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OBJECTIVE: Clinical, radiographic, and microbiologic changes in deep caries lesions were assessed after incomplete carious dentin removal and tooth sealing. METHOD AND MATERIALS: Thirty-two teeth with deep caries lesions were studied. Treatment consisted of incomplete excavation of the demineralized dentin, application of calcium hydroxide, and sealing for a 6- to 7-month period. The color and consistency of the dentin were clinically assessed. Differences in radiographic density were assessed by digital image subtraction. Microbiologic samples were obtained from the demineralized dentin before the temporary sealing and after the experimental period. The samples were cultivated on blood agar under aerobic and anaerobic conditions, in Mitis Salivarius agar, and Rogosa selective Lactobacillus agar. RESULTS: Two cases were lost during the study; one presented pulpal necrosis. In the other case, there was pulpal exposure during removal of provisional sealing. In all teeth, the initial demineralized dentin was soft and wet; one lesion was yellow, 21 were light brown, and eight were dark brown. After treatment, the dentin was dry, and 80.00% of specimens were hard, 16.67% were leathery, and 3.33% remained soft. The dentin was light brown in five teeth and dark brown in 25. There was a statistically significant mean difference in radiographic density (pixel intensity), 88.77 +/- 7.02 in the control areas and 94.66 +/- 6.75 in the test areas. The counts of anaerobic and aerobic bacteria, lactobacilli, and Streptococci mutans had decreased significantly by the end of treatment. CONCLUSION: Incomplete removal of carious dentin and subsequent tooth sealing resulted in the arrest of the lesions, suggesting that complete dentinal caries lesion removal is not essential to the control of caries lesions. [ABSTRACT FROM AUTHOR]

Objective: To assess the radiographic pattern of underlying dentine shadows (UDS) in the occlusal surfaces of permanent teeth. Methods: A total of 282 permanent posterior teeth pertaining to 91 individuals, 142 UDS and 140 non-cavitated enamel lesions (NCEL), were included for comparison. UDS was defined as shadows of discolored dentin visible through the enamel surface which may or may not show signs of localized enamel breakdown, classified as code 4 by the International Caries Detection and Assessment System group. Data collection included the application of a questionnaire, clinical examination, and bilateral bitewing radiographs. The risk for presenting radiolucency was estimated using logistic regression model with generalized estimating equations. Results: Approximately 79% of UDS exhibited no radiolucency. The proportion of teeth exhibiting a radiolucency restricted to the enamel-dentin junction was 20.4% for UDS and 3.6% for NCEL (p < 0.001, chi-square test). UDS had a sixfold increased risk for exhibiting radiolucency compared with NCEL (OR = 5.78, 95% CI = 2.73–12.22, p < 0.001). Despite this finding, it is important to highlight that virtually all cases were located at the enamel-dentin junction, and only one tooth in each category of clinical status exhibited radiolucency at the outer one half of dentin. No tooth exhibited radiolucency reaching the deep dentin. Conclusion: The present study showed that UDS presented radiolucency in very few cases. The vast majority of lesions showed no radiolucency. Clinical relevance: Our findings suggest that only a small proportion of UDS would demand restorative treatment. [ABSTRACT FROM AUTHOR]

Objective: To assess the clinical behavior of inactive caries lesion on the occlusal sites of permanent molars over 4-5 years and to estimate the risk for progression of caries-inactive sites compared with sound ones.Methods: Clinical examinations were conducted at baseline (n = 258) and after 4-5 years and included the recording of dental plaque and dental caries at the occlusal surfaces and the eruption stage of each permanent molar.Results: One hudred ninety-three schoolchildren were followed (response rate of 74.8%), totalizing 1152 teeth. Of the children, 30.6% (n = 59) presented at least one molar containing an active lesion, filling, or that had been extracted; according to the activity criterion, inactive lesions presented around a twofold increased risk for caries progression than sound surfaces (OR = 2.34 95%CI = 1.51-3.62). Thirteen percent (n = 25) of the children presented at least one molar progressing to dentine cavity, filling, or extraction; according to the severity criterion, inactive caries lesions presented a significantly higher risk for progression when compared with sound surfaces (OR = 2.69, 95% CI = 1.50-4.83).Conclusion: The vast majority of lesions (85-90%) identified as inactive enamel caries at baseline did not progress over 4-5 years. Despite this fact, it was possible to detect an increased risk for caries progression in caries-inactive occlusal sites compared with the sound ones.Clinical relevance: Considering the low progression rates, inactive caries lesions do not need a specific caries-controlling treatment and should be monitored longitudinally in the same manner as sound surfaces. [ABSTRACT FROM AUTHOR]

