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The treatment of high-risk patients still is a challenge. The understanding and development non-invasive, non-destructive, and non-ionizing techniques, can help to guide the treatment and the diagnosis of primary and recurrent caries. The present study evaluated the behavior of enamel/restoration interface after a cariogenic challenge by Fourier domain optical coherence tomography (FD-OCT), scanning electron microscopy (SEM) examination, and the fluoride release of the different restorative materials. Cavities (1.5 × 0.5 mm) were performed in enamel surface and divided into groups (n = 8): glass ionomer cement (GIC), resin-modified glass ionomer cement (RMGIC), and resin composite (RC). The samples were submitted to pH-cycling, and the solutions analyzed for cumulative fluoride by ion-analyzer. The morphology was analyzed by SEM through replicas. The optical attenuation coefficient (OAC) was calculated through exponential decay from the images generated by FD-OCT. Data were analyzed considering α = 0.05. OAC values increased for all groups after pH-cycling indicating demineralization (p < .05). Considering the remineralizing solution, RMGIC presented higher fluoride release rate, followed by GIC, while RC did not release any fluoride. Yet for the demineralizing solution, RMGIC and GIC released similar fluoride rates, overcoming RC (p < .05). Micrographs revealed no changes on the restorations margins, although enamel detachment was observed for RC and GIC after pH-cycling., (© 2021 Wiley Periodicals LLC.)

The objective of this study was to investigate the experience of caries related to social capital and associated factors in adults in large-scale population-based study. A Cross-sectional study was performed in 163 municipalities in the State of São Paulo, Brazil (SBSP-2015). 17,560 people were evaluated, of which 6051 were adults aged 35-44 years. Hierarchical logistic regression analysis was proposed. Outcome variables (decayed teeth, missing teeth and DMFT) and independent variables were included in the model, considering the distal (income and schooling); intermediate (social capital) and proximal levels (sex and ethnicity). Results showed that income up to 1,500 reais - US$ 367.6 in 11/11/2019 - (OR = 1.91;1.75-2.08), schooling up to 8 years (OR = 1.32;1.12-1.56) and non-white ethnicity (OR = 1.54;1.35-1.76) were more likely to have decayed teeth. Income up to 1500 reais (OR = 1.29;1.15-1.44), schooling up to 8 years (OR = 2.13;1.90-2.38), low social capital (OR = 1.84;1.65-2.04), medium social capital (OR = 1.15;1.01-1.30) and females were more likely to have lost teeth (OR = 1.13;1.03-1.23). Schooling up to 8 years (OR = 1.51;1.35-1.69), low social capital (OR = 1.25; 1.14-1.37) and female (OR = 1.40,1.19-1.53) were associated with DMFT. It was concluded that sociodemographic factors and low social capital were associated with the experience of caries, which should be taken into account in the formulation of public policies.

Iontophoresis is a noninvasive technique, based on the application of a constant low-intensity electric current to facilitate the release of a variety of drugs, whether ionized or not, through biological membranes. The objective of this research was to evaluate the effect of iontophoresis using different electric current intensities on the uptake of fluoride in dental enamel with artificial caries lesions. In this in vitro operator-blind experiment, bovine enamel blocks (n = 10/group) with caries-like lesions and predetermined surface hardness were randomized into 6 groups: placebo gel without fluoride applied with a current of 0.8 mA (negative control), 2% NaF gel without application of any current, and 2% NaF gel applied with currents of 0.1, 0.2, 0.4 and 0.8 mA. Cathodic iontophoresis was applied for 4 min. The concentration of loosely bound fluoride (calcium fluoride) and firmly bound fluoride (fluorapatite) was determined. The results were analyzed by the nonparametric Kruskal-Wallis and Dunn tests. Iontophoresis at 0.8 mA, combined with the application of fluoridated gel (2% NaF), increased fluoride uptake in enamel with caries-like lesions, as either calcium fluoride or fluorapatite.

The study aimed to identify the severity of malocclusions and associated factors among Brazilian adolescents. Data from 5,445 adolescents participating in the Brazilian Oral Health Survey (SBBrasil 2010) were evaluated, of which 4,276 were included in the study based on the inclusion criteria. The dependent variable was severe and very severe malocclusion, according to the Dental Aesthetic Index (DAI > 30). The independent variables were place of residence, macro-region, self-reported ethnicity, income, gender, schooling, access to dental care, untreated caries and front and back teeth loss due to caries. A hierarchical multiple logistical regression analysis was performed, considering the complex cluster sampling plan. Prevalence of severe/very severe malocclusions was 17.5%. After adjustments, black/brown ethnicity group (OR = 1.59, 95% CI: 1.09-2.34), lower household income (OR = 0.67, 95% CI: 0.55-0-82), front (OR = 2.32, 95% CI: 1.14-4.76) and back teeth (OR = 1.45, 95% CI: 1.14-1.84) loss due to caries were associated with the outcome. Therefore, we conclude that black/brown ethnicity, lower household income and greater number of front and back teeth loss due to caries increased the odds for severe/very severe malocclusion.

