Advances in dental research

Variation in the terminology used to describe clinical management of carious lesions has contributed to a lack of clarity in the scientific literature and beyond. In this article, the International Caries Consensus Collaboration presents 1) issues around terminology, a scoping review of current words used in the literature for caries removal techniques, and 2) agreed terms and definitions, explaining how these were decided. Dental caries is the name of the disease, and the carious lesion is the consequence and manifestation of the disease—the signs or symptoms of the disease. The term dental caries management should be limited to situations involving control of the disease through preventive and noninvasive means at a patient level, whereas carious lesion management controls the disease symptoms at the tooth level. While it is not possible to directly relate the visual appearance of carious lesions’ clinical manifestations to the histopathology, we have based the terminology around the clinical consequences of disease (soft, leathery, firm, and hard dentine). Approaches to carious tissue removal are defined: 1) selective removal of carious tissue—including selective removal to soft dentine and selective removal to firm dentine; 2) stepwise removal—including stage 1, selective removal to soft dentine, and stage 2, selective removal to firm dentine 6 to 12 mo later; and 3) nonselective removal to hard dentine—formerly known as complete caries removal (technique no longer recommended). Adoption of these terms, around managing dental caries and its sequelae, will facilitate improved understanding and communication among researchers and within dental educators and the wider clinical dentistry community.

N.P.T. Innes

J.E. Frencken

L. Bjørndal

M. Maltz

D.J. Manton

D. Ricketts

K. Van Landuyt

A. Banerjee

G. Campus

S. Doméjean

M. Fontana

S. Leal

E. Lo

V. Machiulskiene

A. Schulte

C. Splieth

A. Zandona

F. Schwendicke

Advances in Dental Research

Managing Carious Lesions: Consensus Recommendations on Terminology

龋损管理：术语共识建议

This article aims to outline the early development of a King's College London dental spinout company, Reminova, formed to commercialize a novel clinical method of caries remineralization: electrically accelerated and enhanced remineralization (EAER). This method is being developed to address the unmet clinical need identified by modern caries management strategies to keep enamel "whole" through remineralization of clinical caries as a form of nonoperative caries treatment for initial-stage and moderate lesions. A progressive movement within dentistry is shifting away from the restorative-only model, which, it is suggested, has failed. The high prevalence of initial-stage caries across populations provides a significant opportunity to prevent restorations and reduce repeat restorations over a patient's lifetime. Reminova has set out to provide a method to repair lesions without drilling, filling, pain, or injections. The article outlines the rationale for and the chronological stages of the technology and company development. It then outlines corroborative evidence to show that EAER treatment can, in this preliminary in vitro investigation, remineralize clinically significant caries throughout the depth of the lesion as measured by Knoop microhardness and corroborated by scanning electron microscopy. Furthermore, the presented data show that EAER-treated enamel is harder than the healthy enamel measured nearby in each sample and is very similar in appearance to healthy enamel from the subjective interpretation made possible by scanning electron microscopy imagery. The data presented also show that this more "complete" remineralization to a high hardness level has been achieved with 2 remineralizing agents via in vitro human tooth samples. The broad clinical potential of this new treatment methodology seems to be very encouraging from these results. Reminova will strive to continue its mission, to ensure that, in the future, dental teams will not need to drill holes for the treatment of initial-stage and moderate caries lesions.

