Explore the vast range of titles available.

\"Introduces the reader to what a cavity is, how to prevent them, and what happens when you get one\"-- Provided by publisher.

ObjectivesThis study aimed to investigate the effectiveness of deep convolutional neural network (CNN) in the diagnosis of interproximal caries lesions in digital bitewing radiographs.Methods and materialsA total of 1,000 digital bitewing radiographs were randomly selected from the database. Of these, 800 were augmented and annotated as “decay” by two experienced dentists using a labeling tool developed in Python programming language. The 800 radiographs were consisted of 11,521 approximal surfaces of which 1,847 were decayed (lesion prevalence for train data was 16.03%). A CNN model known as you only look once (YOLO) was modified and trained to detect caries lesions in bitewing radiographs. After using the other 200 radiographs to test the effectiveness of the proposed CNN model, the accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC) were calculated.ResultsThe lesion prevalence for test data was 13.89%. The overall accuracy of the CNN model was 94.59% (94.19% for premolars, 94.97% for molars), sensitivity was 72.26% (75.51% for premolars, 68.71% for molars), specificity was 98.19% (97.43% for premolars, 98.91% for molars), PPV was 86.58% (83.61% for premolars, 90.44% for molars), and NPV was 95.64% (95.82% for premolars, 95.47% for molars). The overall AUC was measured as 87.19%.ConclusionsThe proposed CNN model showed good performance with high accuracy scores demonstrating that it could be used in the diagnosis of caries lesions in bitewing radiographs.Clinical significanceCorrect diagnosis of dental caries is essential for a correct treatment procedure. CNNs can assist dentists in diagnosing approximal caries lesions in bitewing radiographs.

ObjectivesTo define an expert Delphi consensus on when to intervene in the caries process and on existing carious lesions using non- or micro-invasive, invasive/restorative or mixed interventions.MethodsNon-systematic literature synthesis, expert Delphi consensus process and expert panel conference.ResultsCarious lesion activity, cavitation and cleansability determine intervention thresholds. Inactive lesions do not require treatment (in some cases, restorations will be placed for reasons of form, function and aesthetics); active lesions do. Non-cavitated carious lesions should be managed non- or micro-invasively, as should most cavitated carious lesions which are cleansable. Cavitated lesions which are not cleansable usually require invasive/restorative management, to restore form, function and aesthetics. In specific circumstances, mixed interventions may be applicable. On occlusal surfaces, cavitated lesions confined to enamel and non-cavitated lesions radiographically extending deep into dentine (middle or inner dentine third, D2/3) may be exceptions to that rule. On proximal surfaces, cavitation is hard to assess visually or by using tactile methods. Hence, radiographic lesion depth is used to determine the likelihood of cavitation. Most lesions radiographically extending into the middle or inner third of the dentine (D2/3) can be assumed to be cavitated, while those restricted to the enamel (E1/2) are not cavitated. For lesions radiographically extending into the outer third of the dentine (D1), cavitation is unlikely, and these lesions should be managed as if they were non-cavitated unless otherwise indicated. Individual decisions should consider factors modifying these thresholds.ConclusionsComprehensive diagnostics are the basis for systematic decision-making on when to intervene in the caries process and on existing carious lesions.Clinical relevanceCarious lesion activity, cavitation and cleansability determine intervention thresholds. Invasive treatments should be applied restrictively and with these factors in mind.

