Papers by Rodrigo A. Giacaman
Journal of Oral Research, Jun 30, 2022
Objetive: To evaluate microleakage of composite resins (CR) placed over different cavitary liners... more Objetive: To evaluate microleakage of composite resins (CR) placed over different cavitary liners after managing deep caries lesions through selective removal of soft carious tissue to soft dentin (SRCT-S). Material and Methods: Fifty four human teeth were collected for microleakage testing. Each assay comprised ICDAS 5 or ICDAS 6 carious lesions and sound teeth for controls. Sound teeth were prepared with cavities that mirrored the carious teeth cavities, which were prepared with SRCT-S. Sound and carious teeth were further randomly assigned to one of the three experimental groups: Group A: universal adhesive (UA) + CR, Group B: glass ionomer cement liner + UA + CR, and Group C: calcium hydroxide + UA+ CR. Occlusal microleakage (OM) and cervical microleakage (CM) was classified within one of 5 depth categories. ANOVA and Chi-square tests were computed (p<0.05). Results: OM and CM were similarly distributed across subgroups (p>0.05). All Group C samples with carious lesions presented some degree of microleakage. However, no statistically significant differences were observed between groups and within each group (p>0.05). Conclusion: Teeth restored with CR after SRCT-S using calcium hydroxide as a liner material seem to exhibit higher microleakage than those restored using glass ionomer or UA alone. Further clinical research is needed to deepen into these findings. Clinical significance: The application of calcium hydroxide as a liner under a composite resin may reduce the longevity of a restoration after performing selective or partial removal of carious tissues. Clinicians should rethink the need of using calcium hydroxide for this application, albeit limited of clinical evidence.
Journal of Dentistry, Jul 1, 2019
Self-administered non-invasive therapies with high-fluoride dentifrices are an attractive alterna... more Self-administered non-invasive therapies with high-fluoride dentifrices are an attractive alternative to traditional restorative management of root carious lesions (RCLs), but the available evidence is still scarce, particularly in community-dwelling elders. The aim of this randomized controlled trial (RCT) was to compare the effectiveness of toothbrushing with 5,000 ppm versus 1,450 ppm fluoridated dentifrice (F-dentifrice) on preventing and arresting RCLs, in community-dwelling elders. Methods: A two years double-blinded RCT was carried out with 345 independently-living older adults, with at least one tooth with RCL. Participants were instructed to brush twice per day with either high-fluoride (5,000 ppm F) or the control dentifrice (1,450 ppm F). Incidence of new and arrested existing RCLs was recorded at two years and compared with the baseline data. Linear mixed regression model with repeated measures were used to test differences between groups (p < 0.05). Results: The percentage of teeth with active lesions varied significantly at two years, but in opposite directions for both groups. While the control group significantly increased the mean percentage of RCLs activity from baseline to two years, from 24.32% to 40.52%, the intervention decreased the percentage of activity from 29.74% to 3.72%. The incidence of RCL was 93.5% and 35.2% in participants of the 1,450 ppm and 5,000 ppm in the F-dentifrice groups, respectively, with a relative risk (RR) of 0.10 [CI: 0.05-0.19]. Conclusion: Non-invasive treatment with 5,000 ppm F dentifrice is more effective than conventional dentifrices in preventing and arresting RCLs in community dwelling elders. ClinicalTrials.gov NCT02647203. Clinical Significance: RCLs can be effectively prevented and arrested with the use of 5,000 ppm F dentifrice. Oral health programs directed to community-dwelling older adults might benefit from the inclusion of high fluoride dentifrice in their portfolio.
