Cariology, Operative Dentistry and Dental Public Health Works
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Item Effect of dentifrice slurry abrasivity and erosive challenge on simulated non-carious cervical lesions development in vitro(J-STAGE, 2021-04) Nassar, Hani M.; Hara, Anderson T.; Cariology, Operative Dentistry and Dental Public Health, School of DentistryPURPOSE: To investigate the effect of slurry abrasive levels and acidic challenges on the development of non-carious cervical lesions. METHODS: Ninety-six extracted upper premolars were affixed in pairs to acrylic blocks and had their root surfaces covered by acrylic resin except for 2 mm from the cemento-enamel junction. The specimens were distributed into six groups (n = 8 pairs) based on two experimental factors: (1) slurry abrasivity level [low/medium/high] and (2) citric acid challenge [yes/no]. Specimens were brushed for 5,000, 15,000, 35,000, and 65,000 strokes. Volume loss (VL) was determined based on optical profilometry scans of specimens impressions at the baseline and at subsequent brushing levels. Data were analyzed using repeated measures analysis of variance and Bonferroni pairwise comparison (α = 0.05). RESULTS: Higher VL values were associated with high-abrasivity slurries relative to low- and medium-abrasivity slurries (P < 0.001). Increasing the slurry abrasivity level increased the VL regardless of the acidic challenge, which did not have a significant effect (P = 0.184). After 65,000 strokes, significant VL was recorded in all groups relative to preceding brushing levels (P < 0.001). CONCLUSION: Higher values of time-dependent surface loss were associated with increased dentifrice slurry abrasivity, regardless of the citric acid challenge.Item Negligible therapeutic impact, false-positives, overdiagnosis and lead-time are the reasons why radiographs bring more harm than benefits in the caries diagnosis of preschool children(BMC, 2021-03-31) Pontes, Laura Regina A.; Lara, Juan Sebastian; Novaes, Tatiane Fernandes; Gomes Freitas, Julia; Gimenez, Thais; Moro, Bruna Lorena P.; Maia, Haline C. M.; Imparato, José Carlos P.; Braga, Mariana M.; Raggio, Daniela P.; Mendes, Fausto M.; Cariology, Operative Dentistry and Dental Public Health, School of DentistryBackground: To evaluate the clinical course and interventions required during two years of follow-up of dental surfaces of deciduous molars diagnosed, and consequently treated, by two different strategies: diagnosis made by clinical examination alone or associated with radiographs. Methods: This is a secondary analysis of a two-arm randomized clinical trial with parallel groups related to the diagnostic strategy for caries detection in preschool children. 216 children (3-6 years old) were followed-up for two years. All dental surfaces were diagnosed by visual inspection and later, through radiographic assessment. Baseline treatment was made in accordance with the results obtained by visual inspection performed alone or combined with radiographic method, considering the allocated group. Dental surfaces with no restoration needs, or those restored at the beginning of the study were followed-up for two years. The treatment decision was made according to the allocated group. The outcome was the occurrence of failure (a new caries lesion or a restoration replacement) during the follow-up. Results: 4383 proximal and occlusal surfaces of deciduous molars in 216 preschool children were diagnosed and treated according to the abovementioned diagnostic strategies and followed-up for 24 months. The assessment of radiographs made change the initial decision reached by visual inspection in about 30% of the surfaces when all types of interventions were considered. However, most disagreements occurred for initial lesions, where radiographs tended to underestimate them. Discordances between methods occurred in less than 5% of all surfaces when considered lesions requiring operative treatment. For discrepancy cases, the placed interventions guided by following the radiographic results did not present less failures against those made following only visual inspection. As a matter of fact, the use of radiographs in the diagnostic strategy for caries detection in children brought more harms than benefits due to the occurrence of false-positives, overdiagnosis and lead-time bias. Conclusions: Simultaneous association