Oral diseases affect some 3.9 billion people

Population Distribution and Patients' Awareness of Food Impaction: A Cross-Sectional Study

BACKGROUND

Food impaction can contribute to a variety of oral health problems. However, the prevalence of food impaction in the population and patient awareness of these issues are poorly reported on.

METHODS

A questionnaire about food impaction was designed and uploaded to an online platform (Sojump) which was then circulated among the study participants using various social media platforms. Participants were asked to anonymously respond to the questionnaire regarding the prevalence of food impaction, its influence on their quality of life, their consultation rates and their oral cleaning methods. The survey was conducted through an online survey portal. Statistical analyses were performed using SPSS and GraphPad. The Chi-Square test, Bonferroni test and the Kruskal-Wallis H test were used to measure categorical variables from the survey.

RESULTS

The results showed that the prevalence of food impaction in non-dental professional participants was 86.9%. Among these patients, 12,157 pairs/cases of proximal contacts were affected. The number of food impaction cases in posterior teeth was significantly higher than in anterior teeth. Approximately 81.9% of patients believed that food impaction could affect their lives. However, the consultation rate for these patients was only 17.7%.

CONCLUSIONS

This study revealed that food impaction continued to have a high rate of incidence and a low rate of consultation, potentially due to a lack of awareness regarding its influence on oral health. To effectively prevent and address problems resulting from food impaction, both dentists and society need to enhance oral health knowledge in the population.

AI-initiated second opinions: a framework for advanced caries treatment planning

Integrating artificial intelligence (AI) into medical and dental applications can be challenging due to clinicians' distrust of computer predictions and the potential risks associated with erroneous outputs. We introduce the idea of using AI to trigger second opinions in cases where there is a disagreement between the clinician and the algorithm. By keeping the AI prediction hidden throughout the diagnostic process, we minimize the risks associated with distrust and erroneous predictions, relying solely on human predictions. The experiment involved 3 experienced dentists, 25 dental students, and 290 patients treated for advanced caries across 6 centers. We developed an AI model to predict pulp status following advanced caries treatment. Clinicians were asked to perform the same prediction without the assistance of the AI model. The second opinion framework was tested in a 1000-trial simulation. The average F1-score of the clinicians increased significantly from 0.586 to 0.645.

Chitosan Phytate Nanoparticles: A Synergistic Strategy for Effective Dental Caries Prevention

Dental caries is a widespread oral disease that poses a significant medical challenge. Traditional caries prevention methods, primarily the application of fluoride, often fall short in effectively destroying biofilms and preventing enamel demineralization, thereby providing limited efficacy in halting the progression of caries over time. To address this issue, we have developed a green and cost-effective synergistic strategy for the prevention of dental caries. By combining natural sodium phytate and chitosan, we have created chitosan-sodium phytate nanoparticles that offer both the antimicrobial properties of chitosan and the enamel demineralization-inhibiting capabilities of sodium phytate. In an ex vivo biofilm model of human teeth, we found that these nanoparticles effectively prevent biofilm buildup and acid damage to the mineralized tissue. Additionally, topical treatment of dental caries in rodent models has shown that these nanoparticles effectively suppress disease progression without negatively impacting oral microbiota diversity or causing harm to the gingival-mucosal tissues, unlike traditional prevention methods.

A microfluidic organ-on-a-chip: into the next decade of bone tissue engineering applied in dentistry

A comprehensive understanding of the complex physiological and pathological processes associated with alveolar bones, their responses to different therapeutics strategies, and cell interactions with biomaterial becomes necessary in precisely treating patients with severe progressive periodontitis, as a bone-related issue in dentistry. However, existing monolayer cell culture or pre-clinical models have been unable to mimic the complex physiological, pathological and regeneration processes in the bone microenvironment in response to different therapeutic strategies. In this point, 'organ-on-a-chip' (OOAC) technology, specifically 'alveolar-bone-on-a-chip', is expected to resolve the problems by better imitating infection site microenvironment and microphysiology within the oral tissues. The OOAC technology is assessed in this study toward better approaches in disease modeling and better therapeutics strategy for bone tissue engineering applied in dentistry.

Periodontal-Systemic Disease: A Study on Medical Practitioners' Knowledge and Practice

OBJECTIVE

Oral health is intricately linked with systemic health. However, the knowledge and practice levels of medical practitioners (MPs) about this concern are extremely variable. The current study, therefore, sought to assess the status of knowledge and practice of MPs concerning the link between periodontal disease and different systemic conditions as well as the efficacy of a webinar as an interventional tool in enhancing knowledge of MPs of Jazan Province of Saudi Arabia.