The aim of the present study was to evaluate the long-term effects of the caries treatment provided by a dental care program on changes in schoolchildren's OHRQoL. A one-year follow-up was conducted with a sample of 372 children aged 8 to 10 years which were clinically examined and divided into two matched groups according to their caries experience: dental treatment group (DTG) and group without caries (GWC). Both groups were assessed three times (at baseline, at 4 weeks, and at 1 year) using the Child Perceptions Questionnaire (CPQ8-10). The normality test was performed for the statistical analyses; the Friedman test was used for the dependent variables (longitudinal assessment repeated three times for the same group); and the Mann-Whitney test was used for the independent variables (test and control groups in each time period). There was improvement in all domains and in overall CPQ8-10 (p < 0.0001) in the DTG over time, but no significant changes (p > 0.05) were observed at baseline for overall CPQ8-10 and for the emotional well-being domain in the GWC. The comparison between groups demonstrated that OHRQoL was persistently better for the GWC (p < 0.05) over time. In conclusion, dental caries treatment has a long-term positive impact on schoolchildren's OHRQoL, highlighting the importance of health policies that promote access to dental care for this population.

Objective: To identify desirable characteristics, including different sample sizes and dental caries prevalences, in virtual samples that allow, at the same time, higher values of general agreement percentage (GPA) and Kappa coefficient (κ), under a low confidence interval (CI), in reproducibility studies., Method: A total of 384 statistical simulations of inter-examiner calibration, varying sample size (12, 15, 20, 60, 200 and 500 individuals), caries prevalence (30, 50, 60 and 90%) and percentages of positive (PA) and negative (NA) agreement (30, 50, 60 and 90%) were undertaken. GPA and κ were used to measure reproducibility and define deviation between them., Results: The sample of 60 individuals, under caries prevalence of 50%, PA and NA of 90%, presented a GPA and Kappa values of 90 and 80%, respectively, a relative small confidence interval (95%CI 0.65 - 0.95) and a GPA/Kappa deviation of 10.00., Conclusion: A virtual sample of 60 individuals, under caries prevalence of 50%, seems feasible to produce a satisfactory interexaminer agreement at epidemiological conditions. However, epidemiological studies to corroborate or refute this assertion are necessary.

This study presents the results of a cost-effectiveness analysis in a controlled clinical trial on the effectiveness of a modified glass ionomer resin sealant ( Vitremer, 3M ESPE) and the application of fluoride varnish (Duraphat, Colgate) on occlusal surfaces of first permanent molars in children 6-8 years of age (N = 268), according to caries risk (high versus low). Children were examined semiannually by the same calibrated dentist for 24 months after allocation in six groups: high and low risk controls (oral health education every three months); high and low risk with varnish (oral health education every three months + varnish biannually); and high and low risk with sealant (oral health education every three months + a single application of sealant). Economic analysis showed that sealing permanent first molars of high-risk schoolchildren showed a C/E ratio of US$ 119.80 per saved occlusal surface and an incremental C/E ratio of US$ 108.36 per additional saved occlusal surface. The study concluded that sealing permanent first molars of high-risk schoolchildren was the most cost-effective intervention.

Enhancement filters are potentially supposed to improve the diagnostic performance of digital images. Thus, the aim of this study was to compare the performance of digital radiography with and without enhancement filters for the detection of induced proximal caries lesions. The total sample consisted of 120 sound human teeth (40 premolars, 80 molars). Enamel subsurface demineralization was induced in one of the proximal surfaces of 60 teeth. Standardized radiographs of all teeth were acquired after the demineralization phase using the Digora-Optime® system. Four radiologists examined the digital radiographs and applied the following filters provided by the Digora® for Windows 2.6 package: Negative, Sharpen and both (Negative plus Sharpen). Validation of radiographic diagnosis was carried out by Knoop cross-sectional micro-hardness profiling on the proximal surfaces. Intraobserver agreement was estimated using Kappa statistics (k). Sensitivity, specificity and over-all accuracy were compared using ANOVA/Tukey test (α = 5%). Intraobserver agreement ranged from good to very good/optimal (k: 0.65-0.83). Although not statistically significant, the highest sensitivity (0.68 ± 0.22) and accuracy (0.76 ± 0.16) values were observed using the Sharpen filter as opposed to the Negative filter, which presented the lowest performance indices (0.57 ± 0.13 and 0.70 ± 0.10, respectively). Specificity ranged from 0.84 to 0.85, considering all imaging modalities (p > 0.05). Insofar as the Sharpen filter had the highest performance indices, it may be considered a useful adjunct for detecting subtle proximal caries lesions.

