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RESUME Baggrund: Med en øget levetid og flere mennesker i behandling for forskellige sygdomme stiger forekomsten af medicininduceret mundtørhed. Tandlægens rolle i at identificere og behandle denne tilstand bliver derfor stadig vigtigere. Formål og problemformulering: Formålet med denne kandidatopgave er, at redegøre for begreberne mundtørhed og hyposalivation samt at identificere medicinpræparater, der ofte er forbundet med mundtørhed og hvordan de antages at forårsage mundtørhed. Derudover er ønsket at analysere tandlægens rolle i behandlingen af patienter, der lider af medicininduceret mundtørhed. Problemformulering er som følger: 1. Hvordan defineres mundtørhed, herunder begrebet hyposalivation? 2. Hvad er patogenesen bag præparater, der forårsager mundtørhed? 3. Hvad kan vi som behandlere gøre for at håndtere denne problematik? Disse spørgsmål belyses gennem et litteraturstudie. Resultater: Baseret på litteraturgennemgang er der mange medicinske præparater, der kan forårsage dysfunktion i spytkirtlerne. Disse præparater virker ved at interagere med receptorer placeret på forskellige steder og påvirker dermed spytkirtlernes funktion. Undersøgelser viser øget forekomst af mundtørhed hos patienter, der tager tre ud af de fire mest anvendte præparater. Morfin er en undtagelse, sandsynligvis pga. kortvarig brug. Tandlægens vigtige roller omfatter samarbejde med andre sundhedsprofessionelle for at justere medicin, behandle symptomer og opretholde god mundhygiejne. Patientens samarbejdsvillighed er afgørende for behandlingsprognosen. Konklusion: Undersøgelser viser, at terapeutisk fremprovokeret mundtørhed har betydelige konsekvenser, især for ældre patienter. Diverse lægemidler kan medføre mundtørhed ved at påvirke spytkirtlerne via forskellige receptorer, der er lokaliseret på acinære celler i spytkirtlerne eller andre steder i nervesystemet. Lægemiddel aktivering af disse receptorer kan have en indvirkning på både kvantiteten og kv, Background: With increased life expectancy and more people undergoing treatment for various conditions, the prevalence of medication-induced dry mouth is on the rise. Therefore, the dentist's role in identifying and treating this condition is becoming increasingly important. Purpose and problem statement: The purpose of this thesis is to elucidate the concepts of dry mouth and hyposalivation, as well as to identify medication formulations commonly associated with dry mouth and how they are presumed to cause it. Additionally, the aim is to analyze the dentist's role in treating patients suffering from medication-induced dry mouth. The problem statement is as follows: 1. How is dry mouth defined, including the concept of hyposalivation? 2. What is the pathogenesis behind formulations that cause dry mouth? 3. What actions can we, as healthcare providers, take to manage this issue? The intent is to address these questions through a literature review. Results: Based on a review of the literature, numerous medication formulations can cause dysfunction in the salivary glands. These formulations act by interacting with receptors located at various sites, thereby affecting the function of the salivary glands. Studies indicate an increased prevalence of dry mouth among patients taking three out of the four most used formulations. Morphine is an exception, likely due to its short-term use. The dentist's important roles include collaborating with other healthcare professionals to adjust medications, treat symptoms, and maintain good oral hygiene. Patient cooperation is crucial for treatment prognosis. Conclusion: Studies show that therapeutically induced dry mouth has significant consequences, especially for elderly patients. Various medications can induce dry mouth by affecting the salivary glands via different receptors located on acinar cells in the salivary glands or elsewhere in the nervous system. Activation of these recepto