METHODS

This prospective interventional study involved 201 MPs. A 20-item questionnaire on evidence-based periodontal/systemic health associations was used. The participants answered the questionnaire before and 1 month after a webinar training that explained the mechanistic interrelation of periodontal and systemic health. McNemar test was performed for statistical analysis.

RESULTS

Out of the 201 MPs who responded to the pre-webinar survey, 176 attended the webinar and hence were included in the final analyses. Sixty-eight (38.64%) were female, and 104 (58.09%) were older than 35 years. About 90% of MPs reported not being trained on oral health. Pre-webinar, 96 (54.55%), 63 (35.80%), and 17 (9.66%) MPs rated their knowledge about the association of periodontal disease with systemic diseases as limited, moderate, and good, respectively. Post-webinar, these figures improved remarkably: 36 (20.45%), 88 (50.00%), and 52 (29.55%) MPs rated their knowledge as limited, moderate, and good, respectively. Around 64% of MPs had relatively good levels of knowledge about the positive influence of periodontal disease treatment on diabetic patients' blood glucose levels.

CONCLUSIONS

MPs revealed low levels of knowledge on the oral and systemic disease interrelationship. Conducting webinars on the oral-systemic health interrelationship seems to improve the overall knowledge and understanding of MPs.

Public Awareness on Perio-systemic Interplay: A Cross-Sectional Survey in South India

BACKGROUND

The oral cavity has been referred to as "the gateway to overall health." It is also said to be the meeting point of medicine and dentistry.

AIMS

Our study sought to determine the extent to which the public was aware of the connection between oral/periodontal conditions and general health.

SETTINGS AND DESIGN

The observational cross-sectional study's questionnaire was sectioned into oral health awareness, systemic influence on oral health, and personal oral health assessment.

MATERIALS AND METHODS

A total of 994 responses were recorded and a Chi-square test was performed to uncover the relationships using SPSS version 22.0. According to responses, 70% of the population on average comprehended the responses to the majority of the oral health awareness-related questions.

RESULTS

It has been noticed that only 30% of the general public was aware of the prevalent health issues like diabetes, hypertension, and malnutrition's impact on dental health. However, more than 60% had confidence in their oral health and gave a rating of at least 5.

CONCLUSION

The study indicates that a good number of the population was prioritizing their oral health. However, there exists a definitive need to improve oral health awareness thereby ameliorating the overall health of an individual.

A systematic comparison of machine learning algorithms to develop and validate prediction model to predict heart failure risk in middle-aged and elderly patients with periodontitis (NHANES 2009 to 2014)

Periodontitis is increasingly associated with heart failure, and the goal of this study was to develop and validate a prediction model based on machine learning algorithms for the risk of heart failure in middle-aged and elderly participants with periodontitis. We analyzed data from a total of 2876 participants with a history of periodontitis from the National Health and Nutrition Examination Survey (NHANES) 2009 to 2014, with a training set of 1980 subjects with periodontitis from the NHANES 2009 to 2012 and an external validation set of 896 subjects from the NHANES 2013 to 2014. The independent risk factors for heart failure were identified using univariate and multivariate logistic regression analysis. Machine learning algorithms such as logistic regression, k-nearest neighbor, support vector machine, random forest, gradient boosting machine, and multilayer perceptron were used on the training set to construct the models. The performance of the machine learning models was evaluated using 10-fold cross-validation on the training set and receiver operating characteristic curve (ROC) analysis in the validation set. Based on the results of univariate logistic regression and multivariate logistic regression, it was found that age, race, myocardial infarction, and diabetes mellitus status were independent predictors of the risk of heart failure in participants with periodontitis. Six machine learning models, including logistic regression, K-nearest neighbor, support vector machine, random forest, gradient boosting machine, and multilayer perceptron, were built on the training set, respectively. The area under the ROC for the 6 models was obtained using 10-fold cross-validation with values of 0 848, 0.936, 0.859, 0.889, 0.927, and 0.666, respectively. The areas under the ROC on the external validation set were 0.854, 0.949, 0.647, 0.933, 0.855, and 0.74, respectively. K-nearest neighbor model got the best prediction performance across all models. Out of 6 machine learning models, the K-nearest neighbor algorithm model performed the best. The prediction model offers early, individualized diagnosis and treatment plans and assists in identifying the risk of heart failure occurrence in middle-aged and elderly patients with periodontitis.

