Biofilm dysbiosis and caries activity: a surface or an individual issue?

Abstract Objective This study aimed to analyze the functional profile of supragingival biofilm from sound (CAs), active (CAa), and inactive (CAi) enamel caries lesions from caries-active individuals to provide insights into the diversity of biological processes regarding biofilm dysbiosis. Methodology A metatranscriptome analysis was performed in biofilm samples collected from five caries-active individuals. Total RNA was extracted, and the microbial cDNAs were obtained and sequenced (Illumina HiSeq3000). Trimmed data were submitted to the SqueezeMeta pipeline in the co-assembly mode for functional analysis and further differential gene expression analysis (DESeq2). Results Bioinformatics analysis of mRNAs revealed a similar functional profile related to all analyzed conditions (CAa, CAi, and CAs). However, active and inactive surfaces share up-regulated genes (gtsA; qrtT; tqsA; pimB; EPHX1) related to virulence traits that were not overrepresented in sound surfaces. From a functional perspective, what matters most is the individual carious status rather than the surface condition. Therefore, pooling samples from various sites can be carried out using naturally developed oral biofilms but should preferably include carious surfaces. Conclusion Metatranscriptome data from subjects with caries activity have shown that biofilms from sound, arrested, and active lesions are similar in composition and function.

Association between toothbrushing frequency and dental caries and tooth loss in adolescents: a cohort study

Abstract This cohort study assessed the association between toothbrushing frequency and the increment of dental caries and tooth loss in a population-based sample of southern Brazilian adolescents, to investigate whether there is any additional benefit in performing a third daily brushing. At baseline, 1,528 12-year-old schoolchildren attending 42 schools were examined for gingivitis and dental caries, and answered a questionnaire. After a mean period of 2.5 years, 801 schoolchildren were re-examined. Dental caries and tooth loss increment were outcomes of the study. The main predictor variable was toothbrushing frequency (≥3 times/day vs. twice/day or ≤1 time/day). Poisson regression models were used to estimate the risk for caries and tooth loss increment. Incidence risk ratios (IRR) and 95% confidence intervals (CI) were estimated. The final model adjusted for sociodemographic, behavioral, and clinical variables showed that brushing twice/day afforded 40% greater risk (IRR = 1.40; 95%CI: 1.02-1.92) for caries increment than ≥3 times/day. Regarding the tooth loss increment, adolescents who brushed their teeth twice/day had a fourfold greater risk (IRR = 3.92; 95%CI: 1.23-12.49) than those who brushed ≥ 3 times/day. Sex, school type, and gingivitis were found to act as effect modifiers, inasmuch as a third daily brushing presented advantages against tooth loss only for girls, public school attendees, and those with ≥ 50% of bleeding sites. This study suggests that adolescents benefit from a third daily toothbrushing. Increasing brushing frequency to 3 times/day may be a suitable strategy to control dental caries and tooth loss among high-risk adolescents.

Cost-effectiveness of selective caries removal versus stepwise excavation for deep caries lesions

Abstract A multicenter, randomized controlled clinical trial evaluated the effectiveness of two treatments for deep caries lesions in permanent molars - selective caries removal (SCR) to soft dentin with restoration in a single visit, and stepwise excavation (SW) - regarding pulp vitality for a 5-year follow-up period. The present study aimed to determine the cost-effectiveness of these treatments. Treatments were conducted in two Brazilian cities (Brasília and Porto Alegre). At baseline, 299 permanent molars (233 patients) were treated and 229 teeth (174 patients) were evaluated after 5 years. The discounted cash flow method was adopted. The total cost of each treatment was calculated, and the failure cost (endodontic treatment + restoration) was added to the final cost, according to the 5-year failure rates of each therapy (20% for SCR and 44% for SW). A public health service unit composed of three dentists in 4-hour work shifts was used to calculate the monetary value of the treatments, assuming a total of 528 treatments/month. Considering the 229 teeth evaluated after 5 years (115 SCR and 114 SW), SCR provided savings of 43% (amalgam) and 41% (resin composite) per treatment, compared to SW. The SCR technique provides benefits for public finances (direct economy) and for public health services (increase in the number of treatments performed). Considering that maximizing profit and reducing costs are powerful motivating factors for adopting a certain treatment, this study provides data to better support the decision-making process, regarding the management of deep caries lesions in permanent molars.

The effect of coconut sugar on cariogenic traits in Streptococcus mutans / Efeito do Açúcar de Coco na cariogenicidade do Streptococcus mutans

Aim: The consumption of foods rich in sugar is linked to several non-communicable diseases, including dental caries. Coconut sugar has systemic benefits due to its lower glycemic indexes (GI) than other table sugars. However, there is currently no data regarding its ca-riogenic potential. This study aimed to evaluate the effect of coconut sugar on acidogenicity and adhesion of Streptococcus mutans in vitro, compared to sugarcane products. Materials and methods: Aliquots of cultu-res of S. mutans UA159 were resuspended in a buffer solution enriched with coconut sugar, crystal sugar (refined sugar), and minimally processed sugarcane (demerara light brown sugar and maskavo dark brown sugar), as well as positive (sucrose) and negative con-trols. The decrease in pH and its corresponding area under the curve (AUC; cm2) were evaluated for the analysis of acidogenicity. S.mutans was incubated in BHI supplemented with each sugar and the percentages of microbial adhesion were calculated. After testing data normality, the one-way ANOVA test (Bonferroni post hoc) was used to compare the AUC and the pro-portion of adhesion of each group. Results: Regarding the acidogenic potential, statistical differences were found only between the negative control versus all other groups (p<0.001). Likewise, no significant difference in adhesion was found between the tested sugars (p>0.05). Discussion: Although the tested sugars are marketed as "healthy products," their amount and frequency of usage should be controlled. Conclusion: Coconut su-gar presents a similar cariogenic potential to that of sugarcane products when acidogenicity and adhesion are evaluated. Coconut sugar is not indicated as a substitute for sucrose in the control of cariogenic activity.