Caries Research, 2022
Detection of proximal carious lesions involves the combination of clinical and radiographic metho... more Detection of proximal carious lesions involves the combination of clinical and radiographic methods, both with inherent difficulties. The present cross-sectional study is aimed at estimating the prevalence of cavitation in proximal carious lesions, based on a direct clinical assessment of previously detected radiographic lesions, in permanent molars and premolars. Proximal dental surfaces were radiographically evaluated using the ADA coding system and cavitation was determined through clinical visual examination of the surfaces after separation with elastomeric bands. One-hundred and twenty-six patients attending the dental clinics at the University of Talca were examined, comprising 508 proximal surfaces with radiographic codes ranging from E1 to D3. Two examiners were trained and calibrated for radiographic and clinical detection of proximal lesions. Most participants were females (61.9%). The age mean of participants was 28.7 (0.8) years old. A total of 22.2% of the examined surfaces were cavitated. Only few lesions coded as E1 (n = 4; 2.1%) and E2 (n = 9; 9.8%) were cavitated. Fifty D1 (35.5%) and 22 D2 (41.5%) lesions were cavitated after separation. Most lesions coded as D3 (n = 28; 84.8%) were cavitated. The multilevel binary regression model (p = 0.003) demonstrated that sex, age, jaw, tooth type, surface, and side were not associated with the likelihood of having proximal cavitation. Challenging conventional wisdom, most D1 and D2 lesions were not cavitated. Combining detection methods seems desirable to increase the accuracy in assessing approximal posterior lesions. The low proportion of cavitated lesions reinforces the idea of cautiously indicating invasive approaches for managing proximal carious lesions.
Rural and Remote Health, Apr 16, 2018
Purpose: Rural populations may be at increased risk for prevalent oral diseases. The aim of this ... more Purpose: Rural populations may be at increased risk for prevalent oral diseases. The aim of this study was to compare oral health status of adolescents of rural and urban areas from central Chile. Methods: A representative sample of 552 and 486 adolescents aged 12 and 15 years, respectively, was examined using WHO methods. Adolescents were chosen from schools belonging to urban and rural districts of the region. Caries status was obtained by decayed, missing, filled teeth (DMFT) and significant caries (SiC) indexes. The gingival exam included the oral hygiene index (OHI) of Silness and Löe and the gingival index (GI) of Löe and Silness. Clinical 1 2 3 4 1, 2, 3 4 attachment loss and community periodontal index (CPI) were restricted to 15-year-old adolescents. Statistical comparisons of medians and means were performed with the Mann-Whitney U-test. To determine the association between caries experience and oral hygiene and gingival indexes, Spearman's correlation was used at p<0.05. Results: Twelve-year-old children from rural areas had caries prevalence of 67.50%, which was significantly higher (p<0.05) than children from urban areas, who had 54.04%. Caries experience of 12-year-old rural children was significantly higher (DMFT 3.36; standard deviation (SD) 2.71) than that of urban children (DMFT 2.29; SD 2.17) (p=0.0001). Rural adolescents also showed increased caries severity (SiC 6.21; SD 2.44), whereas urban children showed had a SiC of 4.71 (SD 1.74) (p=0.0001). For periodontal indexes, the average GI for 12-year-olds was 1.51 (SD 0.33), which corresponds to moderate inflammation, but rural subjects (GI 1.55; SD 0.34) had higher values (p=0.002) than their urban counterparts (GI 1.45; SD 0.29). In 15-year-old adolescents, caries prevalence was significantly higher in rural (73.58%) than in urban (64.59%) individuals (p<0.05). Although not significant, caries experience for 15-year-olds in rural areas, like in the other age group, was slightly higher than for urban 15-year-olds (DMFT 5.03; SD 3.61 and DMFT 4.65; SD 3.58, respectively) (p=0.238). The SiC in the rural subjects (9.16; SD 2.26) of this age group was significantly higher than for urban adolescents (8.51; SD 3.00). No significant differences either in the OHI (p=0.418) or in the GI (p=0.624) were observed between rural and urban participants. Conclusions: Adolescents of central Chile show clear disparities in oral health, with rural communities more affected. Gingival health seems to be less impacted by rurality than caries experience. Other social determinants of oral health may also explain these results, and further research appears necessary.
