Comparison of the Detection of Early Occlusal Caries in Extracted Human Permanent Molar Teeth by Electrical Conductance and Biopsy Means.

OBJECTIVES: An in vitro study was performed to detect occlusal caries lesions of extracted permanent human molars by electrical conductance measurement with the Ortek ECD™ electronic device, and each tooth was sectioned and biopsied to validate and evaluate results. METHODS: Thirty-nine permanent molars were extracted. Thirteen were freshly erupted and had little opportunity to develop lesions. Twenty-six were in the mouth longer and likely to be carious. After extraction and storage in a mild disinfectant, each tooth was thoroughly rinsed with distilled water and positioned upright to enable its electrical conductance measurement. Electrical conductance was measured in pits and fissures of carious and non-carious permanent molars with an Ortek ECD. Crowns were sectioned horizontally producing 630 µm thick slices and examined individually for demineralization by light microscopy and photography. Tooth biopsy was analyzed to ascertain the degree of tooth demineralization. RESULTS: Visual examination by light microscopy and photography of the sections of non-carious and carious teeth were analyzed. Noncarious teeth showed no mineral loss and showed an electrical conductance score of 0.0 µA. In carious teeth, this score ranged from 0.3 to 3.0. A significant (p < 0.001) correlation coefficient (r) of 0.914 was obtained. Electrical conductance versus biopsy resulted in high values for sensitivity (100%) and specificity (93%). It showed a positive predictive value (PPV) of 96% and a negative predictive value (NPV) of 100% for electrical conductance versus biopsy. CONCLUSIONS: Subject to in vivo clinical support, the Ortek ECD is likely to prove to be the best method for detection and evaluation of early occlusal caries.

Dental caries experience in school children and the impact of non-cavitated lesions on the caries index.

UNLABELLED: The purpose of this study was to evaluate the current status of dental caries in 11 to 13 year-old schoolchildren residing in Sucre Municipality, Miranda State, and the impact of the non-cavitated lesion on the caries index. Twelve elementary schools were included in this study and a sample of 1484 children was examined using artificial light, a #5 mirror and a #23 probe. The criteria followed were those proposed by Radike (1972) as modified by Acevedo et al. (2005) in order to include initial non-cavitated caries lesions. Teeth were cleaned and dried for 5 seconds with a triple syringe. Caries prevalence was 94.07% and the average DMFS index for the total sample was 4.35 +/- 4.21. This increased significantly to 6.45 +/- 5.01, when the initial caries lesions were included (p < 0.05). According to gender, DMFS was higher in the female population (4.51 +/- 4.45) than in males (4.21 +/- 3.97), but the difference was not statistically different (p > 0.05). The same pattern was observed, when the initial caries lesions were added. The new mean DMFS was 6.67 +/- 5.15 and 6.26 +/- 4.88 for females and males, respectively. Non-cavitated lesions represent 33% of the total caries lesions recorded. CONCLUSION: These results show that (i) dental caries prevalence in this population remains high and (ii) initial lesions contribute significantly to the DMFS index.

Dental caries experience in schoolchildren and the impact of non-cavitated lesions on the caries index

El objetivo de este artículo fue evaluar la experiencia de caries en escolares de 11 a 13 años de edad del Municipio Sucre y el impacto de las lesiones no cavitadas en el índice de caries. Seseleccionó una muestra a conveniencia de 12 escuelas ubicadas en el Municipio Sucre, Estado Miranda, Venezuela. Previo consentimiento informado, se examinaron 1484 niños utilizandoluz artificial, espejo #5 y explorador #23; siguiendo los criterios propuestos por Radike (1972), modificados por Acevedo et al (2005). La detección de las lesiones iniciales se realizó previaprofilaxis y secado del diente durante 5 segundos (con jeringa triple). Resultados: La prevalencia de caries fue de 94,07 por ciento y el índice CPOS promedio fue de 4,35±4,21 aumentandosignificativamente a 6,45±5,01 cuando se incorporaron las lesiones iníciales (p<0,05). De acuerdo al género, seobservó un CPOS mayor en las niñas (4,51±4,45) al compararlo con los varones (4,21±3,97), sin diferencia estadísticamente significativa (p>0,05). El mismo patrón se observó cuando seincorporaron las lesiones iníciales al CPOS, 6,67±5,15 para niñas y 6,26±4,88 para varones. Las lesiones no cavitadas representaron el 33 por ciento del total de lesiones cariosas. Conclusión: Los resultados indican una alta prevalencia de caries en lapoblación estudiada, así como la importancia de incluir las lesiones no cavitadas al índice CPOS.