Objetivo: O consumo de alimentos ricos em açúcar está associado a diversas doenças não transmissíveis, incluindo a doença cárie. O açúcar de coco tem benefícios sistêmi-cos devido aos seus índices glicêmicos (IG) mais baixos do que outros açúcares de mesa. No entanto, atualmente não há dados sobre seu potencial cariogênico. Esse estu-do teve como objetivo avaliar o efeito do açúcar do coco na acidogenicidade e adesão de Streptococcus mutans in vitro, em comparação com produtos derivados da cana--de-açúcar. Materiais e métodos: alíquotas de culturas de S. mutans UA159 foram suspensas em solução tampão enriquecida com açúcar de coco, açúcar cristal (açúcar refinado) e cana-de-açúcar minimamente processada (açúcar mascavo demerara claro e açúcar mascavo), além de controles positivo (sacarose) e negativo. A diminuição do pH e correspondente área sob a curva (AUC; cm2) fo-ram avaliadas na análise de acidogenicidade. S. mutansfoi incubado em BHI suplementado com cada tipo de açúcar e as porcentagens de adesão microbiana foram calculadas. Após testar a normalidade dos dados, o teste ANOVA de uma via (Bonferroni post hoc) foi utilizado para comparar a AUC e a proporção de adesão de cada grupo. Resultados: Em relação ao potencial acidogênico, diferenças estatísticas foram encontradas apenas entre o controle negativo versus todos os outros grupos (p <0,001). Não foi encontrada diferença significativa na adesão en-tre os açúcares testados (p> 0,05). Discussão: Apesar dos açúcares testados serem comercializados como "produtos saudáveis", sua quantidade e frequência de consumo deve ser controlada. Conclusão: O açúcar do coco apresenta potencial cariogênico semelhante à dos produtos da cana-de-açúcar quanto a acidogenicidade e a adesão. O açúcar de coco não é indicado como substituto da sacarose no controle da atividade cariogênica.

Remoção seletiva de tecido cariado e proteção pulpar indireta: relato de casos clínicos / Selective caries removal and indirect pulp capping: clinical cases report

Objetivo: este artigo se propõe a discutir o tratamento de lesões profundas de cárie em molares permanentes, através da técnica de remoção seletiva de tecido cariado e restauração de resina composta, em dois casos clínicos, utilizando apenas sistema adesivo (caso 1) ou proteção pulpar indireta com cimento de hidróxido de cálcio (caso 2). Relato de casos: os indivíduos foram diagnosticados com dentes apresentando lesões profundas de cárie, isto é, com mais de 50% em profundidade da dentina, confirmada pelo exame radiográfico interproximal. O conjunto de resultados de testes de sensibilidade pulpar positivo ao frio e teste de percussão horizontal e vertical negativos, juntamente com a ausência de dor espontânea e normalidade do periápice (radiografia periapical), completaram os requisitos exigidos para execução da técnica de remoção seletiva de dentina cariada amolecida. Os dentes receberam restaurações adesivas na mesma sessão, sobre a dentina cariada amolecida da parede pulpar que havia recebido forramento de cimento de hidróxido de cálcio ou não, dependentes de uma randomização. Ambos os casos apresentados mostraram sucesso clínico em acompanhamento de 18 meses, tanto na manutenção da vitalidade pulpar quanto na sobrevivência da restauração. Considerações finais: com base nos casos apresentados, sabendo das limitações deste modelo de estudo, e em concordância com a literatura, a remoção seletiva de tecido cariado pode ser executada com sucesso no tratamento de lesões profundas de cárie, respeitando-se todos os passos da técnica, e parece não haver necessidade de uso de proteção pulpar indireta.(AU)

Objective: this article aims to discuss the treatment of deep caries lesions in permanent molars through the selective caries tissue removal technique and composite resin restoration of two clinical cases, using only an adhesive system (case 1) or an indirect pulp protection of calcium hydroxide cement (case 2). Cases report: the participants were diagnosed with deep caries lesions, that is, more than 50% in depth of the dentin involved, which was confirmed by the interproximal radiography. In both cases, it was obtained positive response to cold test, negative response to horizontal and vertical percussion tests, absence of spontaneous pain and no periapical lesion (periapical radiography), which completed the requirements for performing the selective caries removal of soft dentin. These teeth received adhesive restorations in the same session, under the softened carious dentin of the pulp wall that had received calcium hydroxide cement or not, depending on randomization. Both cases had clinical success in the 18-month follow- -up, showing pulp vitality and restoration survival. Final considerations: based on the clinical cases reported, considering de limitations of this study model, and in agreement with the literature, the selective removal of carious tissue can be successfully performed in the treatment of deep carious lesions, respecting all the steps of the technique and indirect pulp protection seems to be unnecessary.(AU)