This study aimed to analyze how the prevalence and the distribution of dental caries influence the sample size in epidemiological surveys, and how much are the costs. Secondary data of oral health surveys in 12-year-old schoolchildren from Bauru in 1976, 1984, 1990, 1994, and 2001, and from Piracicaba in 2001 and 2005 were studied. Sample sizes were estimated taking into account the mean DMFT and standard deviation of each survey, establishing sampling errors of 1%, 2%, 5%, and 10%. Costs were estimated considering permanent material, consumption material and human resources. The sample size in both towns needed to be increased, ranging from 119 in 1976 to 1,118 in 2001 in Bauru, and from 954 in 2001 to 1,252 in 2005 in Piracicaba, when a sampling error of 10% was considered. The cost of dental caries surveys was verified considering different sampling errors. This cost depends on how acceptable is the margin of difference between the true mean and the one found in the survey. In conclusion, the reduction in the prevalence of dental caries has determined the need for increase in sample size and in costs for conducting the surveys.

Purpose: To evaluate the validity of the visual exam and adjunct diagnostic technologies for posterior permanent teeth under epidemiological conditions., Methods: A probabilistic sample of 165 12-year-old schoolchildren from Piracicaba, São Paulo, Brazil, was examined by visual exam (VI1), visual exam + artificial lighting (VI2), bitewing (BW), fiber optic transillumination (FOTI), DIAGNOdent and the associations among them. The D1+D3 and D3 diagnostics criteria, under epidemiological conditions, were adopted. The sensitivity, specificity and accuracy were calculated to determine the validity of the exams., Results: The most accurate diagnostic method was VI2+BW exam for all dental surfaces under both diagnostic criteria. It was concluded that the BW was the best adjunct diagnostic technology on epidemiological dental caries surveys, increasing the validity of the dental exams.

Objective: The aims of this study were to investigate the effectiveness of sealant placement under the guidelines of the Oral Health Promotion Program for Children and Adolescents (Portugal), and to test the influence of clinical and socioeconomic variables on the DMFT increment in 277 children, born in 1997., Material and Methods: A dental hygienist performed the initial examinations and sealant placement (Helioseal, Vivadent) on the permanent first molars in 2005. These activities were registered in dental records that were assessed in 2007. Children were classified according to caries risk at baseline [high (HR: DMFT+dmft>0); low (LR: DMFT+dmft=0) risk] and sealant placement as follows: HR-S and LR-S Groups (with sealant placement); HR-NS and LR-NS Groups (without sealant placement). A calibrated dentist performed the final examination in 2007 at school, based on the World Health Organization recommendations. The variables collected were: dental caries, visible dental plaque, malocclusions, and socioeconomic level (questionnaire sent to children's parents). For univariate (Chi-square or Fisher tests) and multivariate (Multiple logistic regression) analyses the DMFT increment >0 was selected as dependent variable., Results: Approximately 17.0% of the children showed DMFT increment>0 (mean=0.25). High-risk children presented a significant increase in the number of decayed and/or filled teeth. These children had 7.94 more chance of developing caries. Children who did not receive sealant were 1.8 more prone to have DMFT increment >0., Conclusion: It appears that sealant placement was effective in preventing dental caries development. Moreover, the variables "risk" and "sealant placement" were predictors for DMFT increment in the studied children.

Purpose: To evaluate the caries-preventive effect of a resin-modified glass-ionomer cement used as occlusal sealant (Vitremer) compared with fluoride varnish (Duraphat) application on occlusal surfaces of permanent first molars (OSPFM) in 6-8 year-old schoolchildren (n=268) at high (HR) and low (LR) caries risk., Methods: The children were followed-up for 24 months after being systematically allocated into six groups as follows: Control Groups HRC and LRC: children receiving oral health education (OHE) every 3 months; Groups HRV and LRV: children receiving OHE plus varnish application biannually; and Groups HRS and LRS: children receiving OHE plus a single sealant application . The baseline and follow-up examinations were performed by the same calibrated dentist under natural light, using CPI probes and mirrors, after toothbrushing and air-drying. The DMFS was used to record dental caries, in addition to the detection of initial lesions (IL). Data analysis was performed with two primary outcome measures: DMF and DMF+ IL on the OSPFM., Results: After 24 months, only the HRS group showed statistically lower DMF and DMF+IL increments on OSPFM compared with HRC group. HRV group did not differ from HRC and HRS groups. For LR groups, no statistical difference (P> 0.05) was observed among the treatments.

The objectives of this study were: (1) test the psychometric properties of OHIP-14 in a rural population; and (2) compare the oral health impacts in two riverine communities in the Brazilian Amazon that were living at different distances from an urban center. Data were obtained from a cross-sectional study in a consecutive sample (n = 126). The validity was assessed through the association of OHIP with clinical and subjective variables, which showed a more significant association with: pain, caries, need of extraction or endodontic treatment; than with tooth loss, periodontal disease or need of prostheses. The stability and internal consistency were good (ICC = 0.97; Cronbach's alpha = 0.89). The prevalence of oral impacts was greater in the community far from the urban center [70.3 (59.9-80.7)] than in the community closer to it [44.3 (30.7-57.7)], and in women [66.7 (56.0-77.3)] in comparison with men [49.1 (35.3-62.7)]. The OHIP-14 adapted to rural populations in Amazonas State was valid, reproducible, and consistent. There was high prevalence of impacts, especially for riverine communities that lived far from urban centers.

