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Development of multi-species consortia biofilms of oral bacteria as an enamel and root caries model system.

The aim was to establish defined-species consortium plaque biofilms to investigate enamel and root caries in an artificial mouth. Strains of the putative enamel and root caries pathogens, Streptococcus mutans, Strep. sobrinus, Actinomyces naeslundii and Lactobacillus rhamnosus, were screened in batch culture for potential cariogenic properties: a low terminal pH, ability to aggregate, and catabolic diversity. The strains selected were grown as monoculture biofilms and as consortium plaque biofilms in a multiplaque artificial mouth. The biofilms were supplied with a constant flow of a simulated oral fluid and were given periodic sucrose (and in some instances glucose) to simulate meals. All the bacteria except L. rhamnosus formed large, monospecies biofilms with resting pH in the range 5.3-5.8. The consortia biofilms were larger and had a resting pH of 4.9-5.3. The consortia biofilms supplied with 8-hourly carbohydrate comprised mainly 'mutans' streptococci (58, SD 5.5%) and L. rhamnosus (42, SD 5.7%). A. naeslundii characteristically was absent or present in a low percentage (up to 4% colony-forming units). All biofilms demineralized polished bovine enamel and dentine blocks, as assessed by microradiography and enamel-surface microhardness measurement. The consortia also demineralized intact enamel and tooth roots; they were more cariogenic to enamel than any of the monoculture biofilms, as measured by enamel-surface softening, but variation in lesion depth was proportional to biofilm wet weight irrespective of acidogen composition (r = 0.93, p < 0.05). Enamel lesions had a well-mineralized intact surface and a zone of subsurface demineralization, typical of early natural lesions. Dentine and root lesions showed extensive demineralization but lacked a pronounced surface mineralized zone. Substitution of glucose for sucrose had no effect on the cariogenicity of the consortium to bovine enamel or human roots and had no major effect on the plaque composition. Continuously supplied fluoride (19 parts/10(6)) resulted in a substantially reduced enamel surface softening and subsurface demineralization of intact roots. It was concluded that consortia biofilms of selected caries pathogens generate realistic caries lesions in all tooth hard tissues under controlled growth conditions in the artificial mouth. This in vitro caries experimental model may prove useful for the study of interrelations between the plaque biofilm, tooth tissues and the oral environment, and for the development of procedures to modify the course of caries development.

Actinomyces↗

Prevention of root caries with dentin adhesives.

This in vitro investigation determined the feasibility of using dentin adhesives to protect root surfaces against caries. The roots of 22 recently extracted human teeth were all painted with a protective lacquer leaving two unprotected small windows. On each specimen, one window (control) was left untreated and the other window (experimental) was treated using a dentin adhesive (Scotchbond Multi-Purpose). The roots were then immersed in an in vitro acetate/calcium/phosphate demineralization model at pH 4.3. After 70 days, the samples were removed and sectioned through the windows. The undecalcified ground sections were examined under transmitted and polarized light. Lesions characteristic of natural root caries were seen in the untreated control windows. No such lesions were apparent in the experimental windows. The results of this preliminary study suggest that dentin adhesives may provide protection against root caries.

Dentin-Bonding Agents↗

Root caries in Scandinavia in the 1980's and future trends to be expected in dental caries experience in adults.

The large variety of diagnostic criteria used adds some uncertainty to comparisons of recent clinical and epidemiological data on root caries in Scandinavia. Nevertheless, it is apparent that the prevalence of frank carious cavities on the root among 60(+)-year-olds is about 30-40%. When inactive and recurrent lesions and fillings are included, the prevalence is almost 100% in 60(+)-year-olds. At this age, the mean number of root surface fillings is about 7, and the mean number of active caries lesions ranges from 0.9 to 3.4. The degree of gingival recession does not appear to be a direct measure of root caries risk in a population. When the number of teeth at risk is accounted for, the age-dependent increase in prevalence of root caries is very weak. Therefore, comparisons of root caries prevalence between populations are meaningful only when information on number of teeth present and teeth at risk is also available. Recent studies from various parts of the world have demonstrated that caries is ubiquitous in all populations and that caries progression continues throughout life. The impact of this on trends in prevalence and incidence of dental caries in adults is discussed in the light of what is known about the natural history of dental caries.

