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3 pages, 191 KiB

Open AccessEditorial

Updates on Caries Management in the Primary and Permanent Dentition

by Julian Schmoeckel

Medicina 2025, 61(2), 316; https://doi.org/10.3390/medicina61020316 - 11 Feb 2025

Viewed by 880

Abstract

Caries is still one of the most prevalent diseases affecting children and adults worldwide [...] Full article

(This article belongs to the Special Issue Updates on Caries Management in the Primary and Permanent Dentition)

Research

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15 pages, 2630 KiB

Open AccessArticle

Dental Decision-Making in Pediatric Dentistry: A Cross-Sectional Case-Based Questionnaire Among Dentists in Germany

by Bakr A. Rashid, Ahmad Al Masri, Christian H. Splieth, Mustafa Abdalla and Julian Schmoeckel

Medicina 2024, 60(11), 1907; https://doi.org/10.3390/medicina60111907 - 20 Nov 2024

Viewed by 1819

Abstract

Background and Objectives: The most recent guidelines and recommendations regarding treatments of dental caries in children are shifting towards evidence-based minimal or non-invasive approaches aiming to preserve the vitality of teeth and potentially reduce the need for dental general anesthesia. This study [...] Read more.

Background and Objectives: The most recent guidelines and recommendations regarding treatments of dental caries in children are shifting towards evidence-based minimal or non-invasive approaches aiming to preserve the vitality of teeth and potentially reduce the need for dental general anesthesia. This study investigated the treatment recommendations of dentists actively practicing pediatric dentistry in Germany regarding different patient cases with caries in primary teeth. Materials and Methods: The questionnaire was distributed on paper or online to pediatric dentists and general dentists practicing pediatric dentistry. Five cases of children with dental treatment needs representing a variety of clinical situations were selected for the questionnaire. Considering four different scenarios regarding pain symptoms (yes/no) and cooperation level (good/low) for each case resulted in 20 questions, where the preferred treatment option could be chosen out of 21 options ranging from observation only to extraction with/without different sedation techniques. The answers were categorized into three categories for each case and scenario according to guidelines, recent scientific evidence, and recommendations (recommended, acceptable, or not recommended/contraindicated). Results: In total, 222 participants responded to the survey (161 female; 72.5%). In 55.2% of the total 4440 answers, the participants chose a “recommended” treatment option, in 16.4% “acceptable”, but in 28.4%, a “not recommended” treatment, which ranged for the five cases between 18.7 and 36.1%. While pain and low cooperation levels led to more invasive and justified treatment choices (only 26.3% “not recommended”), less severe scenarios resulted more often in “not recommended” options (pain with good cooperation: 31.0%; or low cooperation without pain: 32.6%). The dentist’s age, experience, and educational background did not significantly correlate to choosing “not recommended” treatment options. Conclusions: A child’s pain and cooperation level greatly impact the treatment decisions made by dentists, with a risk of too invasive treatment options in low-severity cases. Substantial disparities in treatment recommendations for caries in primary teeth persist among dental practitioners regardless of their age, experience, and educational background. Full article

(This article belongs to the Special Issue Updates on Caries Management in the Primary and Permanent Dentition)

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12 pages, 1157 KiB

Open AccessArticle

Survival Analysis of Glass Ionomer Cement and Resin-Based Sealant Retention: A 10-Year Follow-Up Study

by Sandra Petrauskienė, Kristina Saldūnaitė-Mikučionienė and Julija Narbutaitė

Medicina 2024, 60(5), 756; https://doi.org/10.3390/medicina60050756 - 1 May 2024

Cited by 1 | Viewed by 2566

Abstract

Background and Objective: Sealant application is a proven method to prevent occlusal caries; however, long-term studies on this topic are scarce. This study aimed to assess the survival rate and clinical effectiveness of glass ionomer cement (GIC) and resin-based sealants (RBSs) on [...] Read more.