Objective: The principal aim of this randomized clinical trial (RCT) was to test the effectiveness in the prevention of Early Childhood Caries (ECC) through an educational intervention program with the use of a printed guide for pediatricians and parents both designed by pediatric dentists. Materials and methods: After ethical approval, the first step was to design the educational guides, which were based on the information obtained from a focus group with pediatricians (n = 3), phone interviews with mothers to toddlers' (n = 7), and the best evidence available about children's oral health. For the RCT, 309 parents with their 10–12 months old children were randomly allocated to either the intervention or the control group. Parents in the intervention group received oral health education from the pediatricians supported by the printed guides. Parents in both groups received an oral health kit with a toothbrush and toothpaste at the first visit as well as at each 6-month follow-up visit. After 18 months the children were evaluated using ICDAS criteria. Results: At baseline, data were available from 309 children (49.8% girls). The mean age of the children was of 10.8 months (SD = 0.8) and 69.3% had not had their teeth brushed with toothpaste. After 18 months, a total of 28 (22%) children in the intervention group and 44 (24%) in the control group were clinically examined. Regarding the number of tooth surfaces with caries lesions, the children in the intervention group had a mean of 6.50 (SD = 6.58) surfaces, while the children in the control group had a mean of 5.43 (SD = 4.74) surfaces with caries lesions. This difference was not significant (p = 0.460). Conclusion: The RCT showed no effectiveness in caries-progression control. Despite this result, this study managed to identify barriers that do not allow pediatricians from offering parents adequate oral health recommendations. With this learning, it is possible to work on collaborative pro, Objective: The principal aim of this randomized clinical trial (RCT) was to test the effectiveness in the prevention of Early Childhood Caries (ECC) through an educational intervention program with the use of a printed guide for pediatricians and parents both designed by pediatric dentists. Materials and methods: After ethical approval, the first step was to design the educational guides, which were based on the information obtained from a focus group with pediatricians (n = 3), phone interviews with mothers to toddlers' (n = 7), and the best evidence available about children's oral health. For the RCT, 309 parents with their 10–12 months old children were randomly allocated to either the intervention or the control group. Parents in the intervention group received oral health education from the pediatricians supported by the printed guides. Parents in both groups received an oral health kit with a toothbrush and toothpaste at the first visit as well as at each 6-month follow-up visit. After 18 months the children were evaluated using ICDAS criteria. Results: At baseline, data were available from 309 children (49.8% girls). The mean age of the children was of 10.8 months (SD = 0.8) and 69.3% had not had their teeth brushed with toothpaste. After 18 months, a total of 28 (22%) children in the intervention group and 44 (24%) in the control group were clinically examined. Regarding the number of tooth surfaces with caries lesions, the children in the intervention group had a mean of 6.50 (SD = 6.58) surfaces, while the children in the control group had a mean of 5.43 (SD = 4.74) surfaces with caries lesions. This difference was not significant (p = 0.460). Conclusion: The RCT showed no effectiveness in caries-progression control. Despite this result, this study managed to identify barriers that do not allow pediatricians from offering parents adequate oral health recommendations. With this learning, it is possible to work on collaborative pro

OBJECTIVES: To investigate the effect of daily use of a lozenge containing arginine and probiotics for 10-12 months on caries increment, gingivitis- and plaque occurrence in children aged 5-9 years.METHODS: In this placebo-controlled, double-blinded, parallel-grouped randomized clinical trial, 343 children were randomly assigned to one of the study arms (1:1). The intervention group (n= 172) received a lozenge containing Lacticaseibacillus rhamnosus, LGG® (DSM33156), Lactobacillus paracasei subsp. paracasei, L. CASEI 431® (DSM33451) and prebiotic (arginine 2%). The placebo group (n= 171) received an identical lozenge without arginine or probiotics. Primary canines and molars, and permanent first molars were examined clinically (d/D= ICDAS 1-6) and radiographically (d/D= R 1-6) at baseline and follow-up. Missing (m/M), sealed (s/S), and filled (f/F) surfaces (-s/-S) in both dentitions were also included. Utilizing clinical and radiographic scorings, caries experience was classified as d ICDAS1-6msf-s (primary teeth), D ICDAS1-6MSF-S (permanent teeth), d/D ICDAS1-6m/M-s/S-f/F-s/S (mixed dentition). A weighted and an unweighted score system was applied. RESULTS: The study was completed by 288 children. The dropout rate was 15%. The increase in ∆mean d ICDAS3-6msf-s and ∆mean d/D ICDAS3-6m/M-s/S-f/F-s/S was lower in the intervention group (p= 0.007). No differences were found for gingivitis- and plaque occurrence. No product-related side effects were reported. This study followed ICH-GCP including monitoring. CONCLUSION: Daily intake of combined prebiotic arginine and two strains of probiotics lozenges showed statistically significantly reduced caries increment but no effect on the mean plaque or gingivitis in children. The use of the lozenge has a promising potential as a supplementary tool for future management of caries. www.CLINICALTRIALS: gov (NCT03928587).CLINICAL SIGNIFICANCE: The combination of prebiotic arginine and probiot