N.B. Pitts

J.P. Wright

Reminova and EAER: Keeping Enamel Whole through Caries Remineralization

Reminova与EAER：通过龋齿再矿化保持牙釉质完整

Understanding the microbiology of dental caries is not a mere academic exercise; it provides the basis for preventive, diagnostic, and treatment strategies and gives the dentist a theoretical framework to become a better professional. The last years have seen the development of new research methodologies, ranging from high-throughput sequencing or “omics” techniques to new fluorescence microscopy applications and microfluidics, which have allowed the study of the oral microbiome to an unprecedented level of detail. Those studies have provided new insights about oral biofilm formation, biomarkers of caries risk, microbial etiology, appropriate sampling, identification of health-associated bacteria, and new anticaries strategies, among others. Several pitfalls are associated with the new technologies, including a small number of samples per study group, elevated cost, and genus- or species-based analyses that do not take into consideration intraspecies variability. However, the new data strongly suggest that saliva may not be an appropriate sample for etiological studies or for bacterial caries-risk tests, that microbial composition alone may be insufficient to predict caries risk, and that antimicrobial or immunization strategies targeting single species are unlikely to be effective. Strategies directed toward modulation of the oral biofilm, such as pre- and probiotics, emerge as promising new approaches to prevent tooth decay.

A. Mira

Oral Microbiome Studies: Potential Diagnostic and Therapeutic Implications

口腔微生物组研究：潜在的诊断和治疗意义

Technological advances in DNA sequencing have provided unprecedented insights into the composition of the oral microbiome in health and disease, and RNA-sequencing and metabolomics-related technologies are beginning to yield information on the activities of these organisms. Importantly, progress in this area has brought the scientific community closer to an understanding of what constitutes a health-associated microbiome and is supporting the notion that the microbiota in healthy sites assumes an active role in promoting health and suppressing the acquisition, persistence, and activities of overt and opportunistic pathogens. It is also becoming clear that a significant impediment to developing a conclusive body of evidence that defines a healthy microbiome and the mechanisms by which beneficial bacteria promote health is that an inherent characteristic of the most abundant members of the oral flora, those that potentially play the greatest roles in health and disease, is intraspecies genomic diversity. In particular, individual isolates of abundant commensal and pathogenic streptococci show tremendous variability in gene content, and this variability manifests in tremendous phenotypic heterogeneity. Analysis of the consequences of this diversity has been complicated by the exquisite sensitivity these bacteria have evolved to environmental inputs, inducing rapid and substantial fluctuations in behaviors, and often only within subpopulations of the organisms. Thus, the conditions under which the oral microbiota is studied can produce widely different results within and between species. Fortunately, continually diminishing costs and ongoing refinements in sequencing and metabolomics are making it practical to study the oral microbiome at a level that will create a sufficiently robust understanding of the functions of individual organisms and reveal the complex interrelationships of these microbes ("the known unknowns") in a way that researchers will be able to engage in the rational design of reliable and economical risk assessments and preventive therapies.

R.A. Burne

Getting to Know “The Known Unknowns”: Heterogeneity in the Oral Microbiome

了解“已知的未知”：口腔微生物群的异质性

Erythritol belongs chemically to the family of polyols (or sugar alcohols), yet it is metabolized by animals and humans very differently compared to all other polyols. While polyols have been used traditionally (for about 80 y) to replace sugar in sweet foods to reduce demineralization of tooth enamel and to reduce postprandial blood glucose levels, benefits achieved merely through the absence of sugar, emerging evidence shows that erythritol can play a number of functional roles to actively support maintenance of oral and systemic health. Oral health studies revealed that erythritol can reduce dental plaque weight, reduce dental plaque acids, reduce counts of mutans streptococci in saliva and dental plaque, and reduce the risk for dental caries better than sorbitol and xylitol, resulting in fewer tooth restorations by dentist intervention. Systemic health studies have shown that erythritol, unlike other polyols, is readily absorbed from the small intestine, not systemically metabolized, and excreted unchanged within the urine. This metabolic profile renders erythritol to be noncaloric, to have a high gastrointestinal tolerance, and not to increase blood glucose or insulin levels. Published evidence also shows that erythritol can act as an antioxidant and that it may improve endothelial function in people with type 2 diabetes. This article reviews the key research demonstrating erythritol's oral and systemic health functionalities and underlying mechanisms.