of visual inspection and radiographic assessment for caries detection in preschool children causes more harms than benefits, and therefore, visual inspection should be conducted alone in the regular clinical practice. Trial registration Clinicaltrials.gov platform: NCT02078453, registered on 5th March 2014.Item Dietary Fluoride Intake Over the Course of Pregnancy in Mexican Women(Cambridge, 2021-06) Castiblanco-Rubio, Gina A.; Muñoz-Rocha, Teresa V.; Cantoral, Alejandra; Téllez-Rojo, Martha M.; Ettinger, Adrienne S.; Téllez-Rojo, Adriana; Peterson, Karen E.; Hu, Howard; Martínez-Mier, E. Angeles; Cariology, Operative Dentistry and Dental Public Health, School of DentistryObjective: To estimate dietary fluoride intake (F) over the course of pregnancy and the overall adjusted difference in dietary F intake by pregnancy stages and levels of compliance with dietary recommendations. Design: Secondary data analysis from a longitudinal pregnancy cohort study in a population exposed to fluoridated salt. Women were followed during the early, middle and late stages of their pregnancy (n 568). The dietary intake of recommended prenatal nutrients according to Mexican dietary guidelines and F intake (mg/d) was estimated with a validated FFQ. Data were summarised with descriptive statistics. Levels of F intake were compared with the USA’s Institute of Medicine adequate intake (AI) of 3 mg/d for pregnancy. Adjusted differences in F intake by pregnancy stages and levels of compliance with recommendations were estimated using random effects models. Setting: Mexico City. Participants: Women participating in the Early Life Exposures in Mexico to ENvironmental Toxicants (ELEMENT) project, from 2001 to 2003. Results: Median dietary F intake throughout pregnancy ranged from 0·64 (interquartile range (IQR) 0·38) in the early to 0·70 (IQR 0·42) in the middle, and 0·72 (IQR 0·44) mg/d in the late stage (0·01 mg F/kg per d). Corresponding adjusted intakes of F were 0·72 (95 % CI 0·70, 0·74), 0·76 (95 % CI 0·74, 0·77) and 0·80 (95 % CI 0·78, 0·82) mg/d. Women who were moderately and highly compliant with Mexican dietary recommendations ingested, on average, 0·04 and 0·14 mg F/d more than non-compliant women (P < 0·005). Conclusions: Dietary F intake was below current AI, was greater with the progression of pregnancy and in women who were moderately and highly compliant with dietary recommendations.Item Artificial Caries Lesion Characteristics after Secondary Demineralization with Theobromine-Containing Protocol(MDPI, 2021-01-08) Nassar, Hani M.; Lippert, Frank; Cariology, Operative Dentistry and Dental Public Health, School of DentistryDeveloping artificial caries lesions with varying characteristics is needed to adequately study caries process in vitro. The objective of this study was to investigate artificial caries lesion characteristics after secondary demineralization protocol containing theobromine and fluoride. Sixty bovine enamel slabs (4 × 3 mm) were demineralized using a Carbopol-containing protocol for 6 days. A baseline area (2 × 3 mm) was protected with acid-resistant nail varnish, after which specimens were exposed for 24 h to a secondary demineralization protocol containing acetic acid plus one of four fluoride/theobromine combinations (n = 15): theobromine (50 or 200 ppm) and fluoride (0 or 1 ppm). Specimens were sectioned and analyzed using transverse microradiography for changes in mineral content, lesion depth, and surface layer mineralization. Data was analyzed using paired t-test and analysis of variance followed by Bonferroni test at 0.05 significance level. After secondary demineralization, fluoride-containing groups had significantly deeper lesions (p = 0.002 and 0.014) compared to the group with 0 ppm fluoride and 50 ppm theobromine. Mineral content and lesion depth were significantly different compared to baseline for all groups. Theobromine did not show an added effect on mineral uptake. Theobromine-containing groups exhibited particularly deep lesions with a more uniform mineral profile in the presence of fluoride.Item Associations between Urinary, Dietary, and Water Fluoride Concentrations among Children in Mexico and Canada(MDPI, 2020-11-08) Green, Rivka; Till, Christine; Cantoral, Alejandra; Lanphear, Bruce; Martinez-Mier, E. Angeles; Ayotte, Pierre; Wright, Robert O.; Tellez-Rojo, Martha M.; Malin, Ashley