Longitudinal clinical and microbiological study on the relationship between infection with Streptococcus mutans and the development of caries in humans.
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Child↗
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Results for “Tooth Remineralization”
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Mineralized tissue-formation in periodontal wound healing.
The purpose of the present study was to examine and compare the different mineralized tissues that are found on and around the dental root following treatment of different periodontal pathosis. The material has been compiled from previously published experimental studies on periodontal therapies and trauma treatments. 4 distinctly different appearances of the mineralized tissue layers on the marginal dentin surfaces were described; new cementum, non-attached bone-like tissue, partly attached bone-like tissue and ankylosis preceded by root resorption. It was concluded that, healing in the periodontal/root interface following periodontal therapy may yield different mineralized tissues, depending on a number of host-specific and external factors. The temporal pattern of such healing processes is schematically represented.
Alveolar Bone Loss↗
Longitudinal study of caries and cariogenic bacteria in an elderly disabled population.
A 2-yr longitudinal study was conducted among elderly disabled residents of a longterm care facility. Each of the 50 subjects examined at the beginning of the study had a mean of 14 teeth, with a mean of 6 carious and 6 restored teeth, per person. Most of the subjects had very poor oral hygiene, and 26 of them had dental plaque that produced cultures of mutans streptococci and lactobacilli in excess of 10(5) CFU/ml. At the end of the first year, 40 subjects were examined again and, apart from a decrease in the mean number of carious root lesions per person, there was very little change in their dental or microbial status. Although only 18 subjects were available at the end of the second year, they presented with fewer carious lesions after 2 yr. The reduction in caries appeared to result from the remineralization of tooth structure, but new lesions did appear in 33% of the 1-yr group, and in 78% of the 2-yr group. This dynamic environment around the teeth produced a mean net incidence of one lesion in the first year, and three lesions over 2 yr. There was a significant (P less than 0.05) association between large (greater than 10(5) CFU/ml) numbers of mutans streptococci and the development of new lesions, but there was no association between the dental status of the subjects and the dental treatment they received. Overall, the results indicate that caries is not rampant in this population.
Aged↗
A random effects model for some epidemiological features of dental caries.
We describe a random effects model for caries lesion development and progression based on considering the effects of the pH fluctuations over time in microbial dental plaque as a Wiener process with a single absorptive barrier. The model predicts that the period of greatest risk to developing caries occurs shortly after eruption, but thereafter the longer a surface survives without developing a lesion, the less likely will it be that a lesion will subsequently develop. The model is able to anticipate why the effect of water fluoridation on caries prevalence is most pronounced when caries is diagnosed at cavity level. This model offers one way in which the variability which characterizes the complex ecosystem associated with dental caries may be considered a subject of interest for enhancing our understanding of its pathogenesis and epidemiology.
Absorption↗
Restoration of approximal carious lesions--application of decision analysis.
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Decision Support Techniques↗
Assessing the stage of caries lesion activity on the basis of clinical and microbiological examination.
The dynamic nature of caries lesion progression may require that classification of caries lesions makes distinctions in activity status. The aim of the present review was to compile and discuss the literature which pertains to clinical assessment of caries lesion activity, and to examine whether recent developments in microbiological research may justify the use of microbiological methods for evaluation of caries activity. Clinical observations suggest that caries lesion progression can be arrested at any stage of lesion development, provided that clinically plaque-free conditions are obtained. However, there is no universal level of oral hygiene to be recommended. The diagnoses "active" and "inactive/arrested" caries have been validated by a range of histological and chemical methods which have supported a separation into distinct clinical categories. Simple microbiological methods have so far not been useful in differentiating between active and inactive caries lesions. Very few studies have evaluated the inter- and intraexaminer reliability of caries diagnostic criteria based on assessment of the activity state of lesions, but recent data indicate that active and inactive caries lesions can be diagnosed with a high degree of reliability. A decision-making tree for dental caries is presented by means of which it is possible to associate the assessment of caries lesion activity with an appropriate treatment modality. It is concluded that research into better methods of assessing caries lesion activity clinically should be stimulated.
Decision Trees↗
Spatial and temporal repair patterns of orthodontically induced surface resorption patches.