P. de Cock

Erythritol Functional Roles in Oral-Systemic Health

赤藓糖醇在口腔-系统健康中的功能作用

Research in aging has significantly advanced; scientists are now able to identify interventions that slow the biologic aging processes (i.e., the “hallmarks of aging”), thus delaying the onset and progression of multiple diseases, including oral conditions. Presentations given during the 3-part session “Geroscience: Aging and Oral Health Research,” held during the 2023 American Association for Dental, Oral, and Craniofacial Research meeting, are summarized in this publication. Speakers’ topics spanned the translational research spectrum. Session 1 provided an overview of the geroscience and health span (disease-free and functional health throughout life) concepts. The common molecular mechanisms between oral cancer and aging were discussed, and research was presented that showed periodontal microflora as a potential factor in Alzheimer’s disease progression. Session 2 focused on behavioral and social science aspects of aging and their oral health significance. The keynote provided evidence that loneliness and isolation can have major health effects. These social conditions, along with poor oral health, tooth loss, and cognitive decline, could potentially affect healthy eating ability and systemic health in older adults. Research could help elucidate the directions and pathways connecting these seemingly disparate conditions. Session 3 focused on the delivery of oral care in different settings and the many barriers to access care faced by older adults. Research is needed to identify and implement effective technology and strategies to improve access to dental care, including new delivery and financing mechanisms, workforce models, interprofessional provider education and practice, and use of big data from medical–dental integration of electronic health records. Research to improve the “oral health span,” reduce oral health disparities, and increase health equity must be tackled at all levels from biologic pathways to social determinants of health and health policies.

J.A. Weintraub

M. Kaeberlein

C. Perissinotto

K.A. Atchison

X. Chen

R.N. D’Souza

J.S. Feine

E.M. Ghezzi

K.L. Kirkwood

M. Ryder

L.D. Slashcheva

R. Touger-Decker

B. Wu

Y. Kapila

Geroscience: Aging and Oral Health Research

老年科学：衰老与口腔健康研究

The aim of this review is to investigate the growth of diversity and inclusion in global academic dental research with a focus on gender equality. A diverse range of research methodologies were used to conduct this review, including an extensive review of the literature, engagement of key informants in dental academic leadership positions around the world, and review of current data from a variety of national and international organizations. Results provide evidence of gender inequalities that currently persist in dental academics and research. Although the gender gap among graduating dental students in North America and the two most populous countries in Europe (the United Kingdom and France) has been narrowed, women make up 30% to 40% of registered dentists in countries throughout Europe, Oceania, Asia, and Africa. In academic dentistry around the globe, greater gender inequality was found to correlate with higher ranking academic and leadership positions in the United States, United Kingdom, several countries in European Union, Japan, and Saudi Arabia. Further disparities are noted in the dental research sector, where women make up 33% of dental researchers in the European Union, 35% in North America, 55% in Brazil, and 25% in Japan. Family and societal pressures, limited access to research funding, and lack of mentoring and leadership training opportunities are reported as also contributing to gender inequalities. To continue advancing gender equality in dental academia and research, efforts should be geared toward the collection and public dissemination of data on gender-specific distributions. Such evidence-driven information will guide the selection of future strategies and best practices for promoting gender equity in the dental workforce, which provides a major pipeline of researchers and scholars for the dental profession.