Objective: This multicenter randomized controlled clinical trial aimed to compare the outcomes of stepwise excavation (SW) and partial caries removal (PCR) regarding the maintenance of pulp vitality in deep caries lesions over 5 years.Methods: At baseline, 299 permanent molars with deep caries lesions were randomly assigned to control or test groups. The control group received the stepwise excavation treatment (SW), while the test group received partial caries removal from the pulpal wall followed by restoration in a single session (PCR). Treatments were conducted in two centers located in the cities of Porto Alegre (South Brazil) and Brasília (Midwest Brazil). Survival analysis was performed to compare PCR and SW over time (Weibull regression models). The primary outcome of this study was pulp vitality, determined by the combination of the following characteristics: positive response to cold test, negative response to percussion, absence of spontaneous pain, and absence of periapical lesion (radiographic examination).Results: This 5-year study includes data pertaining to 229 teeth: 121 teeth actually examined at the 5-year appointment, and 108 teeth contributed with data collected in previous follow-ups (18 months or 3 years). Survival analysis showed success rates of 80% in PCR group and 56% in SW group (p < 0.001). Failure was significantly associated with treatment [PCR, HR=0.38; 95%CI=0.23-0.63)] and region [South, HR=2.22; 95%CI=1.21-4.08].Conclusion: PCR significantly reduced the occurrence of pulp necrosis when compared with SW.Clinical relevance: This study supports the PCR as a single-visit technique to manage deep caries lesions in permanent teeth. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: This population‐based longitudinal study investigated the incidence, progression and risk factors for dental erosion among South Brazilian adolescents. Methods: Eight hundred and one schoolchildren attending 42 public and private schools were clinically examined at 12 years of age; clinical examinations were repeated after 2.5 years (SD=0.3). After tooth cleaning and drying, permanent incisors and first molars were classified using the Basic Erosive Wear Examination (BEWE) scoring criteria. Questionnaires were used to collect data on socio‐demographic characteristics, dietary habits, toothbrushing frequency and general health. Poisson regression analysis was used to assess the association between dental erosion incidence and explanatory variables, with adjusted incidence risk ratios (IRR) and 95% CI estimated. Results: Among those who did not have dental erosion at baseline, 49 of 680 schoolchildren (7.1%; 95% CI=5.2‐9.1) developed erosive lesions over the follow‐up period. Among schoolchildren who had dental erosion at baseline, 31 of 121 (25.4%; 95% CI=17.6‐33.3) had new or more severe lesions. Boys were more likely to develop dental erosion than girls (IRR=1.88; 95% CI=1.06‐3.32). Conclusions: A moderate incidence of dental erosion was observed among South Brazilian adolescents, with boys being at higher risk. The high progression rate of 25% observed here is very concerning, and it should be taken in consideration when designing preventive strategies for dental erosion. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the extent to which dental caries and fluorosis, in addition to sociodemographic and oral health behavior determinants, impact the oral health-related quality of life (OHRQoL) of adolescents. Methods: All adolescents attending from sixth to eighth grades in the Region of Itapoã, Federal District of Brazil ( n = 1122), were screened, and 618 10-15-year-olds were selected. Parents answered a questionnaire about their family's socioeconomic status. Adolescents answered a questionnaire about demographic and oral health behavior determinants in addition to the Child Perception Questionnaire. Results: Cavitated dentine lesions and fluorosis were observed in 39.5 and 48.5 %, respectively. The outcome was a high score on OHRQoL (median split >9). The prevalence of adolescents with at least one domain being impacted 'often' or 'every day/almost every day' was 34.8 %. Adolescents with tooth brushing frequency ≤once per day and with moderate or severe cavitated dentine lesions reported a significant impact on their OHRQoL ( p = 0.002; p = 0.001). Fluorosis did not impact daily life performances ( p = 0.545). Conclusion: Increased impact on OHRQoL was related to the severity of cavitated dentine lesions, but fluorosis resulting from combined fluoride exposure from early ages was not of concern for the adolescents. Clinical relevance: Combined fluoride exposure from fluoridated drinking water, consumption of food prepared with fluoridated water, and daily twice brushing with conventional fluoride toothpaste from early ages may be recommended to control caries progression at population level without impact on OHRQoL. This information is particularly relevant for supporting oral health police for disadvantaged populations. [ABSTRACT FROM AUTHOR]