Prævalensen af approksimal caries i såvel det primære som de permanente tandsæt er relativt høj i de nordiske lande. Approksimal forsegling og infiltration er behandlingsmetoder, der anvendes med det formål at forhindre, at carieslæsioner progredierer til fyldningskrævende læsioner. Denne artikel gennemgår effekten af de to metoder baseret på data fra et nyere systematisk review, der viser, at anvendelse af approksimal forsegling eller infiltration reducerer risikoen for progression af carieslæsion 2 til 16 gange i forhold til andre non-operative behandlingsmetoder som f.eks. fluorid applikationer. Tiltroen (baseret på gradering af evidens) til effektiviteten af approksimal forseglinger er moderat, mens tiltroen til infiltration vurderes at være høj. På trods af videnskabelig evidens for metodernes effektivitet, er hverken forsegling eller infiltration særlig udbredte behandlingsmetoder til behandling af approksimal caries i de nordiske lande. Mulige årsager til dette diskuteres. I aktuelle artikel gennemgås desuden vores præliminære resultater fra et studie i Chile, hvor der anvendes en ny metode til forsegling af approksimal caries.

Objective: The International Caries Classification and Management System (ICCMS™), a comprehensive, evidence-informed, best clinical practice system, comprises a 4D cycle: 1D-Determine risk; 2D-Detect and assess lesions; 3D-Decide on a personalized care plan; and 4D-Do preventive and tooth-preserving care. The aim of this study was to establish how Colombian dental practitioners, educators and students diagnose and manage caries risk and caries lesions using the COM-B model and the ICCMS™ system. Methods: A total of 1094 participants (practitioners: n = 277; educators: n = 212; students: n = 605) completed a previously validated 79-item questionnaire which explores, based on the COM-B model, the practitioners' self-reported caries diagnosis and management behaviours. Descriptive statistics, Welch's ANOVAs and multiple linear regressions were computed. Results: All groups generally performed the behaviours within the 4-D categories ‘Most of the time’ to ‘Always’ (students: 4.06 ± 0.95; educators: 3.94 ± 0.98; practitioners: 3.86 ± 1.01). The most frequently performed diagnosis behaviours (1D/2D) were for practitioners assessing initial/moderate lesions (4.09 ± 1.01) and for educators and students cleaning teeth before lesion assessment (4.41 ± 0.80 and 4.38 ± 0.77 respectively). The least frequently performed decision/management (3D/4D) behaviour was non-operative care for moderate-caries lesions (when applicable) (practitioners: 2.64 ± 1.23; educators: 2.68 ± 1.17; students: 3.22 ± 1.41). Opportunity (Resources and Relevance) was the best COM-B predictor for diagnostic behaviours, whereas capability and opportunity (Relevance) were the strongest predictors for management behaviours. Conclusion: Colombian practitioners, educators and students diagnose and manage caries risk and caries lesions implementing best practice with a high to very high frequency.