T. Tiwari

C.L. Randall

L. Cohen

J. Holtzmann

J. Webster-Cyriaque

S. Ajiboye

L. Schou

M. Wandera

K. Ikeda

M. Fidela de Lima Navarro

M. Feres

H. Abdellatif

E. Al-Madi

S. Tubert-Jeannin

C.H. Fox

E. Ioannidou

Gender Inequalities in the Dental Workforce: Global Perspectives

牙科劳动力中的性别不平等：全球视角

In the last few decades, the number of women graduating from North American (NA) dental schools has increased significantly. Thus, we aimed to determine women’s representation in leadership positions in NA dental and specialty associations/organizations, dental education, and dental journals, as well as the proportion of men/women researcher members of the American Association for Dental Research (AADR). We contacted NA dental associations to provide us with the total number and the men/women distribution of their members. Men/women distributions in leadership positions were accessible from the internet, as were data on the sex of deans of NA dental schools. Data on the editors in chief of NA dental journals were gathered from their websites, and the AADR provided the number and sex of its researcher members. Collected data underwent descriptive statistics and binomial tests (α = 0.05). Our findings suggest that women are underrepresented in leadership positions within the major NA dental professional associations. While the median ratio of women leaders to women members in professional associations is 0.91 in Canada, it is only 0.67 in the United States. The same underrepresentation of women is evident in the leadership of the Canadian Dental Association and the American Dental Association. We found that women are underrepresented as deans and editors in chief for NA oral health journals. Only 16 of 77 NA dental school deans are women, while 3 of 38 dental journals have women editors in chief. The probability of finding these ratios by chance is low. However, the number of women dental researcher AADR members underwent an overall increase in the past decade, while the number of men declined. These results suggest that, despite the increase in women dentists, it will take time and effort to ensure that they move through the pipeline to senior leadership positions in the same manner as their male colleagues.

J. Li

R. de Souza

S. Esfandiari

J. Feine

Have Women Broken the Glass Ceiling in North American Dental Leadership?

北美牙科领导层中女性是否已打破玻璃天花板？

This commentary integrates and expands on the preceding articles in this issue that document and celebrate a century of women's achievements in the International Association for Dental Research (IADR). The increasing participation and leadership of women in dental and craniofacial research and within the IADR were viewed from the perspective of a changing culture of science. The steps that have been taken by the IADR to develop greater inclusiveness are acknowledged, and some of the challenges that remain are discussed in terms of obstacles that are most often social or cultural in origin. Comparisons are made across countries, and the social determinants that lead to differences in women's participation are described. Recommendations are made for developing strategies to change elements of our institutional cultures that have provided advantages to some groups of researchers more than to others. The unconscious biases and a lack of commitment to diversity, equity, and inclusion that limit the participation of members of some groups limit the progress and achievements of science in general.

J. Albino

F. Teles

L.K. Cohen

Commentary: Challenges and Opportunities for Women in Dental Research

评论：牙科研究中女性的挑战与机遇

The International Association for Dental Research (IADR) Distinguished Scientist Awards are prestigious recognitions of outstanding scientific accomplishments in various areas of dental, oral, and craniofacial research, which correspond to several of the IADR Scientific Groups and Networks. These 17 awards were established over a period of 60 y. The objective of this report is to highlight women recipients of IADR Distinguished Scientist Awards. Additionally, we report the distribution of awards to women scientists over time and compare the number of women nominees, awardees, and gender distribution of the membership. Information about the awards was obtained from the IADR member database and press releases. Information collected included name of the award, year received, and the awardee’s name, institution, and position held at the time of the award. For the last 14 y, the time span for which reliable information was available, the gender distribution of the membership of the IADR was also retrieved. Overall, only 13% of the awardees have been women; even in the last 20 y, &lt;20% have been women. In the last 14 y, the number of women awardees paralleled the number of nominees for each award. However, the proportion of women nominees was significantly lower than the female membership each year ( P &lt; 0.001). With the exception of 1 y, the percentage of women awardees trailed the women membership of the IADR. In the past 4 y, women represented 12% to 18% of the awardees, whereas they composed 41% to 46% of the IADR’s membership. Given the benefits of prestigious recognitions on recruitment and retention of faculty and on attracting new research trainees into a discipline, it is important that policies be implemented to increase the proportion of women nominees for awards to appropriately recognize the efforts of remarkable women scientists.

ISSN	0895-9374, 1544-0737
h-index	71

涉及主题	医学牙科生物化学内科学病理遗传学生物化学材料科学复合材料口腔正畸科物理有机化学艺术视觉艺术地质学
出版信息	出版商: International Association for Dental Research，出版周期: ，期刊类型: journal，开源期刊: 否
基本数据	创刊年份: 2023，原创研究文献占比: 0.00%，自引率:N.A.， Gold OA占比: 0.00%

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