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Aims: A previous meta-analysis showed that individuals with Type 2 diabetes mellitus (T2D) have a greater chance of developing both coronal caries and root caries than systemically healthy ones, which can be influenced by hyperglycemia per se. This study aimed to associate blood and salivary glucose levels with caries.Methods: This research is a subset of a cross-sectional study. N = 39 individuals underwent a dental examination and salivary glucose, fasting blood glucose (FBG) and glycated hemoglobin (A1c) measurements.Results: The prevalence of active coronal caries was 10.2%, and that of root caries was 20.5%. A1c and FBG averages were higher in individuals with root caries (9.75 ± 1.71 and 186.3 ± 62.5) than without (7.01 ± 2.23 and 115.1 ± 48.6; p < 0.05). Individuals with T2D showed weak correlation of salivary glucose and number of active coronal caries. Significant correlations were observed between salivary and blood glucose. There was relevance of A1c (0.53; CI=0.124-0.941; p = 0.01) and FBG (0.019; CI=0.006-0.033; p = 0.006) toward the increased number of root caries lesions, even after adjustment for salivary flow and age.Conclusion: Blood glucose levels are associated with an increased number of root caries in adults with or without T2D. In individuals with T2D, salivary glucose was correlated with active coronal caries. Additional studies are needed to support this association. [ABSTRACT FROM AUTHOR]

This systematic review provides an update on the development and efficacy of direct restorative dental materials for root caries interventions from in vitro and clinical studies. PubMed, Embase, and Web of Science were searched using specific MeSH keywords. Full articles from September 1990 to October 2021 were collected. Additional articles were identified by reference retrieval and manual searching. Studies not related to restorative materials for root caries treatment, case reports, non-original articles, and/or articles not written in English were excluded. Bias risk assessment was performed for the clinical studies. Forty-two articles (eleven clinical studies and thirty-one in vitro studies) were included for analysis. Most in vitro studies indicated an excellent cariostatic effect of glass ionomer cement. Resin-modified glass ionomer restorations also presented reduced recurrent caries activity but had a lower efficacy than glass ionomer cement restorations. For composite resin restorations, the main material development strategies are to strengthen the tooth structure and integrate antimicrobial activity. The clinical studies offered limited data, so the most appropriate material for surface root caries treatment is still inconclusive. However, atraumatic restorative treatment (ART) is an alternative treatment for patients with limiting conditions. Further clinical studies are required to confirm the efficacy of bioactive materials. [ABSTRACT FROM AUTHOR]

The aim of this in-vitro study was to assess the effect of bioglass with different concentrations on root caries. Ninety freshly-extracted teeth with root caries were randomly assigned to a single-use prophylaxis paste containing 15 % bioglass for 30 s with 1,450 ppmF toothpaste (15 % bioglass, n = 30), 1,450 ppmF toothpaste with 5 % bioglass (5 % bioglass, n = 30), and toothpaste containing 1,450 ppmF (Control, n = 30). Each sample received a standard brushing procedure for 10 s twice a day using the toothpastes. Teeth were immersed in remineralising solution with pH of 7 at 37 °C for 720 h. Surface roughness (Ra) was measured at baseline and after the application of the products at 0.5, 1, 4, 12, 24, 48, 168, 336 and 720 h. Subsequently, three samples from each group were randomly selected to measure calcium ion release over 15 h immersion in deionised water. These samples were then analysed using the SEM for the qualitative assessment of lesion topography. Repeated measures ANOVA, Wilcoxon paired tests and percentage changes were carried out to assess Ra. Calcium ion release data was analysed using one-way ANOVA and Tukey post-hoc tests. After 720 h, 15 % bioglass had the highest decrease in Ra (Mean-difference = 1.502 µm, p = 0.001), then 5 % bioglass (Mean-difference = 0.723 µm , p = 0.09) whereas the control had the lowest Ra decrease (Mean-difference = 0.518 µm , p = 0.55). The differences in Ra between the groups were highly significant (p < 0.001). The cumulative calcium ion release was significantly high for the 5 % bioglass in comparison to the 15 % bioglass, whilst the control had the lowest release (p < 0.001). SEM analysis showed the presence of bioglass particles only on 15 % bioglass samples. The use of prophylaxis paste with 15 % bioglass and 1,450 ppmF toothpaste was promising to reverse/arrest root caries when compared to the toothpaste containing 1,450 ppmF with 5 % bioglass for a period of 30 days. [ABSTRACT FROM AUTHOR]

Studies among type 2 diabetes mellitus patients have reported total caries experience; however the severity and clinical consequences of untreated dental caries are often ignored. For this study, 150 well (I) and poorly controlled (II) diabetic participants were recruited. The spectrum of caries was evaluated using DMFT (Decayed, Missing and Filled Tooth) index, Dental Caries Severity Classification Scale, PUFA (Pulpal involvement, Ulceration, Fistula and Abscess) index, RCI (Root Caries Index) and the severity of radicular caries by Root Surface Caries Severity Index. The prevalence of coronal and root caries was 90.7% and 23.3%, respectively. There was significant difference among caries experiences for D, M and DMFT. In group II, severity of coronal caries and mean rank of P, F, A and PUFA scores were higher, so were prevalence of root caries and severity of RD2, RD3 and RD4. HbA1c level had positive correlation with DMFT and PUFA scores (r = 0.458 and 0.522), so was the duration of diabetes with coronal caries, DMFT, PUFA score, root caries and RCI score (r = 0.235, 0.320, 0.273, 0.308 and 0.323). This is probably the first study to examine the severity of coronal caries, prevalence of untreated dental caries and severity of radicular caries in diabetic patients. Uncontrolled diabetes causes substantial increase in prevalence and severity of coronal and radicular caries. [ABSTRACT FROM AUTHOR]

