Dietary effects on dental diseases

A cytometric approach to follow variation and dynamics of the salivary microbiota

Microbial flow cytometry is an established fast and economic technique for complex ecosystem studies and enables visualization of rapidly changing community structures by measuring characteristics of single microbial cells. Cytometric evaluation routines are available such as flowCyBar which are useful for automatic data processing. Here, a cytometric workflow was established which allows to routinely analyze salivary microbiomes on the example of ten oral healthy subjects. First, saliva was collected within a 3-month period, cytometrically analyzed and the evolution of the microbiomes followed as well as the calculation of their intra- and inter-subject similarity. Second, the respective microbiomes were stressed by exposition to high sugar or acid concentrations and immediate changes were recorded. Third, bactericide solutions were tested on their impact on the microbiomes. In all three set ups huge intra-individual variations in cytometric community structures were found to be largely absent, even under stress, while inter-individual diversity was obvious. The bacterial cell counts of saliva samples were found to vary between 3.0×10⁷ and 6.2×10⁸ cells per sample and subject in undisturbed environments. The application of the two bactericides did not cause noteworthy diversity changes but the loss in cell numbers by about 50% was high after treatment. Illumina® sequencing of whole microbiomes or sorted sub-microbiomes revealed typical phyla such as Firmicutes, Proteobacteria, Actinobacteria, Bacteroidetes and Fusobacteria. This approach is useful for fast monitoring of individual salivary microbiomes and automatic calculation of intra- and inter-individual dynamic changes and variability and opens insight into ecological principles leading to their sustainment in their individual environment.

Associations between dental knowledge, source of dental knowledge and oral health behavior in Japanese university students: A cross-sectional study

The aim of this study was to investigate the associations between dental knowledge, the source of dental knowledge and oral health behavior in a group of students at a university in Japan. A total of 2,220 university students (1,276 males, 944 females) volunteered to undergo an oral examination and answer a questionnaire. The questionnaire assessed dental knowledge, the source of dental knowledge and oral health behavior (e.g., daily frequency of tooth brushing, use of dental floss and regular dental checkups). The odds ratio and 95% confidence interval for oral health behavior based on dental knowledge and source of dental knowledge were calculated using logistic regression models. Of the participants, 1,266 (57.0%) students obtained dental knowledge from dental clinics, followed by school (39.2%) and television (29.1%). Logistic regression analyses indicated that use of dental floss was significantly associated with source of dental knowledge from dental clinics (P = 0.006). Receiving regular dental checkups was significantly associated with source of dental knowledge; the positive source was dental clinic (P < 0.001) and the negative sources were school (P = 0.004) and television (P = 0.018). Dental clinic was the most common source of dental knowledge and associated with better oral health behavior among the Japanese university students in this study.

General dentists', pediatric dentists', and endodontists' diagnostic assessment and treatment strategies for deep carious lesions: A comparative analysis

BACKGROUND

There is a large variation among clinicians when managing deep carious lesions (DCLs). The purpose of this study was to assess general dentists' (GDs), pediatric dentists' (PDs), and endodontists' (EDs) diagnostic methods, clinical decision-making considerations, treatment strategies, and knowledge, behavior, and attitudes related to the diagnosis and treatment of DCLs.

METHODS

A total of 175 GDs, 511 PDs, and 377 EDs responded to a nationwide Web-based survey.

RESULTS

Most EDs (68%) and GDs (47%) practiced complete caries removal. PDs (31%) were more likely than GDs (12%) and EDs (4%) to remove carious tissues partially. Dentin hardness was the most important diagnostic criterion used during caries excavation (GDs, 90%; PDs, 72%; EDs, 88%). Only 30% of GDs, 17% of PDs, and 90% of EDs used diagnostic tests (for example, a cold test) when assessing pupal health. A substantial percentage of respondents considered endodontic treatment as a choice for treating DCLs in asymptomatic teeth in young patients (GDs, 40%; PDs, 30%; EDs, 40%). GDs rarely used a rubber dam when treating these lesions.

CONCLUSIONS

Most respondents practiced complete caries removal until hard dentin was felt, using hardness as the primary excavation criterion, and did not use pulp diagnostic tests routinely before making decisions about treatment of teeth with DCLs.

PRACTICAL IMPLICATIONS

Efforts should be made to translate the growing body of evidence supporting the use of conservative caries removal criteria to preserve pulpal health and tooth structure integrity when managing DCLs.

Enamel and dentine demineralization by a combination of starch and sucrose in a biofilm - caries model

Sucrose is the most cariogenic dietary carbohydrate and starch is considered non-cariogenic for enamel and moderately cariogenic for dentine. However, the cariogenicity of the combination of starch and sucrose remains unclear. The aim of this study was to evaluate the effect of this combination on Streptococcus mutans biofilm composition and enamel and dentine demineralization. Biofilms of S. mutans UA159 were grown on saliva-coated enamel and dentine slabs in culture medium containing 10% saliva. They were exposed (8 times/day) to one of the following treatments: 0.9% NaCl (negative control), 1% starch, 10% sucrose, or 1% starch and 10% sucrose (starch + sucrose). To simulate the effect of human salivary amylase on the starch metabolization, the biofilms were pretreated with saliva before each treatment and saliva was also added to the culture medium. Acidogenicity of the biofilm was estimated by evaluating (2 times/day) the culture medium pH. After 4 (dentine) or 5 (enamel) days of growth, biofilms (n = 9) were individually collected, and the biomass, viable microorganism count, and polysaccharide content were quantified. Dentine and enamel demineralization was assessed by determining the percentage of surface hardness loss. Biofilms exposed to starch + sucrose were more acidogenic and caused higher demineralization (p < 0.0001) on either enamel or dentine than those exposed to each carbohydrate alone. The findings suggest that starch increases the cariogenic potential of sucrose.

Oral Health Knowledge, Attitudes and Practice Behaviour among Secondary School Children in Chandigarh

INTRODUCTION

Oral health knowledge is considered to be an essential prerequisite for health-related practices and better oral health. Healthy practices adopted at young age are more sustainable.

AIM

Present cross-sectional exploratory study was planned to assess oral health knowledge and practices of secondary school students in Chandigarh, India.

MATERIALS AND METHODS

A cross-sectional survey was under-taken amongst 1027 secondary level school students, in Chandigarh, India. After obtaining informed consent subjects were administered pretested self administered questionnaire addressing demographics, knowledge, attitude and practice behaviour of participants. Frequency analysis was done using descriptive statistics.

RESULTS

Survey revealed that only 40% subjects brushed twice daily. About 17% reported use of dental floss and 20% used either mouthwash or tongue cleaner as adjuncts. A total of 58% had knowledge that infrequent brushing led to dental caries, staining of teeth, dental plaque and bleeding from gums. Most of them knew sweets (92.7%) and soft drinks (67.8%) affected dental health. Only 12.9% visited dentist regularly after every 6-12 months.

