Browsing by Author "Zandona, Andrea"

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    How to intervene in the caries process in adults: proximal and secondary caries? An EFCD-ORCA-DGZ expert Delphi consensus statement
    (Springer, 2020) Schwendicke, Falk; Splieth, Christian H.; Bottenberg, Peter; Breschi, Lorenzo; Campus, Guglielmo; Doméjean, Sophie; Ekstrand, Kim; Giacaman, Rodrigo A.; Haak, Rainer; Hannig, Matthias; Hickel, Reinhard; Juric, Hrvoje; Lussi, Adrian; Machiulskiene, Vita; Manton, David; Jablonski-Momeni, Anahita; Opdam, Niek; Paris, Sebastian; Santamaria, Ruth; Tassery, Hervé; Zandona, Andrea; Zero, Domenick; Zimmer, Stefan; Banerjee, Avijit; Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
    Objectives To provide consensus recommendations on how to intervene in the caries process in adults, specifically proximal and secondary carious lesions. Methods Based on two systematic reviews, a consensus conference and followed by an e-Delphi consensus process were held with EFCD/ORCA/DGZ delegates. Results Managing an individual’s caries risk using non-invasive means (oral hygiene measures including flossing/interdental brushes, fluoride application) is recommended, as both proximal and secondary carious lesions may be prevented or their activity reduced. For proximal lesions, only cavitated lesions (confirmed by visual-tactile, or radiographically extending into the middle/inner dentine third) should be treated invasively/restoratively. Non-cavitated lesions may be successfully arrested using non-invasive measures in low-risk individuals or if radiographically confined to the enamel. In high-risk individuals or if radiographically extended into dentine, for these lesions, additional micro-invasive (lesion sealing and infiltration) treatment should be considered. For restoring proximal lesions, adhesive direct restorations allow minimally invasive, tooth-preserving preparations. Amalgams come with a lower risk of secondary lesions and may be preferable in more clinically complex scenarios, dependent on specific national guidelines. In structurally compromised (especially endodontically treated) teeth, indirect cuspal coverage restorations may be indicated. Detection methods for secondary lesions should be tailored according to the individual’s caries risk. Avoiding false positive detection and over-treatment is a priority. Bitewing radiographs should be combined with visual-tactile assessment to confirm secondary caries detections. Review/refurbishing/resealing/repairing instead of replacing partially defective restorations should be considered for managing secondary caries, if possible. Conclusions An individualized and lesion-specific approach is recommended for intervening in the caries process in adults.
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    How to Intervene in the Caries Process in Older Adults: A Joint ORCA and EFCD Expert Delphi Consensus Statement
    (Karger, 2020) Paris, Sebastian; Banerjee, Avijit; Bottenberg, Peter; Breschi, Lorenzo; Campus, Guglielmo; Doméjean, Sophie; Ekstrand, Kim; Giacaman, Rodrigo A.; Haak, Rainer; Hannig, Matthias; Hickel, Reinhard; Juric, Hrvoje; Lussi, Adrian; Machiulskiene, Vita; Manton, David; Jablonski-Momeni, Anahita; Santamaria, Ruth; Schwendicke, Falk; Splieth, Christian H.; Tassery, Hervé; Zandona, Andrea; Zero, Domenick; Zimmer, Stefan; Opdam, Niek; Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
    Aim: To provide recommendations for dental clinicians for the management of dental caries in older adults with special emphasis on root caries lesions. Methods: A consensus workshop followed by a Delphi consensus process were conducted with an expert panel nominated by ORCA, EFCD, and DGZ boards. Based on a systematic review of the literature, as well as non-systematic literature search, recommendations for clinicians were developed and consented in a two-stage Delphi process. Results: Demographic and epidemiologic changes will significantly increase the need of management of older adults and root caries in the future. Ageing is associated with a decline of intrinsic capacities and an increased risk of general diseases. As oral and systemic health are linked, bidirectional consequences of diseases and interventions need to be considered. Caries prevention and treatment in older adults must respond to the patient’s individual abilities for self-care and cooperation and often involves the support of caregivers. Systemic interventions may involve dietary counselling, oral hygiene instruction, the use of fluoridated toothpastes, and the stimulation of salivary flow. Local interventions to manage root lesions may comprise local biofilm control, application of highly fluoridated toothpastes or varnishes as well as antimicrobial agents. Restorative treatment is often compromised by the accessibility of such root caries lesions as well as the ability of the senior patient to cooperate. If optimum restorative treatment is impossible or inappropriate, long-term stabilization, e.g., by using glass-ionomer cements, and palliative treatments that aim to maintain oral function as long and as well as possible may be the treatment of choice for the individual.
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    Violet-blue light and streptococcus mutans biofilm-induced carious lesions
    (2018-07) Felix Gomez, Grace Gomez; Gregory, Richard L.; Zandona, Andrea; Ando, Masatoshi; Lee, Chao-Hung; Anderson, Gregory
    Dental caries is a continuum of disease process. Early carious lesions are reversible and preventable. The primary etiological factor of dental caries is oral biofilm also known as dental plaque. It is an aggregate of oral bacteria, and one of the principal cariogenic bacteria is a facultative anaerobic microbe, Streptococcus mutans, which is indispensable for the initiation of caries. Management of prevention of carious lesions at the microbial level begins with reducing, eliminating and inhibiting the attachment of oral biofilm. Non-invasive phototherapy is widely studied to control oral biofilm as an alternative method to overcome the emergence of antibiotic resistant strains. In vitro studies demonstrated that Violet-Blue light with a peak wavelength of 405 nm had an inhibitory effect on S. mutans biofilm cells irradiated for 5 min. Metabolic activity of S. mutans cells was significantly reduced immediately after treatment with some recovery at 2 and 6 hrs. An in vitro translational study was conducted to determine the inhibitory effect of Violet-Blue light with twice daily treatments for 5 min over a period of 5 days on S. mutans biofilm cells grown on human enamel and dentin specimens. Bacterial viability was significantly reduced in the Violet-Blue light treated group for both dentin and enamel. Lesion depth, obtained by imaging fluorescence loss through Quantitative Light Induced Fluorescence (QLF-D) Biluminator and through transverse microradiography (TMR), was significantly reduced in S. mutans grown in tryptic soy broth with 1% sucrose (TSBS) for dentin. Mineral loss obtained through TMR in the absence of sucrose (TSB) was significant with enamel. However, all the parameters in the Violet-Blue treated groups were numerically reduced, albeit some being not significant. Accurate Mass Quadrupole Time of Flight Mass Spectrometry was used to identify Protoporphyrin IX (PP-IX) in S. mutans biofilm that may play a role in the photoinactivation and emission of fluorescence within specific wavelengths of the visible spectrum namely Violet-Blue light.