• Different calcium phosphate additives in F varnishes have distinct remineralising efficacy. • Combined use of F varnishes with 5000 ppm F toothpastes improved remineralisation. • Proanthocyanidin as an adjunct to F regimens improved remineralisation in dentine subsurface. • Increased mineral density was not necessarily translated into improved hardness of dentine. To evaluate the remineralising effects of fluoride (F) varnishes containing bioavailable calcium-phosphate compound (Ca-P) based remineralisation systems and 5000 ppm F toothpaste (FTP) on root caries lesions (RCLs) and the potential effects of proanthocyanidin (PA) for the treatments of RCLs when used as an adjunct to F regimens. Demineralised root dentine and a pH-cycling model were used to mimic RCLs and the oral environment. Remineralising effects of MI VarnishTM (MIV) containing casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) and Clinpro™ White Varnish (CPWV) containing tri-calcium phosphate (TCP) along with FTP and PA were evaluated regarding the birefringence, elemental composition, mechanical properties and mineral density of remineralised dentine with DuraphatTM as a comparison. MIV, CPWV and DuraphatTM promoted the incorporation of F into RCLs and increased mineral density but did not change microhardness of root dentine significantly. Surface microhardness increased significantly when MIV or CPWV was used with 5000 ppm FTP. Application of PA with F regimens significantly increased subsurface mineral density. When PA was applied with MIV or CPWV along with FTP, the highest ion uptake and relative mineral gain (%ΔZ) was achieved, and significant increase of microhardness was up to 30 μm depth. Generally, MIV was associated with a higher mineral content gain than CPWV. Treatment of carious root surfaces remains challenging due to the complex pathological processes and difficulty in restoring the highly organised structure of root dentine. Treatment strategies targeting both remineralisation and preservation of the dentinal organic matrix have the potential to improve the fluoride-mediated remineralisation approaches. [ABSTRACT FROM AUTHOR]

The objectives of this studywere to: (1) develop a novel bioactive nanocomposite for Class V restorations with subgingival margins to inhibit periodontal pathogens; and (2) investigate if the bioactive nanocomposite could inhibit multi-species periodontal biofilms with a potency as strong as that against single species biofilms. Nanocomposite was fabricated using dimethylaminohexadecyl methacrylate (DMAHDM), 2-methacryloyloxyethyl phosphorylcholine (MPC) and nanoparticles of amorphous calcium phosphate (NACP). Biofilms with 1, 3, 6 and 9 species of periodontal pathogens were grown on the composites and tested for live/dead staining, colony-forming units (CFU), metabolic activity, and biofilm matrix polysaccharide production. The bioactive composite reduced protein adsorption by an order of magnitude (p < 0.05) and greatly reduced biofilm viability. It decreased the biofilm CFU by more than 3 orders of magnitude for all four types of periodontal biofilms, compared to control composite. With increasing the biofilm species from 1 to 9, the antibacterial efficacy of DMAHDM composite decreased; the CFU reduction folds decreased from 947 folds to 44 folds. In contrast, the MPC + DMAHDM composite maintained a CFU reduction folds of greater than 3000, showing a similar antibacterial potency from 1 to 9 species in the biofilms (p > 0.1). Dual agents MPC + DMAHDM achieved the greatest inhibition in biofilm, without decreasing its antibacterial potency when the biofilm species was increased from 1 to 9. A single agent became less effective when the biofilm species was increased from 1 to 9. The multifunctional MPC + DMAHDM composite is promising for root caries treatment and Class V restorations with subgingival margins to effectively inhibit multispecies periodontal biofilms, combat periodontitis and protect the periodontium. [ABSTRACT FROM AUTHOR]

• Synergistic interactions between Candida albicans and Actinomyces viscosus. • The ergosterol pathway was critical for the cross-kingdom interactions. • Voriconazole can block the interactions in vitro and in vivo. Candida albicans and Actinomyces viscosus are prominent microbes associated with dental root caries. The aim of this study was to investigate the effect of C. albicans on A. viscosus biofilms and to identify the mechanisms associated with this interaction. A. viscosus and C. albicans strains (wide-type and mutants) were used to form biofilms in vitro and in vivo , which were subsequently analysed by crystal violet assay and scanning electron microscopy (SEM) to investigate the effect of C. albicans on A. viscosus growth. A viable plate count and survival curve for C. albicans mutants and A. viscosus combinations were used to identify which C. albicans pathway was crucial for cross-kingdom interactions. Voriconazole was used to block their interactions both in vitro and in vivo. SEM, fluorescence in situ hybridisation (FISH), quantitative PCR and survival curve analyses were performed to evaluate the activity of voriconazole on C. albicans and A. viscosus interactions. The biomass and virulence of mixed-species biofilms were significantly enhanced compared with the A. viscosus biofilm alone. However, this was not observed in the mixed-species biofilms with the C. albicans mutant erg11 Δ / Δ in vitro and in vivo , indicating that azoles may work on the mixed-species biofilms. As expected, voriconazole can effectively reduce the biomass of mixed-species biofilms. A high concentration of voriconazole (1 µg/mL) reduced the abundance of C. albicans , whilst a low voriconazole concentration (0.25 µg/mL) blocked their interactions similar to the effect of the erg11 Δ/Δ mutant. Voriconazole may be a candidate strategy to combat root caries pathogens. [ABSTRACT FROM AUTHOR]