Background and Objective: Sealant application is a proven method to prevent occlusal caries; however, long-term studies on this topic are scarce. This study aimed to assess the survival rate and clinical effectiveness of glass ionomer cement (GIC) and resin-based sealants (RBSs) on second permanent molars over a long-term follow-up period. Materials and methods: Sixteen patients aged 11–13 years with all four completely erupted permanent second molars were enrolled in the study. All patients attended 1-year and 3-year follow-ups; however, one participant did not respond after 10 years and was excluded from the final analyses. The oral health status evaluation was based on WHO criteria. A total of 32 teeth received an RBS (Clinpro), and a further 32 teeth were sealed with GIC (Fuji IX). The sealant retention was determined according to the Kilpatrick criteria after 1 year, 3 years, and 10 years, respectively. Statistical analysis included a chi-square test, the Kaplan–Meier method, and the Cox proportional hazard model. Results: At baseline, seven boys and eight girls participated in the study, with a mean age of 12.3 ± 0.9 years. The 1-year follow-up results revealed that 90% of the RBSs and 43.3% of the GIC sealants were completely retained, and no caries lesions were recorded (p = 0.01). The 3-year follow-up results showed that 23.3% of the RBSs and 0% of the GIC sealants demonstrated complete retention (p = 0.034). Moreover, 10.0% of the occlusal surfaces in the RBS group and 13.3% of the occlusal surfaces in the GIC group were filled (p > 0.05). A total of 6.7% of the RBSs showed complete retention. One-third of the sealed teeth (30.0% of the teeth sealed with RBSs and 36.7% of teeth applied with GIC) were filled after 10 years. The Kaplan–Meier analysis demonstrated a higher survival rate in the RBS group when compared with the GIC over the entire follow-up period (p = 0.001). Conclusions: Although the survival rate of RBSs was higher than GIC sealants, their effectiveness in preventing fissure caries in permanent second molars did not differ significantly over a 10-year follow-up. Full article

(This article belongs to the Special Issue Updates on Caries Management in the Primary and Permanent Dentition)

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11 pages, 2450 KiB

Open AccessArticle

Comparative Meta-Analysis of Minimally Invasive and Conventional Approaches for Caries Removal in Permanent Dentition

by Diego González-Gil, Javier Flores-Fraile, Vicente Vera-Rodríguez, Andrea Martín-Vacas and Joaquín López-Marcos

Medicina 2024, 60(3), 402; https://doi.org/10.3390/medicina60030402 - 27 Feb 2024

Cited by 4 | Viewed by 3137

Abstract

Background and Objectives: Addressing deep carious lesions poses significant challenges in daily dental practice due to the inherent complexity of their treatment. Traditionally, complete removal of carious tissues has been the norm, potentially leading to pulp tissue exposure and subsequent pulpitis. In contemporary [...] Read more.

Background and Objectives: Addressing deep carious lesions poses significant challenges in daily dental practice due to the inherent complexity of their treatment. Traditionally, complete removal of carious tissues has been the norm, potentially leading to pulp tissue exposure and subsequent pulpitis. In contemporary dentistry, there is a growing preference for minimally invasive techniques, such as selective removal, offering a more conservative approach with enhanced predictability and success rates. Materials and Methods: Our study commenced with a comprehensive systematic review. After that, we performed a meta-analysis focused exclusively on randomized controlled trials involving permanent dentition. Our investigation incorporated seven selected articles, which scrutinized success rates and the incidence of pulp exposure in minimally invasive techniques (MIT) versus conventional techniques (CT). Statistical analysis employed U Mann–Whitney and Wilcoxon tests to interpret the results. Results: Although the difference did not reach statistical significance, MIT demonstrated marginally superior success rates compared to CT. Furthermore, MIT exhibited a lower percentage of pulp exposure when contrasted with CT. However, due to the limited sample size, statistical significance for this difference could not be established. Conclusions: Minimally invasive techniques for caries removal emerge as a conservative and promising approach to safeguard pulp tissues in comparison to conventional techniques. The need for additional randomized controlled trials is emphasized to unequivocally establish the superior success rates of these procedures over their conventional counterparts. Full article

(This article belongs to the Special Issue Updates on Caries Management in the Primary and Permanent Dentition)

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12 pages, 1414 KiB

Open AccessArticle

Clinical Investigation of the Inhibitory Effects of Tooth-Coating Materials on Initial Active Root Caries: A Pilot Randomized Controlled Trial

by Yoko Asahi, Katsuaki Naito, Hikaru Kanda, Kazuaki Niwano, Daisuke Takegawa, Hiromichi Yumoto, Yuichiro Noiri and Mikako Hayashi

Medicina 2024, 60(1), 150; https://doi.org/10.3390/medicina60010150 - 13 Jan 2024

Cited by 2 | Viewed by 2208

Abstract

Background and Objectives: Caredyne ZIF-C is a novel, capsule-mixed zinc-containing prototype glass ionomer cement (GIC). Zinc ions are reported to inhibit root dentin demineralization, dentin collagen degradation, bacterial growth, acid production, and in vitro bacterial biofilm formation. However, the effectiveness of GICs [...] Read more.

