Resin-modified glass-ionomer cement (RM-GIC) may provide greater caries preventive effect compared with composite resin, but high-quality studies are needed.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Caries-preventive effect of resin-modified glass-ionomer cement (RM-GIC) versus composite resin: a quantitative systematic review. Yengopal V, Mickenautsch S. Eur Arch Paediatr Dent 2011;12(1):5-14. REVIEWER: David G. Pendrys, DDS, PhD. PURPOSE/QUESTION: Does light-cured resin-modified glass-ionomer cement provide a better caries preventive effect as compared with composite resin? SOURCE OF FUNDING: Information not available. TYPE OF STUDY/DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 2: Limited-quality, patient-oriented evidence. STRENGTH OF RECOMMENDATION GRADE: Grade B: Inconsistent, limited-quality patient-oriented evidence.

The risk of enamel fluorosis and caries among Norwegian children: implications for Norway and the United States.

BACKGROUND: The authors investigated the associations between enamel fluorosis, caries and early fluoride use among Norwegian children who received fluoride supplementation under a protocol similar to the current U.S. protocol. METHODS: Two examiners whose techniques were calibrated examined randomly selected middle-school-aged children living in Bergen, Norway-where the water supply contains less than 0.10 milligrams of fluoride per liter-for both enamel fluorosis and caries by using the Fluorosis Risk Index and modified National Institute of Dental and Craniofacial Research criteria. The authors ascertained past fluoride exposure via a follow-up questionnaire mailed to parents. RESULTS: The questionnaire had an 88 percent response rate and 87 percent reliability. Adjusted analyses revealed a strong association between regular supplementation (given in the form of lozenges) and mild to moderate enamel fluorosis (odds ratio [OR], 6.85; P < .05), as well as fluorosis of lesser severity (OR, 3.07; P < .05). No children who had exclusively used only a pea-sized amount of toothpaste (0.1 percent fluoride) had mild to moderate fluorosis. The authors found a 40 percent reduction in caries risk associated with early use of pea-sized amounts of fluoridated toothpaste and a 46 percent reduction associated with regular use of fluoride supplement lozenges. CONCLUSIONS: These findings suggest that both risk of fluorosis development and caries-preventive benefit are associated with regular use of fluoride supplements, and caries prevention was associated with early use of a pea-sized amount of toothpaste. CLINICAL IMPLICATIONS: These findings underscore the need for clinicians to consider thoroughly-and discuss with a child's parent or guardian-both the benefit and the potential risk of fluorosis development associated with preventive fluoride agents before introducing them. Clinicians also should emphasize the proper use of such agents.

Use of the ART technique within the school setting can be a practical and effective method of treating caries among large populations of underserved children.

SUBJECTS: The study sample was composed of 197 children, mean age 12.560.6 years at baseline, attending 4 schools in Deyang City, Sichuan Province, China. They had a mean decayed, missing, or filled teeth (DMFT) score of 0.6, with a mean decayed teeth (DT) score of 0.4. At the 6-year follow-up, 117 children (59% of original cohort) remained in the study. KEY EXPOSURE/STUDY FACTOR: The primary study factor was caries treatment using atraumatic restorative treatment (ART) restorative therapy. A total of 294 ART restorations were placed by 5 local assistant dentists, who had received a short training course in the procedure. Seventy-eight percent were single-surface restorations not involving more than half of the surface (so-called "small" restorations); the remaining 22% involved either more than half of a single surface or extended onto more than one surface (so-called "large" restorations), including 5% that were class II restorations. MAIN OUTCOME MEASURE: The main outcome measure was failure of the ART restoration at 6 years. Failure included loss of the restoration (total or partial), replacement by another restoration, or the presence of either a gross defect or gross wear. Assessment using US Public Health Service criteria, including caries assessment, at 5 years was also reported. MAIN RESULTS: The principal findings were that 76% of small ART restorations and 59% of large restorations had not failed at 6 years. The large restorations were nearly 6 times more likely to fail as compared with the small (hazard ratio = 5.87, P <.05). Loss of the restoration was the principal reason for failure for both small and large restorations. Recurrent caries was specifically diagnosed at 5-year follow-up, and found to be present in around 6% of small restorations, with none of the larger restorations having been diagnosed as carious. CONCLUSIONS: The authors concluded that the 6-year survival of ART restorations in this study sample was high, with the likelihood of success related to restoration size. They further concluded that application of this treatment technique at school could be used to help address the needs of large populations of underserved children.