Root resorption appears to be an inevitable sequel to orthodontic tooth movement, occurring either apically or along surfaces in and around the pressure zones. However, there is uncertainty as to the location of initial cementum repair in resorbed areas as well as the time of onset of repair. The aim of the present study was to map the spatial and temporal patterns of cementum repair in orthodontically induced areas of surface resorption following maxillary expansion. Two spatial patterns of repair of orthodontic surface resorption patches were observed with cementum deposition proceeding either from the periphery or starting somewhere in the center of the resorbing areas, although the deposition starting centrally was argued to be artifactual. Furthermore, onset of reparative cementum mineralization appeared to follow within 2 wk after release of the force, involving initially only acellular cementum formation. However, the pattern of formation changed gradually, favouring a slow deposition of cellular cementum at more advanced stages of healing.
Bicuspid↗
A computer-assisted videodensitometric method to visualize mineral distributions in in vitro and in vivo formed root caries lesions.
A computer-assisted videodensitometry (CAV) method is presented for the microradiographical mineral determination and mineral visualization of in vitro and in vivo formed dentin lesions. The method employs as essential steps (1) image digitizing by a CCD camera, (2) conversion of gray values to equivalent aluminium thicknesses and (3) conversion of aluminium thickness to vol% of mineral. Procedure and accuracy are described. The CAV method is illustrated for dentin lesions formed in vitro as well as for clinical root caries lesions. The CAV method is especially advantageous for clinical lesions because it can be employed for very complex mineral distributions and irregular lesion outlines. In given areas of interest, the mineral distribution (in vol%) can be plotted in 3D form in pseudo-colors. Conventional microradiographical profiles can be obtained directly from the CAV images. For in vitro lesions, the mineral distribution parameters, lesion depth, mineral loss, and mineral acquisition values can be generated from CAV images with a reproducibility of better than 7%. The CAV method is a valuable tool in quantitative mineral studies of clinical lesions in extracted teeth as well as in in situ lesion investigations.
Absorptiometry, Photon↗
Flexural strength and modulus properties of carbamide peroxide-treated bovine dentin.
BACKGROUND: The effects of carbamide peroxide bleach on tooth structure are uncertain. PURPOSE: The purpose of this study was to investigate the effects of direct or indirect carbamide peroxide application on dentin flexural strength and modulus in vitro. MATERIALS AND METHODS: Dentin bars were machined from bovine incisors and treated with 10% carbamide peroxide for 6 h/d for 14 days. Four groups were created, with eight bars in each group: group 1-direct bleach application only; group 2-indirect bleach application only; group 3-direct bleach application followed by a 2-week storage in artificial saliva; group 4-direct bleach application followed by a 2-week storage in artificial saliva and daily topical fluoride treatments. The specimens' flexural strength and modulus were tested after 24 hours, and the results were compared with water controls using independent t-tests (p < .05). RESULTS: Flexural strength results (in megapascals) for bleached versus control dentin (1=205+/-26 vs 215+/-14, 2=257+/-25 vs 261+/-14, 3=180+/-22 vs 193+/-36, 4=157+/-18 vs 184+/-11) were significantly lower in group 4 (p=.005). Modulus results (in gigapascals) for bleached versus control dentin (1=10.7+/-1.4 vs 12.2+/-0.6, 2=14.2+/-1.7 vs 14.4+/-1.6, 3=10.0+/-2.0 vs 10.9+/-1.3, 4=9.0+/-1.2 vs 11.1+/-1.0) were significantly lower in groups 1 and 4 (p=.013 and p=.003, respectively). There were no significant differences in strength and modulus results between the bleached and control dentin in groups 2 and 3. A direct application of carbamide peroxide to bovine dentin significantly decreased some dentin mechanical properties in vitro. An indirect application of carbamide peroxide to dentin did not significantly decrease dentin strength and stiffness. CLINICAL SIGNIFICANCE: This in vitro study suggests that a bleaching treatment, when applied to the enamel of intact teeth, does not significantly affect the mechanical properties of the underlying dentin. However, when applied directly to dentin in clinical situations such as root exposure or occlusal attrition, the bleaching treatment may result in altered mechanical properties of dentin. The clinical consequences of this observation are, however, unknown.
Animals↗
Clinical reversal of root caries using ozone, double-blind, randomised, controlled 18-month trial.