CONCLUSION

Efficacy of dental health education can be increased only if health programs are tailored to directly impinge on attitudes of targeted population, especially school children in whom healthy practices can be inculcated easily and be sustained for long times.

Fluoride mouthrinses for preventing dental caries in children and adolescents

BACKGROUND

Fluoride mouthrinses have been used extensively as a caries-preventive intervention in school-based programmes and by individuals at home. This is an update of the Cochrane review of fluoride mouthrinses for preventing dental caries in children and adolescents that was first published in 2003.

OBJECTIVES

The primary objective is to determine the effectiveness and safety of fluoride mouthrinses in preventing dental caries in the child and adolescent population.The secondary objective is to examine whether the effect of fluoride rinses is influenced by:• initial level of caries severity;• background exposure to fluoride in water (or salt), toothpastes or reported fluoride sources other than the study option(s); or• fluoride concentration (ppm F) or frequency of use (times per year).

SEARCH METHODS

We searched the following electronic databases: Cochrane Oral Health's Trials Register (whole database, to 22 April 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 3), MEDLINE Ovid (1946 to 22 April 2016), Embase Ovid (1980 to 22 April 2016), CINAHL EBSCO (the Cumulative Index to Nursing and Allied Health Literature, 1937 to 22 April 2016), LILACS BIREME (Latin American and Caribbean Health Science Information Database, 1982 to 22 April 2016), BBO BIREME (Bibliografia Brasileira de Odontologia; from 1986 to 22 April 2016), Proquest Dissertations and Theses (1861 to 22 April 2016) and Web of Science Conference Proceedings (1990 to 22 April 2016). We undertook a search for ongoing trials on the US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the World Health Organization International Clinical Trials Registry Platform. We placed no restrictions on language or date of publication when searching electronic databases. We also searched reference lists of articles and contacted selected authors and manufacturers.

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials where blind outcome assessment was stated or indicated, comparing fluoride mouthrinse with placebo or no treatment in children up to 16 years of age. Study duration had to be at least one year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces in permanent teeth (D(M)FS).

DATA COLLECTION AND ANALYSIS

At least two review authors independently performed study selection, data extraction and risk of bias assessment. We contacted study authors for additional information when required. The primary measure of effect was the prevented fraction (PF), that is, the difference in mean caries increments between treatment and control groups expressed as a percentage of the mean increment in the control group. We conducted random-effects meta-analyses where data could be pooled. We examined potential sources of heterogeneity in random-effects metaregression analyses. We collected adverse effects information from the included trials.

MAIN RESULTS

In this review, we included 37 trials involving 15,813 children and adolescents. All trials tested supervised use of fluoride mouthrinse in schools, with two studies also including home use. Almost all children received a fluoride rinse formulated with sodium fluoride (NaF), mostly on either a daily or weekly/fortnightly basis and at two main strengths, 230 or 900 ppm F, respectively. Most studies (28) were at high risk of bias, and nine were at unclear risk of bias.From the 35 trials (15,305 participants) that contributed data on permanent tooth surface for meta-analysis, the D(M)FS pooled PF was 27% (95% confidence interval (CI), 23% to 30%; I(2) = 42%) (moderate quality evidence). We found no significant association between estimates of D(M)FS prevented fractions and baseline caries severity, background exposure to fluorides, rinsing frequency or fluoride concentration in metaregression analyses. A funnel plot of the 35 studies in the D(M)FS PF meta-analysis indicated no relationship between prevented fraction and study precision (no evidence of reporting bias). The pooled estimate of D(M)FT PF was 23% (95% CI, 18% to 29%; I² = 54%), from the 13 trials that contributed data for the permanent teeth meta-analysis (moderate quality evidence).We found limited information concerning possible adverse effects or acceptability of the treatment regimen in the included trials. Three trials incompletely reported data on tooth staining, and one trial incompletely reported information on mucosal irritation/allergic reaction. None of the trials reported on acute adverse symptoms during treatment.

AUTHORS' CONCLUSIONS

This review found that supervised regular use of fluoride mouthrinse by children and adolescents is associated with a large reduction in caries increment in permanent teeth. We are moderately certain of the size of the effect. Most of the evidence evaluated use of fluoride mouthrinse supervised in a school setting, but the findings may be applicable to children in other settings with supervised or unsupervised rinsing, although the size of the caries-preventive effect is less clear. Any future research on fluoride mouthrinses should focus on head-to-head comparisons between different fluoride rinse features or fluoride rinses against other preventive strategies, and should evaluate adverse effects and acceptability.

Self-reported oral health and quality of life of postmenopausal breast cancer survivors on aromatase inhibitors and women without cancer diagnoses: a longitudinal analysis

INTRODUCTION

Aromatase inhibitors (AIs) are a well-established component of adjuvant therapy in postmenopausal women with hormone receptor (HR) + early stage breast cancer (BCa). We explored in an 18-month cohort study whether subjective oral health (OH), subjective periodontal health (PH), and oral health-related quality of life (OHRQoL) of postmenopausal BCa survivors on AIs differ from those of women without cancer diagnoses, and whether saliva flow, OH, PH, and OHRQoL are related.

METHODS

Data were collected from 29 postmenopausal BCa survivors on AIs and 29 postmenopausal women without cancer diagnoses. Socio-demographic information, OH, PH, and OHRQoL were collected at baseline and 6, 12, and 18 months later. Unstimulated whole saliva volume per 15 min was determined by drooling.

RESULTS

The two groups did not differ in background characteristics at baseline. Women on AIs had poorer OH (p = .043), PH (p = .04), and OHRQoL (p = .017), and lower saliva flow rate (p < .001) than control respondents. BCa survivors had the poorest PH at the 18-month visit. Xerostomia was correlated with OH at baseline and with OH and PH at 18 months. However, objective saliva flow rate was not correlated with OH or OHRQoL at this visit.

CONCLUSIONS

This study is the first to investigate the effects of AIs on patients' subjective OH, subjective PH, and OHRQoL. The data suggest that women treated with AIs have worse OH, PH, and OHRQoL than women without cancer diagnoses. Interprofessional care is recommended so that women on AIs receive optimal supportive oral care to assure long-term OH and positive OHRQoL.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01272570 https://clinicaltrials.gov/ct2/show/NCT01272570 .

Public Health Aspects of Paediatric Dental Treatment under General Anaesthetic

Early childhood caries (ECC) has negative psychosocial effects on children, with chronic pain, changed eating habits, disrupted sleep and altered growth very common, and it disrupts the day-to-day lives of their families. The treatment of young children with ECC places a considerable burden on health systems, with a considerable amount having to be provided under general anaesthesia (GA), which is resource-intensive. Justifying its use requires evidence of the efficacy of treatment in improving the lives of affected children and their families. This paper discusses the available evidence and then makes some suggestions for a research agenda.