Brazilian Dental Journal, Aug 1, 2021
According to the best available scientific evidence, mouth rinses with sodium fluoride (NaF) 0.05... more According to the best available scientific evidence, mouth rinses with sodium fluoride (NaF) 0.05% (226 ppm F) for daily use or with 0.2% (900 ppm F) for weekly use are effective for caries control (1). Aqueous solutions of 0.2% NaF are still used in community programs to control caries (2), but most of the commercial products are formulated with 0.05% NaF. Commercial fluoride mouth rinses are products with a cosmetic rather than a therapeutic use. These products contain complex formulations with several ingredients to make the product attractive to the consumer. Some of these substances can positively or negatively interfere with the anticaries mechanism of action of fluoride (3). The anticaries mechanism of action of fluoride mouth rinses involves an increase in the fluoride concentration in the oral cavity during rinsing, followed by retention of varying levels of fluoride in the oral cavity over time (4). Fluoride retention occurs by the enrichment of dental biofilms and the formation of reaction products with enamel (5-7). While the diffusion of fluoride throughout the biofilm is a simple phenomenon that depends only on fluoride solubility in the mouth rinse (6), other ingredients of the formulation, such as detergents, preservatives, and some additives (8-11), might influence the formation of reaction products on clean dental surfaces. When fluoride reacts with enamel two reaction products are formed, one that is soluble in alkali and another only solubilized by acids. As these products were not still characterized chemically, they are respectively named in the literature as loosely bound (or CaF2-like) and firmly bound (or FAptype). Loosely bound fluoride is the main product of reaction in terms of concentration (>90%) and is currently considered the most important product regarding anticaries efficacy of topical fluorides (12), mainly professional fluoride application (13-14). The formation of fluoride reservoirs on enamel by fluoridated products depends directly on the concentration of fluoride applied and inversely to the pH of the product (15). It also depends on the type of fluoride salt used in the commercial product. Thus,
Objective. Whether a minimum quantity of saliva is needed to inhibit the caries process is unclea... more Objective. Whether a minimum quantity of saliva is needed to inhibit the caries process is unclear. Here, we evaluated the effect of saliva dilutions on an in vitro caries model with Streptococcus mutans (S. mutans) biofilms. Methods. S. mutans biofilms were grown on enamel and root dentin slabs, in culture media containing different proportions of saliva (v/v): 0%, 5%, 10%, 25%, 50%, 75% and 100% saliva, and exposed to a 10% sucrose solution (5 min, 3x/day), with appropriate controls. After 5 (enamel) and 4 (dentin) days, demineralization, biomass, viable bacteria and polysaccharide formation were analyzed. The acidogenicity of the spent media was monitored overtime. Assays were carried out in triplicate in 2 independent experiments (n=6). Results. An inverse relationship was observed between acidogenicity, demineralization, and saliva proportion, both in enamel and dentin. A marked reduction in enamel and dentin demineralization was observed when small amounts of saliva were incor...
Frontiers in Oral Health
New paradigms in caries conceptualization have emerged during the last decades, leading to intens... more New paradigms in caries conceptualization have emerged during the last decades, leading to intense debate and discussion on how to approach the disease, both from a preventive and a therapeutic perspective. Among many new ideas, research discoveries and technologies, one major concept can be highlighted that created a deep frontier between the old and the new paradigm in caries conceptualization; the non-communicable nature of the disease, firmly associated with behaviors and lifestyles. This article synthetizes the conceptual construction of dental caries as a non-communicable disease (NCD) based on the current evidence and discusses the appropriate management of the disease in this context. Dental caries has shifted from being considered transmissible and infectious to an ecological and non-communicable disease. Environmental factors such as frequent sugars intake, disrupt the symbiosis of the dental biofilm leading to a dysbiosis, which favors caries lesion initiation and progres...