Highlights • Synergistic interactions between C. albicans and A. viscosus. • Synergistic interactions elevated the cariogenic virulence factors. • New possible therapeutic target to treat root caries by blocking the interactions. Abstract Objective How the interactions between Candida albicans and Actinomyces viscosus contributed to the root caries was not clear. This study aimed to investigate their cross-kingdom interactions on the biomass and the cariogenic virulence in dual-species biofilms. Design Suspensions of C. albicans and A. viscosus were formed the mono and polymicrobial biofilms in vitro. Crystal violet assay, viable plate count, scanning electron microscopy and fluorescence in situ hybridization were used to analyze the biomass and biofilm structure. Glycolytic pH drop and the spectrophotometric method were used to evaluate the acid production and hydroxyapatite dissolution, respectively. The exopolysaccharide production was measured by the anthrone-sulfuric acid method, while the adhesion force was measured by atomic force microscopy. Results The biomass and colony-forming units of mixed-species were significantly increased compared to that of the mono-species at 24 h, 48 h, 72 h. The structure of dual-species biofilm had more microcolonies and was much denser. The dual-species biofilms significantly decreased the pH value and damaged the hydroxyapatite compared with the mono-species biofilms at various time points, indicating the strong cariogenic virulence. Moreover, the dual-species biofilms significantly enhanced the exopolysaccharide production and adhesion force suggesting the increase of biofilm adhesion. Conclusions Cross-kingdom interactions of C. albicans and A. viscosus significantly elevated the biomass and cariogenic virulence of dual-species biofilm. [ABSTRACT FROM AUTHOR]

Graphical abstract Abstract Treatment of carious root surfaces remains challenging due to the complex pathological processes and difficulty in restoring the original structure of root dentine. Current treatments targeting the de-/re-mineralisation processes are not entirely satisfactory in terms of the protection of the dentinal organic matrix and the highly organised structure of dentine. In this in vitro study, a cross-linking agent – proanthocyanidin (PA) was used in conjunction with a fluoride-based treatment – silver diamine fluoride/potassium iodide (SDF/KI) to putatively stabilise the organic dentinal framework as well as strengthen the collagen-mineral phase interaction. The effectiveness of this strategy was evaluated 24 h after application in terms of the distribution of ion uptake and microstructure of dentine after treatment as well as analysis of the nano-mechanical properties using a dynamic behaviour model. Results showed that individual use of SDF/KI significantly improved the surface microhardness and integrated mineral density (Z) up to 60 µm depth and the recovery of creep behaviour of demineralised dentine in the surface area compared to that treated with deionised distilled water (DDW). The combined treatment of PA and SDF/KI achieved a more homogenous mineral distribution throughout the lesions than SDF/KI alone; a more significant incremental increase in surface microhardness and Z was observed. Specifically, a superior effect on the subsurface area occurred with PA + SDF/KI, with significant improvements in microhardness, elastic modulus and recovery of creep behaviour of the demineralised dentine. Application of SDF/KI induced small discrete crystal formation distributed over the dentine surface and PA contributed to the formation of slit-shaped orifices of the dentinal tubules that were partially occluded. Statement of Significance Demographic transitions and improved oral health behaviour have resulted in increased tooth retention in elderly people. As a consequence, the risk of root dentine caries is increasing due to the age-associated gingival recession and the related frequent exposure of cervical root dentine. Root caries is difficult to repair because of the complex aetiology and dentine structure. The recovery of dentine quality depends not only on reincorporation of minerals but also an intact dentinal organic matrix and the organic-inorganic interfacial structure, which contribute to the biomechanics of dentine. With the capability of dentine modification, cross-linking agents were applied with a fluoride regimen, which improved its treatment efficacy of root caries regarding the distribution of ion uptake and recovery of dentine biomechanics. [ABSTRACT FROM AUTHOR]

• Laser fluorescence values correlated with depth of non-cavitated demineralization in µCT. • Laser fluorescence is a predictor of lesion depth/vertical extension of demineralization in vitro. • Laser fluorescence can be recommended for monitoring of non-cavitated root surfaces. This in vitro study was designed to compare the assessment of carious root surfaces using laser fluorescence or visual assessment and µCT. A total of 107 extracted human teeth were included in the study. For the subsequent assessment, a clinical evaluation according to Ekstrand and Nyvad criteria, laser fluorescence measurements (DIAGNOdent-Pen©), and µCT imaging (Bruker Skyscan 1172) of the included root surfaces were performed. For cavitated lesions, the surface was reconstructed on µCT. Target parameters were: clinical appearance, laser fluorescence reading (0–99), and lesion depth in µm (µCT). The statistical analysis included chi² and Spearman-Rho tests. Laser fluorescence values were significantly higher (p < 0.01) in leathery non-cavitated (median [IQR]: 73.50 [48.00]) and cavitated (88.50 [29.00]) surfaces than in hard intact surfaces (7.00 [35.00]). In addition, laser fluorescence values showed a significant correlation with lesion depth for non-cavitated surfaces (0.750; p < 0.01). Further statistically significant correlations were not detectable. Regression analysis showed that the laser fluorescence values increased with increasing demineralization depth (β : 0.648, CI95: 0.631–1.053; p < 0.01). Laser fluorescence measured by DIAGNOdent© is a predictor for the depth of demineralization in carious root caries lesions with intact surfaces. Considering the limitations of this in vitro study, laser fluorescence is suitable for assessing the depth extent of (non-cavitated) root caries lesions and is a tool for clinical diagnosing and assessing the course of lesion development. [ABSTRACT FROM AUTHOR]