Background and Objectives: Caredyne ZIF-C is a novel, capsule-mixed zinc-containing prototype glass ionomer cement (GIC). Zinc ions are reported to inhibit root dentin demineralization, dentin collagen degradation, bacterial growth, acid production, and in vitro bacterial biofilm formation. However, the effectiveness of GICs against initial root caries lesions is unclear. Therefore, this study aimed to evaluate the efficacy of GICs, especially the new zinc-containing Caredyne ZIF-C GIC, as tooth-coating materials in patients with initial active root caries. Materials and Methods: A total of 58 lesions in 47 older adults (age > 65 years) were randomly allocated to one of the following three groups: Caredyne ZIF-C, Fuji VII (a conventional GIC), and sodium fluoride (NaF). All the lesions were treated with the assigned materials without removing the infected dentin, and the rates of dental plaque attachment and coating material fall-out were evaluated after 3, 6, and 12 months. The failure rate was defined as the number of teeth that needed restoration due to caries progression. Results: The plaque attachment rates tended to be lower in the material-coated root surfaces than in the healthy exposed root surfaces after 3, 6, and 12 months, although the differences among the three groups were not significant. Moreover, the coating material fall-out rate tended to be lower in the Caredyne ZIF-C group than in the Fuji VII group. There was no significant difference in the failure rate among the three groups at the 12 months mark. Conclusions: Though this pilot study offers a new direction for suppressing the progression of initial active root caries by controlling plaque attachment using GICs including Caredyne ZIF-C, clinical studies with a larger sample size are needed. Full article

(This article belongs to the Special Issue Updates on Caries Management in the Primary and Permanent Dentition)

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11 pages, 897 KiB

Open AccessArticle

Silver Diamine Fluoride Renaissance in Paediatric Dentistry: A 24-Month Retrospective and Cross-Sectional Analysis

by Ruba Abdulrahim, Christian H. Splieth, Mhd Said Mourad, Annina Vielhauer, Manasi R. Khole and Ruth M. Santamaría

Medicina 2024, 60(1), 16; https://doi.org/10.3390/medicina60010016 - 21 Dec 2023

Cited by 3 | Viewed by 2268

Abstract

Background and Objectives: Silver diamine fluoride (SDF) has been incorporated into the treatment of dental caries in children, mainly in countries with high caries prevalence. In Europe, however, SDF started to gain popularity during the COVID-19 pandemic. This study aimed to investigate the [...] Read more.

Background and Objectives: Silver diamine fluoride (SDF) has been incorporated into the treatment of dental caries in children, mainly in countries with high caries prevalence. In Europe, however, SDF started to gain popularity during the COVID-19 pandemic. This study aimed to investigate the efficacy of SDF and to evaluate dentists’/parents’ acceptance of SDF use in paediatric patients treated in a German university setting. Materials and Methods: A retrospective analysis of all patients treated with SDF between 2017 and 2020 was carried out. Only teeth with no reported clinical/radiographic evidence of irreversible pulpal inflammation were included. The outcome measures were success, minor failures (caries progression, reversible pulpitis) and major failures (irreversible pulpitis, abscess). The treatment acceptance by dentists and the parents of SDF-treated children was cross-sectionally evaluated using questionnaires. Descriptive statistics and Kaplan–Meier survival analysis were performed. Results: A total of 93 patients (mean age 5.3 ± 2.9 years) with 455 treated teeth (418 primary/91.9%; 37 permanent/8.1%) were included and followed up for up to 24 months (19.9 ± 10.5 months). SDF was used for dental caries (98.2%) and hypersensitivity relief on MIH teeth (1.8%). Most teeth did not show any failure (total success 84.2%). A total of 5 teeth (1.1%) showed minor failures, and 67 teeth (14.7%) showed major failures (p = 0.001). Success/failure rates were not affected by patient compliance, gender, dentition, or operator (p > 0.05). In total, 30 questionnaires were collected from parents (mean age 36.8 ± 6.4 years). SDF was applied on anterior (n = 2/6.7%), posterior (n = 15/50%) and anterior/posterior teeth (n = 13/43.3%). At the 1-week follow-up, 80% of parents noticed black teeth discoloration. Treatment satisfaction was higher for posterior (95.2%) than for anterior teeth (36.4%; p < 0.001). In the 27 responses from clinicians, SDF was generally considered a viable option in paediatric dentistry (n = 23; 85%). Conclusions: SDF was found to be effective and well-accepted by parents and dentists for caries inactivation in a paediatric dentistry German university setting. Full article