Universidad de Chile. Vicerrectoría de Investigación y Desarrollo, 2021
International journal of interdisciplinary dentistry, 2021
El manejo terapéutico de lesiones de caries primarias y secundarias concentra gran parte del queh... more El manejo terapéutico de lesiones de caries primarias y secundarias concentra gran parte del quehacer de los dentistas en el mundo. Recientes cambios en la concepción
Brazilian Oral Research, 2021
For fluoride to be effective in controlling caries, it should be bioavailable in commercial produ... more For fluoride to be effective in controlling caries, it should be bioavailable in commercial products, so that it can be released into the mouth in the products it contains. We chemically determined the available fluoride and pH in nine mouth rinses marketed in Chile, and eleven, in Brazil, and then discussed the legislation in force in both countries, regarding the anticaries potential of these oral hygiene products. The fluoride was analyzed with an ion-selective electrode (F-ISE), using the direct technique. The determinations were made in duplicate, and the results were expressed in ppm F (μg F/mL). The total fluoride concentration found in all the mouth rinses evaluated ranged from 94.7 to 233.5 ppm F, and closely matched what was declared by the manufacturers (100.0 to 226.2 ppm F). However, some mouth rinses showed lower fluoride concentrations (90 and 180 ppm F) in both countries. A Na 2 FPO 3-formulated mouth rinse was found only in Chile, with 216.8 ppm F as the FPO 3 2ion, and 4.9 ppm F as the F-. The findings show that fluoride was potentially bioavailable in all the mouth rinses evaluated. Regarding the national legislations, although the mouthwashes sold in Brazil comply with the Brazilian legislation, discrepancies were found for Chile. However, neither country had a legislation matching the best available evidence on fluoride mouthwash efficacy for caries control. Thus, some products with low fluoride concentrations (below 226 ppm F), or manufactured with a fluoride salt other than NaF (Na 2 FPO 3) are being sold in the Brazilian and Chilean markets.
Journal of Dental Research, 2021
The dental profession has experienced a dramatic acceleration in the use of communication systems... more The dental profession has experienced a dramatic acceleration in the use of communication systems and information-based technologies over recent years, originating new paradigms for the prevention and promotion of oral health. The purpose of this systematic review was to determine the effect of teledentistry-based (telematic) strategies, reported in randomized controlled trials and quasi-randomized trials, with a focus on oral health prevention and promotion–related outcomes in patients of all ages. We searched Medline via PubMed, SCOPUS, and Web of Science from inception until August 2020, regardless of the language of publication. We selected studies for inclusion and conducted data extraction, assessed risk of bias (Cochrane tool), and evaluated the certainty of the evidence (GRADE approach) in duplicate and independently. Out of 898 potentially eligible references, we selected 43 for full-text screening, of which 19 studies proved eligible: 18 randomized controlled trials and 1 ...
Revista clínica de periodoncia, implantología y rehabilitación oral, 2018
(año 2011), se elaboró una propuesta de currículo inicial, basado en los dominios propuestos por ... more (año 2011), se elaboró una propuesta de currículo inicial, basado en los dominios propuestos por la Unión Europea (Schulte AG y cols). Durante el año 2016, dicha propuesta fue analizada mediante diálogos digitales y grupos de trabajo, con la participación del 96% de las Escuelas de Odontología existentes en el país, que concluyeron en un documento intermedio. Este documento fue analizado, discutido y perfeccionado durante el Taller para el Desarrollo de un Currículo de Competencias Mínimas en Cariología para las Escuelas de Odontología Chilenas (22/Mayo/
Brazilian Dental Journal, 2021
The ability of mouthrinses, available in the international market, to form reaction products on d... more The ability of mouthrinses, available in the international market, to form reaction products on demineralized enamel (bioavailability test) was evaluated in vitro. Nine mouthrinses purchased in Chile were evaluated; eight formulated with NaF (one containing 100 µg F/mL and seven containing 226) and one with Na2FPO3 (226 µg F/mL as ion FPO3 ). Demineralized enamel slabs (n=15 per mouthrinse) were sectioned; one half was subjected to the assigned mouthrinse treatment for 10 min and the other half was used to obtain baseline data. Loosely bound and firmly bound fluoride formed on enamel were determined with an ion-specific electrode and the values were expressed in µg F/cm2. The concentration of fluoride and the pH of the mouthrinses were previously determined. Concentrations of loosely bound and firmly bound fluoride formed on enamel were independently analyzed by ANOVA and Tukey’s test (α=5%). The loosely bound and firmly bound fluoride concentrations formed ranged from 3.2 to 36.2 a...
Journal of Dentistry, 2021
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
International journal of interdisciplinary dentistry, 2020
Este artículo realiza una revisión y síntesis de las principales encuestas poblacionales de salud... more Este artículo realiza una revisión y síntesis de las principales encuestas poblacionales de salud en Chile. Se describen sus principales características y hallazgos con el objetivo de orientar a los profesionales odontólogos en el conocimiento de material existente para el diagnóstico odontológico objetivo, así como el impacto de la salud oral en la calidad de vida, a nivel poblacional.