Prevalence and risk indicators for underlying dentin shadows among 12-year-old southern Brazilian schoolchildren

Abstract This study aimed to assess the prevalence, extent, and associated factors of underlying dentin shadows (UDS) in the occlusal surfaces of permanent posterior teeth among 12-year-old schoolchildren from southern Brazil. A population-based cross-sectional study that included a representative sample of 1,528 schoolchildren was conducted in Porto Alegre, southern Brazil (participation rate: 83.2%). A questionnaire on sociodemographic characteristics, behavioral habits, and access to dental services was sent to parents/legal guardians of each student selected. Caries examination included the recording of non-cavitated and cavitated lesions, including the presence of UDS, as defined by the ICDAS Group (i.e., a shadow of discolored dentin visible through an apparently intact enamel surface that may or may not show signs of localized breakdown - ICDAS Code 4). The association between predictor variables and UDS prevalence was assessed using survey Poisson regression models. The prevalence of UDS was 6.3% (95%CI = 1.2 -11.3). The mean number of affected teeth among the schoolchildren presenting UDS was 1.51 (95%CI = 1.40 -1.61), ranging from 1 to 6. Type of school (public, PR = 2.23, 95%CI = 1.22 -4.07) and caries experience (DMFT 1-2, PR = 2.41, 95%CI = 1.15 -5.04; DMFT ≥ 3, PR = 3.09, 95%CI = 1.52 -6.27) were significantly associated with UDS prevalence. In conclusion, this population-based cross-sectional study found a low prevalence of UDS in the occlusal surfaces of the permanent posterior teeth of 12-year-old southern Brazilian schoolchildren. Overall caries experience and type of school were associated with UDS in this population.

Bacterial analysis of biofilms from tooth root surfaces presenting different caries activity / Análise bacteriológica de biofilmes de superfícies dentárias radiculares apresentando diferentes estágios de atividade de cárie

This study evaluated the numbers and determined the proportion of mutans streptococci and Lactobacillus spp., which are possible relevant cariogenic organisms, in biofilms recovered from lesions at root surfaces with active caries lesions (ARC), inactive caries lesions, and sound root surfaces (SRS). Samples were cultured in MSB agar for mutans streptococci counts, Rogosa agar for Lactobacillus spp. counts, and brain-heart infusion agar for total viable anaerobic counts. After incubation, the number of colony-forming units (CFUs) was determined and compared between groups by the Mann-Whitney U test with a significance level set at 95%. The proportion of counts of mutans streptococci and Lactobacillus spp. in the total viable microorganisms was also analyzed by Chi-square test. Ninety samples (30 from each surface) from 37 patients were cultured and analyzed. The CFU was similar between mutans streptococci and Lactobacillus spp.These species were present in at least half of the samples and no difference was found in the frequency of isolation of these species. Only 6 samples showed a proportion of more than 10% of mutans streptococci; 4 of the samples were from ARC. Most (93%) SRS samples did not contain viable Lactobacillus spp. The data indicate the low counts of mutans streptococci and Lactobacillus spp. in root sur-faces, regardless of the activity of caries lesions.

O estudo analisou contagens e proporções de mutans strep-tococci e Lactobacillus spp., que podem ser microorganismos importantes em lesões de cárie radicular com diferentes atividades. Biofilmes foram coletados em três locais: ARC ­ superfície radicular com lesão ativa de cárie; IRC ­ superfícies radiculares com lesão inativa de cárie; SRS ­ superfícies de raizes hígidas. As amostras foram cultivadas em agar MSB para contagens de mutans streptococci; agar Rogosa para Lactobacillus spp., e agar BHI para contagens de microrganis-mos viáveis anaeróbicos totais. Após a incubação, o número de unidades formadoras de colônias (UFCs) foi determinado e comparado entre os grupos pelo teste de Mann-Whitney U test. O nível de significância foi estabelecido em 95%. A pro-porção de contagem de mutans streptococci e Lactobacillusspp. no total de microrganismos viáveis também foi analisado através do teste de qui-quadrado. Um total de 90 amostras de 37 pacientes foram cultivadas e analisadas: 30 amostras de ARC, 30 de IRC e 30 de SRS. Números de UFC foram seme-lhantes entre os grupos para ambos, mutans streptococci e Lactobacillus spp. Estas espécies estavam presentes em pelo menos metade de todas as amostras e nenhuma diferença foi encontrada na frequência de isolamento dessas espécies dentro dos grupos. Apenas 6 amostras apresentaram mais de 10% de mutans streptococci e 4 foram de ARC. Em relação aos Lactobacillus spp., 93% das amostras não apresentaram proporção dessas bactérias nas SRS. Mutans streptococci e Lactobacillus spp. estão presentes em baixa proporção nas superfícies radiculares, independentemente da atividade das lesões de cárie.

