A controlled study comparing salivary osmolality, caries experience and caries risk in patients with cerebral palsy

Cerebral palsy (CP) is a permanent neurological disorder accompanied by secondary musculoskeletal masticatory disorder, with repercussion on chewing and deglutition functions. In these conditions, the liquids ingestion is compromised resulting in salivary osmolality alteration. The objective of this study was to compare salivary osmolality, caries experience and caries risk between normoreactive individuals and patients with CP. The participants were 4-20 years old: 52 patients with CP treated at a reference rehabilitation centre (study group, SG), and 52 normoreactive individuals (control group, CG). Saliva was collected for five minutes using cotton rolls. Following centrifugation, salivary osmolality was determined by freezing point depression osmometry. Evaluations included caries experience (DMFT index), and caries risk based on a caries-risk assessment tool (CAT). Descriptive and inferential statistics (Chi square and Student t tests) were used to compare the groups. Receiver operating characteristic (ROC) analyses were performed and the area under the ROC curve (Az) was calculated. The level of significance was set at 5%. The groups were homogeneous for sex (p=0.843) and age (p=0.128). In the SG, spastic type CP was the most prevalent (80.8%), and patients showed significantly higher salivary osmolality values compared with the CG (p74 for the SG and >54 for the CG in the presence of dental caries. A significant correlation was verified between salivary osmolality and the DMFT index for the SG (p?0.05). Although patients with CP showed higher salivary osmolality values, higher caries experience and caries risk were not observed compared with normoreactive individuals

Optical magnification has no benefits on the detection of occlusal caries lesions in permanent molars using different visual scoring systems : an in vitro study

Some studies have addressed the influence of optical magnification on the detection of caries lesions using a visual scoring system. However, there is a lack of research related to the use of the CAST and ADA-CCS visual scoring systems. In addition, the reliability and accuracy of ADA-CCS index in permanent teeth were not studied yet. So, the aim of this study was to evaluate, in vitro, the influence of different levels of optical magnification on the detection of occlusal caries lesions in permanent molars using three visual scoring systems. One occlusal site per tooth was analyzed in 120 extracted permanent molars. Two trained examiners inspected the teeth using ICDAS (International Caries Detection and Assessment System), CAST (Caries Assessment Spectrum and Treatment), and ADA-CCS (American Dental Association-Caries Classification System) visual criteria, twice with each scoring system, with a one-week interval between examinations. The study was conducted in three phases: (A) without optical magnification, (B) using a binocular lens (3.5× magnification), and (C) using an operating microscope (16× magnification). Then, the teeth were sectioned longitudinally through the center of the selected site and the section with the more severe lesion was histological evaluated considering the D1 (lesions in enamel and dentin) and D3 (dentin lesions) thresholds. Kappa values for intra- and inter-examiner reproducibility were good to excellent for all systems. At the D1 threshold, sensitivity, accuracy, and area under the ROC curve were high for ICDAS and CAST in all phases. However, this was not the case for the ADA-CCS in phase C (0.05). The magnification does not improve the accuracy of the visual scoring systems in the detection of occlusal caries lesions in permanent molars

Protocol for Low-level laser therapy in traumatic ulcer after troncular anesthesia : case report in pediatric dentistry

The aim of this study was to report a protocol of use for low-level laser therapy (LLLT) in traumatic ulcer in the lower lip after inferior alveolar nerve block anesthesia (IANBA). A 3-year-old patient, male, undergoing treatment of carious lesions was submitted to an indirect pulp capping in tooth 74 under IANBA. The procedure was completed without intercurrences, but on next day, the child presented extensive traumatic ulcer in the left lower lip, with complaint of pain. Two sequential applications with LLLT were applied in punctual mode under pressure around the lesion. After 1 week, the mother reported significant improvement. After 30 days, the lesion was fully healed. In conclusion, LLLT promoted rapid analgesia and healing, being a good treatment alternative for traumatic ulcer after troncular anesthesia

Effects of treatments for drooling on caries risk in children and adolescents with cerebral palsy

Neuromuscular impairment makes individuals with cerebral palsy (CP) more prone to drooling. Among the treatment options, there are procedures that interfere with saliva production. It is imperative to evaluate the effect of the different modalities since the reduction in salivary flow rate/production may exacerbate the risk of dental caries. The aim of this study was to compare the effects of different treatments for drooling on caries risk and salivary parameters in children and adolescents with CP. A total of 142 children and adolescents with CP, aged 6 to 18 years, were assigned to groups based on the different treatments they had received for drooling: G1?anticholinergic drugs (n = 18), G2?botulinum toxin injection (n = 16), G3?salivary glands surgery (n = 16), G4?no treatment (n = 42), and G5?non-drooling subjects (n = 50). All participants were evaluated on the Simplified Oral Hygiene Index, and for the prevalence of dental caries (decayed, missing, and filled teeth index and white spot lesions). Unstimulated whole saliva was collected, and salivary flow rate and osmolality were measured. Chi-square, ANOVA and Poisson regression were calculated. Prevalence ratios and their respective 95 % confidence intervals were obtained. The significance level was fixed at 5%. No differences were found in the decayed, missing, and filled teeth index (p = 0.128) and Simplified Oral Hygiene Index (p = 0.674) among the different groups. G3 presented significantly higher percentages of WSL (p<0.001), lower values of salivary flow rate (p<0.001), and higher values of osmolality (p<0.001). The white spot lesion prevalence ratio was higher only for G3 (Prevalence ratio = 14.36; IC 95% = 4.64-44.40; p<0.001). Children and adolescents with CP who had received surgical treatment for drooling exhibited higher number of white spot lesions because of the reduced salivary flow rate and higher salivary osmolality