This study compared the ability of adhesive systems to inhibit in vitro caries lesions in enamel under high cariogenic challenge. Bovine enamel blocks with cavity preparations were restored with AP-X resin composite (Kuraray Med) using four adhesives systems: Clearfil SE Bond (Kuraray Med); Clearfil Protect Bond (Kuraray Med); One-Up Bond F (Tokuyama) and Single Bond (3M ESPE). The specimens were submitted to an eight-day pH-cycling regimen. After cariogenic challenge, the enamel was evaluated to detect caries lesions using cross-sectional microhardness, polarized light microscopy and scanning electronic microscopy. Data from cross-sectional microhardness and polarized light microscopy evaluations were statistically analyzed by ANOVA and Tukey's test. The mineral % volume showed no statistical difference among adhesives (p > 0.05); however, polarized light microscopy analysis showed lower caries lesions with Clearfil Protect Bond (p < 0.05). The scanning electron microscopy images showed greater caries lesions and demineralization areas close to restorations for Clearfil SE Bond, One-Up Bond F and Single Bond compared to Clearfil Protect Bond. The pH-cycling regimen promoted subsurface enamel demineralization in all specimens treated. The polarized light microscopy and scanning electronic microscopy analyses showed that Clearfil Protect Bond seems to produce lower enamel demineralization around restorations; however, cross-sectional microhardness did not demonstrate differences among the adhesives.

Objective: The aim of this 2-year cohort study (2003 to 2005) was to investigate how caries experience, at initial lesions (early or non-cavited lesions) and cavited stages, predicts caries increment in permanent teeth in 7-10- year-olds., Material and Methods: The random sample of 765 children attending public schools in the city of Piracicaba, SP, Brazil, was divided into two groups: 423 children aged 7-8 years and 342 children aged 9-10 years. All subjects were examined by a calibrated examiner, using dental mirror and ball-ended probes, after tooth brushing and air-drying in an outdoor setting, based on the World Health Organization criteria. Active caries with intact surfaces were also recorded as initial lesion (IL). Univariate analysis was used for statistical analysis (Odds Ratios and Chi-square)., Results: The association between the DMFT (decayed, missing and filled teeth) increment and the presence of IL was significant only for 9-10-year-old children. The children with DMFT>0 at baseline were more prone to have DMFT increment, with the highest risk for caries increment occurring in children aged 7-8 years., Conclusions: The predictors of caries increment were the presence (at baseline) of caries experience in permanent teeth for both age groups (7-8; 9-10-year-olds) and the presence of the IL (at baseline) for 9-10-year-olds.

Background: The detection of carious lesions in the initial stages of development is very important in order to prevent the occurrence of cavitation., Aims and Objectives: The aim of the present study was to compare three methods-visual examination, FOTI, and bitewing radiographic examination-for the detection of noncavitated and cavitated approximal carious lesions., Materials and Methods: Seventy students (mean age 14 years) with low caries prevalence were examined by three examiners. The tooth surfaces judged as having caries by at least one examiner or one diagnostic method were scheduled for tooth separation., Results: The results showed that the incorporation of FOTI and radiographic examination represented an additional diagnostic yield of 50% and about 110%, respectively, compared to clinical examination alone., Conclusion: We conclude that FOTI or radiographic examination, or both, used as adjuncts to clinical examination, could improve the detection of noncavitated and cavitated approximal carious lesions. Although FOTI should not replace bitewing radiographic examination, it does seem to have additional value for the detection of carious lesions on approximal surfaces of the posterior teeth in school children with low caries prevalence.

The objective of the study was to develop regression models to describe the epidemiological profile of dental caries in 12-year-old children in an area of low prevalence of caries. Two distinct random probabilistic samples of schoolchildren (n=1,763) attending public and private schools in Piracicaba, Southeastern Brazil, were studied. Regression models were estimated as a function of the most affected teeth using data collected in 2005 and were validated using a 2001 database. The mean (SD) DMFT index was 1.7 (2.08) in 2001 and the regression equations estimated a DMFT index of 1.67 (1.98), which corresponds to 98.2% of the DMFT index in 2001. The study provided detailed data on the caries profile in 12-year-old children by using an updated analytical approach. Regression models can be an accurate and feasible method that can provide valuable information for the planning and evaluation of oral health services.

The purpose of this study was to identify risk indicators of high caries level at baseline (HCLB) based on cross-sectional data and predictors of high caries increment (HCI) based on a 7-year-follow-up examination in 6-8-year-old schoolchildren. Two hundred and six schoolchildren were examined in 1997 and in 2004 by the same two calibrated dentists, in Piracicaba, Brazil. At baseline, dental caries, presence of sealants, fluorosis, and oral hygiene status were recorded. The children's parents completed a questionnaire concerning socioeconomic level, fluoride use, dental service utilization, dietary and oral hygiene habits. HCLB and HCI were defined considering the upper quartile of the total caries experience distribution (dmfs+DMFS) and caries increment distribution, respectively. Logistic regression models were adjusted estimating the Odds Ratio (OR), 95% confidence intervals and p-values. Having white spot lesions (OR=5.25) was found to be a risk indicator of HCLB. Schoolchildren with dental fluorosis (OR=0.17) or those who brushed the teeth more than two times a day (OR=0.37) presented less probability of HCLB. The predictors of HCI were: dmfs>0 (OR=2.68) and mothers' educational level up to 8 years of schooling (OR=2.87). Clinical and socioeconomic variables were found to be risk indicators and/or predictors of dental caries in schoolchildren.