High sucrose intake at 3 years of age is associated with increased salivary counts of mutans streptococci and lactobacilli, and with increased caries rate from 3 to 16 years of age

OBJECTIVE

We aimed to study the long-term associations between sucrose intake (SI), selected representatives of the cariogenic oral flora, and the dental health of children from 3 to 16 years of age.

METHODS

At 7 months of age 1,062 infants (540 intervention; 522 controls) were included in the prospective, randomised STRIP-project aimed at restricting the child's saturated fat and cholesterol intake to prevent atherosclerosis when they become adults. At 3 years of age, every fifth child was invited (n = 178) to an oral sub-study, and 148 (78 boys) children attended. A restudy was conducted on 135 children aged 6, 127 aged 9, 114 aged 12 and 88 aged 16. SI using 4-day food records, plate-cultured mutans streptococci (MS), salivary lactobacilli (LB) and yeasts using commercial kits (Orion Diagnostica, Espoo Finland), toothbrushing frequency using fluoridated toothpaste and dental health expressed as d 3 mft/D 3 MFT were regularly recorded.

RESULTS

The SI of children whose intake was ≥ 10 E% (high SI) at 3 years remained high throughout the entire follow-up (p < 0.001, GLM for repeated measures) period, and they had higher salivary MS and LB counts (p = 0.024 and p = 0.068, respectively, GLM) than their counterparts whose SI was below 10 E% (low SI). No differences in toothbrushing habits were found between the high and low SI-groups. Caries-survival was strongly associated with low 6-year-counts of MS (p = 0.008, Cox regression analysis), and the d 3 mft/D 3 MFTscores of the high SI-group were higher than those of the low SI-group (p = 0.046, GLM).

CONCLUSIONS

High SI at 3 years was associated with high MS-counts ( ≥ 10 5 cfu/ml) and with a high risk for caries.

Emerging Early Actions to Bend the Curve in Sub-Saharan Africa's Nutrition Transition

BACKGROUND

Sub-Saharan Africa is the last region to undergo a nutrition transition and can still avoid its adverse health outcomes.

OBJECTIVE

The article explores emerging responses to "bend the curve" in sub-Saharan Africa's nutrition transition to steer public health outcomes onto a healthier trajectory.

METHODS

Early responses in 3 countries at different stages of food system transformation are examined: South Africa-advanced, Ghana-intermediate, and Uganda-early. By comparing these with international experience, actions are proposed to influence nutrition and public health trajectories as Africa's food systems undergo rapid structural change.

RESULTS

Arising from rapid urbanization and diet change, major public health problems associated with overweight are taking place, particularly in South Africa and among adult women. However, public health responses are generally tepid in sub-Saharan Africa. Only in South Africa have policy makers instituted extensive actions to combat overweight and associated noncommunicable diseases through regulation, education, and public health programs. Elsewhere, in countries in the early and middle stages of transition, public health systems continue to focus their limited resources primarily on undernutrition. Related pressures on the supply side of Africa's food systems are emerging that also need to be addressed.

CONCLUSIONS

Three types of intervention appear most feasible: maternal and child health programs to simultaneously address short-term undernutrition problems while at the same time helping to reduce future tendencies toward overweigh; regulatory and fiscal actions to limit access to unhealthy foods; and modernization of Africa's agrifood food system through job skills training, marketing reforms, and food industry entrepreneurship.

How much sugar is hidden in drinks marketed to children? A survey of fruit juices, juice drinks and smoothies

OBJECTIVE

To investigate the amount of sugars in fruit juices, juice drinks and smoothies (FJJDS) marketed to children.

DESIGN

We surveyed the sugars content (per 100 ml and standardised 200 ml portion) of all FJJDS sold by seven major UK supermarkets (supermarket own and branded products). Only products specifically marketed towards children were included. We excluded sports drinks, iced teas, sugar-sweetened carbonated drinks and cordials as being not specifically marketed towards children.

RESULTS

We identified 203 fruit juices (n=21), juice drinks (n=158) and smoothies (n=24) marketed to children. Sugars content ranged from 0 to 16 g/100 ml. The mean sugars content was 7.0 g/100 ml, but among the 100% fruit juice category, it was 10.7 g/100 ml. Smoothies (13.0 g/100 ml) contained the highest amounts of sugars and juice drinks (5.6 g/100 ml) contained the lowest amount. 117 of the 203 FJJDS surveyed would receive a Food Standards Agency 'red' colour-coded label for sugars per standardised 200 ml serving. Only 63 FJJDS would receive a 'green' colour-coded label. 85 products contained at least 19 g of sugars-a child's entire maximum daily amount of sugars. 57 products contained sugar (sucrose), 65 contained non-caloric sweeteners and five contained both. Seven products contained glucose-fructose syrup.

CONCLUSIONS

The sugars content in FJJDS marketed to children in the UK is unacceptably high. Manufacturers must stop adding unnecessary sugars and calories to their FJJDS.

Relationship between premature loss of primary teeth with oral hygiene, consumption of soft drinks, dental care, and previous caries experience

We determine the relationship between premature loss of primary teeth and oral hygiene, consumption of soft drinks, dental care and previous caries experience. This study focused on 833 Mexican schoolchildren aged 6–7. We performed an oral examination to determine caries experience and the simplified oral hygiene index. The dependent variable was the prevalence of at least one missing tooth (or indicated for extraction) of the primary dentition; this variable was coded as 0 = no loss of teeth and 1 = at least one lost primary tooth. The prevalence of at least one missing tooth was 24.7% (n = 206) (95% CI = 21.8–27.7). The variables that were associated with the prevalence of tooth loss (p < 0.05) included: the largest number of decayed teeth (OR = 1.11), the largest number of filled teeth (OR = 1.23), the worst oral hygiene (OR = 3.24), a lower frequency of brushing (OR = 1.60), an increased consumption of soda (OR = 1.89) and use of dental care (curative: OR = 2.83, preventive: OR = 1.93). This study suggests that the premature loss of teeth in the primary dentition is associated with oral hygiene, consumption of soft drinks, dental care and previous caries experience in Mexican schoolchildren. These data provide relevant information for the design of preventive dentistry programs.