JDR Clinical & Translational Research, 2018
Knowledge Transfer Statement: This article provides an overview of the oral health status of olde... more Knowledge Transfer Statement: This article provides an overview of the oral health status of older people from Latin American countries and the emergence of recent gerodontology research initiatives within the region.
Gerodontology, 2018
The purpose of this review was to gather information and discuss oral health status of older peop... more The purpose of this review was to gather information and discuss oral health status of older people in the Latin American and Caribbean region (LAC). Scarce data are available to portrait the oral situation of older people in the region. This review paper is the result of a meeting of the IADR's Latin American Geriatric Oral Research Group held in Porto Alegre, Brazil, in November of 2016, part of the activities of an IADR Regional Development Programme (RDP). A group of researchers from 8 countries of LAC held a discussion using 5 questions related to the oral health situation of older Latin Americans, the most appropriate strategies to face the problem and the challenges for the future, with an open discussion format. In a second step, a group of 6 experts refined the answers and reviewed the existent literature. The review of the evidence revealed that only a few LAC countries have information, which suggests the need for multinational efforts to understand the oral health st...
International Journal of Paediatric Dentistry, 2017
BackgroundStorage time may reduce the amount of soluble fluoride (F) in toothpastes. Although we ... more BackgroundStorage time may reduce the amount of soluble fluoride (F) in toothpastes. Although we previously studied the type and concentration of F in fresh samples of commercial Chilean toothpastes, their stability was not determined.AimTo evaluate the stability of soluble F in Chilean toothpastes after 1 year of storage.DesignAll the toothpastes (n = 30) previously used were re‐analyzed after 1 year of storage time at room temperature (±22°C). Total F (TF = soluble F + insoluble F) and total soluble F (TSF = F ion + MFP ion) were assessed using an ion‐specific electrode, through a validated methodology. Data were expressed in ppm of F (mg F/kg).ResultsMean (±SD; n = 30) TF and TSF concentrations after storage were 1049 ± 427 and 987 ± 411 ppm F, respectively. Five toothpastes showed between 30% and 50% of insoluble F, four of them formulated with MFP/calcium‐based abrasive. In two products, there was a reduction in TSF below the evidence‐based anticaries effectiveness threshold of...
Revista Clínica de Periodoncia, Implantología y Rehabilitación Oral, 2016
Flujo salival; Caries radicular; Actividad de caries; Envejecimiento Resumen Introducción: Pese a... more Flujo salival; Caries radicular; Actividad de caries; Envejecimiento Resumen Introducción: Pese al aparente rol de la saliva como protector de la caries radicular, pocos estudios han estudiado la asociación con el flujo salival. Objetivo: El propósito de este estudio fue determinar si un menor flujo salival se relaciona con un aumento en la prevalencia y actividad de la caries radicular en personas mayores autovalentes. Materiales y métodos: Se aplicó una encuesta sociodemográfica y se solicitó una muestra de flujo salival no estimulado y estimulado a 332 personas mayores autovalentes. Mediante un examen clínico se obtuvo la presencia y actividad de la caries radicular utilizando los criterios ICDAS y los de Ekstrand, respectivamente. Se calculó el root caries index (RCI) y el porcentaje de caries radiculares activas (% CRA). Los datos fueron analizados con el test t de Student, Anova y Kruskal Wallis, con un nivel de significación de 0,05. Resultados: El flujo salival fue menor en mujeres y disminuyó con el aumento de la cantidad de fármacos y enfermedades sistémicas (p < 0,05). Ni el RCI ni el % CRA mostraron diferencias significativas en relación con el flujo salival no estimulado, pese a que ambos fueron levemente mayores en sujetos con un flujo salival estimulado normal (p < 0,05). Conclusión: El flujo salival no parece asociarse numéricamente con una mayor presencia o actividad de caries radicular en adultos mayores autovalentes.
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Papers by Rodrigo A. Giacaman