Marisa Maltz

Deep caries lesions after incomplete dentine caries removal: 40-month follow-up study.

Radiographic changes after indirect pulp capping (32 teeth in 27 patients) were studied for up to 36–45 months. Radiolucent zone (RZ) depth and tertiary dentine formation were assessed qualitatively and changes in radiographic density (by image subtraction) in RZ and control areas (CA) were estimated. During follow-up there were 1 pulp necrosis, 1 pulp exposure, 3 fractures and 3 withdrawals. Twelve cases showed decreased RZ depth and 4 displayed tertiary dentine. No changes with time in density of CA or RZ, or in the difference between them, were observed. It is concluded that indirect pulp capping arrests lesion progression, suggesting that complete dentine caries removal is not essential for caries control.

Relação entre cárie, gengivite e fluorose e nível socioeconômico em escolares

OBJETIVO: Determinar a relacao entre o nivel socioeconomico e a prevalencia de carie dentaria, gengivite e fluorose em escolares brasileiros. METODOS: Foram examinados mil escolares de 12 anos de idade provenientes das redes particular e publica de ensino. Os indices utilizados foram: Indice de Dentes ou Superficies Cariadas, Perdidas e Obturadas (CPOD ou CPOS), Indice de Sangramento Gengival (ISG) e Indice de Thylstrup e Feyerskov (ITF). O nivel socioeconomico foi determinado pela renda per capita e pelo nivel educacional dos pais. RESULTADOS: O nivel educacional dos pais apresentou forte correlacao de Pearson com a renda per capita. Correlacoes extremamente fracas, quase nulas, foram observadas entre o nivel educacional dos pais e os eventos examinados. Foram observadas diferencas nos eventos examinados (p<0,05) separando-se a amostra em escolares das redes particular e publica. O CPOD na rede particular foi de 1,54±2,02 e na publica foi de 2,48±2,51; o ISG foi de 14,7%±12,7% na rede particular e de 21,7%±17,9% na publica; e a prevalencia de fluorose foi de 60,8% e 49,9%, respectivamente. Os individuos com maior numero de superficies com experiencia de carie e os de maior numero de superficies sangrantes situaram-se nas escolas publicas. CONCLUSOES: Nao se observou correlacao das variaveis do nivel socioeconomico com os eventos estudados. Outras variaveis socioeconomicas podem estar contribuindo para as diferencas observadas nos escolares das redes particular e publica.

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).

Qualitative and quantitative radiographic assessment of sealed carious dentin: a 10-year prospective study

OBJECTIVE The objective of this study was to assess radiographic outcomes after partial carious dentin removal performed in deep caries lesions over a 10-year period. STUDY DESIGN Baseline image was compared to 3 follow-up radiographs (at 6-7 months, 3 years, and 10 years). Tertiary dentin deposition and lesion depth were qualitatively assessed. Radiographic density changes in the radiolucent zone (RZ) beneath the restoration were quantitatively compared to the control areas (CA) using digital subtraction radiography (Friedman repeated-measures analysis of variance). RESULTS A total of 13 teeth were evaluated. In most cases, lesion depth remained unchanged or decreased (12/13) and tertiary dentin formation was observed (10/13) after the 10-year follow-up. Differences between RZ and CA at the 6- to 7-month and 3-year follow-up periods were similar but significantly lower than those at the 10-year assessment. CONCLUSIONS Sealing of carious dentin arrested the caries process, promoted deposition of tertiary dentin, and induced mineral gain in the radiolucent zone.

The monitoring of deep caries lesions after incomplete dentine caries removal: results after 14–18 months

This paper aims to assess radiographic changes after incomplete carious dentine removal and tooth sealing. Thirty-two teeth with deep caries lesions were studied. The treatment consisted of incomplete excavation, application of a Ca(OH)2 layer, sealing temporarily for a 6- to 7-month period and then restoration. Standardised bitewing radiographs were taken immediately after the temporary sealing and at 6- to 7- and 14- to 18-month intervals. The digitised images were analysed blind by image subtraction. The quantitative analyses subtractions were performed in the radiolucent zone (RZ) beneath the restoration and in two adjacent control areas (CA). Two cases were lost during the 6- to 7-month period (one pulp necrosis and one pulp exposure during removal of the provisional sealing). No difference (p>0.05) was observed in the radiographic density of the CA and the RZ in the two experimental periods. The mean and standard deviation (grey tonalities scale) were 129.42±5.83 and 127.65±4.67 (control areas) and 132.96±7.41 and 132.90±5.99 (RZ) for the first and second experimental periods, respectively. The radiographic density of the CA differed from the RZ (Tukey test, p<0.001). Interference in environmental conditions by partial dentine caries removal and tooth sealing arrests lesion progression, suggesting that complete dentine caries removal is not essential to control caries progression.

Traumatic dental injury among 12-year-old South Brazilian schoolchildren: prevalence, severity, and risk indicators

An increasing prevalence of traumatic dental injury (TDI) has been reported in the last few decades. The aim of this study was to assess the prevalence and severity of TDI and its association with socio-demographics and physical characteristics in the anterior permanent teeth of 12-year-old Brazilian schoolchildren. A cross-sectional study was carried out in a population-based sample of 1528 subjects attending 33 public and nine private schools (response rate of 83.17%). A single calibrated examiner performed the clinical examinations at the schools and recorded the TDI index (Childrens Dental Health Survey criteria), overjet and lip coverage. Height and weight were measured to calculate the body mass index (BMI). Parents/legal guardians answered a questionnaire containing socio-demographic questions. The relationships among TDI, socio-demographic variables and physical characteristics were assessed by survey Poisson regression models. The prevalence of TDI was 34.79% (mild trauma = 24.37%; severe trauma = 10.43%). Male schoolchildren (RR = 1.41, 95% CI = 1.23-1.61, P = 0.002) and schoolchildren from low socioeconomic status (RR = 1.32, 95% CI = 1.07-1.64, P = 0.021) were more likely to present at least one tooth with TDI, whereas students attending 7th grade (advanced students) were less likely to experience TDI (RR = 0.59, 95% CI = 0.43-0.82, P = 0.012). Regarding the severity analysis, students of mid-high (RR = 1.46, 95% CI = 1.09-1.94, P = 0.022), mid-low (RR = 1.68, 95% CI = 1.01-2.77, P = 0.045) and low (RR = 1.78, 95% CI = 1.11-2.85, P = 0.027) socioeconomic status were more likely to have mild trauma when compared with schoolchildren of high socioeconomic status. No significant association between severe trauma and socioeconomic status was observed. In conclusion, this study showed a high prevalence of TDI in 12-year-old Brazilian schoolchildren. Socio-demographic data and school achievement were associated with TDI.

Results after two years of non-operative treatment of occlusal surface in children with high caries prevalence

The aim of this study was to describe the 2-year results of an individualized treatment program designed to control occlusal caries in erupting first permanent molars. The sample consisted of 145 five-to-six-year-old students divided into a control group (n = 71) and a test group (n = 74). All test children received a biannual basic preventive program and a recall system according to individual disease activity. The basic program consisted of 3 (March) and 2 (August) sessions of oral hygiene orientation and toothbrushing with fluoride gel. The analysis of the baseline and 1-2-year data showed a significant reduction in the number of active lesions in the test group. In the control group, there were initially 70 active lesions and after two years 68 surfaces remained with disease and 24 surfaces had been filled. The children in the test group had 80 surfaces with active lesions initially and after two years only 3 surfaces with disease remained. From the 15 cavitated lesions, only 5 surfaces needed to be filled. This program showed that care of erupting teeth on an individualized basis can control occlusal caries.

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.