Association between Knowledge about Comprehensive Food Education and Increase in Dental Caries in Japanese University Students: A Prospective Cohort Study

In Japan, comprehensive food education (shokuiku) programs are carried out with the aim of improving dietary practices and thereby reducing the incidence of lifestyle-related diseases, including dental caries. The purpose of this prospective cohort study was to investigate the association between knowledge about shokuiku and the increase in dental caries among Japanese university students who had attended a shokuiku program while in junior/senior high school. A total of 562 students volunteered to undergo oral examinations over a three-year follow-up period, during which the number of cases of dental caries were recorded. Additional information was collected using a questionnaire survey regarding knowledge about shokuiku, dietary habits, and oral health behaviors. In logistic regression analysis, males who lacked knowledge about shokuiku had significantly higher odds for dental caries than those who did not (odds ratio (OR), 2.00; 95% confidence interval (CI), 1.12-3.58; p = 0.019). On the other hand, among females, those who frequently consumed sugar-sweetened soft drinks had significantly higher odds for dental caries than those who did not (OR, 1.89; 95% CI, 1.05-3.42; p = 0.035). These results suggest that having no knowledge about shokuiku is associated with a risk of increase in dental caries in Japanese male university students.

The Shape of the Dose-Response Relationship between Sugars and Caries in Adults

Dental caries is considered a diet-mediated disease, as sugars are essential in the caries process. However, some gaps in knowledge about the sugars-caries relationship still need addressing. This longitudinal study aimed to explore 1) the shape of the dose-response association between sugars intake and caries in adults, 2) the relative contribution of frequency and amount of sugars intake to caries levels, and 3) whether the association between sugars intake and caries varies by exposure to fluoride toothpaste. We used data from 1,702 dentate adults who participated in at least 2 of 3 surveys in Finland (Health 2000, 2004/05 Follow-up Study of Adults' Oral Health, and Health 2011). Frequency and amount of sugars intake were measured with a validated food frequency questionnaire. The DMFT index was the repeated outcome measure. Data were analyzed with fractional polynomials and linear mixed effects models. None of the 43 fractional polynomials tested provided a better fit to the data than the simpler linear model. In a mutually adjusted linear mixed effects model, the amount of, but not the frequency of, sugars intake was significantly associated with DMFT throughout the follow-up period. Furthermore, the longitudinal association between amount of sugars intake and DMFT was weaker in adults who used fluoride toothpaste daily than in those using it less often than daily. The findings of this longitudinal study among Finnish adults suggest a linear dose-response relationship between sugars and caries, with amount of intake being more important than frequency of ingestion. Also, daily use of fluoride toothpaste reduced but did not eliminate the association between amount of sugars intake and dental caries.

Mother's Perception of General Family Functioning and Sugar Consumption of 3- and 4-Year-Old Children: The East London Family Study

Frequent consumption of sugary foods is a common risk factor for chronic diseases such as dental caries and obesity. Dietary patterns are acquired at home during early life and form a blueprint for dietary behaviours in later life. A favourable family environment can provide a supportive context that enhances the adoption of healthy dietary habits. The aim of this study was to identify the contribution of general family functioning towards the frequent consumption of sugary foods by 3- and 4-year-old children in Outer North East London. The research question was explored with data from the East London Family study, which collected data through home visits from a representative sample of adults and children living in Outer North East London in 2008-2010. This study analysed data from 3- and 4-year-old children (n = 698) and their mothers and included logistic regression, conceptual hierarchical modelling and mediation analysis. The results showed that 17% of the sample consumed sugary foods more than 4 times per day, and that effective general family functioning may help reducing frequent consumption of sugary foods. There was a 67% reduction in children's frequent consumption of sugary foods with every unit increase in the general family functioning score. Mother's higher education may also help reduce the frequent consumption of sugary foods by children. The negative impact of mother's lower education was buffered by the effect of effective general family functioning. The study findings underscore the prospect of identifying factors that contribute to the acquisition of good dietary behaviours.

Diet and Dental Caries: The Pivotal Role of Free Sugars Reemphasized

The importance of sugars as a cause of caries is underemphasized and not prominent in preventive strategies. This is despite overwhelming evidence of its unique role in causing a worldwide caries epidemic. Why this neglect? One reason is that researchers mistakenly consider caries to be a multifactorial disease; they also concentrate mainly on mitigating factors, particularly fluoride. However, this is to misunderstand that the only cause of caries is dietary sugars. These provide a substrate for cariogenic oral bacteria to flourish and to generate enamel-demineralizing acids. Modifying factors such as fluoride and dental hygiene would not be needed if we tackled the single cause--sugars. In this article, we demonstrate the sensitivity of cariogenesis to even very low sugars intakes. Quantitative analyses show a log-linear dose-response relationship between the sucrose or its monosaccharide intakes and the progressive lifelong development of caries. This results in a substantial dental health burden throughout life. Processed starches have cariogenic potential when accompanying sucrose, but human studies do not provide unequivocal data of their cariogenicity. The long-standing failure to identify the need for drastic national reductions in sugars intakes reflects scientific confusion partly induced by pressure from major industrial sugar interests.

Interaction model of steviol glycosides from Stevia rebaudiana (Bertoni) with sweet taste receptors: A computational approach

Docking studies were performed on natural sweeteners from Stevia rebaudiana by constructing homology models of T1R2 and T1R3 subunits of human sweet taste receptors. Ramachandran plot, PROCHECK results and ERRAT overall quality factor were used to validate the quality of models. Furthermore, docking results of steviol glycosides (SG's) were correlated significantly with data available in the literature which enabled to predict the exact sweetness rank order of SG's. The binding pattern indicated that Asn 44, Ans 52, Ala 345, Pro 343, Ile 352, Gly 346, Gly 47, Ala 354, Ser 336, Thr 326 and Ser 329 are the main interacting amino acid residues in case of T1R2 and Arg 56, Glu 105, Asp 215, Asp 216, Glu 148, Asp 258, Lys 255, Ser 104, Glu 217, Leu 51, Arg 52 for T1R3, respectively. Amino acids interact with SG's mainly by forming hydrogen bonds with the hydroxyl group of glucose moieties. Significant variation in docked poses of all the SG's were found. In this study, we have proposed the mechanism of the sweetness of the SG's in the form of multiple point stimulation model by considering the diverse binding patterns of various SG's, as well as their structural features. It will give further insight in understanding the differences in the quality of taste and will be used to improve the taste of SG's using semi-synthetic approaches.

Fluoride gels for preventing dental caries in children and adolescents

BACKGROUND

Topically applied fluoride gels have been widely used as a caries-preventive intervention in dental surgeries and school-based programmes for over three decades. This updates the Cochrane review of fluoride gels for preventing dental caries in children and adolescents that was first published in 2002.

OBJECTIVES

The primary objective is to determine the effectiveness and safety of fluoride gels in preventing dental caries in the child and adolescent population.The secondary objectives are to examine whether the effect of fluoride gels is influenced by the following: initial level of caries severity; background exposure to fluoride in water (or salt), toothpastes, or reported fluoride sources other than the study option(s); mode of use (self applied under supervision or operator-applied), and whether there is a differential effect between the tray and toothbrush methods of application; frequency of use (times per year) or fluoride concentration (ppm F).