Controlling caries in exposed root surfaces with silver diamine fluoride: A systematic review with meta-analysis. Oliveira BH, Cunha-Cruz J, Rajendra A, Niederman R. J Am Dent Assoc 2018;149(8):671-9.e1. Government funding, partially supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health , and partially funded through a Patient-Centered Outcomes Research Institute (PCORI) award. The Teacher Training Program of the University of the State of Rio de Janeiro also supported the work. Systematic review with meta-analysis on randomized clinical trials. [ABSTRACT FROM AUTHOR]

Objectives Dentin hypersensitivity often is treated by promotion of dentin tubule occlusion. In this in vitro study we evaluated nanomechanical properties and degree of tubule occlusion conferred to sound and demineralized human root dentin following treatment with a 10% (w/w) strontium acetate solution and its relation to the treatment duration and delivery method. Methods 24 human cervical root dentin disks (8 groups of 3) were polished through 0.25 μm. 12 disks were subjected to an acid challenge (1% citric acid, pH3.8) for 2 min. The specimens were incubated in artificial saliva, treated by soaking or brushing with deionized (DI) water or a solution of 10% strontium acetate for 2 min twice a day for 28 days. The occlusion percent and nanomechanical properties were determined at the baseline, 5, 14 and 28 days. Cross-sectioned specimens were prepared to evaluate the depth affected by strontium acetate / dentin interaction by SEM. Statistical analysis was performed using linear mixed effects models. Results A 10% strontium acetate treatment over 5-28 days significantly increased tubule occlusion for normal root dentin and to a lesser extent for demineralized dentin and increased the AFM based nanomechanical properties of demineralized dentin. Brushing was more effective than soaking in recovery of properties of demineralized dentin when treated with strontium. No difference in tubuleocclusion was found between the two delivery methods. Significance Strontium acetate itself proved to have the ability to occlude dentin tubules and result in small changes in the mechanical properties of dentin. [ABSTRACT FROM AUTHOR]

Objective This study aimed to evaluate the effect of fluoridated dentifrice (FD) and mouthwash (FM) under different treatment regimens on root caries (RC) inhibition. Methods Dual-species biofilms formed by Streptococcus mutans and Lactobacillus casei were grown on the surface of bovine root dentine slabs which were exposed during 3 consecutive days to one of the following treatments: T1—distilled and deionized water 3×/day; T2—FD (1450 ppm F) 2×/day; T3—FD 2×/day + FM (226 ppm F) 1×/day; T4—FD 3×/day. Viable microorganisms counts were performed after 4 days of biofilm formation. Percentage of surface microhardness change (%SMC), lesion depth (LD; μm), integrated mineral loss (IML; vol% × μm) and the percentages of change (Δ%) in the ratio of fluorapatite (FAp/amide) and hydroxiapatite (HAp/amide) were calculated. Results Minor changes were found on microbial counts in response to different treatments ( p < 0.05). %SMC in T4 was statistically lower compared with T2, but with no significant difference compared with T3. LD of slabs treated with T4 was statistically lower compared with T2 and T3, which were not significantly different between them. No significant differences were found for IML, FAp and HAp among the fluoridated treatments ( p > 0.05). Conclusion The use of FD 3×/day may be more effective than the use of FD 2×/day or the tested association between FD and FM on RC inhibition. [ABSTRACT FROM AUTHOR]

• The QLF parameter ∆F correlated with depth of non-cavitated demineralization in µCT. • ∆F is a predictor of lesion depth/vertical extension of demineralization in vitro. • QLF can be recommended for monitoring of non-cavitated root surfaces. This in vitro study aimed to assess carious lesions on root surfaces using quantitative light-induced fluorescence (QLF) and to compare the readings with axial lesion depth on µCT. The root surfaces of 107 extracted human teeth were included after visual-tactile inspection. For further analysis, the following parameters were assessed: clinical findings (non-cavitated: leathery or hard, cavitated), QLF- (QLF-D Biluminator 2+), and µCT-images (Bruker Skyscan 1172). The shape of the undamaged tooth surface of the cavitated lesions was virtually re-constructed during µCT analysis. Clinical surface texture,% fluorescence loss, and lesion depth (µCT) were determined. Statistical analysis: chi²-test, Spearman-Rho test, regression analysis. ∆F was significantly lower in non-cavitated leathery (-50.37 ± 15.10) and cavitated (-61.23 ± 9.92) compared to non-cavitated surfaces with a hard texture (-17.04 ± 16.10, p < 0.01). For non-cavitated surfaces, a negative correlation was observed between ∆F and lesion depth in µCT images regardless of texture (-0.748, p < 0.01). Regression analysis revealed that ∆F predicted lesion depth in µCT for non-cavitated surfaces (β: 0.703, CI95: 0.67–-0.43, p < 0.01). The percentage of fluorescence loss (∆F) in QLF predicted lesion depth of non-cavitated demineralized root surfaces. Therefore, QLF can be recommended for estimating the lesion depth of carious root lesions and seems to expand the possibilities of follow-up and lesion monitoring, especially for non-cavitated surfaces. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To compare the performance of LFpen (DIAGNOdent pen) with two different wedge-shaped tips to conventional bitewing radiography (BW) for detecting proximal secondary caries at the cervical margin of amalgam restorations in vitro. Methods: Seventy-five molars with class II amalgam restorations were selected. Depending on the marginal filling extension, data was subdivided into a crown group (C), when the filling ended in enamel, and into a root group (R), when the filling ended beyond the cementum-enamel junction. Bayesian analysis including calculation of the area under the receiver operating curve (AUC) was performed. Furthermore, Spearman correlations between caries and cofactors, such as presence of plaque or stain, occlusal ditching, marginal gap size, filling overhangs, and shortfalls, were calculated. Additionally, for group R the correlation coefficient between LFpen measurements and lesion depth was calculated. Histology served as gold standard. Results: In group C both at the D1 and D3 levels, LFpen with two different tips showed a better performance than bitewing radiography (AUC at D1: 0.83/0.79 (LFpen) and 0.63 (BW); at D3: 0.66/0.66 (LFpen) and 0.53 (BW)). In group R, the respective AUC values were 0.53/0.56 (LF) and 0.59 (BW). A significant medium correlation was observed for occlusal ditching and proximal caries. Stain accumulation at the restoration margins especially in combination with filling overhangs interfered with LFpen readings, resulting in false positive measurements. Conclusions: Compared to BW, LFpen enhances the detection of secondary caries lesions at the cervical margin of amalgam restorations that do not extend below the cementum-enamel junction. [Copyright &y& Elsevier]

