In spite of a knowledge explosion in cariology science, dental caries still remains a misunderstood phenomenon by the clinicians. In order to effectively use the wide range of preventive and management strategies, it is imperative to look beyond those black and white spots that manifest on the tooth surfaces. This paper focuses on the revised versions of the etiopathogenesis and definition of dental caries disease in the present century.

Realization that dental caries is a reversible, dynamic biochemical event at a micron level has changed the way the profession recognizes the caries disease and the caries lesion. The diagnosis of dental caries poses challenges due to the complex interaction of multiple endogenous causal factors. The most appropriate diagnostic aid for this purpose is the risk model of caries risk assessment. The analyses of the biological determinants provide clues to the dominant causal factor. The detection of a carious lesion has undergone a rigorous revision and revolution in order to identify the earliest mineral change so that it can be controlled without resorting to invasive management options. Apart from detection, it became mandatory to assess the extent of the lesion (noncavitated/cavitated), assess the activity status of the lesion (active/arrested), monitor the lesion progress (progression/regression over a period of time), and finally to predict the prognosis of the lesion as well as the disease. The prognosis of the disease can be best assessed by analyzing the predictor factors in caries risk assessment. The ultimate objective of such a meticulous and methodical approach aids in devising a tailor-made treatment plan, using preventing measures precisely and restorative measures minimally. This ensures the best oral health outcome of the patient.

Aim:To assess the anticariogenicity of microwave-assisted 0.5% extract of Stevia rebaudiana leaves in high caries risk patients. Materials and methods:Forty-six patients with high risk for caries were selected. They were randomly assigned to two groups; group I was allocated for chlorhexidine (CHX) mouthwash (0.12% Perio-Aid) and group II for S. rebaudiana (0.5% extract of Stevia bio) mouthwash. Salivary pH, buffer, and microbial count were assessed before the patients were asked to use the mouthwashes. Patients were prescribed the mouthwash/extract twice a day for 7 days. On the 8th day, postrinse salivary pH, buffer analysis and Streptococcus mutans and Lactobacilli count were done.Results: Significant difference in pre-and postrinse values of pH and buffer was found in both groups. However, no difference was noted between groups. Both groups decreased the bacterial count to <10 5 colony-forming units (CFUs) in all the patients. Conclusion:Stevia rebaudiana extract in 0.5% concentration improved the pH and buffering capacity of the saliva in a high caries risk patient. It also reduced cariogenic organisms in saliva.Clinical significance: Stevia rebaudiana extract in 0.5% concentration can be used as a mouthwash for moderate-to-high caries risk patients. However, long-term clinical studies are required to prove its substantivity like that of CHX.

Comprehensive management of dental caries should involve the management of disease as well as the lesion. Current decision making process in cariology is influenced by numerous factors such as the size/ depth/ activity of the carious lesion and age/ the caries risk status of the patient. Treatment decisions should involve planning the non-operative/ preventive treatment for non-cavitated or early cavitated lesions and also formulating operative treatment for cavitated lesions. Apart from these two responsibilities, a clinician should also be knowledgeable enough to decide when not to interfere in the caries dynamics and how frequently to recall the patient for follow-ups. The non-operative treatment prescriptions vary in dose, intensity and mode of delivery according to the caries risk status. Minimal invasion and maximal conservation of tooth structure has become the essence of current operative treatments. This part of the series elaborates on the paradigm shift in the management of dental caries.

Background:Minimally invasive dentistry (MID) encompasses early caries diagnosis through caries risk assessment (CRA), early detection of incipient carious lesion including primary and secondary prevention based on scientific evidence that remineralization of demineralized enamel and dentin is possible if detected early. Although the dental curriculum focuses on the advantages of MID in tooth preservation, this science is not usually translated into practice.Aim:This study aimed to evaluate the knowledge, attitude, and skills of dental practitioners of Puducherry regarding the concepts of MID.Subjects and Methods:Data were collected through an online survey questionnaire based on awareness and practice of MID. Statistical evaluation was done on SPSS by Chi-square test.Results:A total of 126 dentists responded of which only 55% were trained in MID during their undergraduate and internship period, mainly through lectures (49.6%). Nearly 81% agreed that CRA should be conducted for all patients. Almost 42.7% had heard about International Caries Detection and Assessment System, but only 25.9% used a blunt explorer for caries detection. About 13.7% use magnification (loupes/microscope), but majority (84.7%) use radiographs. More than 70% were unaware of newer methods of caries detection. Statistically significant differences were found (P < 0.05) regarding qualification and experience about the effectiveness of Atraumatic Restorative Treatment and sandwich technique for treatment of caries in permanent teeth and high caries-risk children.Conclusion:Although there is knowledge about advantages of MID among dentists of Puducherry, it does not benefit patients, as many practitioners still follow the traditional principles of total caries removal.

Microhybrid and nanohybrid resin composites tend to stain to Indian food colorants, especially to turmeric powder.

Background: Ultra conservative caries removal now has become an integral part of Minimal Invasive Dentistry. The main objective of deep caries removal is to conserve the tooth structure as well to maintain the integrity of the health of the pulp. Recently burs made of polymers have been proposed as alternatives for metallic burs to selectively remove caries in dentin. Aims: This in vitro, split-tooth, comparative study evaluated the efficacy of two commercially available Polymer burs, namely Poly bur-I (Komet) and Smart prep bur (SS White) for their efficacy in removing deep dentinal carious lesions. The time taken for caries removal was also assessed. Methodology: IO extracted carious mandibular molars were split into buccal and lingual halves. Caries in one half(n= IO) was removed by Poly bur-I (Komet) and in the other half(n= IO) by Smart prep bur (SS white). They were then sectioned in the hard tissue microtome, subsequently manually thinned out and were mounted for evaluation under Polarized Light Microscopy. Results: The qualitative evaluation of the micro graphs revealed that both the polymer burs were equally effective in removing the deep dentinal caries. However the time taken by Poly bur-I was lesser than the Smart prep bur.

Introduction: Bonding of composite resin to dentin mandates a wet substrate whereas, enamel should be dry. This may not be easily achievable in intracoronal preparations where enamel and dentin are closely placed to each other. Therefore, Dentin Bonding Agents (DBA) are recommended for enamel and dentinal bonding, where enamel is also left moist. A research question was raised if the "enamel-only" preparations will also benefit from wet enamel bonding and contemporary DBA. Aim:The aim of this study was to compare the shear bond strengths of composite resin, bonded to dry and wet enamel using fifth generation DBA (etch and rinse system) containing various solvents such as ethanol/water, acetone and ethanol. Materials and Methods:The crowns of 120 maxillary premolars were split into buccal and lingual halves. They were randomly allocated into four groups of DBA: Group 1-water/ethanol based, Group 2-acetone based, Group 3-ethanol based, Group 4-universal bonding agent (control group). The buccal halves and lingual halves were bonded using the wet bonding and dry bonding technique respectively. After application of the DBAs and composite resin build up, shear bond strength testing was done.Results: Group 1 (ethanol/water based ESPE 3M, Adper Single Bond) showed highest bond strength of (23.15 MPa) in dry enamel. Group 2 (acetone based Denstply, Prime and Bond NT, showed equal bond strength in wet and dry enamel condition (18.87 MPa and 18.02 MPa respectively). Conclusion:Dry enamel bonding and ethanol/water based etch and rinse DBA can be recommended for "enamel-only" tooth preparations.Carounanidy Usha et al., Shear Bond Strength of Composite Resin to Wet and Dry Enamel www.jcdr.net