

Association between two visual criteria in assessing non-cavitated caries lesion activity on occlusal surfaces of permanent molars

ObjectiveThis study aimed to evaluate the association between two visual criteria in assessing non-cavitated caries lesion activity on occlusal surfaces of permanent molars.Materials and methodsThirty-nine patients with at least one permanent molar with non-cavitated caries lesion on the occlusal surface were selected. Molars were assessed according to their activity status following two criteria: ICDAS-LAA and a qualitative criterion based on clinical characteristics.ResultsThe results showed that the LAA criterion seems to overestimate caries activity. A weak association between both criteria in assessing caries lesion activity and low specificity for ICDAS-LAA was observed.ConclusionsThe ICDAS-LAA criterion is not suitable to assess non-cavitated caries lesion activity on occlusal surfaces of permanent molars because it assesses the lesions to be active more frequently than the qualitative criterion.Clinical relevanceThe determination of caries lesion activity is a key decision point in the treatment of caries disease. This study discusses the best option to assess the activity of non-cavitated occlusal caries lesions.

Does the Duration of Fixed Orthodontic Treatment Affect Caries Activity among Adolescents and Young Adults

This cross-sectional study assessed the relationship between fixed orthodontic treatment duration and caries activity. Two hundred and sixty 10- to 30-year-olds were divided into 4 groups (n = 65): no fixed orthodontic appliances (G0), orthodontic treatment for 1 year (G1), 2 years (G2), or 3 years (G3). Orthodontic treatment duration was significantly associated with active caries: prevalence was 1.5% for G0, 27.7% for G1, and 72.3% for G2 and G3; the median number of lesions was 0 for G0 and G1 and 2 for G2 and G3. No differences were observed between G2 and G3. The longer the duration of orthodontic treatment, the higher the prevalence/extent of active caries lesions.

Biofilm Control and Oral Hygiene Practices

As the thick biofilm in the presence of fermentable carbohydrates is the main etiological factor of dental caries, the frequent and systematic removal of this colony by means of an effective biofilm control should result in the prevention of caries lesions or in the arrest of the local carious process. However, the role of biofilm control in the management of dental caries has been questioned. This chapter will discuss the biofilm control and oral hygiene practices on root surfaces. Laboratory and clinical studies describing the effect of biofilm control and oral hygiene practices on the arrestment of root carious lesions are described. Epidemiological surveys evaluating the association between oral hygiene and root caries are discussed. Finally, some aspects on chemical biofilm control are also presented.

Gingival enlargement in orthodontic patients: Effect of treatment duration

Introduction In this study, we aimed to assess the effect of the duration of fixed orthodontic treatment on gingival enlargement (GE) in adolescents and young adults. Methods The sample consisted of 260 subjects (ages, 10‐30 years) divided into 4 groups: patients with no fixed orthodontic appliances (G0) and patients undergoing orthodontic treatment for 1 year (G1), 2 years (G2), or 3 years (G3). Participants completed a structured questionnaire on sociodemographic characteristics and oral hygiene habits. Clinical examinations were conducted by a calibrated examiner and included the plaque index, the gingival index, and the Seymour index. Poisson regression models were used to assess the association between group and GE. Results We observed increasing means of plaque, gingivitis, and GE in G0, G1, and G2. No significant differences were observed between G2 and G3. Adjusted Poisson regression analysis showed that patients undergoing orthodontic treatment had a 20 to 28‐fold increased risk for GE than did those without orthodontic appliances (G1, rate ratio [RR] = 20.2, 95% CI = 9.0‐45.3; G2, RR = 27.0, 95% CI = 12.1‐60.3; G3 = 28.1; 95% CI = 12.6‐62.5). Conclusions The duration of orthodontic treatment significantly influenced the occurrence of GE. Oral hygiene instructions and motivational activities should target adolescents and young adults undergoing orthodontic treatment. HighlightsDuration of fixed orthodontic treatment affected anterior tooth gingival enlargement.Longer treatment was related to more plaque, gingivitis, and gingival enlargement.Motivational activities should target adolescent and young adult patients.

Assessment of the frequency of routine removal of dental plaque prior to caries diagnosis by dentists in three cities in southern Brazil.

The aim of this study was to assess the frequency of routine use of dental prophylaxis prior to visual inspection, in order to diagnose caries, by dentists with different lapses of time after graduating time. One hundred and fifty one Brazilian dentists were interviewed in 3 Brazilian cities to determine if they usually remove dental plaque prior to visual inspection for caries diagnosis. The dentists were stratified according to year of graduation. The association between the lapse of time after graduating and the practice of routinely removing dental plaque before clinical examination was tested using the chi-square test with a significance level of 5%. Only 28.5% of the dentists reported that they usually remove dental plaque prior to clinical examination. The dentists who graduated in the last 15 years presented the lowest percentages of plaque removal prior to clinical examination (15.1%), whereas the more experienced dentists reported that they perform prophylaxis more frequently. Of the professionals who graduated from 1960-1975, 23.9% reported that they performed dental plaque removal prior to diagnosis, whereas the figure for those graduating from 1976-1990 was 46.2%. Most of the dentists interviewed reported that they did not remove dental plaque prior to performing visual diagnosis of caries.