OBJECTIVE: To assess the effect of an ozone delivery system, combined with the daily use of a remineralising patient kit, on the clinical severity of non-cavitated leathery primary root carious lesions (PRCL's), in an older population group. DESIGN: A total of 89 subjects, (age range 60-82, mean +/- SD, 70.8 +/- 6 years), each with two leathery PRCL's, were recruited. The two lesions in each subject were randomly assigned for treatment with ozone or air, in a double-blind design, in a general dental practice. Subjects were recalled at three, six, 12 and 18 months. Lesions were clinically recorded at each visit as soft, leathery or hard, scored with a validated root caries severity index. RESULTS: There were no observed adverse events. After three months, in the ozone-treated group, 61 PRCL's (69%) had become hard and none had deteriorated, whilst in the control group, four PRCL's (4%) had become worse (p<0.01). At the six-month recall, in the ozone group, seven PRCL's (8%) remained leathery, the remaining 82 (92%) PRCL's had become hard, whilst in the control group, 10 PRCL's had become worse (11%) and one had become hard (p<0.01). At 12 and 18 months, 87 Subjects attended. In the ozone group at 12 months, two PRCL's remained leathery, compared to 85 (98%) that had hardened, whilst in the control group 21 (24%) of the PRCL's had progressed from leathery to soft, i.e. became worse, 65 PRCL's (75%) were still leathery, and one remained hard (p<0.01). At 18 months, 87 (100%) of ozone-treated PRCL's had arrested, whilst in the control group, 32 lesions (37%) of the PRCL's had worsened from leathery to soft (p<0.01), 54 (62%) PRCL's remained leathery and only one of the control PRCL's had reversed (p<0.01). CONCLUSIONS: Leathery non-cavitated primary root caries can be arrested non-operatively with ozone and remineralising products. This treatment regime is an effective alternative to conventional "drilling and filling".
Aged↗
Remineralisation study of artificial root caries lesions after fluoride treatment. An in vitro study using electric caries monitor and transversal micro-radiography.
AIMS: To evaluate and compare remineralisation of root caries lesions after in vitro treatment with various fluoride (F) agents using an Electric Caries Monitor (ECM) and Transversal Micro-Radiography (TMR). MATERIALS: Permanent human teeth were extracted and root surface specimens were sectioned, prepared (n = 35), and randomly allocated into seven different experimental groups (groups 1-7). METHODS: Root surfaces were demineralised in an acidified gel (pH = 5.0) for 3 weeks followed by various F treatments and stored in a standardised remineralising solution at 37 degrees C for 6 weeks. The root surfaces were treated twice daily with different dentifrice slurries for 2 min, either with a neutral placebo dentifrice without F (group 5); or a neutral sodium fluoride (NaF) 1400 p.p.m. F dentifrice (group 1); or a neutral 1250 p.p.m. F dentifrice (group 6); or an acid dentifrice (pH 4.7) with 1400 p.p.m. F containing amine fluoride (AmF) (groups 3 and 4) or a 1250 p.p.m. (pH 4.7) AmF dentifrice (group 6). In groups 1, 2, 5, 6, and 7, the root surfaces were additionally rinsed for 2 min with a neutral non-F placebo solution. In groups 3 and 4, rinsing were performed for 2 min with an acid (pH 4.7) 250 p.p.m. F solution, containing 125 p.p.m. F as AmF and 125 p.p.m. F as potassium fluoride (KF), once or twice per day respectively. ECM was used to measure electrical resistance on root surfaces at baseline and after 3 and 6 weeks respectively. TMR technique was used to measure and compare root surface lesion depths and mineral loss. RESULTS: Six weeks daily treatment with a dentifrice slurry containing AmF followed by rinsing with a combination of equal amounts of AmF and KF solution twice a day showed a statistical significant higher ECM values compared with the other groups. TMR data measuring lesion depths and mineral loss reduction supported the results of the ECM findings. CONCLUSIONS: Daily application of a dentifrice slurry containing 1400 p.p.m. F as AmF combined with twice daily rinsing with a 250 p.p.m. F solution containing equal amount of AmF and KF significantly remineralise primary root caries lesions in vitro. ECM and TMR are valuable complementary methods in order to analyse the remineralisation processes.