Abstract: Objective: The purpose of the study was to investigate whether dentine irradiation with a pulsed CO2 laser (10.6μm) emitting pulses of 10ms is capable of reducing dentine calcium and phosphorus losses in an artificial caries model. Design: The 90 dentine slabs obtained from bovine teeth were randomly divided into six groups (n =15): negative control group (GC); positive control group, treated with fluoride 1.23% (GF); and laser groups irradiated with 8J/cm2 (L8); irradiated as in L8+fluoride 1.23% (L8F); irradiated with 11J/cm2 (L11); irradiated as in L11+fluoride 1.23% (L11F). After laser irradiation the samples were submitted to a pH-cycling model for 9 days. The calcium and phosphorous contents in the de- and remineralization solutions were measured by means of inductively coupled plasma optical emission spectrometer – ICP-OES. Additionally intrapulpal temperature measurements were performed. The obtained data were analysed by means of ANOVA and Tukey''s test (α =0.05). Results: In the demineralization solutions the groups L11F and GF presented significantly lower means of calcium and phosphorous losses than the control group; and in L11F means were significantly lower than in the fluoride group. Both irradiation parameters tested caused intrapulpal temperature increase below 2°C. Conclusion: It can be concluded that under the conditions of this study, CO2 laser irradiation (10.6μm) with 11J/cm2 (540mJ and 10Hz) of fluoride treated dentine surfaces decreases the loss of calcium and phosphorous in the demineralization process and does not cause excessive temperature increase inside the pulp chamber. [Copyright &y& Elsevier]

Abstract: Objective: This study aimed to analyze in vitro inhibitory effects of restorative materials containing the antibacterial monomer 12-methacryloyloxydodecylpyridinium bromide (MDPB) on the formation of artificial secondary root caries lesions. Methods: Class V cavities (2mm×2mm) were prepared in 75 human root fragments. Specimens were randomly divided into five groups (n =15 fragments per group) and restored as follows: (I) MDPB-free adhesive system+MDPB-free composite (negative control); (II) resin modified glass ionomer (RM-GIC; positive control); (III) MDPB-free adhesive system+MDPB-containing composite (2.83% MDPB); (IV) MDPB-containing adhesive system+MDPB-free composite; (V) MDPB-containing adhesive system+MDPB-containing composite. Artificial secondary root caries lesions were produced by a biological artificial caries challenge. The restored specimens were immersed into a culture medium containing Streptococcus mutans and sucrose for 15 days. Histological slices (80±20μm) of the specimens were used for measuring the mean depths of the artificial lesions produced in both margins of the restorations using polarized light microscopy. Results were expressed in percentage related to the mean depth of the negative control, considered 100%. Data were compared by ANOVA followed by the Tukey''s test (p ≤0.05). Results: The depths of lesions adjacent to cavities filled with RM-GIC (GII; 85.17±15.2%) were significantly (p <0.01) shallower than those adjacent to restorations with MDPB-free composite (GI; 100.00±10.04%), despite the presence of MDPB in the adhesive system (GIV; 101.95±21.32%). The depths of lesions adjacent to cavities restored with MDPB-containing composite (GIII; 82.68±12.81% and GV; 85.65±15.42%), despite the adhesive system used, were similar to those of RM-GIC (GII). Mean lesions depths in these groups decreased from 13% (GV) to 17% (GIII) in relation to the negative control (GI). Conclusions: MDPB-containing composite inhibits the progression of artificial secondary root caries lesions regardless of adhesive systems. [Copyright &y& Elsevier]

Abstract: Objectives: Little is known about the effect of Cervitec®, a chlorhexidine-thymol varnish, on root caries. Our objective was to determine whether a 3-monthly application of Cervitec® over 1 year would limit the progress of existing root caries lesions and reduce the incidence of dental root caries in a group of dentate institutionalized elderly, as a complement to their usual oral hygiene practices. Methods: A double-blind randomized clinical trial was conducted in 68 subjects (34 per group) in two residences in Almería (Spain). Twenty-one subjects with 60 root caries lesions and 25 with 65 lesions, in the Cervitec® and placebo groups, respectively, completed the study. Varnishes were applied twice in the first week, 1 month later, and every 3 months until the end of the study. Clinical parameters associated with established lesions were determined at baseline and after 6 and 12 months, as was the incidence of root caries lesions. Results: The clinical evolution of lesions was significantly better in the Cervitec® group as opposed to the placebo group in terms of width, height, color, and texture. The increase in root caries was significantly lower (p =0.039) in the Cervitec® group. Conclusion: According to these results, Cervitec® may help to control established root lesions and reduce the incidence of root caries lesion among institutionalized elderly. [Copyright &y& Elsevier]