This study aimed to evaluate the in vitro performance in detecting caries around composite restorations in permanent posterior teeth and the impact of treatment decisions of two visual criteria: International Dental Federation (FDI) criteria and the Caries Associated with Restorations and Sealants (CARS) system. The correlation among secondary caries and the presence of gap measured with a three-dimensional (3D) intraoral scanner was also aimed. One hundred sixteen teeth were assessed by a trained and calibrated examiner according to the FDI criteria or CARS system. A second examiner measured the gap on the 3D models using specific software. The reference standard was the histological examination performed by a third examiner blind to the other evaluations. Other 30 extracted permanent teeth were used only to assess the reproducibility of the methods. The same random sample was selected for re-examination by all three methods, and there were seven days between the examinations. Unweighted and weighted kappa tests were conducted to assess intra-examiner reproducibility. Spearman's correlation coefficient (Rho) and 95% confidence intervals (95%CI) were calculated between the histological examination and scores obtained with FDI criteria, CARS system and treatment decisions. Spearman correlation between the visual and scanner evaluation with the reference standard was performed. Spearman's rank correlation analyses were conducted independently between the gap evaluated and measured by the visual inspection with the gap assessed using the scanner. The reproducibility of the visual score systems reached high values. Spearman's correlation coefficients (Rho; 95%CI) between the following variables versus histology were: FDI presence of caries (0.65; 0.53 to 0.74); CARS scores (0.65; 0.52 to 0.74); FDI treatment decision (0.46; 0.31 to 0.59); and CARS treatment decision (0.62; 0.49 to 0.72). Rho (95%CI) between histology and the gap assessment by the visual inspection wa

Additional information of bitewings to first time clinical examination of caries and restoration status in permanent dentition, Objectives Identifying additional information obtained by X-rays combined with clinical examination concerning primary caries, caries adjacent to restorations and quality of restorations. Material and methods A total of 240 adult patients, equally distributed in gender and six age-groups, were randomly selected from an original study population of 4,402 subjects (DANHES). Clinical and radiographical registrations on occlusal and approximal surfaces in posterior teeth were categorized into unrestored surfaces (sound/primary caries) and restored surfaces (without/with caries adjacent to restorations). Material and quality of restorations were also recorded. Chi-square and Fisher-exact tests were used for statistical analyses. Results Of potentially 11,520 surfaces, 3,015 occlusal and 5,112 approximal surfaces were analysed. Occlusal: Of 907 unrestored surfaces, 110 had primary caries and 53% were detected radiographically. A total of 183 of 2,108 restored surfaces had caries adjacent to restorations, and 99% were found radiographically. A total of 190 restorations were over/under-extended, and 89% were registered radiographically. Approximal: Of 2,649 unrestored surfaces 648 had primary caries, and 92% were registered radiographically. A total of 565 of 2,463 restored surfaces had caries adjacent to restorations, and 99% were found radiographically. A total of 638 restorations were over/under-extended, and 98% were found radiographically. For all restorations, material and depth influenced quality of restorations and incidence of caries adjacent to restorations. At least one independent variable (gender/age group/tooth-type/jaw/side/mesial-distal surface) influenced frequencies of primary caries, caries adjacent to restorations and quality of restorations. Conclusions First-time clinical examination must be supplemented with X-rays to obtain a complete impression of caries status in posterior regions regarding diagnostics of