SEARCH METHODS

We searched the Cochrane Oral Health Group Trials Register (to 5 November 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library 2014, Issue 11), MEDLINE via OVID (1946 to 5 November 2014), EMBASE via OVID (1980 to 5 November 2014), CINAHL via EBSCO (1980 to 5 November 2014), LILACS and BBO via the BIREME Virtual Health Library (1980 to 5 November 2014), ProQuest Dissertations and Theses (1861 to 5 November 2014) and Web of Science Conference Proceedings (1945 to 5 November 2014). We undertook a search for ongoing trials on ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform on 5 November 2014. We placed no restrictions on language or date of publication in the search of the electronic databases. We also searched reference lists of articles and contacted selected authors and manufacturers.

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials where blind outcome assessment was stated or indicated, comparing topically applied fluoride gel with placebo or no treatment in children up to 16 years. The frequency of application had to be at least once a year, and study duration at least one year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces in both permanent and primary teeth (D(M)FS and d(e/m)fs).

DATA COLLECTION AND ANALYSIS

At least two review authors independently performed study selection, data extraction and 'Risk of bias' assessment. We contacted study authors for additional information where required. The primary measure of effect was the prevented fraction (PF), that is, the difference in mean caries increments between the treatment and control groups expressed as a percentage of the mean increment in the control group. We performed random-effects meta-analyses where we could pool data. We examined potential sources of heterogeneity in random-effects metaregression analyses. We collected adverse effects information from the included trials.

MAIN RESULTS

We included 28 trials (3 of which are new trials since the original review), involving 9140 children and adolescents. Most of these trials recruited participants from schools. Most of the studies (20) were at high risk of bias, with 8 at unclear risk of bias.Twenty-five trials (8479 participants) contributed data for meta-analysis on permanent tooth surfaces: the D(M)FS pooled prevented fraction (PF) estimate was 28% (95% confidence intervals (CI) 19% to 36%; P < 0.0001; with substantial heterogeneity (P < 0.0001; I(2) = 82%); moderate quality evidence). Subgroup and metaregression analyses suggested no significant association between estimates of D(M)FS prevented fractions and the prespecified trial characteristics. However, the effect of fluoride gel varied according to the type of control group used, with D(M)FS PF on average being 17% (95% CI 3% to 31%; P = 0.018) higher in non-placebo-controlled trials (the reduction in caries was 38% (95% CI 24% to 52%; P < 0.0001, 2808 participants) for the 10 trials with no treatment as control group, and 21% (95% CI 15% to 28%; P < 0.0001, 5671 participants) for the 15 placebo-controlled trials. A funnel plot of the 25 trials in the D(M)FS PF meta-analysis indicated a relationship between prevented fraction and study precision, with an apparent lack of small studies with statistically significant large effects.The d(e/m)fs pooled prevented fraction estimate for the three trials (1254 participants) that contributed data for the meta-analysis on primary teeth surfaces was 20% (95% CI 1% to 38%; P = 0.04; with no heterogeneity (P = 0.54; I(2) = 0%); low quality evidence).There was limited reporting of adverse events. Only two trials reported information on acute toxicity signs and symptoms during the application of the gel (risk difference 0.01, 95% CI -0.01 to 0.02; P = 0.36; with no heterogeneity (P = 36; I(2) = 0%); 490 participants; very low quality evidence). None of the trials reported information on tooth staining, mucosal irritation or allergic reaction.

AUTHORS' CONCLUSIONS

The conclusions of this updated review remain the same as those when it was first published. There is moderate quality evidence of a large caries-inhibiting effect of fluoride gel in the permanent dentition. Information concerning the caries-preventive effect of fluoride gel on the primary dentition, which also shows a large effect, is based on low quality evidence from only three placebo-controlled trials. There is little information on adverse effects or on acceptability of treatment. Future trials should include assessment of potential adverse effects.

Association between dairy intake and caries among children and adolescents. results from the Danish EYHS follow-up study

The aim of this paper was to investigate associations between the intake of dairy products and the development in caries (DMFS, decayed, missing and filled surfaces) among children/adolescents over a period of 3 and 6 years, and to investigate whether dairy intake protects against caries incidence. A total of 68.9% of the children were caries free at the age of 9 compared with 34.0% of the adolescents at the age of 15 (measured as DMFS = 0). A larger percentage of children/adolescents with a dairy intake above the mean were caries free compared with the group of children/adolescents with an intake below the mean (72.8 vs. 65.8% at age 9 and 41.1 vs. 30.7% at age 15). The results from the generalized estimation equation showed that dairy and milk intake, as well as intakes of components of dairy such as dairy calcium, whey and casein, was generally inversely associated with childhood/adolescent caries experience (measured as DMFS). With regard to caries incidence, the same inverse association was found for incidence over a period of 3 years and for incidence over 6 years, but the results were only statistically significant for the 3-year incidence and for the unadjusted models of the 6-year incidence. This study found that previous dairy intake, as well as milk intake or intake of dairy components, may be a predictor of future risk of caries measured by the DMFS count level. This relationship was inverse, meaning that a high intake of dairy products was associated with less future caries development. However, more studies on larger cohorts are needed to confirm these findings.

Sugar industry influence on the scientific agenda of the National Institute of Dental Research's 1971 National Caries Program: a historical analysis of internal documents

BACKGROUND

In 1966, the National Institute of Dental Research (NIDR) began planning a targeted research program to identify interventions for widespread application to eradicate dental caries (tooth decay) within a decade. In 1971, the NIDR launched the National Caries Program (NCP). The objective of this paper is to explore the sugar industry's interaction with the NIDR to alter the research priorities of the NIDR NCP.

METHODS AND FINDINGS

We used internal cane and beet sugar industry documents from 1959 to 1971 to analyze industry actions related to setting research priorities for the NCP. The sugar industry could not deny the role of sucrose in dental caries given the scientific evidence. They therefore adopted a strategy to deflect attention to public health interventions that would reduce the harms of sugar consumption rather than restricting intake. Industry tactics included the following: funding research in collaboration with allied food industries on enzymes to break up dental plaque and a vaccine against tooth decay with questionable potential for widespread application, cultivation of relationships with the NIDR leadership, consulting of members on an NIDR expert panel, and submission of a report to the NIDR that became the foundation of the first request for proposals issued for the NCP. Seventy-eight percent of the sugar industry submission was incorporated into the NIDR's call for research applications. Research that could have been harmful to sugar industry interests was omitted from priorities identified at the launch of the NCP. Limitations are that this analysis relies on one source of sugar industry documents and that we could not interview key actors.

CONCLUSIONS

The NCP was a missed opportunity to develop a scientific understanding of how to restrict sugar consumption to prevent tooth decay. A key factor was the alignment of research agendas between the NIDR and the sugar industry. This historical example illustrates how industry protects itself from potentially damaging research, which can inform policy makers today. Industry opposition to current policy proposals-including a World Health Organization guideline on sugars proposed in 2014 and changes to the nutrition facts panel on packaged food in the US proposed in 2014 by the US Food and Drug Administration-should be carefully scrutinized to ensure that industry interests do not supersede public health goals.