Dental caries experience in school children and the impact of non-cavitated lesions on the caries index. / Dental caries experience in school children and the impact of non-cavitated lesions on the caries index.

UNLABELLED: The purpose of this study was to evaluate the current status of dental caries in 11 to 13 year-old schoolchildren residing in Sucre Municipality, Miranda State, and the impact of the non-cavitated lesion on the caries index. Twelve elementary schools were included in this study and a sample of 1484 children was examined using artificial light, a #5 mirror and a #23 probe. The criteria followed were those proposed by Radike (1972) as modified by Acevedo et al. (2005) in order to include initial non-cavitated caries lesions. Teeth were cleaned and dried for 5 seconds with a triple syringe. Caries prevalence was 94.07

and the average DMFS index for the total sample was 4.35 +/- 4.21. This increased significantly to 6.45 +/- 5.01, when the initial caries lesions were included (p < 0.05). According to gender, DMFS was higher in the female population (4.51 +/- 4.45) than in males (4.21 +/- 3.97), but the difference was not statistically different (p > 0.05). The same pattern was observed, when the initial caries lesions were added. The new mean DMFS was 6.67 +/- 5.15 and 6.26 +/- 4.88 for females and males, respectively. Non-cavitated lesions represent 33

of the total caries lesions recorded. CONCLUSION: These results show that (i) dental caries prevalence in this population remains high and (ii) initial lesions contribute significantly to the DMFS index.

Dental caries experience in schoolchildren and the impact of non-cavitated lesions on the caries index

El objetivo de este artículo fue evaluar la experiencia de caries en escolares de 11 a 13 años de edad del Municipio Sucre y el impacto de las lesiones no cavitadas en el índice de caries. Seseleccionó una muestra a conveniencia de 12 escuelas ubicadas en el Municipio Sucre, Estado Miranda, Venezuela. Previo consentimiento informado, se examinaron 1484 niños utilizandoluz artificial, espejo #5 y explorador #23; siguiendo los criterios propuestos por Radike (1972), modificados por Acevedo et al (2005). La detección de las lesiones iniciales se realizó previaprofilaxis y secado del diente durante 5 segundos (con jeringa triple). Resultados: La prevalencia de caries fue de 94,07 por ciento y el índice CPOS promedio fue de 4,35±4,21 aumentandosignificativamente a 6,45±5,01 cuando se incorporaron las lesiones iníciales (p<0,05). De acuerdo al género, seobservó un CPOS mayor en las niñas (4,51±4,45) al compararlo con los varones (4,21±3,97), sin diferencia estadísticamente significativa (p>0,05). El mismo patrón se observó cuando seincorporaron las lesiones iníciales al CPOS, 6,67±5,15 para niñas y 6,26±4,88 para varones. Las lesiones no cavitadas representaron el 33 por ciento del total de lesiones cariosas. Conclusión: Los resultados indican una alta prevalencia de caries en lapoblación estudiada, así como la importancia de incluir las lesiones no cavitadas al índice CPOS.(AU)

Relationship of temporomandibular disorders to muscle tension-type headaches and a neuromuscular orthosis approach to treatment.