(This article belongs to the Special Issue Updates on Caries Management in the Primary and Permanent Dentition)

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13 pages, 954 KiB

Open AccessArticle

Efficacy of Different Fluoride Therapies on Hypersensitive Carious Lesions in Primary Teeth

by Mohamed Abudrya, Christian H. Splieth, Mhd Said Mourad and Ruth M. Santamaría

Medicina 2023, 59(11), 2042; https://doi.org/10.3390/medicina59112042 - 20 Nov 2023

Cited by 4 | Viewed by 2329

Abstract

Background and Objectives: This prospective, comparative, double-cohort study aimed to compare the efficacy of silver diamine fluoride and potassium iodide (38% SDF+KI; Riva Star^®) with sodium fluoride varnish (5% NaF; Duraphat^®) in hypersensitive carious lesions in primary teeth to [...] Read more.

Background and Objectives: This prospective, comparative, double-cohort study aimed to compare the efficacy of silver diamine fluoride and potassium iodide (38% SDF+KI; Riva Star^®) with sodium fluoride varnish (5% NaF; Duraphat^®) in hypersensitive carious lesions in primary teeth to evaluate caries arrest and hypersensitivity relief. Materials and Methods: This study included thirty 2–5-year-olds (mean age = 3.67 ± 1.06 years; 16 males and 14 females) who required a desensitizing treatment for hypersensitive carious defects with visible dentin. A total of 15 of the participants were consecutively allocated to treatment with 5% NaF, and they were further compared to an equal number of participants treated with 38% SDF+KI solutions (n = 15). The treatments were performed following clinical evaluation of caries activity using the International Caries Classification and Management System (ICCMS^TM) and the Bjørndal criteria (score of 0–9). Parental-reported hypersensitivity was evaluated using a visual analogue scale (0–10 = no to severe pain). Results: Clinical variables were evaluated at baseline and three months after treatment. Thereafter, a significant decline in hypersensitivity/pain led to lower final scores in the Riva Star^® group (0.40 ± 1.12, p = 0.002) than in the Duraphat^® group (1.40 ± 2.20, p = 0.004). The caries arrest effect was significantly higher in the Riva Star^® group (86.7%) compared to the Duraphat^® group three months after treatment (13.3%, p < 0.001). In both groups, there were no statistically significant differences in the children’s behavior before, during, and after treatment. Conclusions: Ultimately, with both fluoride therapies reducing hypersensitivity/pain significantly, treatment with 38% SDF+KI was clearly more effective in caries arrest than 5% NaF varnish after a 3-month period. Full article

(This article belongs to the Special Issue Updates on Caries Management in the Primary and Permanent Dentition)

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10 pages, 2215 KiB

Open AccessArticle

Oral Health Survey in Burundi; Evaluation of the Caries Experience in Schoolchildren Using the DMFT Index

by Demetrio Lamloum, Marco Dettori, Pino La Corte, Maria Ruth Agnoli, Andrea Cappai, Arianna Viarchi, Antonella Arghittu, Thomas Gerhard Wolf, Paolo Castiglia and Guglielmo Campus

Medicina 2023, 59(9), 1538; https://doi.org/10.3390/medicina59091538 - 25 Aug 2023

Cited by 5 | Viewed by 2518

Abstract

Background and objectives: There are no data on oral health in the population of Burundi. This study aimed to describe the oral health status of schoolchildren in Burundi using the dmft/DMFT index for the first time. Materials and methods: The study was designed [...] Read more.