Amines↗
Rehardening of caries-like lesions in root surfaces by saliva substitutes.
OBJECTIVE: This study sought to evaluate whether root dentine caries-like lesions could be remineralised by saliva substitutes. METHODS: Root dentine slabs (3 x 3 x 2 mm) were cut from bovine incisors, ground flat, polished and pre-tested for Knoop microhardness (KHN) at five locations spaced 500 microm apart and 500 microm from the left edge of each sectioned piece. After 60 out of the 100 slabs had been selected based upon their KHN values, specimens were coated with wax except for their outer surface. Specimens were then cycled through a highly cariogenic challenge model to induce caries-like lesions, whose formation was confirmed by KHN measurements located 500 microm from the right edge of the specimen. According to a randomised complete block design, the experimental units (n = 15) were exposed to 1.5 ml of saliva substitutes, based on either mucin (MC) or carboxymethylcellulose (CM), to natural human saliva (HS) or to 100% relative humidity (RH) over 20 days. Remineralisation was verified by KHN measurements located 1000 microm apart from the right edge of the specimen. RESULTS: Analysis of variance indicated a significant (p < 0.0001) difference among the KHN values attained by the carious root dentine after exposure to the remineralising agents. Tukey's test ascertained that remineralisation was greatest with MC, intermediate with CM and least with HS, but rehardening did not reach the pre-caries lesion formation values. CONCLUSION: Saliva substitutes may provide partial remineralisation to preformed caries-like lesions in root dentine.
Adult↗
The 48-month increment of root caries in an urban population of older adults participating in a preventive dental program.
The purpose of this study was to determine the effect of a 48-month preventive dental program on the incidence of root caries in an urban, geriatric, noninstitutionalized population residing in an optimally fluoridated area. The 466 participants were randomly assigned to one of three groups at baseline. Group A (control): 171 subjects using a placebo mouthrinse daily; group B: 147 subjects receiving semiannual applications of a topical APF gel (1.2% F-) with the daily use of a placebo mouthrinse; group C: 148 subjects using a fluoridated mouthrinse daily, ACT (0.05% F-). At baseline, the numbers of surfaces at risk, and decayed and filled surfaces were recorded. After 48 months, in addition, the number of reversed and new lesions were determined, and the incremental DMFS calculated. The data were analyzed by ANCOVA. The incremental DMFS were: A = 0.91, B = 0.27, C = 0.26. The incremental DMFS in groups B and C were significantly lower than in group A (P < .05). The number of reversed lesions in group C (1.53 +/- 2.03) was significantly greater than in group A (1.11 +/- 1.74) and group B (1.01 +/- 1.86) (P < .05). The number of new lesions in group B (1.36 +/- 2.00) was significantly less than in group A (1.99 +/- 2.65) (P < .05). The daily use of the fluoride mouthrinse significantly increased the number of reversed lesions.
Acidulated Phosphate Fluoride↗
Microscopic investigation of artificially demineralized surface enamel exposed to controlled intra-oral periods.
BACKGROUND: Arrest and regression of enamel caries is generally followed by clinical surface changes in enamel. The aim of this study was to evaluate microscopic surface changes in demineralized enamel submitted to toothbrushing with a fluoridated dentifrice or to a fluoridated gel in situ. METHODS: Enamel blocks demineralized by an acidic gel, were built in plates of five volunteers during three periods of 14 days each: exposure to the oral cavity (C+); brushing with a fluoridated dentifrice three times a days (B); application of a 2 per cent sodium fluoride gel and exposure to the oral cavity (F). Eight blocks were kept in 100 per cent humidity under refrigeration as negative controls (C-). RESULTS: Stereomicroscopic examination revealed that 15, 47.4 and 30 per cent of samples from C+, B and F presented enamel cavitation after the experimental period. The demineralized enamel area in these groups decreased considerably compared to C-, both in cavitated and non-cavitated samples, although it was statistically significant only in cavitated samples from B (p=0.003; t test). Scanning electron microscopy revealed that C+ and F retained irregularities caused by the acid challenge, while B presented a more leveled profile of the enamel surface. CONCLUSIONS: Exposure of demineralized enamel to intra-oral periods reduced the demineralized enamel area. Tooth brushing enhanced this reduction, because of surface abrasion.