Abstract: Objectives: This clinical study aimed to evaluate the validity of using DIAGNOdent in diagnosing root caries, and to assess the sensitivity and specificity of different cut-off DIAGNOdent values in assessing root caries with reference to visual-tactile criteria. Methods: Exposed root surfaces were assessed by one examiner for root caries on 266 subjects using visual-tactile criteria and DIAGNOdent 2095 after dental scaling. Associations between DIAGNOdent values and visual-tactile diagnosis of root caries were determined. The cut-off level for statistical significance was 0.05. The sensitivity and specificity of DIAGNOdent with difference cut-off points were analysed compared to visual-tactile diagnosis of root caries. Results: There was significant difference between DIAGNOdent values obtained from sound and carious root surfaces (p <0.001). On carious surfaces, active root caries obtained significantly higher DIAGNOdent values than inactive root caries (p <0.001). With increasing cut-off point DIAGNOdent values from 5 to 35, sensitivity decreased from 91.4% to 16.2% and specificity increased from 64.4% to 98.2%. A cut-off point of DIAGNOdent value between 5 and 10 produced the highest combined sensitivity and specificity. Conclusions: There was a significant difference in DIAGNOdent values between sound and carious root surfaces diagnosed by visual-tactile criteria supporting the validity of DIAGNOdent for assessing root caries. A DIAGNOdent value between 5 and 10 produced the highest combined sensitivity and specificity when visual-tactile assessment of root caries was regarded as the criterion. These findings have implications in using and explaining DIAGNOdent values in assessing root caries. [Copyright &y& Elsevier]

Abstract: Objective: The people of the Yayoi period (5th C b.c.–3rd C a.d.), who were the first wet-rice agriculturalists in ancient Japan, had carious lesions that were most frequently located on the root surfaces of their teeth. Root surface exposure is a prerequisite for this type of decay, and alveolar bone loss is the main cause of such exposure. Therefore, we identify the factors associated with root caries, and examine the relationship between root caries and alveolar bone loss in the people of the Yayoi period. Materials and methods: This study was performed using 263 sets of ancient skeletal remains that are believed to be from the Yayoi period and that were excavated at 49 archaeological sites in western Japan. Using 5010 teeth found among the remains, we analysed the relationship between the prevalence of root caries and the cemento-enamel junction–alveolar crest (CEJ–AC) distance. Results: The prevalence of root caries and the mean number of teeth with root caries per person were significantly correlated with age, the presence of coronal caries and the mean CEJ–AC distance per person. We also found that as the mean CEJ–AC distance per tooth surface increased, the percentage of the root surface affected by caries increased. Moreover, after excluding the lingual (palatal) side, the mean CEJ–AC distance per surface was significantly greater for those tooth surfaces with root caries. Conclusion: We present the first evidence that the occurrence of root caries correlated with the CEJ–AC distance in the Yayoi people of Japan. [Copyright &y& Elsevier]

To develop antimicrobial restorative materials for root caries, we assessed a 4-META/MMA-TBB resin (Bondfill SB Plus, Sun Medical) containing benzalkonium chloride (BAC) or cetylpyridinium chloride (CPC) at 1.25, 2.5, and 5.0 wt%. The same resin without antibacterial agent was used as control. The degree of conversion was measured by attenuated total reflectance-Fourier transform infrared spectroscopy. The 3-point flexural strength test was conducted according to ISO 4049. The antimicrobial effect against three oral bacteria (Streptococcus mutans , S. sobrinus , and Actinomyces naeslundii) was assessed using agar diffusion tests. The shear bond strength to root dentin was assessed after 24 h of storage in water with or without 10,000 thermal cycles. The shear bond strength data were statistically compared using a linear mixed-effects model (α = 0.05). The specimen with 5.0 wt% BAC showed a significantly higher degree of conversion than the control, but it also had significantly lower flexural strength and lower shear bond strength after thermal cycling than the other specimens. When BAC or CPC was added at ≥ 2.5 wt%, the resins inhibited the growth of the three investigated microbes. In conclusion, both BAC and CPC showed significant antimicrobial effects when added at 5.0 wt% to the 4-META/MMA-TBB resin. Up to 2.5 wt%, neither antimicrobial agent affected the degree of conversion, flexural strength, or shear bond strength of the resin. [Display omitted] • BAC and CPC were incorporated as antimicrobial agents in 4-META/MMA-TBB resin. • 5 wt% BAC produced a higher degree of conversion in the resin. • 5 wt% BAC caused lower flexural strength and shear bond strength to root dentin. • A CPC content up to 5 wt% did not affect the resin's properties. • Both BAC and CPC inhibited the growth of three microorganisms. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate the effect of two glass-polyalkenoate restorative materials used as root-dentin replacements on the fracture strength of Class II amalgam restorations. Materials and methods: Class II slot preparations extending 2mm apical to the cemento-enamel junction were made in 30 teeth and randomly assigned to three groups. Group 1 (Control): restored entirely with amalgam (Tytin, Sybron Kerr, Orange, CA, USA). Group 2: The root-dentin area was restored with a viscous conventional glass-polyalkenoate restorative material (Fuji IX GP, GC America, Alsip, IL, USA), and the remainder of the preparation restored with amalgam. Group 3: The root-dentin area was restored with a resin-modified glass-polyalkenoate restorative material (Fuji II LC, GC America) and the remainder restored with amalgam. The amalgam restorations were loaded in compression to failure and the data analyzed using one-way ANOVA (α =0.05). Results: No significant differences in fracture strength were found. Conclusion: Root-dentin replacement with the tested glass-polyalkenoate materials did not affect the fracture strength of Class II amalgam restorations. [Copyright &y& Elsevier]