Objective To compare the effectiveness of water and salt community-based fluoridation methods on caries experience among schoolchildren. Methods Data derived from two population-based oral health surveys of 12-year-old schoolchildren exposed to different community-based fluoridation methods were compared: artificially fluoridated water in Porto Alegre, South Brazil and artificially fluoridated salt in Montevideo, Uruguay. Data on socio-demographic characteristics, maternal education and oral hygiene were collected. Dental caries was defined according to the WHO criteria (cavitated lesions) and to the modified WHO criteria (active noncavitated lesions and cavitated ones). The association between community-based fluoridation methods and dental caries was modelled using logistic (caries prevalence) and Poisson regression ( DMFT). Odds ratios ( OR), rate ratios ( RR), and the 95% confidence intervals ( CI) were estimated. Results A total of 1528 in Porto Alegre and 1154 in Montevideo were examined (response rates: 83.2% and 69.6%, respectively). Adjusted estimates for caries prevalence and DMFT showed that schoolchildren from Porto Alegre were less affected by dental caries than their counterparts from Montevideo, irrespective of the criteria used. After adjusting for important characteristics, schoolchildren exposed to fluoridated salt had significantly higher likelihood of having caries ( WHO criteria) than those exposed to fluoridated water ( OR for prevalence=1.61, 95% CI=1.26-2.07; RR for DMFT=1.32, 95% CI=1.16-1.51). Similar differences were observed using the modified WHO criteria. Conclusion Fluoridated water appears to provide a better protective effect against dental caries than fluoridated household salt among schoolchildren from developing countries. [ABSTRACT FROM AUTHOR]

Variation in the terminology used to describe clinical management of carious lesions has contributed to a lack of clarity in the scientific literature and beyond. In this article, the International Caries Consensus Collaboration presents 1) issues around terminology, a scoping review of current words used in the literature for caries removal techniques, and 2) agreed terms and definitions, explaining how these were decided. Dental caries is the name of the disease, and the carious lesion is the consequence and manifestation of the disease—the signs or symptoms of the disease. The term dental caries management should be limited to situations involving control of the disease through preventive and noninvasive means at a patient level, whereas carious lesion management controls the disease symptoms at the tooth level. While it is not possible to directly relate the visual appearance of carious lesions’ clinical manifestations to the histopathology, we have based the terminology around the clinical consequences of disease (soft, leathery, firm, and hard dentine). Approaches to carious tissue removal are defined: 1) selective removal of carious tissue—including selective removal to soft dentine and selective removal to firm dentine; 2) stepwise removal—including stage 1, selective removal to soft dentine, and stage 2, selective removal to firm dentine 6 to 12 mo later; and 3) nonselective removal to hard dentine—formerly known as complete caries removal (technique no longer recommended). Adoption of these terms, around managing dental caries and its sequelae, will facilitate improved understanding and communication among researchers and within dental educators and the wider clinical dentistry community. [ABSTRACT FROM AUTHOR]