Oral Care and Maintenance Habits Among Pharmacy Students

Objective. This study aimed to identify and evaluate oral care habits, awareness, and knowledge of oral dental health among a group of pharmacy students.Methods. An e-questionnaire on oral care habits, awareness, and knowledge was completed by students in a university pharmacy.Results. A total of 484 students with a mean (SD) age of 21.4 (1.6) years participated. Of all participants, 9.3% were not regularly brushing their teeth. The percentage of regular fluoridated toothpaste usage was 44.8%. Three in 5 (64.5%) participants had visited a dentist for a complaint. When answering questions on the possible effects of dental plaque accumulation on teeth, the causative factors for dental decay and signs of periodontal disease, the percentages of students who indicated they "did not know" were 16.3%, 4.8%, and 43.2%, respectively. Among participants, 38.7% were unaware of the cariogenic or erosive effects of pediatric syrups or suspensions. Of all the pharmacy students, 32% stated they have been consulted about some issue related to oral health.Conclusion. The oral care habits, awareness, and oral health knowledge of pharmacy students in one program needs to be improved. Improvement of these measures is a multi-layered issue, not limited only to the quality of life but also to increased awareness associated with public health-related issues related to dental care.

Exploring the Mechanisms and Association between Oral Microflora and Systemic Diseases

The scope of dentistry is ever-changing and dynamic in all fields of dentistry including periodontal health and disease. Recent studies show that oral health and systemic health are interdependent, particularly in the way that poor oral hygiene and periodontal health affect the systemic health of an individual and vice versa. Periodontal diseases are multifactorial in nature in which the role of bacterial infections is inevitable. Furthermore, high-throughput sequencing technologies have shed light on the dysregulation of the growth of oral microbial flora and their environment, including those that are associated with periodontitis and other oral and non-oral diseases. Under such circumstances, it becomes important to explore oral microbiota and understand the effects of periodontal pathogens in the pathogenesis of systemic diseases. In addition, it may strengthen our view that a better understanding of oral microbial flora and proper examination of the oral cavity may aid in the early diagnosis and possible treatment of systemic diseases and conditions. This will eventually lead to providing better care to our patients. Therefore, in this research, we attempt to outline the periodontal pathophysiology along with the role of periodontal pathogens in some commonly encountered systemic conditions.

Association between Four Dietary Patterns and the Risk of Periodontal Diseases: A Systematic Review and Meta-Analysis

Background: Several dietary patterns are reported as risk factors for several chronic diseases including oral diseases. However, thus far, there has been no comprehensive quantitative analysis of nutrition and periodontal diseases. Methods: This systematic review was conducted according to the PRISMA guidelines. Cohort, case–control, and cross-sectional studies were eligible for inclusion in this study. The Newcastle–Ottawa scale was used to qualitatively assess the risk of bias in the included studies. The number of samples was used for odds ratio calculation, followed by the unadjusted value and 95% confidence interval. Results: Nine papers were included for the systematic review and meta-analysis. The results of screening for database search records showed that four diet patterns (western diet, dairy product intake, sugar intake, and vitamin C intake) have enough data for meta-analysis. The risk of periodontal disease in the western-diet group and the lowest dairy product intake group was 1.05 (0.51–2.13) and 1.28 (0.89–1.84), respectively. The risk of periodontal disease in the highest sugar intake group and the lowest vitamin C intake group was 1.52 (0.79–2.91) and 1.15 (1.08–1.23), respectively. Conclusions: With aging of the population globally, the prevalence of periodontal disease increases, and the associated cost also increases. Though this study, we found foods related to the risk of periodontal disease, and we are confident that it will contribute to lowering the incidence of the disease.

A continuous flow PCR array microfluidic chip applied for simultaneous amplification of target genes of periodontal pathogens

The concept of time to place conversion makes using a continuous flow polymerase chain reaction (CF-PCR) microfluidic chip an ideal way to reduce the time required for amplification of target genes; however, it also brings about low throughput amplicons. Although multiplex PCR can simultaneously amplify more than one target gene in the chip, it may easily induce false positives because of cross-reactions. To circumvent this problem, we herein fabricated a microfluidic system based on a CF-PCR array microfluidic chip. By dividing the chip into three parts, we successfully amplified target genes of Porphyromonas gingivalis (P.g), Tannerella forsythia (T.f) and Treponema denticola (T.d). The results demonstrated that the minimum amplification time required for P.g, T.d and T.f was 2'07'', 2'51'' and 5'32'', respectively. The target genes of P.g, T.d and T.f can be simultaneously amplified in less than 8'05''. Such a work may provide a clue to the development of a high throughput CF-PCR microfluidic system, which is crucial for point of care testing for simultaneous detection of various pathogens.