Abstract: Grape seed extract (GSE) contains proanthocyanidins (PA), which has been reported to strengthen collagen-based tissues by increasing collagen cross-links. We used an in vitro pH-cycling model to evaluate the effect of GSE on the remineralization of artificial root caries. Sound human teeth fragments obtained from the cervical portion of the root were stored in a demineralization solution for 96h at 37°C to induce artificial root caries lesions. The fragments were then divided into three treatment groups including: 6.5% GSE, 1000ppm fluoride (NaF), and a control (no treatment). The demineralized samples were pH-cycled through treatment solutions, acidic buffer and neutral buffer for 8 days at 6 cycles per day. The samples were subsequently evaluated using a microhardness tester, polarized light microscopy (PLM) and confocal laser scanning microscopy (CLSM). Data were analyzed using ANOVA and Fisher''s tests (p <0.05). GSE and fluoride significantly increased the microhardness of the lesions (p <0.05) when compared to a control group. PLM data revealed a significantly thicker mineral precipitation band on the surface layer of the GSE-treated lesions when compared to the other groups (p >0.05), which was confirmed by CLSM. We concluded that grape seed extract positively affects the demineralization and/or remineralization processes of artificial root caries lesions, most likely through a different mechanism than that of fluoride. Grape seed extract may be a promising natural agent for non-invasive root caries therapy. [Copyright &y& Elsevier]

Abstract: Objective: The influence of low-level fluoride (F) concentrations and lesion characteristics on the remineralisation of sub-surface root caries was investigated in vitro. Design: Experimentally produced dentinal carious lesions were exposed to artificial saliva in the presence of 0.00ppm, 0.48ppm, 2.49ppm or 4.91ppm F (as NaF) for 5 days. Calcium, phosphate and fluoride ion uptake was quantified by chemical assay. Baseline changes in the mineral content and distribution of the lesions were assessed by transverse microradiography (TMR). Results: The uptake of calcium and phosphate was significantly increased (p <0.05) by fluoride, even at low concentrations. The action of fluoride was influenced by the mineral content and distribution of the lesions at baseline, however, with the location and degree of mineral deposition being strongly related to the mineral content of the lesions surface layer. Conclusions: The process of remineralisation of root dentine is multifactorial. The morphology of lesions at baseline significantly affected the location and quantity of mineral deposition. [Copyright &y& Elsevier]

Abstract: Root caries is the predominant disease of the tooth tissues in the elderly population and differs in progression and micromorphology from coronal dentin caries. Therefore, different clinical concepts are needed for the treatment of these progressing and arrested lesions. It was the aim of this study to investigate the three-dimensional structure and volume of stagnating and progressing root caries lesions and to determine the mineral composition of the different lesion zones to achieve a better understanding of the natural history of root caries lesion formation. Of 21 extracted human teeth of patients between 42 and 77 years of age with stagnating and progressing root caries lesions serial sections were cut and investigated with polarized light and scanning electron microscopy. From the polarized light micrographs 3D reconstructions were made to determine the volumes of the lesion zones and their relations expressed in a demineralization index (DI). With increasing size of the demineralizing zone the DI increased indicating an increase in the size of the translucent zone. The 3D reconstructions showed distinct differences between stagnating and progressing root caries lesions. In the hypermineralized translucent dentin not all dentin tubules were obliterated by intratubular dentin and within the translucent dentin scattered dead tracts were found. Electron dispersive X-ray (EDX) analysis showed that the intertubular dentin of the translucent dentin was also demineralized to a certain extent. The results indicate distinct morphological differences between progressing and stagnating root caries lesions which may have consequences for treatment strategies. [Copyright &y& Elsevier]

Streptococcus mutans (Sm), Lactobacillus acidophilus (La) and Actinomyces israelii (Ai) have been associated with root surface caries, which is an increasing problem in elderly Chinese. The aim of this study therefore, was to evaluate in vitro, the growth, acidogenicity and cariogenicity of these organisms, both in mono- and co-cultures using an in vitro model. Forty-eight root specimens were prepared using intact extracted human molars. Fresh, wild-type bacteria obtained from root caries lesions were assembled into seven experimental groups as either mono- or co-cultures and incubated with the root specimens. Appropriate controls were included. Growth curve of each experimental group was monitored for 24h, aerobically, at 37°C using a microplate reader. The pH of the medium was recorded after 24-h incubation using a pH meter. Mean depths of artificial root lesions produced in each cultural group were measured using polarized light microscopy in specimens cut into thin sections (100±20μm). Compared with mono-cultures, synergistic growth was observed in co-cultures of ‘La+Sm’, ‘Ai+La’ and ‘Ai+La+Sm’. Mean lesion depth produced in La group was significantly shallower than other mono- or co-culture groups (p<0.01). The pH values of all culture media were similar after 24-h incubation. The current data elucidate the complex interactions of three predominant bacterial species considered prime agents of human root surface caries. [Copyright &y& Elsevier]