The International Caries Consensus Collaboration undertook a consensus process and here presents clinical recommendations for carious tissue removal and managing cavitated carious lesions, including restoration, based on texture of demineralized dentine. Dentists should manage the disease dental caries and control activity of existing cavitated lesions to preserve hard tissues and retain teeth long-term. Entering the restorative cycle should be avoided as far as possible. Controlling the disease in cavitated carious lesions should be attempted using methods which are aimed at biofilm removal or control first. Only when cavitated carious lesions either are noncleansable or can no longer be sealed are restorative interventions indicated. When a restoration is indicated, the priorities are as follows: preserving healthy and remineralizable tissue, achieving a restorative seal, maintaining pulpal health, and maximizing restoration success. Carious tissue is removed purely to create conditions for long-lasting restorations. Bacterially contaminated or demineralized tissues close to the pulp do not need to be removed. In deeper lesions in teeth with sensible (vital) pulps, preserving pulpal health should be prioritized, while in shallow or moderately deep lesions, restoration longevity becomes more important. For teeth with shallow or moderately deep cavitated lesions, carious tissue removal is performed according to selective removal to firm dentine. In deep cavitated lesions in primary or permanent teeth, selective removal to soft dentine should be performed, although in permanent teeth, stepwise removal is an option. The evidence and, therefore, these recommendations support less invasive carious lesion management, delaying entry to, and slowing down, the restorative cycle by preserving tooth tissue and retaining teeth long-term. [ABSTRACT FROM AUTHOR]

The aim of this systematic literature review was to investigate whether the incorporation of antimicrobial agents into dental restorative materials truly exerts an antimicrobial effect against common cariogenic bacteria (primary outcome), and whether the inclusion of antimicrobial agents is able to prevent caries around restorations (secondary outcome). MEDLINE, via PubMed, was searched for papers published between 1980 and 30 November 2014. A total of 1126 articles were retrieved. After inclusion/exclusion assessment, 147 full text articles were read and included in the review, comprising 130 in vitro, 1 in situ, and 4 in vivo studies, as well as 12 literature reviews. In about 78% of in vitro studies, and in all identified in situ and in vivo studies, a positive antimicrobial effect had been found. However, the anticaries effect had not been tested in any of the selected studies. It was concluded that there is indeed evidence that restorative dental materials containing antimicrobial agents exert an antimicrobial effect, both in laboratory and in clinical studies. However, no evidence has been found regarding the role of these agents in preventing or controlling dental caries, or in preventing caries around restorations. [ABSTRACT FROM AUTHOR]

Objectives: The aims of this study were to compare caries incidence and progression on sound occlusal surfaces and on surfaces presenting inactive enamel lesions in children and adolescents over 1 year and to estimate the risk of caries incidence and progression on these surfaces. Methods: This prospective cohort study followed 200 7-15-year-old caries-inactive schoolchildren over 1 year. Stage of eruption, occlusal plaque, and occlusal caries were recorded on permanent molars. Statistical analysis was performed using generalized estimating equations with a logistic link function. Results: Twenty-two children (11 %) presented 'caries progression' (at least one active lesion on molar teeth). At site level, no difference was observed in caries incidence and progression between sites classified either sound (2.6 %) or with inactive enamel lesion (3.9 %) at the baseline examination ( χ test, p = 0.48). Adjusted for plaque, stage of eruption, type of molar and dental arch, inactive enamel lesions presented a similar risk for caries progression than sound occlusal surfaces (OR = 0.98, 95 % CI = 0.40-2.38). Conclusion: Within the limitations of this study, no difference was observed in caries incidence, progression, and risk on sound occlusal sites in comparison with sites presenting inactive enamel lesions. Clinical relevance: Occlusal surfaces harboring inactive caries lesions did not require additional attention than the one normally given to sound occlusal surfaces over a 1-year period. [ABSTRACT FROM AUTHOR]

Objective: This 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 methods: Thirty-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. Results: The 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. Conclusions: The 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 relevance: The 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. [ABSTRACT FROM AUTHOR]

This population-based cross-sectional study aimed to assess the prevalence and risk indicators for tooth loss due to dental caries among 12-year-old schoolchildren from South Brazil. 1,528 out of 1,837 (participation rate = 83.17%) schoolchildren were included. Tooth loss prevalence was 5.81% (95% CI = 3.71-8.98) and 0.08 (95% CI = 0.04-0.12) teeth were missing. Schoolchildren with low socioeconomic status (OR = 2.28, 95% CI = 1.23-4.21), who repeated years in school (OR = 1.56, 95% CI = 1.01-2.42), and with gingivitis (OR = 1.81, 95% CI = 1.33-2.45) were more likely to have missing teeth. Schoolchildren brushing 2 times/day (OR = 0.78, 95% CI = 0.64-0.96) or more (OR = 0.49, 95% CI = 0.33-0.74), and those with dental insurance or private dentists (OR = 0.60, 95% CI = 0.39-0.93) were less likely to present missing teeth. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