A prominent etiological theory proposed for TMD related headache is that it results from a dysfunctional masticatory muscle system, wherein muscle hyperactivity is frequently caused by dental temporomandibular disharmony. The central goal of this article was to determine from a literature review of the subject whether there is significant evidence to support a relationship between headaches and TMD prevalence. A second purpose was to determine from such a review whether any relationship was one of cause and effect and whether treatment of the TMD condition can result in meaningful reduction or resolution of headaches. In the literature, there was a substantial amount of evidence for a positive relationship between TMD and the prevalence of headaches, and most importantly, that these were the muscle tension-type. Evidence for a cause and effect relationship was strong. It generally showed in numerous patients that TMD treatment of a large number of patients resulted in significant improvement in the physiological state of the masticatory system (muscles, joints and dental occlusion). Reduction or resolution of muscle tension-type headaches that were present was clinically significant. The authors concluded that TMD should be considered and explored as a possible causative factor when attempts are made to determine and resolve the cause of headaches in patients with this affliction. A benefit of resolving headaches at an early stage in their development is that it might result in the reduction of its potential for progression to a chronic and possibly migraine headache condition.

Clinical evaluation of the ability of CaviStat in a mint confection to inhibit the development of dental caries in children.

OBJECTIVE: The aim of the present study was to determine if a sugarless mint containing CaviStat (an arginine bicarbonate calcium carbonate complex) is capable of preventing the development of dental caries in the primary molars and first permanent molars of 10 1/2- to 11-year-old Venezuelan children. METHODS: Two-hundred children were entered into this one-year study who showed the following: (i) age between 10 1/2 and 11 years; (ii) first and second primary molars still present; (iii) sound primary molars or early caries lesions in any of these teeth; and (iv) at least some caries in the primary or permanent teeth as evidence of caries activity. Out of the 200 children initially selected, 195 finished and provided complete data. Children entered into the study were examined and then randomly divided into two groups (A and B), with distribution performed on the basis of the DMFS levels of the first permanent molars. All subjects were examined visually by a single examiner using good artificial light, mirror, and probe. Group A received a sugarless confection containing CaviStat (BasicMints); Group B received a sugarless mint control that contained all ingredients except for the CaviStat. Packaging and appearance of both types of mints were identical, except for their A and B designations. RESULTS: Mean differences in DMFS, defs, and DMFS + defs scores between Groups A and B were determined. In the first permanent molars and some early erupting premolars and second molars, the data showed 75.6% fewer caries in Group A than in Group B children after six months, and 50.7% fewer after 12 months. Corresponding defs scores showed reduced development of dental caries in deciduous molars of 76.7% after six months and 131.3% after 12 months. Combined DMFS and defs scores showed 76.2 and 74.8% fewer caries lesions at six and 12 months, respectively. As exfoliation of primary molars occurred during the study period (approximately equal in the two groups), a proportion correction was made to allow for caries score reductions due to lesions lost because of such exfoliation. When this was done, the results at the end of the study still showed larger caries reductions in Group A than in the Group B subjects, and statistical analyses showed these differences were still highly significant (p < 0.001). Noncavitated caries lesions in the first permanent molars were also determined. These showed once again less caries development in Group A than in Group B subjects, and did so at both six and twelve months (57.0 and 52.4%, respectively). Levels of statistical significance at these times were p = 0.013 and 0.005. CONCLUSION: It was evident from this clinical trial that mint confections containing CaviStat are able to inhibit both caries onset and caries progression. As a result, one can conclude that CaviStat mint confection technology is a simple and economical means for reducing substantially one of the most prevalent diseases in these children.

Establishment of a temporomandibular physiological state with neuromuscular orthosis treatment affects reduction of TMD symptoms in 313 patients.