Background and objectives: There are no data on oral health in the population of Burundi. This study aimed to describe the oral health status of schoolchildren in Burundi using the dmft/DMFT index for the first time. Materials and methods: The study was designed as a cross-sectional population-based epidemiological survey. The survey was designed according to the WHO methodology for oral health surveys. Oral examinations were conducted in school rooms using a dental mirror, probe, and headlight. The following characteristics of primary dentition status were recorded: decayed (d/D), missing (m/M), and filled (f/F) teeth, and the dmft/DMFT (d + m + f t/D + M + F T) index was calculated for each subject. Quantitative and qualitative variables were represented by measures of position and variability. One-way ANOVA was used to assess differences between parametric variables. Logistic regression was performed for total caries experience and gender, age groups, living area, and geographical provinces. Results: A total of 1902 children were examined, 1007 (52.94%) six-year-olds and 895 (47.06%) in the older group. The dmft/DMFT and subgroups were statistically significantly different in terms of age groups, living areas, and geographical regions (dmft/DMFT d-subgroup and D-subgroup p < 0.01), but only for DMFT for sex. The ORs estimated by logistic regression by total caries experience showed a protective effect for 12 year old subjects and those living in southern provinces, an OR of 0.52 (95%CI 0.43–0.64) and an OR of 0.26 (95%CI 0.21–0.32), respectively. Conclusions: Dental caries in African countries, including Burundi, remains a major problem affecting the general health and wellbeing of the population. Tackling untreated caries requires a multifaceted approach, including strengthening oral health infrastructure, promoting oral health education, providing affordable dental services, and encouraging healthier eating habits. Full article

(This article belongs to the Special Issue Updates on Caries Management in the Primary and Permanent Dentition)

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10 pages, 1210 KiB

Open AccessArticle

Effect of Vegetable Juices on Properties of Two Resin Composites Used for Dental Caries Management

by Claudia Tighiceanu, Elena Raluca Bulai, Oana Camelia Iatcu, Constantin Dulucheanu and Alexandru Nemtoi

Medicina 2023, 59(4), 774; https://doi.org/10.3390/medicina59040774 - 16 Apr 2023

Cited by 3 | Viewed by 2086

Abstract

Background and Objectives: Resin composites represent a class of materials widely used in restorative dentistry due to patient demands for better aesthetics. Colour changes in composite resins can occur due to intrinsic and extrinsic factors. Beverages, such as vegetable juices, can be [...] Read more.

Background and Objectives: Resin composites represent a class of materials widely used in restorative dentistry due to patient demands for better aesthetics. Colour changes in composite resins can occur due to intrinsic and extrinsic factors. Beverages, such as vegetable juices, can be some of these extrinsic factors. The purpose of this study was to investigate the colour stability and modification of microhardness of two resin composites before and after immersion in different vegetable juices. Materials and Methods: The colour of two resin composite materials (Gradia Direct Anterior-shade A2 and Valux Plus—shade A2) was measured before and after immersion in four different solutions: distilled water (as control), beetroot, carrot, and tomato juice. Colour values (L *, a *, b *) were measured over a white background with a colorimeter, using the CIE L *a *b * system. Colour change values were calculated after 1, 3, 5, and 7 days of immersion. Microhardness measurements were taken before and after seven days immersion in test media. Repeated measures analysis of variance (ANOVA) and independent t-tests were applied for statistical analysis. Results: All vegetable juices produced statistically different discolouration after immersion for 7 days (p < 0.05). Tomato juice produced the most discolouration for the Gradia Direct specimens, whereas beetroot juice and carrot juice produced the most discolouration for the Valux Plus specimens. Microhardness of the materials immersed for 7 days in vegetable juices was reduced compared to the ones immersed in distilled water. Conclusions: Vegetable juices, immersion time, and dental resin composites are significant factors that may affect colour stability and microhardness of composite resins. Full article

(This article belongs to the Special Issue Updates on Caries Management in the Primary and Permanent Dentition)

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14 pages, 7677 KiB

Open AccessCase Report

Introducing an Innovative Approach for Managing Proximal Non-Cavitated Carious Lesions in Juvenile Permanent Dentition: Combining Orthodontic Separators and Silver Fluoride Application

by Eilaf E. A. Ahmed, Salma Al Nesser and Julian Schmoeckel

Medicina 2023, 59(11), 1892; https://doi.org/10.3390/medicina59111892 - 25 Oct 2023

Cited by 2 | Viewed by 3372

Abstract

Background and Objectives: The aim was to introduce an innovative, easy and cheap clinical approach for the control of multiple proximal non-cavitated lesions via the application of 38% silver fluoride after placement of orthodontic separators in the permanent dentition in high-caries-risk children. Materials [...] Read more.