This study investigated the radiographic pattern of underlying dark shadow from dentin (ICDAS 4) in permanent molars and assessed the association between enamel breakdown and radiographic features. Ninety-five teeth (54 patients) were clinically and radiographically assessed. The majority of ICDAS 4 caries lesions presented enamel breakdown (n = 78, 82.1%) and no radiographic image (n = 64, 67.4%) or a radiolucent zone restricted to the enamel-dentin junction (n = 17, 17.9%). No association was found between enamel breakdown and radiographic features. This study suggests that a radiographic examination is needed prior to the decision making process for underlying dark shadows from dentin. [ABSTRACT FROM AUTHOR]

This study investigated the radiographic pattern of underlying dark shadow from dentin (ICDAS 4) in permanent molars and assessed the association between enamel breakdown and radiographic features. Ninety-five teeth (54 patients) were clinically and radiographically assessed. The majority of ICDAS 4 caries lesions presented enamel breakdown (n = 78, 82.1%) and no radiographic image (n = 64, 67.4%) or a radiolucent zone restricted to the enamel-dentin junction (n = 17, 17.9%). No association was found between enamel breakdown and radiographic features. This study suggests that a radiographic examination is needed prior to the decision making process for underlying dark shadows from dentin. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

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. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

We evaluated the effect of calcium hydroxide cement (CHC) and glass ionomer cement (GIC) on carious dentin and bacterial infections after partial caries removal and sealing. Sixty permanent teeth with deep lesions underwent partial caries removal, the application of CHC, GIC or wax, i.e. negative control (NC), and were then sealed for 3-4 months. After the partial caries removal and the sealing period, the dentin was clinically assessed (colour and consistency) and analysed by scanning electron microscopy to assess dentin organization and bacterial infections. The effect of the treatment in each group was assessed by the Wilcoxon and χ2 tests, differences among groups by the Kruskal-Wallis test and the correlations between variables by Spearman correlation. No clinical symptoms or radiographic signals of pulpits or pulp necrosis were observed during the study. Dentin darkening was observed after the sealing period in the CHC and NC groups (p < 0.05). However, there was no difference in the colour after treatment among the 3 groups (p > 0.05). Dentin hardening occurred in all groups after treatment (p < 0.05), also with no differences (p > 0.05). Dentin samples showed better organization after the sealing period than after partial caries removal, with total or partial obliteration of dentinal tubules (CHC p < 0.03, GIC p < 0.05, NC p < 0.01) and a reduction of bacterial infections (CHC p < 0.03, GIC p < 0.05, NC p < 0.03). No differences were observed. Correlations between the different criteria, except for colour and bacterial infection, were detected in all cases. Partial caries removal and sealing resulted in dentin hardening, decreased bacterial numbers and dentin reorganization, irrespective of the dentin protection used. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

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. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

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). [ABSTRACT FROM PUBLISHER]

Antimicrobial methods to augment fluoride-mediated caries inhibition are necessary. Several methods are described here, but none was considered likely to be as effective as fluoride usage. None had been tested in effective models to demonstrate their ability to act either additively or synergistically with fluoride-containing toothpastes. Dental caries is a biofilm-mediated disease: The composition of the biofilm associated with caries initiation and progression is diverse. Caries-associated taxa – including mutans streptococci, lactobacilli, bifidobacteria, and yeasts – may be useful surrogate markers for in vivo investigations. In vitro testing should progress from single-species planktonic cells to multi-species biofilms prior to essential testing in randomized control trials (RCTs). Modern high-throughput sequencing techniques need to be applied to the study of bacterial acquisition from birth and of the composition of the biofilm associated with the formation of white-spot lesions. The determination of the functions of the biofilm and the phenotype of the bacterial components may be determined by RNA-seq techniques, since they must be conserved between caries lesions and will include the ability to produce acids and survive and proliferate in acidic conditions. The application of such methods will significantly improve our understanding of the etiology and progression of dental caries. [ABSTRACT FROM PUBLISHER]