Objective: The aim of this study was to evaluate the relationship between a socioeconomic classification model and prevalence of dental caries and dental fluorosis in Piracicaba, Sâo Paulo, Brazil., Methods: For this classification five indicators were used (family monthly income, number of residents in the same household, parents' formal educational level, type of housing and occupation of person responsible for the family). A scoring system was used in order to arrange in a hierarchy, 812 12 year old school children distributed between six different social classes. Volunteers were examined in the school's back patio under natural light with a dental mirror, by two examiners calibrated for DMFT index (dental caries) and T-F (dental fluorosis). The qui-square test (p<0.01) was used in the statistical analysis for the association of DMFT and the dental fluorosis and between the socioeconomic variable and the proposed social classes., Results: The DMFT average was 1.7, while 31.4%, of the children had dental fluorosis (T-Fe"1)., Conclusion: With respect to socioeconomic class a statistically significant association was only verified with dental caries.

Purpose: This study attempts to describe the caries experience in 12-year-old schoolchildren in Piracicaba, Brazil, and to verify the relationship between the disease and socioeconomic factors, and behavioural variables related to oral health., Materials and Methods: The random sample consisted of 939 individuals from public and private schools in Piracicaba, São Paulo State, Brazil, in 2005. A calibrated dentist performed the examination in an outdoor setting, under natural light, using CPI probes and mirrors, following WHO recommendations. A questionnaire was sent to the parents to collect information on socioeconomic level and behavioural variables related to dental health. The mean number of decayed, missing and filled permanent teeth and surfaces (DMFT/DMFS), the Care Index and the SiC (Significant Caries Index) were determined. Multiple logistic regression analyses using the stepwise procedure were performed in order to identify the risk indicators for the DMFT and for the polarisation group., Results: The DMFT and the SiC Index were 1.32 (SD = 1.92) and 3.52 (SD = 1.86), respectively, and the Care Index was 75.0%. The regression models showed that females and children with either low family income or low education level of the fathers were prone to have caries or take part in the polarisation group., Conclusion: The 12-year-old individuals from Piracicaba presented a low prevalence of caries. Nevertheless, those high caries-level individuals showed moderate caries experience. The socioeconomic and the behavioural variables related to dental health were risk indicators of caries in permanent dentition not only for the entire sample, but also for the polarisation group.

Objective: To investigate the influence of different settings, epidemiological and clinical, and different diagnostic thresholds on caries detection in a group of 7-10-year-old children in Brazil., Materials and Methods: In total, 983 children aged 7-10 years old and enrolled in four public schools were randomly selected. Three examiners performed epidemiological examinations followed by an examination of the same children in a clinical setting. The examinations of cleaned and dried teeth in both settings were carried out using a dental mirror and ball-ended probe, under natural light in the epidemiological setting examinations and under artificial light during the clinical setting examinations. For the analysis of results, comparisons were focused on WHO (World Health Organization) diagnostic thresholds versus WHO+IL (initial lesions) diagnostic thresholds, both under epidemiological conditions, in order to demonstrate the influence of the inclusion of IL in the study; and WHO+IL in the epidemiological setting versus WHO+IL in the clinical setting, aiming to demonstrate the importance of examination setting. Outcome measures were dmfs, DMFS, ds, Ds, sealants and number of children 'free' of caries. Paired t-test and McNemar's test were used to test the difference between means and proportions for each age group., Results: Epidemiological examinations, under the WHO diagnostic threshold, showed significant differences for all outcome measures when compared with the WHO +IL threshold. Statistical differences were also detected when comparingthe WHO+IL threshold under different settings., Conclusion: The choice of a diagnostic threshold (WHO or WHO+IL) and the conditions of examination (epidemiological or clinical) were important for caries detection.

Objectives: (a) To analyze the intra- and inter-examiner reproducibility (reliability) of a calibration trial, at different diagnostic thresholds of dental caries; (b) to verify the accuracy (benchmark validity) though sensitivity (S), specificity (SP), positive (PPV) and negative predictive (NPV) values., Participants: A group of dental examiners (n=11), who had previous experience in epidemiological surveys and six to seven-year-old children. Children were selected according to the dmft and dental caries activity., Methods: Theoretical and clinical training and calibration exercises were arranged for a total of 28 hours. WHO criteria including the active initial lesions (IL) were used., Main Outcome Measures: WHO and WHO+IL diagnostic thresholds according to tooth and dental surface., Results: Excellent mean results of intra and inter-examiner Kappa values were found for both diagnostic thresholds, according to tooth and surface, during the calibration phase. The most relevant errors were related to IL diagnosis and to the first permanent molars. When assessed against a benchmark examiner, moderate to high validity values were observed (0.71-1.00), with some loss mainly for sensitivity and positive predictive value, when including IL., Conclusion: It was possible and feasible to use the proposed methodology of this study in epidemiological surveys, even with the inclusion of IL. However, further examiner calibration studies are still needed in order to improve and establish a methodology of calibration with this new diagnostic threshold.