This randomized, parallel, controlled trial assessed the effect of fluoride varnish, ozone and octenidine on white spot lesions (WSLs) and caries during orthodontic treatment. Patients were enrolled between 1st September 2017 and 31st August 2020 at initiation of orthodontic treatment in Department of Interdisciplinary Dentistry Pomeranian Medical University in Szczecin, Poland. All participants were randomly assigned to four study and one control groups using number random generator. However, investigators were not blinded due to the nature of the study. Groups I, II, III, IV had professional cleaning and varnishing (5% NaF) every 4 weeks. Groups II and IV had in-office ozone therapy before varnishing, groups III and IV received domestic octenidine mouthrinse. Group K had no professional hygienic or prophylactic procedures. WSLs were assessed at T0 and then every 4 weeks (T1–T4) and caries—at T0 and T4. The specific objective was to assess the influence of fluoride varnish, ozone and octenidine on the incidence of white spot lesions and caries during orthodontic treatment. The primary outcome of this report was the highest number of WSLs in group K and the lowest percentage of patients with WSLs in group IV. Each group comprised 30 randomized participants; they were all analyzed. No WSLs were found at T0, but they were stated in all groups at T4. The numbers of patients with WSLs significantly increased between T0-T4 in groups I and K. Group IV had the lowest percentage of patients with WSLs in T1-T4. WSLs in group IV were found no earlier than at T2. Group K had the highest percentage of WSLs at T4: 26%. At T0 all the groups had DMFs above 0 with a significant increase at T4. No side effects of the introduced prophylaxis were observed in any group. Caries is an important problem of fixed orthodontic treatment. Even an extremely intensive prophylaxis could not completely prevent WSLs and caries. Simultaneous application of fluoride varnish, ozone gas exposure and octenidine appears to have a beneficial effect in limiting the development of WSLs. Trial registration: NCT04992481.

The recent developments in the science underpinning our knowledge of both the initiation of dental caries and the subsequent behaviour of lesions over time gives us a solid base to understand caries differently. Advances in understanding the human and oral microbiome have come in parallel with the recognition of the importance of balancing protective and pathological risk factors. Caries prevention and management is now about controlling risk factors to maintain a balanced intraoral biofilm ecology that guards against a continuing low pH driven by the frequent consumption of sugars. Thus, caries control is no longer about attempts at eradicating any specific microorganism. Further, the present knowledge leads to the classification of dental caries as a non-communicable disease (NCD), which is vitally important from a policy perspective (both globally and at the country level). Caries shares similar risk factors with other chronic/systemic diseases, which provides opportunities for developing common prevention strategies and promoting health equity through action on the social determinants of health. So, preventing and controlling caries should be integrated across the so-called upstream, midstream and downstream levels and these activities can also help to control other NCDs.Key pointsAdvances in the understanding of the oral microbiome and the caries process call for re-evaluation of caries prevention and management.Measures counteracting low pH conditions within the oral biofilm support a balanced and health-associated microbiota.Dental caries shares similar risk factors with other non-communicable diseases, and its integrated prevention and management may have a positive impact on overall health.

It is not clear whether different radiation methods have different effects on enamel. The purpose of this study was to compare the effects of single and fractionated radiation on enamel and caries susceptibility and to provide an experimental basis for further study of radiation‑related caries. Thirty-six caries-free human third molars were collected and randomly divided into three groups (n = 12). Group1 (control group) was not exposed to radiation. Group 2 received single radiation with a cumulative dose of 70 Gy. Group 3 underwent fractionated radiation, receiving 2 Gy/day for 5 days followed by a 2-day rest period, for a total of 7 weeks with a cumulative dose of 70 Gy. Changes in microhardness, roughness, surface morphology, bacterial adhesion and ability of acid resistance of each group were tested. Scanning electron microscope revealed that the enamel surface in both radiation groups exhibited unevenness and cracks. Compared with the control group, microhardness and acid resistance of enamel decreased, while roughness and bacterial adhesion increased in both the single radiation and fractionated radiation groups. Compared with the single radiation group, the enamel surface microhardness and acid resistance decreased in the fractionated radiation group, while roughness and bacterial adhesion increased. Both single radiation and fractionated radiation resulting in changes in the physical and biological properties of enamel, with these changes being more pronounced in the fractionated radiation group. Therefore, fractionated radiation is recommended as a more suitable method for constructing a radiation‑related caries model in vitro.

