scholarly journals Atraumatic Restorative Treatment-Sealed versus Nonsealed First Permanent Molars: A 3-Year Split-Mouth Clinical Trial

2020 ◽  
Vol 55 (1) ◽  
pp. 12-20
Author(s):  
Daniela Hesse ◽  
Camila de Almeida Brandão Guglielmi ◽  
Daniela Prócida Raggio ◽  
Marcelo José Strazzeri Bönecker ◽  
Fausto Medeiros Mendes ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Low Income ◽  
Cox Regression ◽  
Caries Experience ◽  
Rank Test ◽  
Atraumatic Restorative Treatment ◽  
Restorative Treatment ◽  
Permanent Molars ◽  
Caries Lesions ◽  
First Permanent Molars

To investigate the efficacy of atraumatic restorative treatment (ART) sealants vs. no sealant in preventing the development of dentine caries lesions in first permanent molars over a period of 3 years. A total of 187 schoolchildren (aged 6–8 years) from a low-income population presenting the 4 first permanent molars without clinically detectable dentine caries lesions were selected to be part of a split-mouth clinical trial. All 4 first permanent molars were investigated in this trial and the children’s mouth was split vertically into left and right sides; therefore, 2 molars were randomly allocated to receive ART sealants, while the other 2 molars remained nonsealed. All children received toothbrushing instructions and dietary advice every 6 months for a period of 3 years. Clinical evaluations were performed after 3, 6, 12, 18, 24, and 36 months and both sealant retention and dental caries were scored. Kaplan-Meier survival analysis, log-rank test, and Cox regression with shared frailty analysis were performed. A cavitated dentine caries lesion was considered a failure. The cumulative survival rates of dentine cavity-free first permanent molars were 90% for ART-sealed molars and 90.8% for nonsealed molars, with no statistically significantly difference between sealed and nonsealed molars (<i>p</i> = 0.70). The retention of sealants was not associated with the development of cavitated dentine caries and children presenting a higher baseline caries experience had greater chances of developing dentine lesions. In conclusion, the application of ART sealants was not more efficacious than nonsealing in reducing the development of dentine cavitated lesions in first permanent molars.

scholarly journals Comparative Effectiveness of Two Nonsurgical Treatments to Reduce Oral Health Disparities From Untreated Tooth Decay in Older Adults: Protocol for a Cluster Randomized Trial (Preprint)

2020 ◽  
Author(s):  
Suchitra Nelson ◽  
Jeffrey M Albert ◽  
Peter Milgrom
Keyword(s):  
Older Adults ◽  
Dental Caries ◽  
Low Income ◽  
Cluster Randomized Trial ◽  
Fluoride Varnish ◽  
Atraumatic Restorative Treatment ◽  
Silver Diamine Fluoride ◽  
Restorative Treatment ◽  
Cluster Randomized ◽  
Caries Lesions

BACKGROUND The majority of dental caries lesions in older adults are at the gumline, at the edges of failed fillings and crowns, and in the surfaces of roots after gum recession. These lesions are difficult to restore with conventional surgical treatments using a dental drill and restorations often fail. Clinical guidelines are general and apply treatments that were designed for younger individuals in the dental care of older adults. OBJECTIVE This study will compare the effectiveness of 2 evidence-based nonsurgical strategies to manage dental caries lesions in adults aged 62 or older: (1) biannual topical application of silver diamine fluoride versus (2) atraumatic restorative treatment + biannual fluoride varnish. METHODS A cluster randomized clinical trial is being conducted in 22 publicly subsidized and other low-income housing facilities/sites (Arm 1: 11 sites, 275 participants; Arm 2: 11 sites, 275 participants). At baseline, participants will be screened for caries lesions. Those with nonurgent lesions will be treated according to the treatment arm to which the housing site was randomly assigned. The primary outcomes are caries lesion arrest, tooth sensitivity, and tooth pain at 52 weeks after treatment. Analytic methods for the primary aim include a generalized estimating equation approach to determine noninferiority of silver diamine fluoride relative to atraumatic restorative treatment + fluoride varnish treatment. RESULTS The trial was funded in April 2019. Enrollment began in September 2019 and results are expected in June 2023. CONCLUSIONS This study will inform the standard of care for treating caries lesions in older adults. If effective, either of these interventions has broad applicability in clinical and community-based settings. CLINICALTRIAL ClinicalTrials.gov NCT03916926; https://clinicaltrials.gov/ct2/show/NCT03916926 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/17840

scholarly journals Comparative Effectiveness of Two Nonsurgical Treatments to Reduce Oral Health Disparities From Untreated Tooth Decay in Older Adults: Protocol for a Cluster Randomized Trial

10.2196/17840 ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. e17840
Author(s):  
Suchitra Nelson ◽  
Jeffrey M Albert ◽  
Peter Milgrom
Keyword(s):  
Older Adults ◽  
Dental Caries ◽  
Low Income ◽  
Cluster Randomized Trial ◽  
Fluoride Varnish ◽  
Atraumatic Restorative Treatment ◽  
Silver Diamine Fluoride ◽  
Restorative Treatment ◽  
Cluster Randomized ◽  
Caries Lesions

