In the final portion of this chapter, we examine diverse fluoride applications for controlling tooth decay on the crown, and outline the evidence-based recommendations for combining these approaches.
A caries risk assessment (CRA) is essential for the customized and precise handling of caries. Existing computerized radiographic analysis (CRA) tools, lacking comprehensive formal evaluation and validation, impede the accurate forecasting of new lesions. This notwithstanding, clinicians should continue to evaluate modifiable risk factors, create preventive measures, and meet the unique requirements of each patient to personalize their care accordingly. Given that caries is a multifaceted and evolving disease, the complexity of CRA is undeniable, influenced by various factors throughout life, necessitating ongoing evaluation. posttransplant infection Caries risk is affected by a multitude of individual, family, and community-level influences; however, unfortunately, existing caries experience remains a strong indicator of future caries risk. To bolster evidence-based, minimally invasive caries management strategies for coronal caries lesions in children, adults, and the elderly, a priority should be given to the development and implementation of validated, inexpensive, and user-friendly CRA tools. CRA tool development efforts should prioritize the evaluation and reporting of pertinent internal and external validation data. Big data and AI-based approaches may potentially determine future risk predictions, and cost-effectiveness analyses will likely contribute to the selection of appropriate risk thresholds for decision-making. The importance of CRA in treatment planning and decision-making compels attention to implementation hurdles, such as conveying risk effectively to inspire behavioral modifications, developing rapidly integrable tools for the busy clinical setting, and ensuring adequate compensation for the time invested in implementation.
The principles governing the diagnosis of dental caries, as practiced clinically, are examined in this chapter, with a focus on clinical evaluation and the auxiliary role of radiographic assessment. immune T cell responses Clinical assessments of caries lesions' symptoms and signs are crucial for dental professionals' diagnosis of caries disease, alongside the use of radiographic imaging as an additional diagnostic tool. The initial step towards diagnosis relies on a comprehensive clinical examination, which is best undertaken after the removal of dental biofilm from tooth surfaces, air-drying, and optimal illumination conditions. Caries lesions are categorized by clinical diagnostic methods, differentiating by severity and, in some instances, activity. The activity of caries lesions was determined by observing their surface reflections and textures. A supplementary diagnostic approach for evaluating the activity of carious lesions involves the detection of pronounced biofilm accumulations on tooth surfaces. Patients who have not experienced any caries in their dentition, devoid of either clinical or radiographic signs of carious lesions, are classified as caries-inactive. Individuals with no current caries activity may still have inactive carious lesions or dental restorations present in their teeth. Patients are considered to be in a state of active caries when any active carious lesion is observed clinically, or when a progression of a lesion is observable through at least two bitewing radiographs taken at different moments. The primary worry regarding caries-active patients lies in the potential for caries lesions to advance unless proactive measures are put in place to halt their progression. Using bitewing radiographs, adjusted to individual necessities, clinicians gain supplemental information for clinical evaluations. These help spot lesions affecting proximal enamel and outer dentin thirds, potentially addressable through non-operative approaches.
Recent decades have seen a substantial increase in the sophistication of dentistry in all its various applications. Whereas operative treatments were commonplace in the past for managing caries, contemporary methods now prioritize non-invasive and minimally invasive interventions, resorting to invasive treatment solely when essential. To ensure the least intrusive and most conservative treatment approach for dental caries, early detection is essential, yet poses a considerable hurdle. Successfully managing the development of early or noncavitated caries lesions is now possible, similarly to arresting the progression of existing lesions by combining oral hygiene, the use of fluoride, sealants, or resin infiltration. By employing methods like near-infrared light transillumination, fiber-optic transillumination, digital fiber-optic transillumination, laser fluorescence, and quantitative light fluorescence measurements, the dental field has achieved X-ray-free caries detection, assessment, and monitoring. Bitewing radiography continues to be the gold standard for detecting caries in those areas of the teeth that are not directly visible. The latest application of artificial intelligence for the detection of caries lesions in bitewing radiographs and clinical images presents a promising opportunity but also necessitates a substantial research commitment in the future. This chapter intends to provide a comprehensive overview of potential strategies for identifying coronal caries lesions, together with suggestions for improving the corresponding procedure.