Caries patterns in the primary dentition: cluster analysis of a sample of 5169 Arizona children 5-59 months of age.

AIM: Cluster analysis was conducted on data from 5,169 United States (U.S.) Arizona children, age's 5-59-months with the goal of delineating patterns of caries in the primary dentition of pre-school children without a priori pattern definitions. METHODOLOGY: Cluster analyses were conducted using all data for children ages 0-4 years in aggregate: (1) for all subjects, and (2) for subjects without crowned restored teeth. Each of these two sets of analyses consisted of 8 differently specified cluster analyses as a validation procedure. RESULTS: The caries patterns identified from the clustering analysis are: (1) smooth surfaces (other than the maxillary incisor), (2) maxillary incisor, (3) occlusal surfaces of first molars, and (4) pit and fissure surfaces of second molars. CONCLUSION: The cluster analysis findings were consistent with results produced by multidimensional scaling. These cross-validated patterns may represent resulting disease conditions from different risks or the timing of various risk factor exposures. As such, the patterns may be useful case definitions for caries risk factor investigations in children under 60 months of age.

Osteonecrosis of the jaws and bisphosphonates.

Osteonecrosis of the jaws associated with bisphosphonate therapy was first identified in 2003 as a condition typified by exposed bone that does not heal after 8 weeks. Other signs and symptoms, such as pain and infection, may or may not be present. There is a strong need for consensus on a case definition for this condition. This condition has occurred primarily among cancer patients treated with the aminobisphosphonates zoledronic acid and pamidronate. The etiology of this condition remains unknown; however, oral disease and trauma appear to be important risk factors. This condition appears to be rare in metabolic bone disease and Paget's disease, with an estimated prevalence of approximately 1 per 100,000 person-years. Thus, the benefits of bisphosphonate therapy appear to outweigh the risks. Recommendations have been established for the oral health management of patients with a history of bisphosphonate therapy.

Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research.

UNLABELLED: ONJ has been increasingly suspected to be a potential complication of bisphosphonate therapy in recent years. Thus, the ASBMR leadership appointed a multidisciplinary task force to address key questions related to case definition, epidemiology, risk factors, diagnostic imaging, clinical management, and future areas for research related to the disorder. This report summarizes the findings and recommendations of the task force. INTRODUCTION: The increasing recognition that use of bisphosphonates may be associated with osteonecrosis of the jaw (ONJ) led the leadership of the American Society for Bone and Mineral Research (ASBMR) to appoint a task force to address a number of key questions related to this disorder. MATERIALS AND METHODS: A multidisciplinary expert group reviewed all pertinent published data on bisphosphonate-associated ONJ. Food and Drug Administration drug adverse event reports were also reviewed. RESULTS AND CONCLUSIONS: A case definition was developed so that subsequent studies could report on the same condition. The task force defined ONJ as the presence of exposed bone in the maxillofacial region that did not heal within 8 wk after identification by a health care provider. Based on review of both published and unpublished data, the risk of ONJ associated with oral bisphosphonate therapy for osteoporosis seems to be low, estimated between 1 in 10,000 and <1 in 100,000 patient-treatment years. However, the task force recognized that information on incidence of ONJ is rapidly evolving and that the true incidence may be higher. The risk of ONJ in patients with cancer treated with high doses of intravenous bisphosphonates is clearly higher, in the range of 1-10 per 100 patients (depending on duration of therapy). In the future, improved diagnostic imaging modalities, such as optical coherence tomography or MRI combined with contrast agents and the manipulation of image planes, may identify patients at preclinical or early stages of the disease. Management is largely supportive. A research agenda aimed at filling the considerable gaps in knowledge regarding this disorder was also outlined.

Associations of ethnicity/race and socioeconomic status with early childhood caries patterns.