Adolescent↗

Relationship among stimulated whole, glandular salivary flow rates, and root caries prevalence in an elderly population: a preliminary study.

A comparison of salivary flow rates was made between two groups of healthy, unmedicated, elderly, Caucasian men and women ranging in age from 60 to 90 years. One group was a control group, while the other group had both active and restored root caries. The control group consisted of 69 individuals with a mean age of 73 years. The root caries group consisted of 39 individuals with a mean age of 71 years. The groups were evaluated for unstimulated (UPAR) and stimulated parotid gland flow rates (SPAR), unstimulated (USUB) and stimulated submandibular/sublingual gland flow rates (SSUB), and stimulated whole saliva flow rates (SWhole). Parotid flow rates were determined with the use of a Carlson-Crittenden cup, while submandibular/sublingual flow rates were determined by means of the NIDR collector. A 2% citrate solution was used for stimulation in glandular collections. Subjects chewed a 1-cm3 cube of paraffin to stimulate whole saliva. The results showed that the control group had higher UPAR, SPAR, USUB, SSUB, and SWhole than the root caries group.

Age Factors↗

Amine fluoride/stannous fluoride and incidence of root caries in periodontal maintenance patients. A 2 year evaluation.

AIM: The purpose of the present study was to evaluate in a group of periodontal maintenance patients, the effect of using a dentifrice and mouthrinse containing amine fluoride (AmF) and stannous fluoride (SnF2) as compared with a dentifrice and mouthrinse both containing sodium fluoride (NaF) with regard to their root caries experience. MATERIAL: In total, 80 patients who had been treated for moderate-to-severe periodontitis agreed to participate in this study. Subjects received supportive periodontal therapy at regular intervals of 3-4 months for at least a period of 1 year. The patients were randomly divided into two groups: (1) the test group used an AmF/SnF2 dentifrice and mouthrinse and (2) the control group used an NaF-containing dentifrice and mouthrinse. Root caries was recorded at four sites per tooth at baseline and 24 months. RESULTS: An increase in number of the exposed root surfaces was noted for both groups during the experimental period (p<0.05). The mean number of active caries lesions at baseline was 2.1 and 1.8 for the test group and control group, respectively. At 24 months, the corresponding values were 1.8 for the test and 2.2 for the control group. An increase of the mean number of restored surfaces was noted for the AmF/SnF2 group (from 7.3 to 13.4) and the control group (from 7.9 to 14.7) during the course of the study. This increase was found to be statistically significant for both groups in comparison with the baseline values (p< or =0.01). No statistically significant differences were noted between groups. Further analysis of the restored surfaces revealed that the major increase in number of the restorations was associated with restorations involving three to four root surfaces in the same tooth. Molars and premolars were the teeth receiving most new restorations. CONCLUSION: The present study did not detect a difference in terms of root caries development between the two groups. Root caries development is a common finding associated with surfaces developing recession in patients once treated for periodontal problems.

Adult↗

Quantification of root caries using optical coherence tomography and microradiography: a correlational study.

PURPOSE: The use of transverse microradiography (TMR) to quantify the amount of mineral lost during demineralization of tooth tissue has long been established. In the present study, the use of an en-face Optical Coherence Tomography (OCT) technology to detect and quantitatively monitor the mineral changes in root caries was investigated and correlated with TMR. MATERIALS AND METHODS: We used an OCT system, developed initially for retina imaging, and which can collect A-scans, B-scans (longitudinal images) and C-scans (en-face images) to quantitatively assess the development of root caries. The power to the sample was 250 microW, wavelength lambda = 850 nm and the optical source linewidth was 16 microm. RESULTS: Both the transversal and longitudinal images showed the caries lesion as volumes of reduced reflectivity. Quantitative analysis using the A-scan (reflectivity versus depth curve) showed that the tissue reflectivity decreased with increasing demineralization time. A linear correlation (r = 0.957) was observed between the mineral loss measured by TMR and the percentage reflectivity loss in demineralized tissue measured by OCT. CONCLUSION: We concluded that OCT could be used to detect incipient root caries, and that the reflectivity loss in root tissue during demineralization, measured by OCT, could be related to the amount of mineral lost during the demineralization.

Analysis of Variance↗

Twenty-four month incidence of root caries among a diverse group of adults.