A global overview of clinical data regarding coronal caries prevalence and associated sociodemographic factors is presented in this chapter, encompassing children, adults, and the elderly. Global caries prevalence maps demonstrated a striking range of rates, highlighting persistent high figures in various nations. Each group is characterized by the disease's prevalence according to age and the average number of affected teeth. The varying rates of dental caries in developed and developing countries are likely attributable to a complex interplay of factors, including variations in the age groups studied, alongside the numerous differences in ethnicity, cultural practices, geographical location, and stages of development. This also includes access to dental services, the availability of healthcare, oral hygiene practices, nutritional factors, and lifestyle choices. Though a decreasing trend is noticeable in the prevalence of caries in Western children and adults, the uneven distribution of the disease remains strongly connected to individual and community-level factors. Studies have indicated a high prevalence of dental caries, often exceeding 98%, in older adults, characterized by a wide range of differences between and within countries. Tooth loss, although still frequent, showed a decreasing pattern. Analysis of the association between sociodemographic factors and caries reveals the critical need for a global oral healthcare system reform that acknowledges the disparities in caries throughout the life course. The creation of national oral healthcare policies, built upon epidemiological models of care, necessitates the collection of further primary oral health data to support policy-makers.
Despite the comprehensive understanding of cariology, contemporary research actively seeks ways to improve dental enamel's resilience to dental caries. Because enamel is predominantly a mineral, significant endeavors have been directed towards improving its ability to withstand the acids produced by dental biofilm, particularly when confronted with dietary sugars. Fluoride's role in preventing tooth decay, once perceived through its incorporation into tooth mineral structure as a micronutrient, is now recognized as primarily contingent upon complex surface interactions. Enamel's behavior, like that of every other slightly soluble mineral, is shaped by its environment, and the influence of saliva and biofilm fluid is especially critical within the dental crown. Enamel's mineral content can vary, possibly decreasing, but also having the ability to regain the lost minerals. Plerixafor research buy The equilibrium processes, along with the loss or gain, adhering to Le Chatelier's principle, are categorized physicochemically as saturating, undersaturating, and supersaturating conditions, respectively. The supersaturation of saliva, and even of biofilm fluid, with calcium (Ca2+) and phosphate (PO43-) is in excess of enamel's solubility; consequently, enamel naturally tends to absorb minerals, hence the remineralizing nature of saliva. Yet, the drop in pH and the presence of free fluoride ions (F-) will ultimately determine the enamel's progression. Although decreasing the pH of the medium introduces an imbalance, fluoride, present at micromolar levels, mitigates the acidic effect. The chapter offers a modern, evidence-driven understanding of how oral fluids affect the enamel's structure and function.
Within the oral cavity, a community of bacteria, fungi, archaea, protozoa, viruses, and bacteriophages cohabit to form the oral microbiome. The harmonious interplay of diverse microorganisms and the equilibrium of microbial populations within a given site hinges upon the synergistic and antagonistic actions of the microbial community members. The equilibrium of microorganisms in this system inhibits the proliferation of potentially harmful microbes, typically maintaining their numbers low within the colonized areas. Compatible with a healthy condition, the host experiences a harmonious coexistence of microbial communities. Instead, stressors impose selective pressures on the microbial population, disrupting the harmonious balance within the microbiome, thus giving rise to dysbiosis. Potentially pathogenic microorganisms become more numerous in this process, subsequently affecting the properties and functions of the assembled microbial communities. Upon achieving the dysbiotic condition, a heightened susceptibility to illness is anticipated. The presence of biofilm is essential for the process of caries development. To develop effective preventive and therapeutic strategies, a fundamental understanding of microbial community composition and metabolic interplays is indispensable. Analyzing health and cariogenic factors together provides crucial insight into the disease process. Advancements in omics approaches provide an unparalleled opportunity to generate new knowledge about the causes and mechanisms of dental caries.