- Email: [email protected]
Progression on surfaces with inactive caries
according to the National Institute on Drug Abuse. Often dentists prescribe a limited number of opioid pills for acute pain, so they believe they limit the chance of diversion, dependence, or addiction. However, the most commonly prescribed opioid amount after third molar extraction is 20 doses, or about a 3-day supply. Most patients take just half this amount, keeping the others for possible future use or giving them to friends or family. With inadequate storage, these drugs can be stolen and sold for nonapproved use by others. Recommendations.—Dentists must balance the responsibility to manage patients’ pain against their obligation to avoid facilitating opioid abuse. Numerous resources are available from the National Institute on Drug Abuse to inform dentists about their alternatives, including videos, treatment prevention literature, and assessment tools. Once educated, dentists should identify potential drug abusers by observing any red flags during their discussions with patients and seek to educate those persons and parents (if applicable) about the health threat opioid pain medications pose. This can be done both before and after dental procedures. Dentists should also evaluate their personal drug prescribing patterns and consider using opioids with
discretion. They can rely instead on NSAIDs or APAP. Refills for acute pain medication should be avoided. Patients should be re-evaluated if they report continuing pain to determine the cause and address it. Remembering that pain should quickly resolve once the source is removed, dentists serve the patient best by focusing on eliminating the source of the discomfort.
Clinical Significance.—The dental community should be well educated regarding the proper use and dangers of opioids for pain control. Ethically, dental professionals are responsible for keeping the best interests of the patient their primary focus and for using good clinical judgment to manage pain while protecting the patient from the potential for adverse events related to prescribing pain medications.
Dionne R, Moore P: Opioid prescribing in dentistry: Keys for safe and proper usage. Compendium Continuing Educ Dent 37:29-32, 2016 Reprints not available
Preventive Dentistry Progression on surfaces with inactive caries Background.—Caries activity is determined by lesion characteristics that indicate if net mineral loss is occurring. The assumption has been that inactive lesions will have higher risk of caries progression than sound surfaces. The truth or inaccuracy of this assumption will impact treatment decisions for caries-inactive surfaces. A clinical trial was done in low caries prevalence children who underwent a nonoperative occlusal caries treatment program. No caries progression was noted in 80% of the children after 1 year and 90% after 3 years. Evidence was gathered in a new study about the 1-year results for inactive occlusal enamel lesions in children and adolescents regularly exposed to fluoride. Caries incidence and progression were evaluated. Methods.—The 200 subjects ranged in age from 7 to 15 years and were considered caries inactive. Over the course of 1 year, stage of eruption, occlusal plaque, and occlusal caries were recorded for their permanent molars. Caries incidence and progression were compared between sound
occlusal surfaces and surfaces with inactive enamel lesions. The risk of caries incidence and progression on occlusal surfaces was calculated. Results.—For most children between 4 and 8 molars were evaluated, with a total of 533 having sound occlusal surfaces and 539 having inactive occlusal enamel lesions. Fifty-eight percent of the sample were permanent first molars and 42% were second molars. After 1 year 89% of the children had no change in their molar teeth and 11% had progression, which was defined as having at least one active lesion on a site classified as sound or inactive at baseline. Surfaces that had been filled between the baseline evaluation and 1-year follow-up were also classified as progression. Caries incidence was found in 2.6% of sound surfaces and progression was noted in 2.6% of noncavitated lesions and 16.6% of cavitated lesions. The caries incidence and
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progression rates were not significantly different between the sound sites and sites with inactive occlusal enamel lesions. Regression analysis of the biological factors predictive of caries incidence and progression on occlusal surfaces was performed, adjusting for plaque, stage of eruption, type of molar, and dental arch. Inactive enamel lesions and sound occlusal surfaces had similar risk for caries progression. The only predictive factor for caries incidence and progression after 1 year was easily detectable plaque on occlusal sites. Discussion.—A high number of children (89%) remained caries inactive after 1 year. In addition, 96.8% of the sites on occlusal surfaces remained inactive from the initial examination to the 1-year check-up.
Clinical Significance.—If caries incidence, progression, and risk on sound occlusal sites remain the same, dentists can confidently give these surfaces the same attention that sound occlusal surfaces receive for 1 year. Having inactive caries lesions does not increase the risk of progression over that for sound surfaces.