Assessment of food habits in children aged 6-12 years and the risk of caries

Food is necessary for the proper growth and development of children. The excessive intake of low-molecular carbohydrates constitutes a serious health issue, which has an unfavourable impact on the dental health status. The aim of this study was to assess the food habits in healthy children aged 6–12 years and the effect on their oral risk profile. The study included 100 children. The assessment of their nutrition was done with the help of a seven-day reproduction of the food intake and a survey used to determine their underlying food habits and preferences. The results revealed unbalanced nutrition of the children and increased intake of simple sugar, which will increase the risk of development of dental caries. The observed high levels of DMFT (number of decayed, missing and filled teeth) in 54% of the children is a logical result of the frequent intake of sugary foods and beverages for a long period of time, as this will increase the acid production by microorganisms in dental plaque, which is one of the leading etiologic factors for the development of caries. It is necessary for dentists to administer control over the carbohydrate intake and the food habits of children, as well as to encourage non-cariogenic diet in order to keep their good oral health.

Effectiveness of motivational interviewing at improving oral health: a systematic review

OBJECTIVE

To analyze the effectiveness of motivational interviewing (MI) at improving oral health behaviors (oral hygiene habits, sugar consumption, dental services utilization or use of fluoride) and dental clinical outcomes (dental plaque, dental caries and periodontal status).

METHODS

A systematic search of PubMed, LILACS, SciELO, PsyINFO, Cochrane and Google Scholar bibliographic databases was conducted looking for intervention studies that investigated MI as the main approach to improving the oral health outcomes investigated.

RESULTS

Of the 78 articles found, ten met the inclusion criteria, all based on randomized controlled trials. Most studies (n = 8) assessed multiple outcomes. Five interventions assessed the impact of MI on oral health behaviors and nine on clinical outcomes (three on dental caries, six on dental plaque, four on gingivitis and three on periodontal pockets). Better quality of evidence was provided by studies that investigated dental caries, which also had the largest population samples. The evidence of the effect of MI on improving oral health outcomes is conflicting. Four studies reported positive effects of MI on oral health outcomes whereas another four showed null effect. In two interventions, the actual difference between groups was not reported or able to be recalculated.

CONCLUSIONS

We found inconclusive effectiveness for most oral health outcomes. We need more and better designed and reported interventions to fully assess the impact of MI on oral health and understand the appropriate dosage for the counseling interventions.

A new understanding of the relationship between sugars, dental caries and fluoride use: implications for limits on sugars consumption

OBJECTIVE

To examine the quantitative relationship between sugar intake and the progressive development of dental caries.

DESIGN

A critical in-depth review of international studies was conducted. Methods included reassessing relevant studies from the most recent systematic review on the relationship between levels of sugars and dental caries. Reanalysis of dose-response relationships between dietary sugars and caries incidence in teeth with different levels of caries susceptibility in children was done using data from Japanese studies conducted by Takeuchi and co-workers.

SETTING

Global, with emphasis on marked differences in both national sugar intake and fluoride use and preferably where one factor such as sugar intake changed progressively without changes in other factors over a decade or more.

SUBJECTS

Children aged 6 years or more and adults.

RESULTS

Caries occurred in both resistant and susceptible teeth of children when sugar intakes were only 2-3 % of energy intake, provided that the teeth had been exposed to sugars for >3 years. Despite increased enamel resistance after tooth eruption, there was a progressive linear increase in caries throughout life, explaining the higher rates of caries in adults than in children. Fluoride affects progression of caries development but there still is a pandemic prevalence of caries in populations worldwide.

CONCLUSIONS

Previous analyses based on children have misled public health analyses on sugars. The recommendation that sugar intakes should be ≤10 % of energy intake is no longer acceptable. The much greater adult burden of dental caries highlights the need for very low sugar intakes throughout life, e.g. 2-3 % of energy intake, whether or not fluoride intake is optimum.

Sugars consumption in a low-income sample of British young people and adults

OBJECTIVE

To report the consumption of non-milk extrinsic sugars (NMES) among a low-income UK sample, compare it with nationally representative estimates and examine the association between socioeconomic position and NMES consumption among low income adults.Design Secondary analysis of the Low Income Diet and Nutrition Survey (LIDNS) data.

SETTING AND SUBJECTS

Two thousand, seven hundred and ninety-six adults and 415 young people from 2,477 households.Main outcome measures Mean NMES intakes (grams) and their percentage contribution to food energy, from dietary data collected via a 24-hour recall 'multiple pass' method.

RESULTS

The low income sample consumed more NMES than the general population sample. The percentage of food energy from NMES exceeded the 11% target, especially among adolescents (17.2% in males, 16.3% in females). After adjusting for age, men who finished full-time education aged 16 years consumed significantly more sugar (p = 0.028), whereas those who finished aged 18 consumed significantly less sugar (p = 0.023) than the reference group (finished aged 15). No significant associations were found between NMES and socioeconomic variables in women.

CONCLUSION

Compared to the general population, the nutritional disadvantage of the most deprived segments of society relates primarily to excessive NMES consumption. In men, higher educational level appears to play a protective role against high sugar intakes.

Oral health: How much do you know? - A study on knowledge, attitude and practices of patients visiting a North Indian dental school

OBJECTIVE

This study was carried out to assess the knowledge, attitude and behavior among patients visiting the out-patient department (OPD) of Gian Sagar Dental College and Hospital, Rajpura.

MATERIALS AND METHODS

A cross-sectional study was conducted on 642 subjects who visited the OPD of Gian Sagar Dental College and Hospital. A self-constructed questionnaire was given to each of the participant. Responses from the subjects were calculated in terms of numbers and percentages.

RESULT

Three hundred six (48%) of the subjects had never visited a dentist before. 304 (47%) of the subjects still prefer other cleaning aids over toothbrush. 207 (32%) subjects were of the view that dental health has no effect on general health, whereas 219 (34%) subjects were of the opinion that tooth loss is a natural sequel of the aging process.

CONCLUSION

There is a dearth of knowledge and careless attitude among people in regard to dental health. People need to be motivated and their concepts regarding the importance of dental health should be made clear through various campaigns and personal counseling.

Nutrient intake and dietary patterns of relevance to dental health of 12-year-old Libyan children

OBJECTIVE

There are few data on the dietary intake of children in Libya, and none on free sugars intake. The present study aimed to report the intake of macronutrients and eating habits of relevance to dental health in a group of Libyan schoolchildren and to investigate any gender differences for these variables.