Dental caries is one of the most common preventable diseases among Indigenous children. The study aimed to estimate the efficacy of an Early Childhood Caries (ECC) intervention among Aboriginal Australian children over 9 years, and to explore potential risk factors associated with dental caries among Indigenous Australian children. Data were from a randomized controlled trial conducted in South Australia, Australia. Four hundred and forty-eight women pregnant with an Aboriginal child were randomly allocated to either an immediate (II) or delayed (DI) intervention group between January 2011 and May 2012. The immediate intervention comprised (1) provision of dental care to mothers during pregnancy; (2) application of fluoride varnish to teeth of children at ages 6, 12; and 18 months; (3) motivational interviewing delivered in conjunction with; and (4) anticipatory guidance. Mothers/children in the DI group received the same intervention commencing at child aged 2 years. Follow-ups occurred when children were aged 2-, 3-, 5-, 7- and 9-years. In this analysis, outcomes were severity of caries experience: mean dmft/DMFT at child aged 9 years. Dependent variables included mothers' baseline and seven years follow-up characteristics (age, education level, source of income, residential location, smoking and alcohol status) and children's birth and feeding, and dental behaviours characteristics (sex, gestation, birth weight, breastfeeding status and sweet food consumption, and frequency of tooth brushing). Multivariable log-Poisson regression models with robust standard error estimation were applied as a statistical model to estimate multivariable relationships of dental caries and other covariates. Risk ratios (RRs) with their 95%CI were calculated. Sensitivity analyses were conducted by using the inverse-probability-of censoring weighting (IPCW) to overcome the loss-follow-up issues. Data were available for 367 (II = 180 and DI = 187) children at age 9 years. The mean dmft was 3.41 (95% CI: 2.95-3.87) and DMFT was 0.31(95%CI: 0.22-0.41). In multivariable modelling, mean dmft was higher (RR = 1.13, 95% CI: 1.01-1.26) among DI children than II children, but there were no significant differences in the permanent dentition. Risk factors for caries severity in both the primary and permanent dentition included lower mothers' education level (<12 years level: dmft; RR = 1.56, 95% CI:1.31-1.86; and 'Trade or TAFT: DMFT: RR =3.40, 95%CI: 1.16-9.98). Other risk factors for dental caries experience in the primary dentition included preterm birth, low birth weight, child not breastfed and sugar consumption more than 10%, and in permanent dentition was self-rated 'fair/poor' or 'Good' children's oral health, compared with self-rated 'Excellent/very good' oral health. The present study suggests that, within this cohort, initiating an early childhood caries intervention during pregnancy and infancy may be associated with lower caries experience in the primary dentition by age 9 years compared to a later start. Low maternal education level was associated with caries severity in both primary and permanent dentitions. Sugar consumption, a modifiable risk factor, greater than 10% was an important contributor to dental caries in primary teeth.

ObjectivesThe aim of this randomized clinical trial was to compare selective removal to soft dentin (SRSD) and selective removal to firm dentin (SRFD) in permanent teeth. The primary outcome of the study was to compare the success rates of the two caries removal techniques. The secondary outcome of the study was to investigate whether or not calcium silicate-based material (CS) had an effect on the success rate of the treatment.Materials and methodsBetween November 2018 and March 2020, patients with deep caries lesions were invited to participate in the study. Posterior teeth (N = 165) with primary caries lesion radiographically extending ¾ of dentin and positive response to cold test were randomly selected. A total of 134 participants meeting the inclusion criteria were randomized to SRSD and SRFD (control) groups. After the caries removal procedure, teeth with exposed pulps were assigned to the pulp exposure (PE) group, and the SRSD group was further divided into test 1 (with CS) and test 2 groups (without CS). Success was defined as a positive response to the cold test, a negative response to percussion, the absence of pain, an abscess, a fistula, and periapical alterations. Fisher–Freeman–Halton exact tests, Kaplan–Meier survival analysis, and the log-rank tests were performed for comparisons between groups.ResultsNo statistically significant difference was found between the success rates of test 1 (100%) and test 2 (93.5%) groups, whereas the proportion of success in control (82.4%) and PE (84%) groups were significantly lower when compared with test groups (p = 0.024; p < 0.05) at the end of 2-year follow-up.ConclusionsSRSD had a higher success rate when compared to SRFD to treat deep carious lesions after 2 years of follow-up. The use of CS material after SRSD as a liner had no effect on the treatment outcome.Clinical relevanceSRSD with good coronal sealing might be recommended without CS application for the treatment of deep caries lesions in permanent teeth.Trial registrationClinical trial registration number NCT04052685 (08/09/2019).