Background The majority of dental caries lesions in older adults are at the gumline, at the edges of failed fillings and crowns, and in the surfaces of roots after gum recession. These lesions are difficult to restore with conventional surgical treatments using a dental drill and restorations often fail. Clinical guidelines are general and apply treatments that were designed for younger individuals in the dental care of older adults. Objective This study will compare the effectiveness of 2 evidence-based nonsurgical strategies to manage dental caries lesions in adults aged 62 or older: (1) biannual topical application of silver diamine fluoride versus (2) atraumatic restorative treatment + biannual fluoride varnish. Methods A cluster randomized clinical trial is being conducted in 22 publicly subsidized and other low-income housing facilities/sites (Arm 1: 11 sites, 275 participants; Arm 2: 11 sites, 275 participants). At baseline, participants will be screened for caries lesions. Those with nonurgent lesions will be treated according to the treatment arm to which the housing site was randomly assigned. The primary outcomes are caries lesion arrest, tooth sensitivity, and tooth pain at 52 weeks after treatment. Analytic methods for the primary aim include a generalized estimating equation approach to determine noninferiority of silver diamine fluoride relative to atraumatic restorative treatment + fluoride varnish treatment. Results The trial was funded in April 2019. Enrollment began in September 2019 and results are expected in June 2023. Conclusions This study will inform the standard of care for treating caries lesions in older adults. If effective, either of these interventions has broad applicability in clinical and community-based settings. Trial Registration ClinicalTrials.gov NCT03916926; https://clinicaltrials.gov/ct2/show/NCT03916926 International Registered Report Identifier (IRRID) DERR1-10.2196/17840

Characteristics and Caries Experience of Tetracycline-Affected Dentitions

1973 ◽  
Vol 52 (3) ◽  
pp. 508-516 ◽  
Author(s):  
Louise J. Brearley ◽  
J. Rennie Porteous
Keyword(s):  
Additive Effect ◽  
Caries Experience ◽  
Paired Control ◽  
Permanent Molars ◽  
Deciduous Molars ◽  
First Permanent Molars

A study of the caries experience of children with tetracycline-affected, but not hypoplastic, dentitions showed significantly lower DMF surface scores for the complete dentition, deciduous molars, and first permanent molars in comparison with paired control dentitions. Tetracycline and fluoride appeared to have an additive effect in lowering caries experience.

Characteristics, management and outcomes of patients with hepatocarcinoma in a low-income country.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16166-e16166
Author(s):  
Jennifer Dominguez ◽  
Bonnie Macario ◽  
Rixci Ramirez ◽  
Mario Daniel Castro
Keyword(s):  
Alcohol Consumption ◽  
Liver Cancer ◽  
Low Income ◽  
Cox Regression ◽  
Target Therapy ◽  
Income Country ◽  
Rank Test ◽  
Excessive Alcohol Consumption ◽  
History Of ◽  
Excessive Alcohol

e16166 Background: Worldwide, every year, there are nearly 905,000 patients diagnosed with liver cancer; it is the sixth most common malignancy and the third most lethal malignancy. Almost three quarters of new patients live in areas with low and medium-income country. Guatemala has the highest mortality and incidence of liver cancer. Objectives: Describe the clinical characteristics, main risk factors, treatment and outcomes of patients with hepatocarcinoma (HCC) in Guatemala. Methods: A retrospective review was performed among patients with HCC from January 2002 to December 2019 in the Instituto Guatemalteco de Seguridad Social (IGSS). Kaplan Meier curves, Cox regression and log-rank test were used to calculate overall survival (OS) and mortality. Results: 140 patients with HCC were analyzed, 114 women and 26 men with a median age of 60 years (20 - 99), 102 patients (73%) have history of excessive alcohol consumption and 11 (8%) has history of chronic hepatitis B or C virus infection. All of the patients have liver cirrhosis, Child-Pugh A 100 patients (71%), B 34 (24%) and C 6 (5%). 10 patients (7%) have HCC BCLC A, 0 (0%) BCLC B, 121 (81%) BCLC C and 9 (6%) BCLC D. All patients with HCC BCLC A received surgical treatment with a median OS of 123 months (95% CI 89 - 156 p < 0.001). 122 patients (89%) received target therapy with Sorafenib with a median OS of 17 months (95% CI 12 - 21 p < 0.001) and 8 patients (6%) underwent to chemoembolization with a median OS of 32 months (95% CI 12 - 52 p < 0.001). At this time, 111 patients (79%) died from the disease, 11 (8%) are alive with the disease and 8 (6%) are alive without disease. Conclusions: The most frequent risk factor for HCC is the excessive alcohol consumption, survival of patients with HCC are associated with treatment at the beginning of the disease.