OBJECTIVES: (1) Describe for a diverse sample the 24-month incidence of root caries, and (2) test its association with a broad range of clinical, behavioral, financial, and sociodemographic factors. METHODS: The Florida Dental Care Study was a cohort study of randomly selected subjects who had at least 1 tooth and were 45 years or older at baseline. In-person interviews and clinical examinations were conducted at baseline and 24 months, with 6-monthly telephone interviews between those times; 723 subjects participated for both examinations. A multinomial logistic regression was done to predict whether the subject was in one of four mutually exclusive groups [new root decay only (NDO); new root filling(s) only (NFO); both new decay and new filling(s) (BOTH), or had neither (NONE)]. RESULTS: Thirty-six percent of subjects had at least 1 new root decayed and/or filled surface (DFS); 17% were in the NDO group, 14% in the NFO group, and 5% in the BOTH group. When limited to participants who had a nonzero increment, the mean (SD) DFS was 2.7 (2.9). Baseline clinical condition (presence of root decay, root filling(s), coronal decay, noncarious root defects, number of teeth present, percent of teeth with at least 4 mm of attachment loss) was predictive of moving from the NONE group into the NDO, NFO, or BOTH groups. The addition of behavioral, financial, and sociodemographic factors improved model fit. For example, regular dental attenders were significantly more likely to move from the NONE group into the NFO group, but regular attendance was not associated with a lower probability of moving from the NONE group into the NDO or BOTH groups. CONCLUSIONS: Root caries is a substantive dental health problem in this diverse sample of adults. These analyses demonstrate the utility of disaggregating caries incidence into four mutually exclusive groups for predictive models.

Adult↗

Take two dentists: a tale of root caries.

Take two dentists, whose practices are about as different as they could possibly be, who both have a healthy respect for root caries. Our paper will start by describing these two practices and then review the literature to show what is known about the management of root caries. The paper ends by returning to the two dentists, who describe how the research reviewed in the literature may affect their work.

Aged↗

Fluoride, remineralization and root caries.

This paper reviews the probable mechanism of dental caries and the role of fluoride in the inhibition or reversal of that process. The initial stages of root caries are comparable to enamel caries, being the acid dissolution of mineral resulting from acids generated by bacterial metabolism. The fermentation of carbohydrates by oral bacteria including mutans streptococci and lactobacilli initiate the root caries process, removing mineral from among the organic matrix which is primarily composed of collagen. Subsequent to this demineralization, the organic material can be further broken down by bacterial enzymes. Fluoride inhibits mineral loss during the acid dissolution process and enhances remineralization in a similar manner to that which occurs in dental enamel.

Bacteria↗

Effect of flexural load cycling on microleakage of extended root caries restorations.

This study evaluated the microleakage of resin-modified glass ionomer, flowable compomer and flowable resin composite restorations on a Class V cavity of simulated advanced root caries under a flexural load cycling condition. Thirty-six non-carious human maxillary premolars were mounted in cylindrical acrylic resin molds. The cavities were prepared in the proximal root surface, from the middle of the buccal surface to the middle of the lingual surface, approximately 1 mm below the cemento-enamel junction, 2 mm axial width and 1.2 mm in depth. The teeth were randomly assigned to one of three groups with 12 teeth in each group: Group 1: Cavity conditioner and Fuji II LC (GC America), Group 2: Prime & Bond NT and Dyract Flow (Caulk-Dentsply), Group 3: Excite and Tetric flow (Ivoclar/Vivadent). Specimens were settled laterally on a fatigue-testing machine that was adjusted to deliver a force of 60N. The specimens were load cycled at 1 Hz for 5000 cycles, placed in a staining solution and sectioned to evaluate microleakage penetration. Results indicate that the coronal and gingival margins showed significant microleakage differences among the three restorations (p<0.05). At the coronal margin, there was no significant difference between Groups 2 and 3. At the gingival margin, there was no significant difference between Groups 1 and 2. It was concluded that the marginal sealing ability of a flowable resin composite under a flexural cycling load was better than in other selected materials and that flowable resin composite with dentin adhesive was a desirable alternative for root caries restorations extended to the proximal surface.

Acrylic Resins↗

Root caries in vitro after low fluence argon laser and fluoride treatment.