J.; Cariology, Operative Dentistry and Dental Public Health, School of DentistryFluoride, which may be toxic to the developing brain, is added to salt in Mexico and drinking water in Canada to prevent dental caries. We compared childhood urinary fluoride (CUF) concentrations in Mexico City and Canada to characterize patterns of fluoride exposure in these two populations. We also examined associations of CUF with dietary and water fluoride levels in Mexico City and Canada respectively. We included 561 children (ages 4–6; mean age 4.8 years) from the Programming Research in Obesity, Growth, Environment, and Social Stress (PROGRESS) cohort in Mexico City, and 645 children (ages 2–6; mean age 3.7 years) from the Maternal–Infant Research on Environmental Chemicals (MIREC) cohort in Canada. We applied Spearman correlations, T-tests, ANOVA or covariate-adjusted linear regression to examine associations of CUF (mg/L; adjusted for specific gravity) with demographics and dietary or water fluoride concentrations. We used Welch equivalence testing to compare means across cohorts. Mean (SD) CUF was equivalent (t = 4.26, p < 0.001) in PROGRESS: 0.74 (0.42) and fluoridated Canadian communities: 0.66 (0.47), but lower in non-fluoridated Canadian communities: 0.42 (0.31) (t = −6.37, p < 0.001). Water fluoride concentrations were significantly associated with CUF after covariate adjustment for age and sex in MIREC (B = 0.44, 95% CI: 0.30, 0.59, p < 0.001). In contrast, daily food and beverage fluoride intake was not associated with CUF in PROGRESS (p = 0.82). We found that CUF levels are comparable among children in Mexico City and fluoridated Canadian communities, despite distinct sources of exposure. Community water fluoridation is a major source of fluoride exposure for Canadian children.Item In vitro Cariostatic effects of cinnamon water extract on nicotine-induced Streptococcus mutans biofilm(BMC, 2020-02-11) Alshahrani, Abdulaziz M.; Gregory, Richard L.; Cariology, Operative Dentistry and Dental Public Health, School of DentistryBackground: Dental caries is one of the most prevalent chronic oral diseases worldwide. Dental caries is mainly associated with Streptococcus mutans and the Lactobacillus species. A specific relationship was found between nicotine and S. mutans growth as the presence of nicotine increased S. mutans biofilm formation. Nicotine is able to increase the number of S. mutans and extracellular polysaccharide (EPS) synthesis. Among the widely used herbs and spices is cinnamon which demonstrated a strong antibacterial activity against a wide variety of bacteria including S. mutans and showed the ability to inhibit S. mutans biofilm formation. Cinnamon essential oil, obtained from the leaves of C. zeylanicum, has been demonstrated to be effective against S. mutans and Lactobacillus acidophilus, which are partially responsible for dental plaque formation and caries development. The aim of this study was to identify the effects of nicotine exposure on the inhibitory effects of cinnamon water extract on S. mutans biofilm formation. Materials and methods: A 24-h culture of S. mutans UA159 in microtiter plates was treated with varying nicotine concentrations (0-32 mg/ml) in Tryptic Soy broth supplemented with 1% sucrose (TSBS) with or without a standardized concentration (2.5 mg/ml) of cinnamon water extract. A spectrophotometer was used to determine total growth absorbance and planktonic growth. The microtiter plate wells were washed, fixed and stained with crystal violet dye and the absorbance measured to determine biofilm formation. Results: The presence of 2.5 mg/ml cinnamon water extract inhibits nicotine-induced S. mutans biofilm formation from 34 to 98% at different concentrations of nicotine (0-32 mg/ml). Conclusion: The results demonstrated nicotine-induced S. mutans biofilm formation is decreased from 34 to 98% in the presence of 2.5 mg/ml cinnamon water extract. This provides further evidence about the biofilm inhibitory properties of cinnamon water extract and reconfirms the harmful effects of nicotine.Item CariesCare International adapted for the pandemic in children: Caries OUT multicentre single-group interventional study protocol(BMC, 2021-12) Martignon, Stefania; Cortes, Andrea; Douglas, Gail V. A.; Newton, J. Timothy; Pitts, Nigel B.; Avila, Viviana; Usuga-Vacca, Margarita; Gamboa, Luis