The objective of this investigation was to test the hypothesis that alteration of the occlusions of patients suffering from temporomandibular disorders (TMD) to one that is neuromuscularly, rather than anatomically based, would result in reduction or resolution of symptoms that characterize the TMD condition. This hypothesis was proven correct in the present study, where 313 patients with TMD symptoms were examined for neuromuscular dysfunction, using several electronic instruments before and after treatment intervention. Such instrumentation enabled electromyographic (EMG) measurement of the activities of the masticatory muscles during rest and in function, tracking and assessment of various movements of the mandible, and listening for noises made by the TMJ during movement of the mandible. Ultra low frequency and low amplitude, transcutaneous electrical neural stimulation (TENS) of the mandibular division of the trigeminal nerve (V) was used to relax the masticatory muscles and to facilitate location of a physiological rest position for the mandible. TENS also made it possible to select positions of the mandible that were most relaxed above and anterior to the rest position when the mandible was moved in an arc that began at rest position. Once identified, the neuromuscular occlusal position was recorded in the form of a bite registration, which was subsequently used to fabricate a removable mandibular orthotic appliance that could be worn continuously by the patient. Such a device facilitated retention and stabilization of the mandible in its new-found physiological position, which was confirmed by follow up testing. Three months of full-time appliance usage showed that the new therapeutic positions achieved remained intact and were associated with improved resting and functioning activities of the masticatory muscles. Patients reported overwhelming symptom relief, including reduction of headaches and other pain symptoms. Experts consider relief of symptoms as the gold standard for assessment of effectiveness of TMD treatment. It is evident that this outcome has been achieved in this study and that taking patients from a less to a more physiological state is an effective means for reducing or eliminating TMD symptoms, especially those related to pain, most notably, headaches.

Examination of a large patient population for the presence of symptoms and signs of temporomandibular disorders.

Temporomandibular Disorder (TMD) is a term generally applied to a condition or conditions characterized by pain and/or dysfunction of the masticatory apparatus. Its characterization has been difficult because of the large number of symptoms and signs attributed to this disorder and to variation in the number and types manifested in any particular patient. For this study, data on 4,528 patients, presenting over a period of 25 years to a single examiner for TMD treatment, was made available for retrospective analysis and determination of whether the TMD care-seeking patient can be profiled, particularly pain difficulties. All patients in this database filled out a questionnaire and were examined for the prevalence of a range of symptoms and clinical examination findings (signs) commonly attributed to TMD. There was no attempt in this study to assign patients to TMD diagnostic subcategories. The data collected were analyzed to determine which of these symptoms and signs were sufficiently "characteristic of the TMD condition" that they might be used in diagnosis, research and treatment, especially in patients needing relief from pain and discomfort. All 4,528 patients reported symptoms and all but 190 of them also showed signs upon examination. Symptoms most commonly reported on the questionnaire included (i) pain (96.1%), (ii) headache (79.3%), (iii) temporomandibular joint discomfort or dysfunction (75.0%) and (iv) ear discomfort or dysfunction (82.4%). In the 4,338 patients who showed signs, the most prevalent was tenderness to palpation of the pterygoid muscles (85.1%), followed by tenderness to palpation of the temporomandibular joints (62.4%). Pain symptoms and signs were often accompanied by compromised mandibular movements, TMJ sounds and dental changes, such as incisal edge wear and excessive overbite. Clearly prevalence of pain disclosed by the symptoms and signs examinations was high. Patients showed variable prevalence and nonprevalence of eight categories of painful symptoms and seven categories of painful signs. Despite the variability, these might be developed in the future into TMD scores or indices for studying and unraveling the TMD conundrum.

Examination of three different methods of dental caries scoring during eruption of the premolar and second molar teeth in 10- to 13-year-old children using cross-sectional data.