Because the numbers of dentate elderly are increasing, root caries prevention has become a great concern to the dental profession. This in vitro study evaluates the influence of combining low fluence argon laser treatment and acidulated phosphate fluoride treatment on caries initiation and progression in human root surfaces. The combination of low energy laser treatment and fluoride treatment increased the caries resistance of root surfaces when compared with no treatment and with laser irradiation treatment alone.

Acidulated Phosphate Fluoride↗

Three-year root caries increments: an analysis of teeth and surfaces at risk.

Seven hundred and ninety-six adult subjects (mean age 39.9 years) received visual-tactile examinations for root caries over a three-year period. All subjects were employed or the spouses of employees and resided in fluoride-deficient communities on Long Island, New York. Incremental caries data were analyzed to provide descriptive information about the susceptibility of individual teeth and surfaces to root caries. Molars were most prone to root caries/fillings, followed in decreasing order by premolars, canines and incisors. While canines and incisors had a nearly identical increment, since there are half as many canines as incisors in a mouth, canines are actually twice as susceptible to root caries/fillings. Facial surfaces comprised 53 percent of the increment followed by distal, lingual and mesial surfaces. Approximately 70 percent of the DFS for facial and lingual surfaces were fillings, compared to approximately 50 percent for mesial and distal surfaces, suggesting that part of the increment for facial-lingual surfaces may be treated abrasion areas rather than caries.

Adult↗

[Orthodontic extrusion of crown-root fractured teeth and teeth with root caries--report of 5 cases].

OBJECTIVE: To discuss orthodontic extrusion of crown-root fractured teeth before restoration. METHODS: 3 cases with fractured teeth and 2 cases with root caries were performed canal therapy. RESULTS: Orthodontic extrusion of the root was carried out before restoration. All cases were satisfactory after treatment. CONCLUSIONS: Orthodontic extrusion of remaining root before restoration not only can maintain the remaining root but also obtain functional and esthetic results.

Humans↗

Five-year incidence of coronal and root caries in 60-, 70- and 80-year-old Swedish individuals.

The 5-year incidence of caries was studied in a random sample of 60-, 70- and 80-year-old inhabitants of Göteborg, with 69, 51 and 28 individuals in the different age groups. One aim of the study was to introduce a root caries index (DMFRS%) in which the missing root surfaces are taken into account. This study, as well as other recent studies, has shown that dental caries is the main reason for tooth extraction. The study also revealed that coronal and root caries occurred more frequently in elderly than younger people and the incidence of root caries was positively correlated with coronal caries (r = 0.3, p < 0.001) and negatively correlated with the number of remaining teeth (r = 0.4, p < 0.0001). The 5-year DMFRS% increment values increased with advancing age from 2.7 involved root surfaces per 100 susceptible ones in the 60-year-olds to 4.8 in the 70-year-olds and 10.7 in the 80-year-olds. It should be mentioned, however, that only people able to come to the clinic were enrolled in the study and an analysis of the attrition bias indicated that oral health may be worse in those who are too ill to participate. The frequent utilization of dental care among the participants was reflected in the finding of several new fillings and prosthetic crowns. Most of the very elderly people with carious lesions at baseline, however, had developed new lesions at the margins of the newly made restorations.

Aged↗

Effect of saliva composition on experimental root caries.

The aim of this study was to determine the effect of saliva composition on caries lesion development independently of the flow rate of unstimulated whole saliva (UWS) and other caries-related variables such as lesion progression time, oral hygiene level, and fluoride exposure. We hypothesized that this could be done by developing experimental root caries under carefully controlled conditions in situ in test subjects with UWS flow rates within a narrow window of normalcy. Fifteen female and 5 male subjects (66 +/- 6 years) were selected for the study according to their UWS flow rates between 0.2 and 0.4 ml/min. All subjects developed experimental root caries lesions during a 62-day period in which UWS as well as stimulated whole saliva (SWS) were repeatedly collected and analysed for flow rate, pH, buffer capacity, inorganic, and organic composition. Caries lesion development was determined by quantitative microradiography. The mean UWS flow rate was 0.30 +/- 0.05 ml/min. Significant negative correlations were obtained between UWS total phosphate concentration and mineral loss (DeltaZ; r(s) = -0.72, p < 0.001) and UWS total protein concentration and DeltaZ (r(s) = -0.70, p < 0.01). SWS and its constituents had only limited or no effect on DeltaZ. Qualitative UWS protein analysis (SDS-PAGE) revealed that subjects with low DeltaZ values had broader and more stained amylase bands than subjects with high DeltaZ values. These findings were confirmed quantitatively by HPLC. We conclude that, within a group of subjects with normal UWS flow rates, the UWS composition was more important for caries lesion development than the SWS composition. Furthermore, high UWS concentrations of phosphate, protein, and amylase were caries-protective.