F.; Deery, Christopher; Abreu-Placeres, Ninoska; Bonifacio, Clarisa; Braga, Mariana M.; Carletto-Körber, Fabiana; Castro, Patricia; Cerezo, María P.; Chavarría, Nathaly; Cifuentes, Olga L.; Echeverri, Beatriz; Jácome-Liévano, Sofía; Kuzmina, Irina; Lara, J. Sebastián; Manton, David; Martinez-Mier, E. Angeles; Melo, Paulo; Muller-Bolla, Michèle; Ochoa, Emilia; Osorio, Jesús R.; Ramos, Ketty; Sanabria, Angie F.; Sanjuán, Johanna; San-Martín, Magdalena; Squassi, Aldo; Velasco, A. Karina; Villena, Rita; Ferreira Zandona, Andrea; Beltrán, Edgar O.; Cariology, Operative Dentistry and Dental Public Health, School of DentistryBackground Comprehensive caries care has shown effectiveness in controlling caries progression and improving health outcomes by controlling caries risk, preventing initial-caries lesions progression, and patient satisfaction. To date, the caries-progression control effectiveness of the patient-centred risk-based CariesCare International (CCI) system, derived from ICCMS™ for the practice (2019), remains unproven. With the onset of the COVID-19 pandemic a previously planned multi-centre RCT shifted to this “Caries OUT” study, aiming to assess in a single-intervention group in children, the caries-control effectiveness of CCI adapted for the pandemic with non-aerosols generating procedures (non-AGP) and reducing in-office time. Methods In this 1-year multi-centre single-group interventional trial the adapted-CCI effectiveness will be assessed in one single group in terms of tooth-surface level caries progression control, and secondarily, individual-level caries progression control, children’s oral-health behaviour change, parents’ and dentists’ process acceptability, and costs exploration. A sample size of 258 3–5 and 6–8 years old patients was calculated after removing half from the previous RCT, allowing for a 25% dropout, including generally health children (27 per centre). The single-group intervention will be the adapted-CCI 4D-cycle caries care, with non-AGP and reduced in-office appointments’ time. A trained examiner per centre will conduct examinations at baseline, at 5–5.5 months (3 months after basic management), 8.5 and 12 months, assessing the child’s CCI caries risk and oral-health behaviour, visually staging and assessing caries-lesions severity and activity without air-drying (ICDAS-merged Epi); fillings/sealants; missing/dental-sepsis teeth, and tooth symptoms, synthetizing together with parent and external-trained dental practitioner (DP) the patient- and tooth-surface level diagnoses and personalised care plan. DP will deliver the adapted-CCI caries care. Parents’ and dentists’ process acceptability will be assessed via Treatment-Evaluation-Inventory questionnaires, and costs in terms of number of appointments and activities. Twenty-one centres in 13 countries will participate. Discussion The results of Caries OUT adapted for the pandemic will provide clinical data that could help support shifting the caries care in children towards individualised oral-health behaviour improvement and tooth-preserving care, improving health outcomes, and explore if the caries progression can be controlled during the pandemic by conducting non-AGP and reducing in-office time.Item The effect of theobromine on the in vitro de- and remineralization of enamel carious lesions(Elsevier, 2020) Thorn, Anna K.; Lin, Wei-Shao; Levon, John A.; Morton, Dean; Eckert, George J.; Lippert, Frank; Cariology, Operative Dentistry and Dental Public Health, School of DentistryObjectives This in vitro study investigated the effect of theobromine on the de- and remineralization of enamel carious lesions under plaque fluid-like conditions. Methods Early carious lesions were created in 272 bovine enamel specimens and assigned to sixteen groups (n = 17) based on Knoop surface microhardness (SMH). Lesions were demineralized again under plaque fluid-like conditions in the presence of fluoride (0.2 or 1 ppm) and theobromine (0; 10; 100 or 200 ppm) at different pH values (5.5 or 7.0) in a factorial design. SMH was determined again and percent SMH recovery (%SMHr) calculated. Three-way ANOVA was used for the fixed effects of fluoride, theobromine and pH levels to compare the differences between each level. Results The three-way interaction was not significant (p = 0.712). The two-way interaction between fluoride and pH was significant (p = 0.030), whereas those