To determine the genetic diversity and possible origin of Lactobacillus paracasei found in the oral biofilm. Lactobacilli were isolated from a biofilm model, formed in situ prior to and during a period of exposure to 20% sucrose solution (28 days), using Rogosa Agar. The lactobacillus colonies were randomly selected ( n = 222) and subcultured. The isolates were identified using pheS or rpoA gene sequence analysis. Lactobacilli identified as Lact. paracasei ( n = 75) were subjected to multilocus sequencing typing (MLST) analysis by determining partial sequences of seven housekeeping genes fusA, ileS, lepA, leuS, pyrG, recA and recG. An increase recovery of lactobacilli after sucrose phase compared with nonsucrose period was observed (31 prior to and 191 following a sucrose exposure period). Seven subjects harboured Lact. paracasei and these represented 14 sequence types (ST). Comparison of the STs showed that unrelated subjects may harbour the same ST and that individuals harbour multiple STs. Three subjects harboured STs previously isolated from dairy products. The present data supports the hypothesis that oral lactobacilli may be of exogenous origin. The study allow us to gain insight into the genetic diversity of Lact. paracasei in oral biofilm . [ABSTRACT FROM AUTHOR]

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. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Contamination by microorganisms of active and inactive noncavitated lesions was analyzed by scanning electron microscopy. The sample comprised 10 active and 14 inactive smooth surface lesions and 5 sound tooth surfaces. The active lesions were obtained through an in situ model. The inactive lesions and the sound surfaces were obtained from extracted teeth. The samples were split and the two resulting halves were analyzed. The lesion areas were measured in order to compare bacterial contamination in active and inactive lesions. Microorganisms were detected within the enamel in all lesions studied (active and inactive). Sound teeth did not harbor bacteria with the exception of one half tooth where one rod was observed in the enamel. Great variation was observed in bacterial contamination in both active and inactive lesions. Microorganisms penetrated rather deeply into some active as well as into inactive lesions, reaching the dentin in 5 inactive lesions. Bacteria were present in the tubular and intertubular dentin. No difference was observed in the number of microorganisms per square millimeter in the active and inactive lesions (p > 0.05). Cocci and rods comprised 99% of the organisms, while filamentous and spiral bacteria were seldom present. Yeast-like microorganisms were found in inactive lesions. The presence of microorganisms in inactive as well as active noncavitated lesions shows that bacteria inside dental tissue (enamel and dentin) do not impede the arrestment of the caries process. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

This study assesses changes in the prevalence of dental caries and gingivitis in a population of Brazilian schoolchildren in 1975 and 1996. The study was carried out in the municipality of Porto Alegre, Brazil, and included all 8- to 10-year-old children attending the second, third, and fourth grades at the same public school. Data were recorded from 233 children in cohort 1975 and from 185 children in cohort 1996. Only the children from cohort 1996 benefited from fluoridated water and regular use of fluoridated toothpaste. Caries experience was registered clinically and radiographically and summarised in DMFT and DMFS indices. The gingival status was described according to the GBI-index. Over a period of 21 years, the percentage of caries-free children increased significantly in all age groups; sevenfold at the age of 8, ninefold at the age of 9 and fourfold at the age of 10. Dental caries has almost disappeared from front teeth and premolars and was mainly located at the groove-fossa-system of permanent first molars. A seventy percent reduction in DMFS scores was observed. A significantly higher percentage of filled surfaces was registered in cohort 1975 than in cohort 1996 (P=0.001). The gingival bleeding index did not diminish during the study period, indicating that children's oral hygiene did not improve. Since the children had neither better access to dental care nor improved oral hygiene, it is tempting to believe that their access to fluorides contributed most to the marked decline in caries prevalence. [ABSTRACT FROM AUTHOR]