Correlation of knowledge, attitude, and practice with their oral health status among young adults of nursing care: A cross-sectional survey

Background:

Nursing profession execute an imperative role in health promotion, disease, and injury prevention, providing care and assist in cure of patients with diverse age groups, and backgrounds both in individual and community settings. The study aimed to determine and compare the oral health knowledge, attitude, and practice (KAP) with oral health status among nursing students in Salem.

Materials and Methods:

A cross-sectional study was conducted on nursing students of Vinayaka Mission's Annapoorna College of Nursing, Salem, Tamil Nadu, India. The study included self-administered questionnaire covering demographic details and oral health KAP questions (18-items) followed by oral examination using the World Health Organization survey (2013). Data analysis was performed using SPSS 22.

Results:

Two hundred and sixty-one students were included in the survey (63 males and 198 females). Females reported better mean ± standard deviation (SD) in knowledge (24.08 ± 4.3), attitude (5.43 ± 1.3), and practice (10.82 ± 1.5, P = 0.000) than males. Moreover third-year students had higher mean ± SD scores in knowledge (24.42 ± 4.3) and practice (10.89 ± 1.7) while higher mean ± SD attitude scores (5.61 ± 1.2) was reported among second years. Relationship between attitude-practice indicated a positive significant correlation (r = 0.145, P = 0.05).

Conclusions:

There are an adequate knowledge, negative attitude, and inadequate practice toward oral health among nursing students. The study introspects the gap between knowledge and actions. As attitude influence on a person's behavior, discriminate knowledge in the right direction to best bring out the outcomes.

Magnetism in Dentistry: Review and Future Perspectives

Tissue engineering or tissue reconstruction/repair/regeneration may be considered as a guiding strategy in oral and maxillofacial surgery, as well as in endodontics, orthodontics, periodontics, and daily clinical practice. A wide range of techniques has been developed over the past years, from tissue grafts to the more recent and innovative regenerative procedures. Continuous research in the field of natural and artificial materials and biomaterials, as well as in advanced scaffold design strategies has been carried out. The focus has also been on various growth factors involved in dental tissue repair or reconstruction. Benefiting from the recent literature, this review paper illustrates current innovative strategies and technological approaches in oral and maxillofacial tissue engineering, trying to offer some information regarding the available scientific data and practical applications. After introducing tissue engineering aspects, an overview on additive manufacturing technologies will be provided, with a focus on the applications of superparamagnetic iron oxide nanoparticles in the biomedical field. The potential applications of magnetic fields and magnetic devices on the acceleration of orthodontic tooth movement will be analysed.

[Maternal periodontitis and low birth weight: systematic review and meta-analysis]

Recent evidence points to the influence of periodontal inflammatory processes on the occurrence of low birth weight. Although many studies employed robust investigation methods, there is still no general agreement on the relationship between maternal periodontitis and low birth weight. The search for studies was conducted until April 2019. The studies included cohort and case-control studies that estimated the association between periodontitis and low birth weight, with no restriction on language or date of publication. Analysis of the heterogeneity of studies, subgroup analyses and meta-analyses with a random effects model were performed. Summary association measurements were estimated using the crude and adjusted Odds Ratio, with respective 95% confidence intervals. Visual inspection of graphs was used to assess publication bias. A total of 21 articles were identified, all of which were selected for the meta-analysis. The final model indicates that periodontitis in pregnant women was associated with low birth weight (ORgross=2.13; CI95%=1.60-2.83; I2=80.0% and ORadjusted=2.64; CI95%=2.04-3.42; I2=17.4%). Pregnant women with periodontitis may be more than twice as likely to have low birth weight babies.