This study compares three measurements (Kappa, general agreement percentage, or GAP, and dice index) used to determine the reproducibility of caries diagnosis in epidemiological surveys under different clinical diagnostic thresholds. Eleven examiners with previous experience in epidemiological surveys were submitted to a theoretical and clinical calibration process. Data analysis used two caries detection thresholds: World Health Organization (WHO) and WHO with the inclusion of initial enamel lesions (WHO + IL). Twenty-three children 6-7 years of age were examined, with and without caries. Mean values for Kappa index, GAP, and Dice were considered high (> 0.90), except for the dice index for the WHO + IL threshold (0.69). Since Kappa is an adjusted agreement index, it can be considered the instrument of choice for calibration of examiners. However, when it is impossible to use, the GAP is recommended together with the dice index in order to orient and improve examiners when examining caries lesions.

Objective: To identify, in a group of 6-8-year-old schoolchildren, risk factors for dental caries increment in permanent dentition., Methods: Two hundred and six children from three different schools in Piracicaba, Brazil, were examined at baseline and after 7 years by the same two calibrated dentists. Data on dental caries (dmfs, DMFS, presence of initial lesions), fluorosis, oral hygiene and presence of sealant were collected at the clinical examination that was performed in an outdoor setting, under natural light, using a dental mirror and probe following the WHO recommendations. Information on socioeconomic level, fluoride usage, dental service utilization, dietary and oral hygiene habits was also obtained at baseline in a semi-structured questionnaire sent to the parents. The dependent variable was the 7-year DMFS increment. A univariate analysis was performed to test the association of independent variables in caries increment. Then a logistic regression model was used to estimate the adjusted Odds Ratio for caries increment., Results: Clinical (dmfs, DMFS) and non-clinical variables (daily toothbrushing, use of preventive topical methods, parents' educational level) were entered in the multiple logistic regression analysis. The prediction model included the clinical and socioeconomic variables, DMFS, dmfs and mother's educational level. The best caries predictor was the dmfs variable., Conclusion: Caries experience and mother's educational level were predictors of caries increment in permanent dentition.

Unlabelled: Investigating dental caries and fluorosis prevalence over time is an important measure for monitoring trends in oral health., Purpose: This work aimed to describe the prevalence of dental caries and dental fluorosis of 11- to 12-year-old schoolchildren from Iracemapolis, Brazil, in 2004 (n=236) and to compare the current prevalence rates with those from previous surveys carried out in 1991 (n=200), 1995 (n=160), 1997 (n=314) and 2001 (n=244)., Materials and Methods: The schoolchildren of both genders from all public schools were examined by two calibrated dentists (Kappa > 0.81), using dental probes and buccal mirrors under natural light in an outdoor setting. Dental caries and fluorosis were measured using the DMFT and Thylstrup-Fejerskov (T-F) indexes, respectively. The variation of DMFT index over time was assessed by analysis of regression and the fluorosis prevalence (T-F>1) was compared over time by the Chi-square test at 5% significance level., Results: In 2004, the mean value for DMFT was 1.2; 50% of the children were caries-free, and 15.7% presented dental fluorosis (T-F>1). A significant caries reduction (82.1%) and a significant increase (685%) of fluorosis prevalence have been observed from 1991 to 2004 (p < 0.01)., Conclusion: The results suggest a continuous decrease of dental caries experience and an increase of dental fluorosis prevalence in 11-to 12-year-old schoolchildren from this Brazilian town as well as indicate that further epidemiological surveys should be carried out in order to monitor these trends.

To evaluate the retention and caries experience effects of three different materials used as fissure sealants after 24 months of clinical application: a resin-modified glass ionomer cement (A), a flowable resin composite (B) and a compomer (C). One hundred and seventeen (117) teeth were sealed with material A, 119 teeth with material B and 120 teeth with material C. Children were randomly assigned. Each one received only one of the materials studied. Plaque index, dmft score and socioeconomic level were scored at baseline. The clinical exams were conducted 6, 12 and 24 months after application of the sealant. Statistical analysis (Kruskal-Wallis) revealed that there were statistically significant differences between the retention rates of groups A and B and between groups B and C after 2 years, with material B showing better results. After 2 years, 3.1% of the teeth of group A, 4.3% of group B and 6.7% of group C were Carious+Filled. There was no evidence of association between caries presence after 2 years and plaque index, dmft score and socioeconomic level. These results suggest that flowable resin composite had a satisfactory retention after this period of evaluation and all three materials were effective on occlusal caries prevention.