The study assessed the use of binary warnings in a detection task with high attentional demands. Participants in the experiment had to decide whether to continue or halt production based on a briefly displayed number that indicated a temperature level. The short time that the number was displayed required that participants focus on the display area. Participants were rewarded for production when the system was intact and were heavily penalized for decisions to produce under dangerous temperature levels. Color-coded warning cues (green for safe, red for danger) were displayed to the participants prior to number presentation. The experimental conditions differed in the validity of the cue and in the probability of red cues. Results showed significant learning for all conditions. Participants tended to ignore the nonvalid and low-validity cues and rely only on highly valid cues. However, the mere existence of cues affected participants' general tendency to take risks. Actual or potential applications of this research include improving systems that require operators to devote attention to complex tasks while receiving and responding to warnings. [ABSTRACT FROM AUTHOR]

This 2-part study focuses on eye movements to explain driving-related visual performance in younger and older persons. In the first task, participants' eye movements were monitored as they viewed a traffic scene image with a numeric overlay and visually located the numbers in their sequential order. The results showed that older participants had significantly longer search episodes than younger participants, and that the visual search of older adults was characterized by more fixations and shorter saccades, although the average fixation durations remained the same. In the second task, participants viewed pictures of traffic scenes photographed from the driver's perspective. Their task was to assume the role of the driver and regard the image accordingly. Results in the second task showed that older participants allocated a larger percentage of their visual scan time to a small subset of areas in the image, whereas younger participants scanned the images more evenly. Also, older participants revisited the same areas and younger participants did not. The results suggest how aging might affect the efficacy of visual information processing. Potential applications of this research include training older drivers for a more effective visual search, and providing older drivers with redundant information in case some information is missed. [ABSTRACT FROM AUTHOR]

The duration of action of tiapamil was assessed in ten patients with stable exertional angina. Maximal symptom-limited treadmill exercise electrocardiography was performed before and at 1, 3, 6 and 9 h after therapy. Significant differences were only found at 1 h after tiapamil with increases in mean exercise duration (312 vs 399 s), the time to onset of angina (221 vs 310 s) and exercise work load (5.9 vs 7.3 METS). Tiapamil had no significant effect on the exercise heart rate but increased the resting heart rate by 6 beats/minute. The resting systolic blood pressure fell by 17 mmHg ( p<0.01), and the diastolic blood pressure by 14 mmHg. Exercise systolic and diastolic blood pressures fell by 19 and 17 mmHg respectively. Side-effects were short-lived and attributable to vasodilatation. Tiapamil is effective for the relief of angina with minimal side-effects, but its duration of action is short. For effective chronic oral use, a sustained release preparation is required. [ABSTRACT FROM AUTHOR]

Ventricular arrhythmias are common in patients with mitral valve prolapse. Ten patients with echocardiographically confirmed mitral valve prolapse and documented ventricular arrhythmias were included in this study. The aim was to assess the value of combined alpha- and beta-blockade (labetalol) compared with beta-blockade alone (propranolol) in the management of ventricular arrhythmias in these patients. The study was performed using physiological stress, such as the Valsalva manoeuvre, isometric exercise and treadmill exercise, to initiate ventricular arrhythmias before and after intravenous propranolol or labetalol and to document arrhythmias during 24 hour electrocardiography before and after oral medication. Labetalol and propranolol decreased the heart rate and blood pressure response to these manoeuvres to a similar extent but labetalol was more effective in the control of the ventricular arrhythmias. These findings suggest that alpha adrenergic receptors may play a role in the pathogenesis of the ventricular arrhythmias in mitral valve prolapse syndrome and that labetalol offers an alternative treatment for the management of this condition. [ABSTRACT FROM PUBLISHER]