DESIGN

Dietary information was obtained from a randomly selected sample using an estimated 3 d food diary. Dietary data were coded using food composition tables and entered into a Microsoft® Access database. Intakes of energy, macronutrients, sugars and the amount of acidic items consumed were determined using purpose-written programs.

SETTING

Benghazi, Libya.

SUBJECTS

Schoolchildren aged 12 years.

RESULTS

One hundred and eighty children (ninety-two boys and eighty-eight girls) completed the study. Their mean age was 12·3 (sd 0·29) years. The average daily energy intake was 7·01 (sd 1·54) MJ/d. The percentage contributions to energy intake from protein, fat and carbohydrate were 16 %, 30 % and 54 %, respectively. Total sugars contributed 20·4 % of the daily energy intake, and free sugars 12·6 %. The median daily intake of acidic items was 203 g/d, and of acidic drinks was 146 g/d. There were no statistically significant differences in nutrient intakes between genders. Intake of acidic items was higher in girls (P < 0·001).

CONCLUSIONS

The contribution to energy intake from macronutrients was in accordance with global nutrition guidelines. The acidic drinks intake was low compared with other populations, while free sugars intake was above the recommended threshold of 10 % of energy intake.

Common risk factors in the management of periodontal and associated systemic diseases: the dental setting and interprofessional collaboration

There is a role for dentistry in the interprofessional management of chronic diseases by addressing common risk factors

BACKGROUND

A critical scientific foundation has developed for management of risk factors common to major diseases including periodontal disease, caries, diabetes, heart disease, and cancer.

PURPOSE

The purpose of this paper is to critically review this scientific literature. This will provide the basis for the current and future role of the dental setting in common risk factor identification and modification; with an emphasis on the role of the dental hygienist.

METHODS

A systematic review of the literature and analysis of the relevant papers was undertaken to support the recommendations.

CONCLUSIONS

We propose that the appropriate risk factor management procedures be adopted in the dental setting for smoking cessation, reduction of sugar consumption, and weight control in those patients at risk for one or a combination of the following diseases: periodontal disease, caries, diabetes, heart disease and certain cancers.

The use of a self-report questionnaire for dental health status assessment: a preliminary study

OBJECTIVES

The aim of this work was to evaluate and validate a new questionnaire for caries assessment of large populations as well as to correlate the results from the questionnaire with the caries lesions detected in clinical and radiographic evaluation.

METHODS

The study population included 460 young adults who arrived to a dental screening provided to all army recruits. Clinical and radiographic examinations were performed to all participants as part of the routine dental screening; two bite-wing radiographs were taken as well. The World Health Organization (WHO) caries diagnostic criterion for decayed, missing and filled teeth (DMFT) was also calculated. First, a questionnaire that included 20 questions regarding different caries risk factors such as socioeconomic status, dietary habits, smoking habits, dental treatment experience etc was filled by all participants. At the next stage, according to the statistical analysis finding, a new questionnaire based on the most predictive questions and answers for DMFT forecast was developed.

RESULTS

The mean total DMFT was 3.71 ± 4.2. DMFT value of 0 (caries free) was found in 28.8% of the participants while no caries lesion (D = 0) was detected in 52.9%. The new questionnaire developed consisted of the most predictive ten questions. When evaluating the ROC curves for the new questionnaire score in prediction of dental caries lesions, the area under the curve was found to be 85.7% (95% confidence interval was between 81.2% and 90.2%). The total value of 5.5 points in the new questionnaire was chosen as a cut-off for caries risk assessment and revealed sensitivity of 85.1% and false positive of 29%.

CONCLUSIONS

The use of a simple and easy questionnaire might serve as a good screening tool for large populations such as army recruits in order to identify the group of high risk populations that require more intensive intervention.

Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to < 10% and < 5% energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption. Data sources included MEDLINE, EMBASE, Cochrane Database, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Health Sciences, China National Knowledge Infrastructure, Wanfang, and South African Department of Health. Eligible studies reported the absolute amount of sugars and dental caries, measured as prevalence, incidence, or severity. The review was conducted and reported in accordance with the PRISMA statement, and the evidence was assessed according to GRADE Working Group guidelines. From 5,990 papers identified, 55 studies were eligible - 3 intervention, 8 cohort, 20 population, and 24 cross-sectional. Data variability limited meta-analysis. Of the studies, 42 out of 50 of those in children and 5 out of 5 in adults reported at least one positive association between sugars and caries. There is evidence of moderate quality showing that caries is lower when free-sugars intake is < 10% E. With the < 5% E cut-off, a significant relationship was observed, but the evidence was judged to be of very low quality. The findings are relevant to minimizing caries risk throughout the life course.

The neolithic demographic transition and oral health: The Southeast Asian experience

The purpose of this article is to present new oral health data from Neolithic An Son, southern Vietnam, in the context of (1) a reassessment of published data on other Neolithic, Bronze, and Iron Age Southeast Asian dental series, and (2) predictions of the Neolithic Demographic Transition (NDT). To this end, frequencies for three oral conditions (caries, antemortem tooth loss, and alveolar lesions) were investigated for seven Southeast Asian adult dental series from Thailand and Vietnam with respect to time period, age-at-death and sex. A clear pattern of elevated rates for oral disease in the Neolithic followed by a marked improvement in oral health during the Bronze and Iron Ages was observed. Moreover, rates of caries and antemortem tooth loss for females were almost without exception higher than that for males in all samples. The consensus view among Southeast Asian bioarchaeologists that oral health did not decline with the adoption/intensification of agriculture in Southeast Asia, can no longer be supported. In light of evidence for (1) the low cariogenicity of rice; (2) the physiological predisposition of females (particularly when pregnant) to poorer oral health; and (3) health predictions of the NDT model with respect to elevated levels of fertility, the most plausible chief explanation for the observed patterns in oral health in Southeast Asia is increased levels of fertility during the Neolithic, followed by a decline in fertility during the subsequent Bronze and Iron Ages.

Sugar restriction: the evidence for a drug-free intervention to reduce cardiovascular disease risk

BACKGROUND/AIM

Uncertainty exists about what dietary component is most likely to cause coronary heart disease. Over the last thirty years, attention has focused on saturated fat and salt as guilty parties. More recently, evidence suggests that excess sugar intake is more likely than either traditional factor to lead to atherosclerotic disease. Some researchers have also speculated that sugar is addictive, in a similar manner to caffeine and established drugs of abuse.

METHODS

Here we review the epidemiological, biochemical and psychological evidence that implicates excess sugar intake as an important cause of ill-health.

RESULTS

We found relatively consistent evidence of association between markers of sugar intake and risk factors for cardiovascular disease, or the disease itself. This evidence contrasted with rather weaker evidence which linked either saturated fat or salt with cardiovascular disease endpoints. We also found some evidence of a sugar addiction syndrome.

CONCLUSION

We suggest that advice to restrict sugar intake should be a routine part of clinical care, particularly when patients are being counselled about cardiovascular risk.