Indirect pulp protection after selective caries removal: a preliminary 6 months randomised controlled trial / Proteção pulpar indireta após a remoção seletiva de tecido cariado: acompanhamento de 6 meses de um ensaio clínico randomizado controlado

This randomized controlled clinical trial evaluated the effectiveness of using indirect pulp protection with calcium hydroxide liner or universal adhesive over a period of 6 months in deep caries on permanent teeth after selective removal to soft dentin. The sample con-sisted of 68 patients with 55 molars and 21 premolars with deep caries lesion (with radiographic involvement ≥ 50% dentin deep caries), (median age 27 [distribution 7-54 years]), with signs of pulp vitality (positive respon-se to cold test, absence of spontaneous pain, negative sensitivity to percussion tests, absence of radiographic imaging suggestive of periapical lesion) and absence of cuspid loss. After selective removal to soft dentin, the test group received a universal adhesive (n = 38), whereas the control group indirect pulp protection with Calcium hydroxide (n = 38). All teeth were restored with compo-site resin. The successful outcome for pulp vitality was assessed after six months. The results were submitted to the Kaplan-Meier survival analysis and the Log Rank test. The baseline variables were analyzed for their distribution in the two treatment groups by x2 test and showed a similarly distributed between groups. Success rates to pulp maintenance vitality were 95.5% for the control group and 96.7% for the test group (P = 0,986). Two cases of failure were recorded, one pulp necrosis (control group) and one pulpitis (test group). There is no difference between the use of calcium hydroxide or only universal adhesive in indirect pulp protection after selective removal to soft dentine followed by composite restoration at six months of follow-up, showing a high rate of success for both treatments.

Este ensaio clínico controlado randomizado avaliou a eficácia da proteção pulpar indireta com ci-mento de hidróxido de cálcio ou apenas adesivo universal na remoção seletiva de dentina amolecida em dentes permanentes após 6 meses de tratamento. A amostra consistiu de 68 pacientes com 55 molares e 21 pré-molares com lesão profunda de cárie (envolvimento radiográfico ≥ 50% da dentina), (mediana de idade 27 [distribuição 7-54 anos]), com sinais de vitalidade pulpar (resposta positiva ao teste frio, ausência de dor espontânea, sensibilidade negativa aos testes de percussão, ausência de imagem radiográfica sugestiva de lesão periapical) e ausência de perda cúspidea. Após remoção seletiva o grupo teste recebeu adesivo universal (n = 38) e o grupo controle cimento de hidróxido de cálcio (n = 38) como proteção pulpar indireta. Todos os dentes foram restaurados com resina composta. Os re-sultados de vitalidade pulpar foram avaliados após seis meses e submetidos à análise de sobrevivência de Kaplan-Meier e ao teste Log Rank. As variáveis explanatórias iniciais foram analisadas quanto à sua distribuição nos grupos de tratamento pelo teste x2 e mostraram distribuição similar. O sucesso na manutenção da vitalidade pulpar foi de 95,5% para o grupo controle e 96,7% para o grupo teste (P = 0,986). Duas falhas foram registradas, uma necrose pulpar (grupo controle) e uma pulpite (grupo teste). Resultados sugerem que não há diferença entre o uso de hidróxido de cálcio e/ou apenas adesivo universal após remoção seletiva de dentina amolecida e restauração de resina composta em 6 meses de acompanhamento, com alta taxa de sucesso nos dois tratamentos.

The role of Candida albicans in root caries biofilms: an RNA-seq analysis

Abstract Objective This study sought to analyze the gene expression of Candida albicans in sound root surface and root caries lesions, exploring its role in root caries pathogenesis. Methodology The differential gene expression of C. albicans and the specific genes related to cariogenic traits were studied in association with samples of biofilm collected from exposed sound root surface (SRS, n=10) and from biofilm and carious dentin of active root carious lesions (RC, n=9). The total microbial RNA was extracted, and the cDNA libraries were prepared and sequenced on the Illumina Hi-Seq2500. Unique reads were mapped to 163 oral microbial reference genomes including two chromosomes of C. albicans SC5314 (14,217 genes). The putative presence of C. albicans was estimated (sum of reads/total number of genes≥1) in each sample. Count data were normalized (using the DESeq method package) to analyze differential gene expression (using the DESeq2R package) applying the Benjamini-Hochberg correction (FDR<0.05). Results Two genes (CaO19.610, FDR=0.009; CaO19.2506, FDR=0.018) were up-regulated on SRS, and their functions are related to biofilm formation. Seven genes ( UTP20 , FDR=0.018; ITR1 , FDR=0.036; DHN6 , FDR=0.046; CaO19.7197 , FDR=0.046; CaO19.7838 , FDR=0.046; STT4 , FDR=0.046; GUT1 , FDR=0.046) were up-regulated on RC and their functions are related to metabolic activity, sugar transport, stress tolerance, invasion and pH regulation. The use of alternative carbon sources, including lactate, and the ability to form hypha may be a unique trait of C. albicans influencing biofilm virulence. Conclusions C. albicans is metabolically active in SRS and RC biofilm, with different roles in health and disease.

Availability and stability of soluble fluoride content in commercial fluoride dentifrices available in Uruguay / Disponibilidade e estabilidade do conteúdo de flúor solúvel em dentifrícios fluoretados comercialmente disponíveis no Uruguai

ABSTRACT Objective The aim of this study was to evaluate the availability and stability of soluble fluoride fraction in commercial fluoride toothpastes available in Uruguay. Methods Fourteen fluoride toothpastes from four different manufacturers were analyzed. Randomized and blinded analyses were performed in duplicate for each dentifrice at the time of purchase (fresh samples) and after 12 months of storage at room temperature (aged samples). Total fluoride and total soluble fluoride concentrations were measured using a fluoride specific electrode. Results Total fluoride concentrations in all of the products were lower than the F levels specified by the manufacturers. Total soluble fluoride fractions were lower than the total fluoride concentrations in fresh samples of five toothpastes and in aged samples of ten toothpastes (p < 0.05). Three toothpastes had insufficient and unstable total soluble fluoride fractions (< 60%) and five toothpastes had only unstable total soluble fluoride fractions (<1000 ppm) after 12 months. Conclusion Based on theresults of this study, it can be concluded that from fourteen Uruguayan commercial fluoride toothpastes analyzed in this study, three toothpastes have insufficient and unstable chemically active F fractions and five other toothpastes have the lack of stability which may compromise their efficacies. Review the guidelines on fluoride dentifrices in Uruguay is necessary, in order to ensure optimum benefit for population.