between fluoride and theobromine as well as that for pH and theobromine were not (p = 0.478 and p = 0.998, respectively). Theobromine did not affect %SMHr at any of the tested concentrations. There were trends for the higher fluoride concentration and the higher pH resulting in more rehardening with the lesions exposed to 0.2 ppm fluoride at pH 5.5 displaying significantly less rehardening than those exposed to 0.2 ppm fluoride at pH of 7.0 and lesions exposed to 1 ppm fluoride at pH of 5.5. Conclusion Theobromine, when continuously present in a plaque fluid-like medium at various concentrations and at different pH values, does not affect de- or remineralization of enamel carious lesions under the presently studied conditions.Item Redesign of an informed consent form to increase participation in a school-based dental program(Wiley, 2021) Mantilla Rodriguez, Andres A.; Soto, Armando; Martinez Mier, E. Angeles; Cariology, Operative Dentistry and Dental Public Health, School of DentistryObjectives The study aimed to determine if modifications to the design of a consent form and consenting process increased participation rates in the Indiana University School of Dentistry's Mobile School-Based Dental Program (Seal Indiana). Methods Kaizen methodology was followed to identify problem areas in the consenting process. Additionally, stakeholders were invited to participate in focus groups and fill out surveys to identify issues preventing participation in the Seal Indiana program (N = 48) and later to evaluate the changes made (N = 48). The redesigned form and process were then used in a pilot study at 14 sites to determine the impact that changes had on levels of participation as measured by the number of consent forms completed and returned. Results There was a statistically significant increase in the number of consent forms returned. The measured change represented a 32 percent increase in program participation (P value = 0.035). A statistically significant increase was observed in how participants viewed the attractiveness of the form and how easy it was to read and comprehend. Conclusions In order to increase consenting rates, our results indicate modifications to the consent form should be focused on the following characteristics: esthetics, ease of reading and comprehending information, and making the Health Insurance Portability and Accountability Act of 1996 (HIPPA) privacy regulations easier to read and comprehend.Item The effect of silver diamine fluoride in preventing in vitro primary coronal caries under pH-cycling conditions(Elsevier, 2021-01) Sorkhdini, Parand; Crystal, Yasmi O.; Tang, Qing; Lippert, Frank; Cariology, Operative Dentistry and Dental Public Health, School of DentistryObjectives This study investigated the ability of SDF, and its individual components, silver (Ag+) and fluoride (F−) ions, in preventing enamel demineralization under pH-cycling conditions in the presence or absence of twice-daily fluoride application. Design Polished human enamel specimens were assigned to five treatment groups (n = 36 per group): SDF (38 %); SDF followed by application of a saturated solution of potassium iodide (SDF + KI); silver nitrate (AgNO3; silver control, 253,900 ppm Ag); potassium fluoride (KF; fluoride control, 44,800 ppm F); deionized water. Treatments were applied once. Specimens in each treatment group were divided into two subgroups (n = 18). During the subsequent 7-day pH-cycling phase, specimens were treated twice daily with either 275 ppm fluoride as sodium fluoride or deionized water, immediately before and after a 3-h cariogenic challenge with exposure to artificial saliva at all other times. Changes in color, Vickers surface microhardness (SMH), transverse microradiography (TMR) was calculated. Data were analyzed using two-way ANOVA. Results In both models, SDF, SDF + KI and KF were superior in inhibiting demineralization compared to AgNO3 and deionized water (p < 0.0001). There was no statistically significant difference between SDF, SDF + KI and KF with twice daily fluoride treatments (p > 0.8). However, KF was more effective in preventing demineralization than SDF and SDF + KI in the absence of fluoride treatments (p = 0.0002). KI did not affect the ability of SDF to prevent demineralization (p > 0.4). Conclusion SDF and SDF + KI appears to be an effective option in preventing primary coronal caries.