The effects of beverages on plaque acidogenicity after a sugary challenge

BACKGROUND

Caries prevention traditionally has emphasized the restriction of cariogenic foods and beverages, but it has placed less emphasis on how the choice, combination and sequence of consumed foods and beverages may help reduce plaque acidogenicity. The authors conducted a study to examine whether whole milk, 100 percent apple juice or tap water affect dental plaque acidity in people after a sugary challenge.

METHODS

Twenty adults participated in a randomized controlled crossover study. Participants consumed four combinations of foods: 20 grams of dry sugary Froot Loops (FL) (Kellogg's, Battle Creek, Mich.) cereal, 20 g of FL followed by 50 milliliters of milk (FL/milk), 20 g of FL followed by 50 mL of juice (FL/juice) and 20 g of FL followed by 50 mL of water (FL/water). The authors used a touch microelectrode to take plaque pH readings at the interproximal space just below the contact area between the maxillary premolars on both left and right sides at two and five minutes after FL consumption and at two to 30 minutes after milk, juice or water consumption.

RESULTS

Consumption of FL plaque pH (standard deviation [SD]) was 5.83 (0.68) at 30 minutes, whereas plaque pH (SD) in the FL/milk group was 6.48 (0.30), which was significantly higher than that for FL/juice (5.83 [0.49]) or FL/water (6.02 [0.41]) (P < .005) at 35 minutes.

CONCLUSION

Drinking milk after a sugary cereal challenge significantly reduced plaque pH drop due to the sugary challenge.

PRACTICAL IMPLICATIONS

When discussing the cariogenicity of foods and beverages with patients, dentists and other health care professionals should emphasize that the order of ingesting sugary and nonsugary foods is important and may affect their oral health.

Epidemiology of dental caries: when structure and context matter

The widespread expansion of the sugar market drove dental caries prevalence to high levels in several regions of the world. On the other hand, the dissemination of fluoride use is one of the reasons for caries decline at the end of the 20th century. However, caries remains one of the most prevalent non-communicable chronic diseases in human beings, and an important cause of pain and dental loss, which lead to school and work absenteeism affecting individuals' daily activities and emotional stability. The decline in caries has important implications for research, human resources and oral healthcare. The aim of this study was to summarize the changes in dental caries occurrence in the population, and bring to light the latest research on the role of non-biological determinants in caries distribution.

Water fluoridation and the association of sugar-sweetened beverage consumption and dental caries in Australian children

OBJECTIVES

We examined demographic and socioeconomic differences in the consumption of sugar-sweetened beverages (SSBs), its association with dental caries in children, and whether exposure to water fluoridation modifies this association.

METHODS

In a cross-sectional study, we used a stratified, clustered sampling design to obtain information on 16 508 children aged 5 to 16 years enrolled in Australian school dental services in 2002 to 2005. Dental staff assessed dental caries, and parents completed a questionnaire about their child's residential history, sources of drinking water, toothbrushing frequency, socioeconomic status (SES), and SSB consumption.

RESULTS

Children who brushed their teeth less often and were older, male, of low SES, from rural or remote areas consumed significantly more SSBs. Caries was significantly associated with greater SSB consumption after controlling for potential confounders. Finally, greater exposure to fluoridated water significantly reduced the association between children's SSB consumption and dental caries.

CONCLUSIONS

Consumption of SSBs should be considered a major risk factor for dental caries. However, increased exposure to fluoridated public water helped ameliorate the association between SSB consumption and dental decay. These results reconfirm the benefits of community water fluoridation for oral health.

Effects of different amounts of a low fluoride toothpaste on primary enamel lesion progression: a preliminary study using in vitro pH-cycling system

AIMS

To evaluate and compare the efficacy of pea and half-pea portions of child formula fluoride (500 ppm) toothpaste on artificially created enamel lesions in primary teeth.

METHODS

Sound primary incisors were painted with nail varnish, leaving a 1 mm wide window and then placed in a demineralising solution for 96 h to produce artificial carious lesions 60-100 microm deep. The teeth were longitudinally sectioned (100 microm thick) and divided into 3 groups. Group A: treated with a pea-sized portion of a non-fluoride containing toothpaste (1:3, toothpaste: deionized water), while Groups B and C were treated with half-pea-sized and pea-sized portions of a 500 ppm fluoride containing toothpaste, respectively. The pH-cycling model was utilized for 7 days.

RESULTS

Groups A and B lesions increased in depth by 60% while those in Group C increased by 19%. The mineral content of the surface zone decreased significantly in Groups A and B but not in Group C.

CONCLUSION

Reduction of the amount of fluoride toothpaste to less than a pea-size in order to minimize the risk of fluorosis should be undertaken with caution because it may compromise the cariostatic effects of the toothpaste.

Nutritional status and dietary intake of urban residents in Gondar, Northwest Ethiopia

BACKGROUND

There is paucity of data on the dietary intake and nutritional status of urban Ethiopians which necessitates comprehensive nutritional assessments. Therefore, the present study was aimed at evaluating the dietary intake and nutritional status of urban residents in Northwest Ethiopia.

METHODS

This cross-sectional community based nutrition survey was conducted by involving 356 participants (71.3% female and 28.7% male with mean age of 37.3 years). Subjects were selected by random sampling. Socio demographic data was collected by questionnaire. Height, weight, hip circumference and waist circumference were measured following standard procedures. Dietary intake was assessed by a food frequency questionnaire and 24-h dietary recall. The recommended dietary allowance was taken as the cut-off point for the assessment of the adequacy of individual nutrient intake.

RESULTS

Undernourished, overweight and obese subjects composed 12.9%, 21.3% and 5.9% of the participants, respectively. Men were taller, heavier and had higher waist to hip ratio compared to women (P < 0.05). Fish, fruits and vegetables were consumed less frequently or never at all by a large proportion of the subjects. Oil and butter were eaten daily by most of the participants. Mean energy intakes fell below the estimated energy requirements in women (1929 vs 2031 kcal/day, P = 0.05) while it was significantly higher in men participants (3001 vs 2510 kcal/day, P = 0.007). Protein intake was inadequate (<0.8 g/kg/day) in 11.2% of the participants whereas only 2.8% reported carbohydrate intake below the recommended dietary allowances (130 g/day). Inadequate intakes of calcium, retinol, thiamin, riboflavin, niacin and ascorbic acid were seen in 90.4%, 100%, 73%, 92.4%, 86.2% and 95.5% of the participants.

CONCLUSIONS

The overall risk of nutritional inadequacy among the study participants was high along with their poor dietary intake. Hence, more stress should be made on planning and implementing nutritional programmes in urban settings aimed at preventing or correcting micronutrient and some macronutrient deficiencies which may be useful in preventing nutrition related diseases in life.