RESUMO Objetivo O objetivo deste estudo foi avaliar a disponibilidade e a estabilidade da fração solúvel de flúor nos dentifrícios fluoretados comercialmente disponíveis no Uruguai. Métodos Quatorze dentifrícios fluoretados de quatro diferentes fabricantes foram analisados. Análises randomizadas e cegas foram realizadas em duplicata para cada dentifrício no momento da aquisição (amostras frescas) e depois de 12 meses de armazenamento em temperatura ambiente (amostras envelhecidas). As concentrações de flúor total e flúor solúvel total foram determinadas usando um eletrodo específico para flúor. Resultados As concentrações de flúor total de todos os produtos testados foram menores do que os níveis de flúor especificados pelos fabricantes. Os valores das frações de flúor solúvel total foram menores do que as concentrações de flúor total nas amostras frescas de cinco dentifrícios e nas amostras envelhecidas de 10 dentifrícios (p < 0.05). Três dentifrícios apresentaram as frações de flúor solúvel total insuficientes e instáveis (< 60%) e cinco dentifrícios tiveram apenas frações instáveis de flúor solúvel total (<1000 ppm) após 12 meses. Conclusão Baseado nosresultados deste estudo pode-se concluir que dos quatorze dentifrícios fluoretados comercialmente disponíveis no Uruguai analisados neste estudo, três produtos apresentaram insuficientes e instáveis frações quimicamente ativas de flúor e cinco outros dentifrícios tiveram falta de estabilidade o que pode comprometer suas eficácias. É necessário revisar as orientações sobre dentifrícios fluoretados no Uruguai a fim de garantir um benefício ótimo para a população.

Obesity and dental caries among South Brazilian schoolchildren: a 2. 5-year longitudinal study

Abstract The aim of this study was to assess the association between weight status and ΔDMFS among 12-year-old schoolchildren from South Brazil. A total of 801 12-year-old schoolchildren were followed-up for 2.5 ± 0.3 years. Data collection included questionnaire, recording of anthropometric measures (height and weight), and caries examination. The outcome was the difference between DMFS (number of decayed, missing or filled surfaces) at follow-up and baseline (ΔDMFS). Weight status, based on body mass index-for-age Z-scores, was considered the main predictor variable. Negative binomial regression models were used to model the association, and rate ratios and their 95% confidence intervals were estimated. A multivariable fractional polynomial model was used to further explore the relationship between obesity and dental caries. DMFS increased by 0.86 (95%CI = 0.65-1.07), 0.91 (95%CI = 0.59-1.23), and 0.42 (95%CI = 0.03-0.80) for normal weight, overweight, and obese schoolchildren, respectively. Obese adolescents had significantly lower ΔDMFS than normal weight ones (p < 0.05). No significant association between categories of weight status and ΔDMFS was found (overweight, IRR=0.92, 95%CI = 0.69-1.21, p = 0.54; obese IRR = 0.75, 95%CI = 0.51-1.12, p = 0.16). However, the multivariable fractional polynomial model showed an inverted U shaped relationship with a decreasing ΔDMFS with increasing BMI (p < 0.05). This population-based longitudinal study showed an inverse association between obesity and ΔDMFS over a 2.5-year period among South Brazilian adolescents.

Microbial load after selective and complete caries removal in permanent molars: a randomized clinical trial

Abstract The aim of this randomized clinical trial was to compare the remaining microbial load after treatments based on complete and selective caries removal and sealing. Patients with active carious lesions in a permanent molar were randomly allocated into 2 groups: a test group (selective caries removal-SCR; n=18) and a control group (complete caries removal - CCR; n=18). Dentin samples were collected following the excavation and three months after sealing. Streptococcus species, Streptococcus mutans, Lactobacillus species, and total viable microorganisms were cultured to count the viable cells and frequency of species isolation. CCR resulted in significant lower total viable microorganisms counts (p≤0.001), Streptococcus species (p≤0.001) and Lactobacillus species (p≤0.001) initially. However, after sealing, a decrease in total viable microorganisms, Streptococcus species, and Lactobacillus species in the SCR resulted in no difference between the groups after 3 months. In conclusion, selective caries removal is as effective as complete caries removal in reducing dentin bacterial load 3 months after sealing.