The aim of this study was to describe the onset, development and arrest of dental caries in Brazilian 1- to 5-year-old children with limited access to dental care. The sample represented 40% of all children in these age groups attending public nursery school in the Federal District of Brazil. A total of 1465 children who benefited from fluoridated water soon after birth were examined for caries. For all teeth and tooth surfaces, the examination recorded whether they were sound, showing active or arrested lesions (non-cavitated or cavitated), filled or indicated for extraction. The onset of dental caries was identified at an early age; 89% of children were free of caries at the age of 1 year, decreasing to 28% at the age of 5 years. Non-cavitated lesions (active and arrested) accounted for 71% (<2 years), 58% (3 years), 47% (4 years) and 40% (5 years) of the total number of surfaces showing caries experience. The corresponding values for cavities were 28%, 38%, 47% and 47%, respectively. Maxillary incisors and molars disclosed the highest caries experience in all ages. For children older than 1 year, both mean deft and defs scores not including non-cavitated lesions were significantly different from those for which non-cavitated lesions were taken into account ( t-test, P<0.0001). At the age of 5 years, defs scores were 5.5 and 8.8, respectively. This study documented that the onset and development of dental disease started at an early age in the population studied, leading to a considerable need for dental care. [ABSTRACT FROM AUTHOR]

Oral microorganisms were tested for their susceptibility to various fluoride salts. SnF2 and CuF2 had a better antimicrobial effect than did NaF and NH4F. Low pH enhanced the bactericidal effect of the fluoride salts. The results indicate that the cariostatic effect of fluoride is not due to a selective bactericidal effect on cariogenic bacteria. [ABSTRACT FROM AUTHOR]

The efficacy and safety of the new cardioselective beta-blocker bisoprolol 5 mg and 10 mg once daily in the treatment of angina pectoris was compared with atenolol 100 mg once daily. 19 patients with coronary artery disease and angina of effort completed a randomised, three-way crossover study which consisted of six-week treatment periods preceeded by a two-week placebo washout. Treadmill exercise stress tests were carried out approximately 24 hours after each dose, at the end of the placebo period and after 2 and 6 weeks of each active treatment period. Patients recorded their angina attack rate and GTN consumption on diary cards. Number of anginal attacks, GTN consumption, resting and exercise systolic blood pressure, heart rate and double product were reduced, and both exercise duration and time to 1 mm ST-segment depression during exercise were increased to a similar extent by all three treatment regimens (P <0.01, paired t test). The only differences between the treatments were that the reductions in heart rate, double product and exercise blood pressure tended to be smaller after 6 weeks of bisoprolol 5mg. Generally, there was no significant difference between the improvements measured at week 2 of each phase and at week 6 (P >0.05, analysis of variance). All three dosage regimens were well tolerated.The data indicate that there is no difference between the safety and efficacy of bisoprolol 10 mg and atenolol 100 mg once daily in the treatment of angina pectoris. In addition, the 10 mg dose of bisoprolol would seem to have only a small advantage over the lower 5 mg once daily dose. [ABSTRACT FROM PUBLISHER]

Ten patients with chronic stable angina were treated with 4 incremental doses of tiapamil (200 mg, 400 mg, 600 mg and 800 mg) in a double-blind, placebo-controlled study. Treadmill exercise electrocardiograms were performed before and after single oral doses of tiapamil. A dose-dependent increase in exercise duration occurred after tiapamil with significant improvement after tiapamil 600 mg amd 800 mg. Mean exercise duration increased from 327±41 seconds (control) to 399±49 seconds (P<0.01) after tiapamil 600 mg and from 314±39 seconds (control) to 416±49 seconds after tiapamil 800 mg, P<0.001. There was an associated improvement in mean exercise time to onset of I mm ST-segment depression from 240±41 seconds (control) to 300±48 seconds in 10 patients after tiapamil 600 mg, (P<0.02) and from 206±35 seconds (control) to 272±51 seconds in 9 patients after tiapamil 800 mg, P<0.01. Two patients were free of angina and 1 patient normalized his ST-segments after tiapamil 800 mg. Dose-dependent side-effects were mild and tolerable. Tiapamil is safe and highly effective in improving exercise tolerance and relieving myocardial ischaemia in patients with chronic stable angina. [ABSTRACT FROM PUBLISHER]

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. [ABSTRACT FROM PUBLISHER]

A letter to the editor is presented in response to the article "Does incomplete caries removal reduce strength of restored teeth?" by M.A. Hevinga, N.J. Opdam, J.E. Frencken, and others in the November 2010 issue.