This is a delayed-type cross-sectional prospective accuracy study nested in a randomized clinical trial. The aim was to investigate the diagnostic accuracy of two visual criteria for caries lesions detection around restorations in primary teeth: the International Dental Federation (FDI) criteria, considering adaptation, staining, and the presence of caries, and the Caries Associated with Restorations and Sealants (CARS) system. For this, one examiner made the diagnosis and subsequent treatment decision using visual assessment in 163 children (3-10 years old) with both FDI and CARS criteria. The order of criteria used was defined by randomization. The reference standard was composed of two approaches: (1) the presence of carious tissue after restoration removal and (2) the presence of caries lesions after 6 and 12 months of follow-up. Sensitivity, specificity, and accuracy parameters were calculated at the dentin threshold. Poisson multilevel regression analyses were performed to evaluate the association of the diagnostic methods and other explanatory variables with the outcomes. Of the 651 restorations included, 480 were evaluated by the reference standard methods and were analyzed. The CARS system presented higher accuracy (0.721) than those obtained with FDI recurrence of caries (0.702), FDI marginal adaptation (0.700), and FDI marginal staining criteria (0.681). The FDI marginal staining showed the study's lowest sensitivity (0.280) and accuracy (0.681) values. The specificity values of FDI recurrence of caries and FDI marginal adaptation were lower than the CARS system. Restorations assessed after the follow-up period resulted in lower sensitivity but higher specificity than those replaced after initial evaluation. In conclusion, the CARS system is more accurate in detecting caries around restorations in primary teeth than the FDI system, in general. However, the FDI recurrence of caries and FDI marginal adaptation present similar performance to the CARS syst

Introduction: The detection of caries lesions around restoration can be challenging. Therefore, the use of some criteria has been proposed in order to give more objectivity to the diagnosis process. Two of them are the International Dental Federation (FDI) and the Caries Associated with Restorations and Sealants (CARS) criteria. Bothmethods have a different approach to caries, and it is not possible to know which one of them is the best to use in clinical practice to assess restorations in children. Thus, the present protocol aims to evaluate the effect of the use of the FDI and CARS criteria in the assessment of caries lesions around restorations in primary teeth on outcomes related to oral health in children and costs resulting from the assessments. Methods and analysis: A total of 626 restorations of children from three to 10 years were randomly assessed and are being treated following the FDI criteria (FDI group) or CARS criteria (CARS group). Participants will be followed-up after six, 12, 18, and 24 months. The primary outcome will be the need for a new intervention in the evaluated restorations. This outcome consists of several components, and each of these events will be analyzed separately as secondary outcomes. The changes in children’s oral health-related quality of life and the cost of the restoration dental treatments will also be analyzed as secondary outcomes. The methods will be compared using the Cox regression model with shared frailty. A significance level of 5% will be adopted for all statistical analyses. Discussion: This will be the first randomized clinical study carried out regarding the detection of caries lesions around restorations in primary teeth. Trial registration: The study underwent registration in Clinicaltrials.gov (NCT03520309) on 9 May 2018

Objective: To examine the relationship between the ICCMS™ (International Caries Classification and Managing System) features of root caries lesions and the underlying depth of the lesion towards the pulp. In order to control for bias, the study followed the tailored document for risk of bias assessment (RoB-tool) recently published. A pilot study showed that the outline of the pulp was much clearer on horizontal compared to vertical sections through the lesions (p = 0.03) and that the histological stereomicroscopical (SM) assessed lesion depth towards the pulp was not influenced by the cutting direction (p = 0.155). Material and methods: A sample of extracted permanent molar teeth (n = 100) were classified independently by two of the authors according to ICCMS™ as no sign of root caries lesion 0 = sound; 1 = initial lesion (non-cavitated); 2 = moderate lesion (cavity depth ≤ 2 mm) and 3 = extensive lesion (cavity depth > 2 mm). After horizontal sectioning (HS) through the lesion, the depth of the underlying lesion was SM assessed independently by two of the authors as 0 = no lesion; 1 = lesion in outer 1/3; 2 = middle 1/3; and 3 = inner 1/3 of the dentine towards the pulp. Results: Intra- and inter-reproducibility (weighted kappa values ≥ 0.83); the accuracy (Spearman’s rho-values) = 0.94 and 0.95; and specificity/sensitivities/AUC values (three different thresholds) were ≥ 0.91, ≥ 0.93, and ≥ 0.96, respectively. Conclusion: Under the umbrella of the RoB-tool, the validity in terms of the reproducibility and accuracy of the ICCMS™ root caries scoring system was high. Clinical relevance: By means of the ICCMS™ root caries scoring system, the underlying lesion depth can be estimated, which must be considered when managing the lesion.