Resumo O objetivo deste ensaio clínico randomizado foi comparar os microrganismos remanescentes após tratamentos baseados em remoção total de tecido cariado e selamento e a remoção seletiva de tecido cariado e selamento. Pacientes com lesões de cárie ativas em molares permanentes foram divididos aleatoriamente em dois grupos: grupo teste (remoção seletiva de tecido cariado-SCR; n=18), e grupo de controle (remoção total de tecido cariado-CCR; n=18). Amostras de dentina foram obtidas após a remoção da tecido cariado e após 3 meses de selamento das cavidades. Streptococcus spp., Streptococcus mutans, Lactobacillus spp. e microrganismos viáveis totais foram cultivados para contagem de células e frequência de isolamento de espécies. CCR resultou em menores contagens totais de microorganismos viáveis (p≤0,001), Streptococcus spp. (p≤0,001) e Lactobacillus spp. (p≤0,001) inicialmente. Entretanto, após o selamento, uma redução significativa nas contagens totais de microrganismos viáveis, Streptococcus spp. e Lactobacillus spp. resultou em nenhuma diferença entre os grupos após 3 meses. Conclui-se que a remoção seletiva de cárie é tão seletiva quanto a remoção completa de cárie na redução da infecção dentinária após três meses com selamento da lesão.

A randomized clinical trial on the sealing of occlusal carious lesions: 3-4-year results

Abstract This randomized clinical trial aimed to assess the efficacy of sealing occlusal carious lesions in permanent teeth. The sample consisted of 54 occlusal carious lesions in permanent molars and premolars of 49 patients aged 8–43 years (median: 19 years). The inclusion criteria comprised the presence of a cavity with no access allowing biofilm control. The maximum depth of the lesion was the middle third of the dentin thickness, as assessed by bitewing radiography. The teeth were randomly assigned to sealant treatment (n = 28) or restorative treatment (n = 26). Clinical and radiographic examinations were performed after 1 year and after 3–4 years. The outcomes depended on the clinical performance of the sealant/restoration and the control of caries progression observed radiographically. Survival analysis was performed to assess success rates. Over the 3-4 years of monitoring, 2 sealants were totally lost, 1 needed repair, and 1 showed caries progression, totaling 4 failures in the sealant group. In the restoration group, 1 failure was observed (in need of repair). The success rates were 76% and 94% in the sealant and the restoration groups, respectively (p > 0.05). The sealing of occlusal carious lesions in permanent teeth succeeded in controlling caries over a 3–4-year period. However, sealed carious lesions require patient compliance in attending regular follow-ups to control the occurrence of clinical failures of the sealants.

Remoção parcial de tecido cariado em dentes permanentes: seis anos deacompanhamento / Partial caries removal in permanent teeth: six-year follow-up

Objetivos: o objetivo deste estudo foi avaliar a efetividade da remoção parcial de tecido cariado (RPTC) de lesões de cárie profundas e restauração em uma única sessão de forma comparativa ao tratamento expectante (TE) em seis anos de acompanhamento. Materiais e método: o estudo foi realizado em Porto Alegre e Brasília. A amostra incluiu pacientes com molares permanentes com lesões de cárie profundas (metade interna de dentina), sem lesão periapical ao exame radiográfico, resposta positiva ao teste de frio, negativa à percussão e ausência de dor espontânea. Esses foram randomicamente atribuídos ao grupo teste (RPTC), recebendo remoção incompleta de tecido cariado e restauração em uma sessão, ou controle (TE). Após, os dentes foram restaurados com resina composta ou amálgama. O desfecho avaliado foi vitalidade pulpar (sensibilidade ao teste térmico, sensibilidade à percussão e ausência de alteração periapical). Análises de sobrevivência foram realizadas para estimar as taxas de sucesso do tratamento e definir variáveis associadas, utilizando o modelo de regressão de Weibull. Foram executados 299 tratamentos, sendo 152 RPTC e 147 TE. Resultados: somente o acompanhamento dos tratamentos realizados em Porto Alegre foi realizado. Após 6 anos, 127 dentes foram avaliados. Foram observadas taxas de sucesso de 60% para RPTC e 32% para TE (p<0,05). Dentre as variáveis analisadas, somente a tipo de tratamento apresentou associação significativa à manutenção da vitalidade pulpar, sendo favorável à RPTC. Conclusão: RPTC pode ser alternativa viável no tratamento de lesões profundas de cárie, mostrando melhora significativa em relação à manutenção da vitalidade pulpar quando comparado ao TE.

Dentes fluoróticos tratados e não tratados: aspecto clínico após 21 anos / Treated and untreated fluorotic teeth: clinical aspect after 21 years

O aumento na ocorrência de fluorose dentária, observado nos últimos anos, tende a promover maior procura pela resolução estética dos manchamentos, o que é geralmente feito com a aplicação de técnicas de erosão-abrasão. Pode-se supor que a abrasão fisiológica e a erosão ácida que ocorrem ao longo da vida atuem no sentido de atenuar a severidade das manchas de fluorose. O presente artigo apresenta um caso de atenuação de manchamentos por fluorose dentária nos dentes anteriores de um paciente de 36 anos que aos 15 havia recebido tratamento erosivo-abrasivo apenas em seus incisivos 11 e 21. Isso permitiu que, após duas décadas, fosse possível comparar os dentes tratados com aqueles que sofreram apenas desgaste fisiológico e a constatação de que, embora as manchas ainda permaneçam, o aspecto de ambos é estético e socialmente aceitável.

The increased prevalence of dental fluorosis observed in recent years tends to promote an increased demand for esthetic resolution of tooth staining, which is usually made by erosion-abrasion techniques. It can be assumed that the physiological abrasion and acid erosion that occur throughout life act to mitigate the severity of fluorosis. This article presents a case of mitigation of fluorosis stains in the anterior teeth of a 36-year-old patient who had received, at 15 years, erosive/abrasive treatment only on his incisors 11 and 21. After two decades, it was possible to compare the treated teeth with those who suffered only physiological wear. It was possible to find that in spite the stains were still present, their clinical aspect is esthetic and socially acceptable.