Predictors for response to cetuximab in a prospective clinical trial (E2303) of patients with head and neck squamous cell carcinoma (HNSCC).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 5576-5576 ◽  
Author(s):  
Amanda Psyrri ◽  
Ju-Whei Lee ◽  
Eirini Pectasides ◽  
Maria Vassilakopoulou ◽  
Barbara Burtness ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Phase Ii ◽  
Cox Regression ◽  
Objective Response ◽  
Eastern Cooperative Oncology Group ◽  
Disease Stage ◽  
Rank Test ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Event Time

5576 Background: Theidentification of resistance mechanisms to Epidermal Growth Factor Receptor (EGFR) inhibitors remains critical lack in the management of HNSCC. We sought to determine predictors for response to cetuximab in a phase II clinical trial. Methods: 63 patients (pts) with operable stage III/IV HNSCC participated in E2303, an Eastern Cooperative Oncology Group (ECOG) phase II trial of induction chemotherapy with weekly cetuximab, paclitaxel and carboplatin x 6 followed by chemoradiotherapy with the same regimen. A tissue microarray was constructed and EGFR, ERK1/2, Met, pAkt and STAT protein expression levels were assessed using AQUA. The objectives of analysis were to determine association of biomarkers with E2303 efficacy outcomes (best objective response (OR), overall survival (OS), progression-free survival (PFS), and event-free survival (EFS)). The logistic regression model was used to examine relationship between marker measurements (on a continuous scale) and OR. The univariate and multivariate Cox proportional hazards models were used to evaluate the relationship between markers and event-time distributions. Fisher’s exact test was used to evaluate differences in response rate between groups (high vs. low AQUA scores). Event-time distributions were estimated by the Kaplan-Meier method and compared by the log-rank test. Results: Cytoplasmic ERK1/2 levels weresignificantly associated with PFS and OS (p=0.03 and 0.01, respectively). Nuclear ERK1/2 levels were significantly associated with OS (p=0.02) and tended towards significance for PFS (p=0.09). The multivariate Cox regression analysis shows that cytoplasmic and nuclear ERK1/2 are significantly associated with OS and PFS after controlling for primary site and disease stage, respectively There was no significant association between cytoplasmic or nuclear ERK1/2 status and OR (p-values 0.98 and 0.41, respectively).No association was found between expression of any of other biomarkers and outcome measures. Our data analysis was based on 35 pts with marker data available. Conclusions: Ras/MAPK/ERKpathway may be associated with resistance to cetuximab in HNSCC.

scholarly journals Caries burden and suitability for atraumatic restorative treatment among schoolchildren in Indonesia

2020 ◽  
Vol 3 ◽  
pp. 77-81
Author(s):  
Irene Adyatmaka ◽  
Jilen Patel
Keyword(s):  
Dental Caries ◽  
Mixed Dentition ◽  
Caries Experience ◽  
Good Effect ◽  
Atraumatic Restorative Treatment ◽  
Older Children ◽  
Cross Sectional ◽  
Restorative Treatment ◽  
Stage Of Development ◽  
Carious Lesions

Objectives: Dental caries remains among the most prevalent chronic conditions in childhood and remains highly prevalent among schoolchildren in Indonesia. Globally, atraumatic restorative treatment (ART) has been used to good effect in the management of carious lesions among high-risk cohorts, particularly in challenging environments. However, in settings, where labor, time, facilities, and materials are particularly limited, strategic triaging of teeth suitable for ART restorations may be valuable to better direct public health expenditure. Therefore, this study aims to (i) describe the prevalence of dental caries among Indonesian schoolchildren and (ii) evaluate the proportion of lesions indicated for ART. Materials and Methods: A cross-sectional cohort study of elementary schoolchildren from West Java, Indonesia, was examined and categorized according to Hellman’s dental development stages (Groups 1–4 corresponding to the early mixed dentition through to complete permanent dentition). Descriptive statistics and proportional analysis were conducted with the following variables being evaluated: Teeth with early caries (EC), late/advanced caries (LC), recurrent caries (RC), and total caries experience (TC = EC+ART+LC+RC). In evaluating the suitability for ART, additional variables of ART indicated carious lesions (ART) and lower molars with lesions indicated for ART (LM) were assessed. Results: A total of 437 children ranging from 8 to 14 years of age were examined. Out of 8882 teeth examined, 996 had active carious lesions and only 57 had received satisfactory restorative treatment. Children in Hellman’s Group 1 stage of development had the highest prevalence of EC (62%) and ART indicated caries (32%). Meanwhile, older children in Group 4 experienced the highest portion of advanced caries (15%). The proportion of lower molars indicated for ART was 87%, 76%, 70%, and 67% in Groups 1–4, respectively. Conclusion: Indonesian schoolchildren face a high burden of untreated dental caries from a young age. The younger the developmental stage, the higher the prevalence of early and ART-indicated lesions with the majority being found in lower permanent molars. Although ART and preventive strategies show the highest potential in the early mixed dentition, they alone cannot completely meet the dental needs of populations such as this where the severity and disease burden are extremely high.

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