Zenkner JEA, Carvalho JC, Wagner MB, et al: One-year evaluation of inactive occlusal enamel lesions in children and adolescents. Clin Oral Invest 20:133-139, 2016 Reprints available from JEA Zenkner, School of Dentistry, Federal Univ of Santa Maria, Rua Floriano Peixoto, 1184, Centro 97015-370, Brazil; e-mail: [email protected]
Arresting dentin caries in preschool children Background.—Early childhood caries (ECC) is more prevalent in children from lower socioeconomic groups, with lesions often left untreated from preschool age on. Providing restorative approaches for these children will be an enormous task for dentists to undertake. Progression of dental caries can be arrested using silver diamine fluoride (SDF) solution, with common frequencies of application of every 6 months or yearly. With repeated applications, it is expected that the proportion of arrested caries increases. To expedite the process, an intensive regimen of three applications of 10% SDF was given over 3 consecutive weeks to a small patient group, with success seen for enamel caries in permanent first molars. The approach may be especially useful for high caries risk populations and migratory populations who cannot attend regular visits. The effectiveness of three topical fluoride application protocols for arresting dentin caries in the primary teeth of high caries risk preschool children living in an area with fluoridated water was investigated. Methods.—At baseline, 304 children (mean age 41 months) had 1670 tooth surfaces with dentin caries treated with one of three interventions, specifically, (1) application of 30% SDF solution every 12 months (100 children), (2) three applications of 30% SDF solution weekly (97 children), or (3) three applications of 5% sodium fluoride (NaF) varnish weekly (107 children). Follow-up evaluations were done every 6 months to determine if lesions had
206
Dental Abstracts
become arrested. After 18 months, 275 children were assessed for arrested lesions, with rates compared among the three groups. Results.—The caries arrest rates at 18 months were 40% for group 1, 35% for group 2, and 27% for group 3. Lesions treated with the NaF varnish had lower caries arrest rates than those treated with SDF regardless of the protocol followed. After 6 and 12 months, lesions that had 3weekly applications of SDF solution at baseline had higher caries arrest rates than lesions receiving a single SDF application. Factors associated with the time to arrest of active caries included treatment group, presence of plaque on the lesion, tooth type, and tooth surface. The time to caries arrest was significantly shorter for the two SDF regimens than for the NaF protocol. However, no significant difference was found between the two SDF groups with respect to caries arrest time. Tooth type, tooth surface, and presence of plaque on lesion surface were statistically significant factors. Lesions in anterior teeth were more likely to be arrested after 18 months than those in posterior teeth. Lesions on buccal/lingual surfaces had a greater chance of being arrested than those on occlusal surfaces. The absence of plaque was associated with a significantly shorter time to caries arrest. The only adverse effect on treated teeth and soft tissues of the SDF solution was blackening of the carious lesions.
discretion. They can rely instead on NSAIDs or APAP. Refills for acute pain medication should be avoided. Patients should be re-evaluated if they report continuing pain to determine the cause and address it. Remembering that pain should quickly resolve once the source is removed, dentists serve the patient best by focusing on eliminating the source of the discomfort.
Clinical Significance.—The dental community should be well educated regarding the proper use and dangers of opioids for pain control. Ethically, dental professionals are responsible for keeping the best interests of the patient their primary focus and for using good clinical judgment to manage pain while protecting the patient from the potential for adverse events related to prescribing pain medications.