Histopathological and immunohistochemical study of periodontal changes in chronic smokers

Periodontal disease is a chronic inflammatory, multifactorial condition, that, in the absence of an early and adequate treatment, may lead to a progressive damaging of the alveolar tissues that support the teeth (periodontal ligament, cement and alveolar bone) followed by teeth mobility and, subsequently, their loss. Periodontal disease is one of the most common inflammatory disease affecting adult individuals all over the world, being considered a real worldwide pandemic. This disease may influence the progression of certain systemic diseases: diabetes mellitus, cardiovascular diseases, ischemic cardiomyopathy, myocardial infarction, stroke, neurodegenerative diseases, chronic kidney diseases, cancer, etc. The association between smoking and periodontal disease was described in numerous clinical and epidemiological studies, suggesting that products derived from tobacco burning may change the clinical aspects and the disease progression. The present study analyzed microscopically and immunohistochemically 58 periodontal fragments, from 50 patients, chronic smokers, clinically diagnosed with severe periodontitis. There were highlighted major changes in the gingival epithelium (epithelium thickening, acanthosis, intraepithelial edema, infiltrates of neutrophils or lymphocytes, epithelial necrosis), in the periodontal conjunctive tissue (more or less intense inflammatory infiltrates, microhemorrhages, vascular congestion, intense immunohistochemical expression for some matrix metalloproteinases). The periodontal changes may be the expression of both toxic factors present in tobacco smoke and due to the changes caused by tobacco in the microbial flora of the oral cavity.

The Dental Aesthetic Index and Its Association with Dental Caries, Dental Plaque and Socio-Demographic Variables in Schoolchildren Aged 12 and 15 Years

The Dental Aesthetic Index (DAI) was determined in 12- and 15-year-old schoolchildren to ascertain the prevalence of malocclusion and to assess its association with dental caries experience, dental plaque accumulation, and socio-demographic variables. We performed a cross-sectional study with a stratified two-stage sampling design. An oral health survey and oral examination were conducted, and socio-demographic data were recorded. The sample comprised 1453 schoolchildren aged 12 (868) and 15 (585). These two samples were analyzed separately because statistically significant differences were found: the 12-year-old age group displayed a higher frequency of schoolchildren who attended state-run public schools (p = 0.004) and belonged to a lower social class (p = 0.001); the 15-year-old age group registered higher levels of caries (p = 0.001) and lower levels of dental plaque (p < 0.001). The malocclusion was 9.5% higher (p = 0.001), and the global mean DAI score was likewise higher among the 12-year-olds (p < 0.001). The multivariate regression analysis not only showed that caries and dental plaque were the variables that were the most strongly associated with malocclusion, but that caries (OR = 1.5) and dental plaque (OR > 2) were also risk factors for malocclusion in both groups. In conclusion, this study revealed a higher prevalence of malocclusion and dental plaque at age 12. A higher risk of caries and dental plaque was found to be related to the presence of malocclusion in both age groups.

Cytotoxicity and dentin composition alterations promoted by different chemomechanical caries removal agents: A preliminary in vitro study

Background

The use of chemomechanical agents for caries removal has been indicated as a non-invasive treatment option; however, their possible deleterious effects on the dental-pulp complex have been insufficiently studied. This study assessed the direct cytotoxicity of two chemomechanical caries removal agents (Brix 3000™ - BX and Papacarie Duo™ - PD) on pulp cells from deciduous teeth, as well as to assess the morphology and chemical compositions of the dentin surface after the application of these materials.

Material and Methods

The cells were seeded (50,000 cells/cm²) in a culture medium (DMEM with 10% fetal bovine serum - FBS). After 24 hours, the BX and PD materials were added to 1:20, 1:100, and 1:1000 dilutions. Non-exposed cells were considered as the control group. The viability test (MTT), Trypan Blue assay (TB), and cell morphology (Scanning Electron Microscopy - SEM) were performed after 24 hours of agent application. For the SEM and chemical (energy-dispersive X-ray spectrometry - EDS) dentin evaluation, 0.3-mm-thick dentin discs were obtained and divided into control group (no treatment) and surfaces covered with 37% phosphoric acid, BX, or PD. Data were compared by one-way ANOVA and Tukey's test (p<0.05).

Results

Decreases in cell viability and numbers of viable cells were observed for both materials, at all dilutions, when compared with the control group (p<0.05). The BX and PD materials did not cause visually perceptible changes, according to SEM, on the surfaces of dentin discs. The EDS analysis did not indicate a statistically significant difference in the levels of calcium (Ca) and phosphorus (P) between the materials and the control group (p>0.05).

Conclusions

Both materials showed cytotoxicity when in direct contact with the pulp cells from deciduous teeth, and the BX material presented lower cytotoxicity than the PD material. Moreover, both materials did not significantly change the dentin composition. Key words:Cell culture, cytotoxicity, dental pulp, papacarie, primary teeth.

Oral Health Knowledge, Attitude, and Behavior of Nursing and Technical Students in Croatia

OBJECTIVE

 The aim of this study is to test knowledge, attitudes, and behavior of the students from the Bjelovar University of Applied Sciences in relation to oral health, and to determine the respectable differences between students of nursing and technical study programs.