In vitro comparison of laser fluorescence performance with visual examination for detection of occlusal caries in permanent and primary molars

The aim of this study was to compare the performance of the DIAGNOdent 2095 with visual examination for occlusal caries detection in permanent and primary molars. The sample comprised 148 permanent human molars and 179 primary human molars. The samples were measured and visually examined three times by two examiners. After measurement, the teeth were histologically prepared and assessed for caries extension. Sensitivity, specificity, accuracy and area under the receiver operating characteristics (ROC) curve were calculated. Intra-class correlation (ICC), unweighted kappa and the Bland and Altman method were used to assess inter- and intra-examiner reproducibility. DIAGNOdent showed higher specificity and lower sensitivity than did visual examination. The ICC values indicated an excellent agreement between the examinations. Kappa values varied from good to excellent for DIAGNOdent but from poor to good for visual examination. In conclusion, the DIAGNOdent may be a useful adjunct to conventional methods for occlusal caries detection

Relationship between DIAGNOdent values and sealant penetration depth on occlusal fissures

The aim of this in vitro study was to evaluate the relationship between laser fluorescence values and sealant penetration depth on occlusal fissures. One hundred and sixty-six permanent molars were selected and divided into four groups, which were each treated using a different sealant (two clear and two opaque). The teeth were independently measured twice by two experienced dentists using two laser fluorescence devices-DIAGNOdent (LF and LFpen)-before and after sealing, and then thermoclycled. After measuring, the teeth were histologically prepared and assessed for caries extension. Digital photographs of the cut sealed sites were assessed, and the sealant penetration depth was measured. All 166 sites were measured by one of the examiners taking as limits the outer and inner surface of the sealant into the fissure. For each device (LF and LFpen) and each group, the difference between the values at baseline and after sealing was plotted against the sealant penetration depth and scatter plots were provided. It could be observed that most of the points were concentrated around the zero line, for both LF and LFpen in the four groups. In conclusion, there is no relation between changes in DIAGNOdent values and increasing of depth sealant penetration within the occlusal fissures

The influence of zero-value subtraction on the performance of two laser fluorescence devices for detecting occlusal caries in vitro

BACKGROUND: The aim of this study was to evaluate the influence of zero-value subtraction on the performance of two laser fluorescence (LF) devices developed to detect occlusal caries. METHODS: The authors selected 119 permanent molars. Two examiners assessed three areas (cuspal, middle and cervical) of both mesial and distal portions of the buccal surface and one occlusal site using an LF device and an LF pen. For each tooth, the authors subtracted the value measured in the cuspal, middle and cervical areas in the buccal surface from the value measured in the respective occlusal site. RESULTS: The authors observed differences among the readings for both devices in the cuspal, middle and cervical areas in the buccal surface as well as differences for both devices with and without the zero-value subtraction in the occlusal surface. When the authors did not perform the zero-value subtraction, they found statistically significant differences for sensitivity and accuracy for the LF device. When this was done with the LF pen, specificity increased and sensitivity decreased significantly. CONCLUSIONS: For the LF device, the zero-value subtraction decreased the sensitivity. For this reason, the authors concluded that clinicians can obtain measures with the LF device effectively without using zero-value subtraction. For the LF pen, however, the absence of the zero-value subtraction changed both the sensitivity and specificity, and so the authors concluded that clinicians should not eliminate this step from the procedure. CLINICAL IMPLICATIONS: When using the LF device, clinicians might not need to perform the zero-value subtraction; however, for the LF pen, clinicians should do so

Caries Experience and Salivary Parameters among Overweight Children and Adolescents

Obesity is a chronic disease characterized by excess body fat, which can lead to other health problems, including insulin resistance, non-alcoholic fatty liver disease, polycystic ovary syndrome, hypertension, dyslipidemia, sleep apnea, asthma, heart attack, stroke, atherosclerosis and metabolic syndrome. Currently, obesity and dental caries are major public health concerns and dietary habits are a very important common component of their etiological factors, showing some correlation with the sociodemographic characteristics of individuals presenting these diseases. In relation to caries experience, the literature suggests a correlation between obesity and dental caries in children and adolescents, in primary and/or permanent dentition, though divergent results exist regarding assessment based on the method recommended by the WHO (1997), i.e., restricted to carious lesions with cavitation. Some studies indicate greater prevalence of proximal carious lesions in obese adolescents compared with those with normal weight. Salivary changes, such as the concentrations of phosphate, sialic acid, proteins and immunoglobulins and in peroxidase activity could explain the increased probability of obese children presenting greater risk of dental caries. Thus, it is important to consider the contribution of salivary parameters in caries experience of overweight children and adolescents and the implementation of preventive measures in this population

The performance of conventional and fluorescence-based methods for occlusal caries detection: an in vivo study with histologic validation

The authors conducted an in vivo study to determine clinical cutoffs for a laser fluorescence (LF) device, an LF pen and a fluorescence camera (FC), as well as to evaluate the clinical performance of these methods and conventional methods in detecting occlusal caries in permanent teeth by using the histologic gold standard for total validation of the sample