Dionne R, Moore P: Opioid prescribing in dentistry: Keys for safe and proper usage. Compendium Continuing Educ Dent 37:29-32, 2016 Reprints not available
Preventive Dentistry Progression on surfaces with inactive caries Background.—Caries activity is determined by lesion characteristics that indicate if net mineral loss is occurring. The assumption has been that inactive lesions will have higher risk of caries progression than sound surfaces. The truth or inaccuracy of this assumption will impact treatment decisions for caries-inactive surfaces. A clinical trial was done in low caries prevalence children who underwent a nonoperative occlusal caries treatment program. No caries progression was noted in 80% of the children after 1 year and 90% after 3 years. Evidence was gathered in a new study about the 1-year results for inactive occlusal enamel lesions in children and adolescents regularly exposed to fluoride. Caries incidence and progression were evaluated. Methods.—The 200 subjects ranged in age from 7 to 15 years and were considered caries inactive. Over the course of 1 year, stage of eruption, occlusal plaque, and occlusal caries were recorded for their permanent molars. Caries incidence and progression were compared between sound
occlusal surfaces and surfaces with inactive enamel lesions. The risk of caries incidence and progression on occlusal surfaces was calculated. Results.—For most children between 4 and 8 molars were evaluated, with a total of 533 having sound occlusal surfaces and 539 having inactive occlusal enamel lesions. Fifty-eight percent of the sample were permanent first molars and 42% were second molars. After 1 year 89% of the children had no change in their molar teeth and 11% had progression, which was defined as having at least one active lesion on a site classified as sound or inactive at baseline. Surfaces that had been filled between the baseline evaluation and 1-year follow-up were also classified as progression. Caries incidence was found in 2.6% of sound surfaces and progression was noted in 2.6% of noncavitated lesions and 16.6% of cavitated lesions. The caries incidence and
Volume 61
Issue 4
2016
205
progression rates were not significantly different between the sound sites and sites with inactive occlusal enamel lesions. Regression analysis of the biological factors predictive of caries incidence and progression on occlusal surfaces was performed, adjusting for plaque, stage of eruption, type of molar, and dental arch. Inactive enamel lesions and sound occlusal surfaces had similar risk for caries progression. The only predictive factor for caries incidence and progression after 1 year was easily detectable plaque on occlusal sites. Discussion.—A high number of children (89%) remained caries inactive after 1 year. In addition, 96.8% of the sites on occlusal surfaces remained inactive from the initial examination to the 1-year check-up.
Clinical Significance.—If caries incidence, progression, and risk on sound occlusal sites remain the same, dentists can confidently give these surfaces the same attention that sound occlusal surfaces receive for 1 year. Having inactive caries lesions does not increase the risk of progression over that for sound surfaces.
Zenkner JEA, Carvalho JC, Wagner MB, et al: One-year evaluation of inactive occlusal enamel lesions in children and adolescents. Clin Oral Invest 20:133-139, 2016 Reprints available from JEA Zenkner, School of Dentistry, Federal Univ of Santa Maria, Rua Floriano Peixoto, 1184, Centro 97015-370, Brazil; e-mail: [email protected]
Arresting dentin caries in preschool children Background.—Early childhood caries (ECC) is more prevalent in children from lower socioeconomic groups, with lesions often left untreated from preschool age on. Providing restorative approaches for these children will be an enormous task for dentists to undertake. Progression of dental caries can be arrested using silver diamine fluoride (SDF) solution, with common frequencies of application of every 6 months or yearly. With repeated applications, it is expected that the proportion of arrested caries increases. To expedite the process, an intensive regimen of three applications of 10% SDF was given over 3 consecutive weeks to a small patient group, with success seen for enamel caries in permanent first molars. The approach may be especially useful for high caries risk populations and migratory populations who cannot attend regular visits. The effectiveness of three topical fluoride application protocols for arresting dentin caries in the primary teeth of high caries risk preschool children living in an area with fluoridated water was investigated. Methods.—At baseline, 304 children (mean age 41 months) had 1670 tooth surfaces with dentin caries treated with one of three interventions, specifically, (1) application of 30% SDF solution every 12 months (100 children), (2) three applications of 30% SDF solution weekly (97 children), or (3) three applications of 5% sodium fluoride (NaF) varnish weekly (107 children). Follow-up evaluations were done every 6 months to determine if lesions had
206
Dental Abstracts
become arrested. After 18 months, 275 children were assessed for arrested lesions, with rates compared among the three groups. Results.—The caries arrest rates at 18 months were 40% for group 1, 35% for group 2, and 27% for group 3. Lesions treated with the NaF varnish had lower caries arrest rates than those treated with SDF regardless of the protocol followed. After 6 and 12 months, lesions that had 3weekly applications of SDF solution at baseline had higher caries arrest rates than lesions receiving a single SDF application. Factors associated with the time to arrest of active caries included treatment group, presence of plaque on the lesion, tooth type, and tooth surface. The time to caries arrest was significantly shorter for the two SDF regimens than for the NaF protocol. However, no significant difference was found between the two SDF groups with respect to caries arrest time. Tooth type, tooth surface, and presence of plaque on lesion surface were statistically significant factors. Lesions in anterior teeth were more likely to be arrested after 18 months than those in posterior teeth. Lesions on buccal/lingual surfaces had a greater chance of being arrested than those on occlusal surfaces. The absence of plaque was associated with a significantly shorter time to caries arrest. The only adverse effect on treated teeth and soft tissues of the SDF solution was blackening of the carious lesions.