Aims: The aims of the study were: (i) to assess different clinical diagnostic methods of dental caries during epidemiological surveys; (ii) to determine which combinations of methods and diagnostic adjuncts show the best performances in epidemiological surveys when compared with examinations performed in a traditional dental setting (standard); (iii) to evaluate the influence of including noncavitated (NC) lesions in dental caries estimation., Methods: Forty 12-year-old children were divided into low and moderate caries prevalence groups. The individuals were submitted to 12 epidemiological examinations (in an outdoor setting), which combined three methods (blade, mirror and mirror + CPI (Community Periodontal Index) dental probe) with or without diagnostic adjuncts (previous dental brushing and dental drying). The last examination was performed in a traditional dental setting (standard examination). The unit of measure was the DMFS (decayed, missing and filled surfaces) index according to WHO criteria. The variance analysis, Dunnet's and Tukey's tests were applied., Results: For the DMFS analysis, the visual/tactile method, with or without diagnostic adjuncts, was the best method for both groups, presenting a performance higher than 90% when compared with the standard examination, except for the examinations without previous dental brushing for the low caries prevalence group. Previous dental brushing was more relevant than dental drying (P = 0.0054). All of the epidemiological examinations underestimated the NC diagnosis even with the association of diagnostic adjuncts when compared with the standard examination., Conclusion: The visual-tactile (for both groups) and the visual (mirror) methods plus dental brushing (for the moderate group) are appropriate for diagnosing cavitated lesions, but not NC lesions.

The aim of this study was to evaluate retention and efficacy of polyacid-modified composite resin used as fissure sealant (Variglass V.L.C.) after six years. Three-hundred and seventy permanent first molars were sealed. After six years, 42.0% of the original group was re-examined and the sealant was found to be totally present in 3.4%, partially present in 16.2% and absent in 70.4% of the previously sealed occlusal surfaces. During the 6 years period, 9.5% of the sealed surfaces became carious, 25.0% were filled and 65.5% remained sound. Although the retention rate of the material has been very low, it appears to have prevented dental caries in 2/3 of the teeth evaluated after six years of placement.

Objectives: To determine the influence of diagnostic adjuncts (dental brushing and drying) in dental caries diagnosis. To analyse the underestimation levels in epidemiological examinations when compared to traditional dental setting examinations. To evaluate the influence of including noncavitated (NC) carious lesions in the estimation of the disease., Participants: 51, 12-year-old children., Interventions/methods: Four epidemiological exams performed in an outdoor setting and one performed in a traditional dental setting (visual-tactile method associated or not with diagnostic adjuncts)., Main Outcome Measures: DMFS (Decayed, Missing and Filled Surfaces) index, according to the WHO criteria., Results: When compared to exams carried out in a traditional dental setting, the epidemiological examinations showed no significant statistical differences for the DMFS score (p>0.05), presenting underestimation levels lower than 10% (except for the low prevalence caries group in the WHO exam). For the DMFS, previous dental brushing was more relevant than previous dental drying, although drying was the most important resource for NC diagnosis (p<0.05)., Conclusion: The visual/tactile method, with or without diagnostic adjuncts, can diagnose cavitated lesions efficiently, but not NC lesions. However, for the low caries prevalence group, the implementation of dental brushing prior to an exam could be suggested.

Purpose: To evaluate the retention and caries-preventive effectiveness of two ionomeric materials (conventional and resin-modified), used as fissure sealants., Materials and Methods: 100 children (6-8 years old) with a total of 400 permanent first molars received 200 conventional glass-ionomer (Ketac Bond) and 200 resin-modified glass-ionomer (Vitremer) sealants. Additionally, 108 children constituted the control group (432 teeth). Two dentists assisted by dental hygienists performed the sealant application. Clinical evaluations were carried out 6, 12, 24, and 36 months after the sealant application by two other dentists, not carrying out clinical procedures, previously calibrated (Kappa > 0.75)., Results: Total retention rates of 26%, 12%, 3%, and 4% for Ketac Bond and 61%, 31%, 14%, and 13% for Vitremer, being 6, 12, 24, and 36 months after clinical evaluation, respectively. The differences between the two materials were statistically significant. The experimental groups showed a caries incidence of 93%, 78%, 49%, and 56% lower than the control group (P< 0.01) for the four evaluation periods, respectively. In conclusion, the retention rates of ionomeric materials were low. Nevertheless, these materials showed a cariostatic effect, supported by statistically lower caries incidence in experimental groups compared to control group. Presence of active incipient caries was statistically associated with caries incidence in the first molars after 36 months, in relation to either experimental or control group.