Aged↗

Identification and characterization of collagen-binding activity in Streptococcus mutans wall-associated protein: a possible implication in dental root caries and endocarditis.

Streptococcus mutans is implicated in coronal and dental root decay, and in endocarditis. Comparative study of the amino acid sequence of S. mutans 47 kDa wall-associated protein A (WapA) revealed a collagen-binding domain (CBD) at the N-terminal region. Recombinant AgA (WapA truncated at the carboxyterminal end) was isolated, biotin-labeled, and analyzed by Solid Phase Binding Assay. The results showed that biotin-labeled AgA bound significantly and in a dose-dependent manner to immobilized collagen type I, and to a lesser extent to fibronectin, but not to collagen type IV or laminin. Binding of biotin-labeled S. mutans cells to collagen-coated surfaces was significantly inhibited by antibody to WapA or AgA (P<0.001). The results obtained confirmed the collagen-binding activity of CBD in AgA and WapA, and suggested that WapA may be used, not only as a vaccine against coronal and dental root caries, but also against S. mutans-mediated endocarditis.

Amino Acid Sequence↗

Clinical reversal of root caries using ozone, double-blind, randomised, controlled 18-month trial.

OBJECTIVE: To assess the effect of an ozone delivery system, combined with the daily use of a remineralising patient kit, on the clinical severity of non-cavitated leathery primary root carious lesions (PRCL's), in an older population group. DESIGN: A total of 89 subjects, (age range 60-82, mean +/- SD, 70.8 +/- 6 years), each with two leathery PRCL's, were recruited. The two lesions in each subject were randomly assigned for treatment with ozone or air, in a double-blind design, in a general dental practice. Subjects were recalled at three, six, 12 and 18 months. Lesions were clinically recorded at each visit as soft, leathery or hard, scored with a validated root caries severity index. RESULTS: There were no observed adverse events. After three months, in the ozone-treated group, 61 PRCL's (69%) had become hard and none had deteriorated, whilst in the control group, four PRCL's (4%) had become worse (p<0.01). At the six-month recall, in the ozone group, seven PRCL's (8%) remained leathery, the remaining 82 (92%) PRCL's had become hard, whilst in the control group, 10 PRCL's had become worse (11%) and one had become hard (p<0.01). At 12 and 18 months, 87 Subjects attended. In the ozone group at 12 months, two PRCL's remained leathery, compared to 85 (98%) that had hardened, whilst in the control group 21 (24%) of the PRCL's had progressed from leathery to soft, i.e. became worse, 65 PRCL's (75%) were still leathery, and one remained hard (p<0.01). At 18 months, 87 (100%) of ozone-treated PRCL's had arrested, whilst in the control group, 32 lesions (37%) of the PRCL's had worsened from leathery to soft (p<0.01), 54 (62%) PRCL's remained leathery and only one of the control PRCL's had reversed (p<0.01). CONCLUSIONS: Leathery non-cavitated primary root caries can be arrested non-operatively with ozone and remineralising products. This treatment regime is an effective alternative to conventional "drilling and filling".

Aged↗

Effect of residence in a fluoridated community on the incidence of coronal and root caries in an older adult population.

Eighteen-month caries incidence among older adult residents of fluoridated and nonfluoridated communities was compared. Rates for both coronal and root caries were consistently lower among long-term residents of the fluoridated communities than among life-long residents of nonfluoridated communities. Coronal caries incidence was significantly lower for people who had resided in fluoridated communities for more than 30 years (1.95 vs 1.33 surfaces). Root caries incidence was significantly less among residents for more than 40 years (0.56 vs 1.11 surfaces). Fluoridation appeared to be beneficial for the older adults examined, even though the exposure to fluoridated water began in adulthood.

Aged↗