OBJECTIVES: The purpose of this project was to evaluate ethnicity/race, household income and caregiver education level as predictors of (1) any early childhood caries, and (2) each of four proposed patterns of primary dentition caries. METHODS: Between February 1994 and September 1995, five examiners visually examined Arizona pre-school children ages 5-59 months old. Self-reported demographic information including family income, caregiver education level and ethnicity/race were obtained at the time of examination. Multivariate analyses were conducted to assess the association of income, education and ethnicity/race with a child having any caries and with each of the proposed caries patterns seen in 3850 examinations. RESULTS: Income and education were inversely associated with: (1) any early childhood caries, and (2) the maxillary incisor caries pattern. A positive association between these caries patterns and minority ethnicity/race status was also identified. Three additional caries intraoral patterns demonstrated more varied associations with socioeconomic status (SES), ethnicity/race and income and education. CONCLUSIONS: This study supports the association of both ethnicity/race and social status with any early childhood caries. The patterns of caries were each found to be associated with specific and different socioeconomic-demographic indicators. The practical importance of these findings is that global measurement of ECC, without regard to specific caries pattern, leads to the potential for substantial non-differential misclassification of disease. The consequence of this is the potential for important ECC-SES-ethnicity/race associations to be masked. This, in turn, decreases the ability of surveys and investigations to accurately identify sub-groups of the population at greatest risk of developing ECC.

Historical evolution of primary dentition caries pattern definitions.

A variety of dental caries patterns encompassing differing teeth have been proposed, and their use may have utility in Early Childhood Caries (ECC) investigations by minimizing case misclassification. Recent reports have proposed multiple pattern schemes. The purpose of this paper was to review the historical evolution of ECC patterns to assist the clinician and researcher in understanding the strengths and limitations of contemporary caries pattern definition(s).

Median ages of eruption of the primary teeth in white and Hispanic children from Arizona.

PURPOSE: The purpose of this project was to establish median eruption ages of primary teeth and evaluate eruption differences between contralateral teeth by gender, ethnicity, and household income. Data was derived from a caries study of preschool children. METHODS: A total of 4,277 white (non-Hispanic) and Hispanic preschool children from Arizona were visually examined for caries and tooth eruption status by 5 examiners between February 1994 and September 1995. Analyses of eruption status were conducted using logistic regression to produce an eruption probability distribution from which median eruption ages for the primary teeth were determined. Possible differences in eruption timing between contralateral teeth by gender, ethnicity, and household income were examined. RESULTS: Eruption status of 1 tooth was significantly predictive of the pair-matched tooth for all pairs. Differences were found for the maxillary central incisor (gender) and the mandibular second molar (ethnicity). Eruption ages did not vary by household income. Median eruption ages for each of the 10 primary teeth are presented. CONCLUSIONS: This study provides contemporary median eruption ages for primary teeth.

Classification of dental caries patterns in the primary dentition: a multidimensional scaling analysis.

OBJECTIVE: Clinical patterns of early childhood caries (ECC) encompassing specific teeth or surfaces have been previously proposed on an a priori basis and have been used as case definitions. The underlying assumption is that the patterns result from different host response and environmental conditions. Identifying caries patterns has utility in refining case definitions of ECC. Well-defined caries patterns should enhance the ability of an analysis to identify meaningful associations between suspected risk factors and ECC. The purpose of this project was to identify patterns of caries in the dentition of preschool children using multidimensional scaling without a priori pattern delineation. METHODS: Between February 1994 and September 1995, five examiners visually examined 5171 Arizona preschool children aged 5-59 months old. Multidimensional scaling (MDS) was used as a classification/taxonomy technique to identify any underlying structure of the caries data. MDS provided a classification scheme for individual tooth surfaces based on the dissimilarity measures of squared Euclidean distance and of variance using an alscal analysis. Both two- and three-dimensional solutions were pursued; s-stress, stress, R-square and residual patterns were assessed in determining the best dimensional model, with the resulting quadrant positions of the tooth surfaces suggesting potential caries patterns. RESULTS: All models demonstrated excellent fit. Two- and three-dimensional solutions suggested four caries patterns: (i) any maxillary incisor surfaces, (ii) first molar occlusal surfaces, (iii) second molar pit and fissure surfaces, and (iv) any smooth surfaces, excluding the maxillary incisor surfaces. CONCLUSIONS: This is the first delineation of primary dentition caries patterns produced by a classification analysis without a priori pattern definitions. The identified caries patterns may arise from specific risk factors and/or be a function of the timing of various risk factor exposures. Use of these patterns as case definitions should enhance the ability to identify associations between suspected risk factors and ECC.