OBJECTIVE: Premolars and second permanent molars mainly erupt in children between 10 and 13 years of age. This age range provides a relatively large number of caries-free or near caries-free tooth surfaces at a baseline measurement that can become carious during such trials. Since traditional DMFS scoring does not take the addition of new surfaces into account, the aim of this study was to compare that scoring system to two methods where sound surfaces are included in the scoring. METHODOLOGY: The comparison was done in a cross-sectional caries prevalence study so that caries progression and tooth eruptions (as occurs in a longitudinal investigation) would not confound the methods assessments. A total of 729 children between 10 and 13 years of age were recruited from four public schools in Venezuela and assigned to age groups 10, 11, 12, and 13. Decayed, missing, and filled surfaces (DMFS) of their respective premolar and second molar teeth were scored by one calibrated examiner (CM) using a mirror and probe and the criteria reported by Radike, but with one major modification; that was, avoidance of any forceful probing of suspected non-cavitated pits and fissures for caries lesions. In each subject, traditional DMFS were determined in which sound surfaces were not considered. These scores were compared to the scoring of DMFS plus sound surfaces (DMFSS) as described by Katz, et al. and Huntington. RESULTS: Mean traditional DMFS scores (+/- SEM) obtained for the permanent premolars and second molars of 10-, 11-, 12-, and 13-year-old children were 3.06 +/- 0.27, 3.32 +/- 0.27, 3.44 +/- 0.27, and 5.69 +/- 0.37, respectively. A large difference in these scores was observed between the 12- and 13-year-old children, in contrast to smaller differences between the 10- and 11-, and the 11- and 12-year-olds. Eruption of premolar and second molar teeth examined at the same time showed per cent eruptions as follows: 27.2% at age 10; 60.8% at age 11; 84.9% at age 12; and 95.5% by age 13. Most eruption was observed in the 10- to 12-year-olds, in contrast to the largest DMFS differences appearing between children 12 and 13 years of age. Looked at longitudinally, the incongruence of prior eruption and resulting caries reaching detection levels was about one to two years. All three methods of scoring showed the sharp increment in their respective caries scores between ages 12 and 13, whereas smaller and directionally opposite score changes occurred between years 11 and 12. With the Katz, et al. and Huntington DMFSS methods, the scores between 11 and 12 years decreased, whereas traditional DMFS scoring showed an increase. Although these differences were not large, the pattern of traditional DMFS scoring differed significantly from the other two methods (p < 0.001). CONCLUSION: Traditional DMFS scoring in children between 10 and 13 years of age will not detect the new surfaces, and the resulting extra caries increments that would arise in a clinical trial. With the Katz, et al. or Huntington scoring methods, where these new surfaces are counted, adjustment is made for any such caries rate error. In caries remineralization studies, this could be of significance.

The inhibitory effect of an arginine bicarbonate/calcium carbonate CaviStat-containing dentifrice on the development of dental caries in Venezuelan school children.

OBJECTIVE: This study assessed the effect of an arginine bicarbonate/calcium carbonate (CaviStat)-containing dentifrice on caries development, mainly in 11- to 12-year-old Venezuelan children over a two-year period. METHODOLOGY: Children (726) with a DMFT between 3 and 6 were examined at baseline, six months, and one and two years using a mirror, probe, and DMFS scoring. Subjects who completed the study consisted of two groups; 304 test and 297 control. The test group received a CaviStat-containing dentifrice, and the controls used a commercially available 1100 ppm fluoride toothpaste. All subjects were instructed to brush three times a day for 1 minute followed by swishing for 30 seconds. RESULTS: After six months, the mean DMFS scores increased only slightly from baseline in both groups, 6.93 +/- 0.22 in the control and 6.59 +/- 0.22 in the test subjects. After one year, the mean DMFS score in the control group rose to 8.00 +/- 0.24 and leveled off at 7.92 +/- 0.30 at two years. In contrast, the mean DMFS score in the test group decreased to 5.50 +/- 0.24 after one year before rising to 6.99 +/- 0.28 at two years. DMFS difference between the two groups was highly significant (p < 0.001), but mainly due to the large difference seen at one year. Dissection of the data showed that the erupted first molars dominated the overall DMFS changes. At the beginning of this study, first molar scores started at high values and showed a pattern thereafter like that seen for the total data. In contrast, premolars/molars, which erupt 4-6 years later (and at the start of the study had a mean DMFS score slightly above zero), showed a clear rise in the DMFS score in the control group during the first year of the study, which continued to rise until the end of the investigation. In contrast, the CaviStat group showed no change in the premolar/second molar DMFS score from baseline during the first year (giving the impression of 100% inhibition at one year), but showed a delayed rise thereafter that paralleled that seen in the controls between one and two years (58.3% inhibition at two years). Reversal of the development of early dental caries lesions in the CaviStat subjects and limitations of the diagnosis of very early caries lesions with standard dental explorers was suggested for the interesting first molar, first year data. Inhibition of caries initiation and caries progression in the CaviStat group was also observed and easier to see in the premolar/second molar, second year data where the DMFS scores were very low at baseline and reversals are not a significant issue. The results were subjected to statistical analysis including analysis of covariance. Largely because of the first year and first molar data, the difference between control and experimental groups was highly significant (p < 0.001). Similar comparison with the later-erupting premolar/molar teeth showed the CaviStat effect was also significant but at a lower level (p < 0.05). The differences could not be due to examiner error since the Kappa for 10% of the subjects randomly selected and re-examined was 0.898 overall and 0.914 for the first molar data. The data also suggested CaviStat inhibition of caries progression because of a slower rate of rise of missing+filled teeth in the CaviStat vs. the control group (p < 0.05). CONCLUSION: A CaviStat-containing toothpaste was more effective both clinically and statistically in inhibiting caries initiation and progression than the fluoride toothpaste control, and manifested its effects differently in the already-erupted first molars than in the later-erupting premolars and second molars.