Objectives. To compare the clinical effects of a fluoride-containing varnish (Fluor-Protector) in combination with a chlorhexidine-containing varnish (Cervitec) on existing root caries lesions in a group of frail elderly subjects.Methods. A randomised double blind longitudinal study was utilised. Subjects (n=102) were randomly allocated to a Test or Placebo group. All leathery and soft root caries lesions in all subjects were coated with Fluor-Protector while the lesions in the Test group were also coated with Cervitec and the lesions in the Placebo group were coated with a Placebo varnish. Treatments were repeated five times in a 12-month period. Clinical parameters associated with root caries, measurements of individual lesions and salivary levels of caries associated bacteria were made at intervals.Results. The clinical severity of the lesions in the Test group did not change significantly during the 12-month study period. In the Placebo group the mean lesion width and lesion height and length of exposed root increased significantly and the lesions were significantly closer to the gingival margin. There were no significant changes in the salivary levels of caries-associated microorganisms after 12 months although, in both groups, there was initially a significant reduction in the salivary levels of mutans streptococci.Conclusions. The combination of Fluor-Protector and Cervitec is a useful, simple, quick and non-invasive method for the control and management of existing root caries lesions. The procedure could be performed by a dental hygienist and may be usefully applied in other high-risk groups including persons with Parkinson''s disease, debilitating neuromuscular conditions and dry mouth from whatever cause. [Copyright &y& Elsevier]

Objective. The aim of this in vitro study was to evaluate the interaction between two sources of fluoride (restorative systems and dentifrices) in inhibiting artificial root caries development.Methods. One hundred and eighty tooth segments were embedded in polyester resin, and sanded flat. Cylindrical cavities 1.0 mm-deep and 1.5 mm-diameter were prepared in root dentin and randomly restored by fluoride-containing restorative systems: Ketac-fil/Espe (Ke), Fuji II LC/GC Corp (Fj), F2000/3M (F2), Surefil/Dentsply (Su) or a control: Filtek Z250/3M (Z2). Ten experimental groups were made to test the association among the five restorative systems and two dentifrices: with F− (Sensodyne Baking Soda) or without F− (Sensodyne Original) (n=18). After surface polishing, a 1 mm-wide margin around the restorations was demarcated and initial dentin surface Knoop microhardness values (KHNi) were obtained. The specimens were submitted to a pH-cycling model, and to applications of slurries of dentifrice. Afterwards the final dentin surface Knoop microhardness values (KHNf) were measured.Results. The differences between KHNi and KHNf, and the covariate KHNi were considered by the ANCOVA and Tukey''s test (α=0.05). The interaction between restorative system and dentifrice was statistically significant (p=0.0026). All restorative systems provided some protection against artificial caries challenge when associated with the fluoride-containing dentifrice treatment. The means (standard deviation) of reductions in Knoop hardness values for systems associated with the fluoride-containing dentifrice were: Ke: 40.0(1.02)a, Fj: 41.9(1.02)b, F2: 43.3(1.04)c, Su: 43.5(1.00)c, Z2: 44.0(1.02)c; and with the non-fluoride-containing dentifrice were: Ke: 42.9(1.02)a, Fj: 44.7(1.01)b, F2: 45.2(1.09)bc, Su: 46.0(0.99)c, Z2: 46.6(0.99)c (statistical differences were expressed by different letters).Conclusion. The cariostatic effect shown by the fluoride-containing dentifrice could enhance that shown by Ketac-fil and Fuji II LC, and could mask that shown by F2000. [Copyright &y& Elsevier]

Topical Fluoride to Prevent Root Caries: Systematic Review with Network Meta-analysis. Zhang J, Sardana D, Li KY, Leung KCM, Lo ECM. J Dent Res. 2020; 99(5):506-13. Other funding. The study was funded by the Tam Wah-Ching endowed professorship of the University of Hong Kong. Systematic review with meta-analysis. [ABSTRACT FROM AUTHOR]

Objectives The occurrence of tooth root caries is increasing as the world population ages and tooth retention in seniors increases. Class V restorations with subgingival margins are difficult to clean and often lead to periodontitis. The objectives of this study were to develop a Class V composite containing dimethylaminohexadecyl methacrylate (DMAHDM) and nanoparticles of amorphous calcium phosphate (NACP), and investigate mechanical properties and the inhibition of six species of periodontitis-related biofilms for the first time. Methods Ethoxylated bisphenol A dimethacrylate (EBPADMA) and pyromellitic glycerol dimethacrylate (PMGDM) were mixed at 1:1 mass ratio to form the resin matrix. DMAHDM, NACP, and glass particles were incorporated at 3%, 20% and 50% by mass, respectively. Six species were tested: Porphyromonas gingivalis , Prevotella intermedia , Prevotella nigrescens , Aggregatibacter actinomycetemcomitans , Fusobacterium nucleatum and Enterococcus faecalis . Colony-forming units (CFU), live/dead assay, biomass via crystal violet staining, and polysaccharide production by biofilms were determined on composites. Result Adding 3% DMAHDM to composite did not affect the flexure strength and elastic modulus (p > 0.1). For all six species of periodontal pathogens, the DMAHDM composite had biofilm CFU nearly three orders of magnitude less than that without DMAHDM. The killing efficacy of DMAHDM composite against the six species was: E. faecalis < F. nucleatum < P. nigrescens = P. intermedia < A. actinomycetemcomitans < P. gingivalis . Biofilm biomass and polysaccharide were also greatly reduced via DMAHDM (p < 0.05). Significance The novel nanocomposite containing DMAHDM and NACP showed strong inhibiting effect against all six species of periodontitis-related pathogens. This composite is promising for Class V restorations to restore root caries and combat periodontitis. [ABSTRACT FROM AUTHOR]