Aim This research aimed to use an extra-oral 3D scanner for conducting volumetric analysis after caries excavation using caries-detecting dyes and chemomechanical caries removal agents in individuals with occlusal and proximal carious lesions. Methods Patients with occlusal (A1, A2, A3) and proximal carious lesions (B1, B2, B3) were treated with the conventional rotary technique, caries detecting dyes (CDD) and chemomechanical caries removal (CMCR) method on 90 teeth ( n  = 45 for each). Group A1, B1: Excavation was performed using diamond points. Group A2, B2: CDD (Sable Seek™ caries indicator, Ultradent) was applied and left for 10 s, and then the cavity was rinsed and dried. For caries removal, diamond points or excavators were used. Group A3 and B3: BRIX3000 papain gel was applied with a micro-brush for 20 s and was activated for 2 min, and then the carious tissue was removed with a sharp spoon excavator. Post-excavation cavity volume analysis was performed using a 3D scanner. The time required and the verbal pain score (VPS) for pain were scored during excavation. Post-restoration evaluation was performed at 1, 3, and 6 months FDI (Federation Dentaire Internationale) criteria. Results Comparison of age, time and volume with study groups were made using Independent Sample’ t’ test and one-way analysis of variance (ANOVA) for two and more than two groups, respectively. Using Cohen’s Kappa Statistics, evaluators 1 and 2 agreed on caries removal status aesthetic, functional and biological properties at different follow-ups. The chi-square test revealed that the rotary groups [A1(2.5 ± 0.4 min) B1(4.0 ± 0.4 min)] had significantly less ( p  = 0.000) mean procedural time than CDD [A2(4.5 ± 0.4 min) B2(5.7 ± 0.4 min)] and CMCR [A3(5.4 ± 0.7 min) B3(6.2 ± 0.6 min)] groups. The CMCR group showed better patient acceptance and less pain during caries excavation than the rotary and CDD groups. CMCR group showed significantly less mean caries excavated volume( p  = 0.000). Evaluation of restoration after 1-, 3-, and 6-month intervals was acceptable for all the groups. Conclusion Brix3000 helps effectively remove denatured teeth with less pain or sensitivity. The time required for caries removal was lowest in the rotary method and highest in the brix3000 group, while the volume of caries removed was the lowest for brix3000 and highest for the rotary group.

Silver diamine fluoride (SDF) can effectively prevent and control dental caries, the world’s most pervasive noncommunicable disease. This study estimated the transition probabilities for caries in children receiving SDF. The CariedAway study was a community-based cluster-randomized trial of SDF, glass ionomer sealants, and atraumatic restorations conducted in 48 primary schools enrolling predominately low-income minority children in New York, USA. For enrolled children receiving SDF, probabilities were computed for transitions between healthy (sound), diseased (carious), and disease-controlled (arrested) states for 6-year molars using multistate Markov models. Subject-level transition probabilities over one- and two-year periods were then calculated by aggregating states of all 6-year molars and first and second bicuspids. Tooth state progression was treated as a relapsing-remitting condition. A total of 7418 children were enrolled in CariedAway, of which 1352 received SDF and completed at least three study observations. Among eligible participants, the baseline prevalence of untreated decay was 29% and the prevalence of preexisting dental sealants was 8%. The probability of transitioning between sound and carious states in 6-year molars ranged from 0.0022 to 0.0074. At the subject-level, the sound to carious transition probabilities were 0.07 and 0.12 after one and two years, respectively. Once in a fully arrested state, the probability of remaining arrested was 0.72 and 0.60 after 1 and 2 years. While the overall probabilities of teeth remaining in disease-free or arrested states was high after receiving SDF, multiple applications might be needed for consistent caries control.