Background and Objectives: The aim was to introduce an innovative, easy and cheap clinical approach for the control of multiple proximal non-cavitated lesions via the application of 38% silver fluoride after placement of orthodontic separators in the permanent dentition in high-caries-risk children. Materials and Methods: The case series describes the management of initial proximal carious lesions using silver fluoride (SF) products in the permanent dentition of two adolescent patients with prior proximal caries progression. Both presented with multiple asymptomatic carious lesions that were identified through the use of bitewing radiographs and classified according to the ADA proximal caries classification system. Using orthodontic separators prior to the planned application of SF, most of the surfaces could then be quickly directly examined to check for surface integrity. Follow-up examinations were conducted clinically and radiographically for at least one year to monitor lesion progression. Results: None of the 25 enamel lesions (E1/E2) exhibited signs of progression after single SF application, while 2 out of 11 dentine lesions (D1) showed progression and required restorative intervention. The progressed lesions potentially had non-cleansable micro-cavitations that were either clinically undetected or not fully reached with the micro-brush in SF application. Thus, this should have been repeated or combined with SF application via soaked superfloss to potentially achieve better results. Conclusions: Single application of 38% silver fluoride directly onto active enamel lesions in juvenile permanent teeth with the prior use of orthodontic separators combined with a caries-risk-specific prevention program appears to be highly effective and should be considered as a viable minimally invasive option for patients and clinicians due to its cost-effectiveness and time efficiency. Full article

(This article belongs to the Special Issue Updates on Caries Management in the Primary and Permanent Dentition)

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25 pages, 424 KiB

Open AccessSystematic Review

Cost-Effectiveness of Treatment Decisions for Early Childhood Caries in Infants and Toddlers: A Systematic Review

by Thomas Gerhard Wolf and Guglielmo Campus

Medicina 2023, 59(10), 1865; https://doi.org/10.3390/medicina59101865 - 20 Oct 2023

Cited by 2 | Viewed by 2411

Abstract

Background and Objectives: Early childhood caries (ECC) is a multifactorial, biofilm-mediated, sugar-related, dynamic disease of primary dental hard tissues occurring in varying degrees of severity in infants and toddlers. Untreated ECC may lead to pain, infections, and severe systemic complications. The aim of [...] Read more.

Background and Objectives: Early childhood caries (ECC) is a multifactorial, biofilm-mediated, sugar-related, dynamic disease of primary dental hard tissues occurring in varying degrees of severity in infants and toddlers. Untreated ECC may lead to pain, infections, and severe systemic complications. The aim of this study was to systematically review and evaluate the scientific evidence on the cost-effectiveness of treatment decisions in ECC in infants and toddlers. Materials and Methods: Observational epidemiological studies, i.e., cohort studies, case–control studies, and randomized controlled trials, reporting cost-effectiveness of treatment decisions in ECC in infants and toddlers were included in the systematic review following the PRISMA guidelines. Using an ad hoc search with search terms or keywords (MeSH), electronic databases Embase, MEDLINE via PubMed, Scopus, and gray literature were searched. Results: The search identified 494 articles, of which 446 remained after removing duplicates. A total of 417 articles were excluded after title and abstract evaluation; 29 full-text articles were screened for eligibility, and five articles were discarded. Twenty-four full-text articles were included in the systematic review, assigning 17 to prevention and seven to restoration. Results were heterogeneous; comparability of included studies is difficult because of the different methodologies used. Conflicting efficacies were demonstrated for different interventions implemented, and cost-effectiveness data were documented. Conclusions: Socioeconomic, cultural, and ethnic differences must be considered when comparing conditions in terms of cost-effectiveness. A paradigm shift from surgical towards preventive treatment decisions can be observed. Cost-effectiveness studies on therapies for ECC in infants and toddlers are needed to identify the best practice approach and the most cost-effective therapy decisions. Full article

(This article belongs to the Special Issue Updates on Caries Management in the Primary and Permanent Dentition)

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