Use of a novel group of oral malodor measurements to evaluate an anti-oral malodor mouthrinse (TriOralTM) in humans.

OBJECTIVE: This study compared the ability of a test mouthwash containing zinc chloride and sodium chlorite (TriOral) to reduce intrinsic oral malodor, to that of two other mouthrinses, one with zinc chloride only and the other with no zinc chloride/no sodium chlorite, using a novel group of oral malodor parameter measurements. METHODOLOGY: Forty-eight subjects completed the study; 16 in the test group, 17 in the zinc only group, and 15 in the no zinc chloride/ no sodium chlorite group. At baseline and after two and four weeks, parameters assessed were 1) malodorants in the headspace of and in solution in resting whole saliva determined organoleptically, 2) breath volatile sulfur compounds (VSC) measured with a sulfide monitor (Halimeter), 3) fresh and incubated saliva oxidation-reduction potential (E(h)) measured with a platinum electrode, and 4) level of saliva indolic compounds (IC), indole and skatole, determined colorimetrically with Kovac's reagent. The VSC, E(h), and IC data for the three mouthrinses were analyzed statistically by repeated measures ANOVA between groups, and by 2-way ANOVA within groups. Corresponding organoleptic data were analyzed by Kruskal-Wallis and Friedman non-parametric tests. RESULTS: Organoleptic, VSC, and E(h) evaluations clearly showed the zinc chloride/sodium chlorite test mouthrinse to be more effective than the other two rinses. In all cases, the level of significance was p < 0.001 between the test mouthrinse and its no zinc chloride/no sodium chlorite control; between test mouthrinse and the zinc chloride only product, significance was p < 0.05, < 0.001 and < 0.01 for the organoleptic, VSC, and E(h) tests, respectively. Noteworthy was the observation that the mean organoleptic saliva headspace score with the test mouthrinse was reduced to zero, and VSC levels fell below 50 ppb S by the end of the study, a level where the breath is usually non-odorous. The test mouthwash also appeared more effective in reducing the salivary IC levels, but the results did not reach significance at p < 0.05 unless IC levels were amplified in the saliva by incubation overnight at 37 degrees C. Correlations between the various procedures were highly significant, achieving in almost all cases a probability level of p < 0.001. CONCLUSION: The results supported the conclusion that the zinc chloride plus sodium chlorite mouthrinse (TriOral) is more effective in reducing oral malodor than a zinc chloride alone mouthrinse, and even more effective than its no zinc chloride/no sodium chlorite mouthrinse control. The methods used in this study were consistent with one another, and highly effective in measuring various parameters that characterize oral malodor.