Purpose: To identify the risk indicators of gingivitis among socioeconomic, clinical and gender variables in 5-year-old children attending preschools in Piracicaba, Brazil, in 2005.Materials and Methods: The sample consisted of 728 subjects attending 22 public (n = 428) and 18 private (n = 300) preschools. A previously calibrated examiner performed the clinical examination in an outdoor setting, under natural light, using a dental mirror, Community Periodontal Index probe and air-drying. Gingival status was measured using the gingival alteration index for 5-year-olds according to the national survey carried out in 2002 in Brazil (Health Ministry of Brazil, 2004). Socioeconomic variables (monthly family income, number of people living in the household, parents' educational level, home ownership and car ownership) were collected by means of a parental semi-structured questionnaire.Results: The prevalence of gingivitis was 16.6%. Monthly family income (p < 0.0001), father's education (p < 0.0007), mother's education (p = 0.0004), type of school (p < 0.0001), car ownership (p = 0.0854), gender (p = 0.0087), initial lesion (p < 0.0001), dental caries (p = 0.0008), crowding (p = 0.0054) and spacing (p = 0.0019) were associated with gingival bleeding at p < 0.15 and were selected for the regression analysis. By means of multiple logistic regression analyses, monthly family income of up to 4 Brazilian minimum wages, presence of initial lesion, presence of crowding and male gender were found to be risk indicators of gingivitis.Conclusion: The prevalence of gingivitis in 5-year-old preschool children in Piracicaba was 16.6%. Also, family income of up to 4 minimum wages, male gender, the presence of initial caries lesion and crowding were risk indicators of gingivitis. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the reproducibility of visual exams under natural light (VE1), visual exams under artificial light (VE2), radiographic bitewing exams (BW), fibre optic transillumination exams (FOTI) and DIAGNOdent exams (DD) in epidemiological settings. Materials and Methods: Three examiners and one benchmark examiner examined thirteen 12-year-old schoolchildren under epidemiological conditions for the D3 (carious lesions in dentin) and D1+D3 (carious lesions in enamel or dentin) diagnostic criteria. Results: The reproducibility (intra/interexaminer agreement) under both diagnostic criteria was 'almost perfect' for the exams VE1 (D3: Kintra = 0.91/Kintra = 0.85; D1+D3: Kintra = 0.89/Kintra = 0.84), VE2 (D3: Kintra = 0.91/Kintra = 0.85; D1+D3: Kintra = 0.88/Kintra = 0.83), BW (D3: Kintra = 0.95/Kintra = 0.92; D1+D3: Kintra = 0.99/Kintra = 0.90) and FOTI (D3: Kintra = 0.97/Kintra = 0.93; D1+D3: Kintra = 0.87/Kintra = 0.83) exams and 'fair' for the DD exam (D3: Kintra = 0.36/Kintra = 0.35; D1+D3: Kintra = 0.30/Kintra = 0.32). Conclusion: It was concluded that the VE1, VE2, BW, and FOTI exams presented good reproducibility under epidemiological conditions, and can be used accurately in epidemiological surveys. [ABSTRACT FROM AUTHOR]

Investigating dental caries and fluorosis prevalence over time is an important measure for monitoring trends in oral health. Purpose: This work aimed to describe the prevalence of dental caries and dental fluorosis of 11-to 12-year-old school children from Iracemapolis, Brazil, in 2004 (n=236) and to compare the current prevalence rates with those from previous surveys carried out in 1991 (n=200), 1995 (n=160), 1997 (n=314) and 2001 (n=244). Materials and Methods: The schoolchildren of both genders from all public schools were examined by two calibrated dentists (Kappa>0.81), using dental probes and buccal mirrors under natural light in an outdoor setting. Dental caries and fluorosis were measured using the DMFT and Thylstrup-Fejerskov (T-F) indexes, respectively. The variation of DMFT index over time was assessed by analysis of regression and the fluorosis prevalence (T-F>1) was compared over time by the Chi-square test at 5% significance level. Results: In 2004, the mean value for DMFT was 1.2; 50% of the children were caries-free, and 15.7% presented dental fluorosis (T-F>1). A significant caries reduction (82.1%) and a significant increase (685%) of fluorosis prevalence have been observed from 1991 to 2004 (p<0.01). Conclusion: The results suggest a continuous decrease of dental caries experience and an increase of dental fluorosis prevalence in 11-to 12-year-old schoolchildren from this Brazilian town as well as indicate that further epidemiological surveys should be carried out in order to monitor these trends. [ABSTRACT FROM AUTHOR]

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This study aimed to review the dental literature about caries risk assessment over the last 10 years in order to show which variables have been considered risk predictors and risk factors of dental caries in infants, preschool-, schoolchildren and adolescents. A Medline search of the published English language literature from 1997 to 2007 was made for papers of longitudinal studies that reported on caries risk assessment. A total of 39 papers were included in this review. Most studies were conducted in schoolchildren (n=19), followed by preschool children (n=9), adolescents (n=7) and infants (n=4). Variables such as caries experience, gingival status, microbiological counts, oral hygiene, plaque mineral concentration, fluoride history, socioeconomic and educational level, demographic, anthropometrical, oral, dietary and toothbrushing habits were studied. Past caries experience has been the predominant predictor for future caries in 0-18-year-old subjects. Other variables, such as dietary habits, including sugar intake, and toothbrushing habits may also help identifying high-risk individuals. In conclusion, the variables related to caries experience continue to be the main predictor of caries increment. [ABSTRACT FROM AUTHOR]