Indicação de tratamento restaurador para lesões cariosas: uma reflexão / Indicating restorative treatment for carious lesions: some thoughts

O presente artigo discute a indicação do tratamento restaurador para lesões cariosas, utilizando como exemplo o caso de uma paciente com atividade de doença cárie durante o período de erupção dos molares permanentes. O diagnóstico precoce da lesão permitiu sua inativação, por meio de abordagem não invasiva. O controle longitudinal do caso foi possível por 18 meses. Após 10 anos sem contato com a paciente, ela retornou com o dente em questão restaurado. O “selamento biológico”, o estabelecimento da oclusão funcional e a superficialidade e amplitude da restauração permitem questionar a indicação do procedimento restaurador executado

This paper discusses the indication of restorative treatment for carious lesions considering a young patient with caries active disease, treated during the period of eruption of permanent molars. Early diagnosis led to caries inactivation by means of a non-invasive approach. Longitudinal control of the disease was possible for 18 months. After 10 years without contact, the patient returned and it was possible to observe that the tooth has been restored. The quality of the “biological sealing”, the occlusal function and the thinness and extension of the restoration led us to question the indication of the restorative procedure executed

Comparison of different methods for evaluating resin composite restorations in posterior teeth / Comparação de Diferentes Métodos para Avaliação de Restaurações de Resina Composta em Dentes Posteriores

Aim: To compare different methods for evaluating composite resin restorations in posterior teeth and to evaluate the reliability of each method by determining the intraobserver agreement. Material and methods: 136 class I resin composite restorations were evaluated by a trained examiner using modified Ryge criteria to assess selected restoration characteristics with three different methods: clinical, photographic and dental cast models.Results: The results showed that intraexaminer agreement was better on dental cast models evaluations for marginal integrity and anatomic form and was similar between photographic and clinical evaluations for marginal integrity and marginal discoloration. Surface texture showed the lowest degree of intraexaminer agreement with all the methods tested. Direct clinical method and the two indirect methods were significantly different for all the characteristics assessed (p<0.05). Photographs and dental cast models methods gave higher mean ranks than direct clinical method for marginal integrity and anatomic form. Photographs and dental cast models evaluations were similar for all the characteristics assessed, except for surface texture (p<0.05). Conclusion: All of the methods were different for all the characteristics assessed. The highest Intraexaminer agreement was obtained from dental cast models evaluation. All the methods showed that are not adequate to evaluate surface texture.

Objetivo: Comparar diferentes métodos para avaliação de restaurações de resina composta em dentes posteriores e avaliar a confiabilidade de cada método através da determinação deconcordância intraexaminador.Materiais e Métodos: 136 restaurações Classe I de resina composta foram avaliadas por um examinador treinado utilizando o critério de Ryge modificado através três métodos diferentes: clínico, fotográfico e modelos de gesso.Resultados: Os resultados mostraramque a concordância intraexaminador foi melhor em avaliação em modelos de gesso para integridade marginal e forma anatômica, e foi similar entre fotografiase avaliação clínica para integridade marginal e descoloração marginal. A textura superficial mostrou a menor concordância intraexaminador para todos os métodos testados. O método clínico direto e os dois métodos indiretos foram diferentes significativamentepara todas as características analisadas (p<0,05). Fotografias e modelos de gesso forneceram maio res médias ranqueadas do que o método clínico direto para integridade marginal e forma anatômica. As avaliações através de fotografias e modelos de gesso foram similares para todas as categorais avaliadas, exceto para textura superficial (p<0,05). Conclusões: Todos os métodos foram diferentes para as características avaliadas. A maior concordância intraexaminador foiobtida com a avaliação através de modelos de gesso. Nenhum dos métodos foi adequado para avaliação da textura superficial.

Amalgam versus resin composite for the restoration of posterior teeth: disparities between public clinical practice and dental education in Southern Brazil / AmálgamaVersusResina Composta para Restaurações deDentes Posteriores: Diferenças entre aPráticaClínica noServiço Público e o Ensino em Faculdadesde Odontologia no Sul do Brasil

Objetivo: Comparar o material restaurador indicado no tratamento de dentes posteriores de acordo com o ensino e realização dos tratamentos em duas Faculdades de Odontologia (UFRGS e ULBRA) e em 8 unidades básicas de saúde (UBS) do Sistema de Saúde Pública em Porto Alegre, Brasil. Materiais e Métodos: Os dados referentes ao ensino de procedimentos restauradores utilizando amálgama (AM) ou resina composta (RC) foram obtidos através da análise de prontuários de pacientes a questionários aplicados aos estudantes de Odontologia do último ano. Informações sobre os procedimentos restauradores nas UBS foram obtidas através de prontuários de pacientes e de questionários aplicados aos dentistas. O tipo de material restaurador utilizado nas Faculdade de Odontologia e nas UBS forma comparados através de teste Qui-quadrado. Resultados: Na UFRGS, 327 restaurações foram realizadas, sendo 78,28% RC e 21,72% AM; na ULBRA, 366 restaurações foram efetuadas, sendo 92,63% RC e 7,37% AM. Nas UBS, 1664 restaurações foram realizadas, sendo 35,93% RC e 64,07% AM. Uma maior proporção de restaurações de AM foram realizadas no Serviço Público de Saúde em comparação às Faculdades de Odontologia, nas quais restaurações com RC foram mais prevalentes (p=0.000). Conclusões: A mudança de AM para RC na escolha do material restaurador para dentes posteriores em Faculdades de Odontologia não foi seguida pelo Sistema Público de Saúde, onde o AM ainda é largamente utilizado.