Adult↗
Cariostatic effects of a xylitol/NaF dentifrice in vivo.
Xylitol has been shown to reduce plaque acids, but its topical cariostatic effect has been equivocal. The purpose of the studies reported here was to optimise the xylitol/NaF combination in dentifrices for an improved anticaries activity. In the first study, the combination of 10 per cent xylitol with 1100 ppm F (NaF), 1100 ppm F (NaF), and placebo dentifrices were tested in a rat caries model to assess the cariostatic effect. The combination was significantly more effective than fluoride by itself (P = 0.05). The xylitol/NaF combination provided significantly more remineralisation of dentine than fluoride by itself. Collectively, results of these investigations confirm the improved anticaries effectiveness of the xylitol/NaF combination in a variety of animal and intra-oral models. A three-year clinical study confirmed these findings.
Acids↗
Minimal intervention dentistry--a review. FDI Commission Project 1-97.
The concept of minimal intervention dentistry has evolved as a consequence of our increased understanding of the caries process and the development of adhesive restorative materials. It is now recognised that demineralised but noncavitated enamel and dentine can be 'healed', and that the surgical approach to the treatment of a caries lesion along with 'extension for prevention' as proposed by G V Black is no longer tenable. This paper gives an overview of the concepts of minimal intervention dentistry, describes suggested techniques for a minimally invasive operative approach, and reviews clinical studies which have been carried out in this area.
Composite Resins↗
The effect of different commercial dentifrices on enamel lesion progression: an in vitro pH-cycling study.
AIMS/OBJECTIVES: To evaluate and compare the de/remineralization effects of dentifrices manufactured locally in some developing countries. DESIGN: Utilisation of the in vitro single-section and the pH-cycling model. SETTING: Laboratory. TEST MATERIALS: Dentifrices: Maxam DFP, Maxam Tartar Control, First, Tianqi Medicated from China; Vicco Vajradenti from India; Colgate MFP2, Crest Tartar Control from USA; and one non-fluoride dentifrice as control. METHODS: Sound molars were painted, leaving a 1 mm wide 'window' on the buccal and/or lingual surface and placed in a demineralisation solution for 96 h to produce artificial caries lesion approximately 80-100 mm deep. The teeth were then longitudinally sectioned (approximately 100 mm thick), and randomly divided into 8 groups (22 sections/group). The pH cycling model was utilised for 10 days. OUTCOME MEASURES: Polarised light microscopy and microradiography were used to evaluate the lesion progression before and after treatment. RESULTS: The control group showed an increase in lesion depth of 70 per cent and was statistically different from some test groups which ranged from -2 per cent to 68 per cent (P < 0.01, t-test). Statistically significant differences were also observed among some of the fluoride containing groups. CONCLUSIONS: This study suggests that, when compared to 'multinational dentifrices', Chinese and Indian dentifrices manufactured locally failed to show 'healing' efficacy even though they claimed to contain varying levels of fluoride.
China↗
Low-levels of fluoride in plaque and saliva and their effects on the demineralisation and remineralisation of enamel; role of fluoride toothpastes.
AIM: To summarise support for current consensus on the likely means by which fluoride toothpastes reduce caries and review some relevant studies of the effect of low levels of fluoride on the demineralisation and remineralisation of enamel. The major anti-caries effect of fluoride toothpastes is thought to result from small but protracted elevations in levels of fluoride in plaque and saliva. Fluoride incorporated into enamel systemically does not reduce enamel solubility sufficiently to exert an anti-caries effect. Fluoride has the potential to exert an anti-caries benefit largely through three mechanisms; inhibition of demineralisation, promotion of remineralisation and interference with bacterial growth and metabolism. However, the low levels of fluoride thought to influence caries are insufficient to have a significant effect via the latter mechanism. Thus reductions in caries resulting from the use of fluoride toothpastes can be linked to modification of the demineralisation/remineralisation balance by direct effects on dental mineral exerted topically by low levels of fluoride. Numerous in vitro studies have shown that low levels of fluoride, typical of those found after many hours in resting plaque and saliva, and resulting from the regular use of fluoride toothpastes, can have a profound effect on enamel demineralisation and remineralisation.
Cariostatic Agents↗