Aim: To compare the restorative material used in the treatment of posterior teeth taught and performed in two Dental Schools (UFRGS and ULBRA) and in 8 basic health units (BHU) from the Public Health System in Porto Alegre, Brazil. Materials and methods: Data referring the teaching of restorative procedures using amalgam (AM) or resin (R) were obtained through the analysis of patient’s files and questionnaires applied to final year dental students. Information regarding restorative procedures at BHU was obtained through patient’s records and a questionnaire applied to the dentists. The type of restorative material used in both BHU and Dental Schools were compared by chi-square test. Results: At UFRGS, 327 restorations were performed, 78.28% R and 21.72% AM, and at ULBRA 366 restorations, 92.63% R and 7.37% AM. At BHU, 1664 restorations were performed (35.93% R and 64.07% AM). A major proportion of AM restorations was performed in the Public Health Service in comparison to both Dental Schools, in which resin restorations prevailed (p=0.000). Conclusion: The change from AM to R in the dental material choice for posterior teeth at Dental Schools was not followed by the Public Health System, where the AM is still widely used in posterior teeth.

Effect of different 1 percent chlorhexidine varnish regimens on biochemical composition of the dental biofilm / Efeito de diferentes posologias do verniz de clorexidina a 1 por cento na composição bioquímica do biofilme dentário

PURPOSE: This investigation evaluated in a randomized controlled study the effect of different 1 percent chlorhexidine varnish (1 percentCHX-V) regimens on biochemical composition of the dental biofilm. METHODS: Subjects with mutans streptococci > 10(5) CFU/mL saliva, were allocated into 4 groups: A - single 1 percent CHX-V application; B - 1 percent CHX-V was applied once daily on 3 consecutive days; C - 1 percent CHX-V was applied 3 times with an interval of 4 days between each application; and D - placebo varnish was applied once daily on 3 consecutive days. Dental biofilm samples were collected at baseline and 1, 4, and 8 weeks after the final varnish application and evaluated for inorganic phosphate and insoluble polysaccharide concentrations. RESULTS: No difference was observed between all groups during the different experimental periods in relation to biochemical composition. After 1 week, a significant increase was observed in inorganic phosphate concentration, returning to baseline values after 4 weeks. All groups showed a significant decrease in insoluble polysaccharide concentration for more than 8 weeks after treatment. CONCLUSION: Varnish application resulted in modification of the dental biofilm toward a less cariogenic one.

OBJETIVO: Este estudo avaliou o efeito de diferentes posologias do verniz de clorexidina a 1 por cento (V-CHX1 por cento) na composição bioquímica do biofilme dental. METODOLOGIA: Voluntários com níveis de Streptococcus mutans > 10(5) UFC/mL saliva, foram divididos em 4 grupos: A - uma única aplicação do V-CHX1 por cento; B - aplicações de 1x/dia do V-CHX1 por cento durante 3 dias consecutivos; C - 3 aplicações de 1x/dia do V-CHX1 por cento com intervalos de 4 dias entre elas; D - aplicações de 1x/dia do verniz placebo durante 3 dias consecutivos. Amostras de biofilme dental foram coletadas, no início e após 1, 4 e 8 semanas das aplicações dos vernizes, e analisadas quanto às concentrações de fosfato inorgânico (Pi) e polissacarídeos insolúveis (PI). RESULTADOS: Não foram observadas diferenças, em relação à composição bioquímica, entre os grupos durante os diferentes períodos experimentais. Foi observado, após 1 semana, um aumento significativo nas concentrações de Pi, retornando aos valores iniciais após 4 semanas. Todos os grupos apresentaram uma redução significativa na concentração de PI por mais de 8 semanas após os tratamentos. CONCLUSÃO: A aplicação do verniz resultou em uma modificação do biofilme dentário tornando-o menos cariogênico.

Effect of different frequencies of fluoride dentifrice and mouthrinse administration: an in situ study

The effect of a combination of topical fluoridation methods for inhibition of enamel demineralization in the face of a cariogenic challenge has not been clearly established. This in situ crossover study aimed to assess whether the addition of daily use of fluoride mouthrinse (FR) to that of fluoride dentifrice (FD) is equivalent to increasing the frequency of FD application in terms of the effect on enamel demineralization and fluoride content. Over 3 phases of 14 days each, 12 volunteers wore appliances containing enamel blocks exposed to a 20 percent sucrose solution 8 times/day. During each phase the blocks underwent one of the following treatments: 2x/day FD, 2x/day FD + 1x/day FR, and 3x/day FD. The blocks were assessed for hardness and fluoride content. Three x/day FD did not differ from 2x/day + 1x/day FR, however it enhanced demineralization protection when compared to 2x/day FD. All treatments produced an increase in enamel fluoride content compared to no treatment (sound blocks) (p < 0.05), but the differences between them were not significant. The results of this study suggest that the daily use of fluoride mouthrinse combined with that of fluoride dentifrice has similar effects on enamel demineralization and fluoride content when compared to increasing the frequency of fluoride dentifrice use.