PARTICIPANTS AND METHODS

 Students were randomly selected to represent a convenient sample. A total of 140 students from nursing and technical studies were interviewed by using the World health organization Oral Health Questionnaire, adapted to fit the study purposes.

STATISTICAL ANALYSIS

 Descriptive statistics were used to determine frequency distribution and percentages for all variables. Pearson's Chi-square test was used to compare the proportions. A p-value less than 0.05 was considered to be statistically significant.

RESULTS

 The distribution of participants regarding gender was significantly different between the study programs (p = 0.000). Significant difference was also observed in their perceived socioeconomic status (p = 0.001). A significant difference was found between the study programs regarding the knowledge whether bad teeth could impair general health (p = 0.001), could tooth decay and periodontal disease may be prevented (p = 0.002), as well as the importance of regular dental check-ups for prevention of tooth decay (p = 0.028). There were significant differences regarding dietary habits and alcohol consumption in the past 30 days between the observed study programs (p = 0.000) while no significant differences were found regarding tobacco and tobacco product use (p = 0.170).

CONCLUSION

 Results obtained and presented in this paper show better knowledge and more favorable habits and behaviors among the students from nursing study program compared with the technical ones. Still all students' habits should be changed to improve oral health. To change attitudes and influence habits, effective oral health promotion programs are needed; not only in colleges, but also in primary and secondary schools.

Oral health problems facing refugees in Europe: a scoping review

Introduction

Europe has been experiencing a flow of refugees and asylum seekers driven by conflicts or poverty. Their oral health is often neglected despite its clear impact on quality of life.

Objective

To explore the status of oral health among refugees and asylum seekers groups by examining the available literature and to determine which evidence exists regarding the problems they face in terms of oral health.

Methods

The current paper followed PRISMA guidelines. A scoping review methodology was followed to retrieve 2911 records from five databases and grey literature. Twelve articles met the following inclusion criteria: experimental research concentrated on the oral and dental health of refugees and/or asylum seekers between 1995 and 2020 in English. Analysis was both descriptive and thematic, whilst a critical appraisal was applied using the Critical Appraisal Skills Program (CASP).

Results

Seven studies (58,3%) were quantitative, while five studies (41,6%) were qualitative. In general, the quality of most of the studies (83.3%) was good. Limited access to oral health care services was shown with a higher prevalence of oral diseases compared to the native populations of the host countries. Approaches to improve oral health have been implemented in some studies and have shown positive outcomes.

Conclusions

Oral health care strategies should consider the oral health problems facing refugees in Europe, and oral health promotion campaigns are essential to give adequate guidance on how to access oral health care in the host countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11272-z.

Screening and Assessment of Antimicrobial Susceptibility of Periodontopathic Bacteria in Peruvian Patients with Periodontitis: A Pilot Study

Background

Severe periodontal disease is highly prevalent worldwide, affecting 20% of the population between the ages of 35 and 44 years. The etiological epidemiology in Peru is scarce, even though some studies describe a prevalence of 48.5% of periodontal disease in the general population. Periodontitis is one of the most prevalent oral diseases associated with site-specific changes in the oral microbiota and it has been associated with a socioeconomic state. This study aimed to determine the etiology and resistance profile of bacteria identified in a group of Peruvian patients with periodontal disease.

Methods

Six subgingival plaque samples were collected from eight patients with severe periodontitis. Bacterial identification was carried out by an initial culture, PCR amplification, and subsequently DNA sequencing. We evaluated the antibiotic susceptibility by the disk diffusion method.

Results

Variable diversity in oral microbiota was identified in each one of the eight patients. The bacterial genus most frequently found was Streptococcus spp. (15/48, 31.3%) followed by Rothia spp. (11/48, 22.9%), Actinomyces spp. (9/48, 18.8%), and Eikenella spp. (4/48, 8.3%). The most common species found was Rothia dentocariosa (8/48, 16.7%). The antimicrobial susceptibility assay varied according to the species tested; however, among all the isolates evaluated, Actinomyces naeslundii was resistant to penicillin and tetracycline; Eikenella corrodens was resistant to dicloxacillin; and Rothia dentocariosa was resistant to amoxicillin + clavulanic acid and metronidazole but also susceptible to trimethoprim-sulfamethoxazole.

Conclusions

The most prevalent periodontal bacterium found in this study was Rothia dentocariosa. Specific antimicrobial therapy is required to improve the treatment outcomes of patients with periodontal disease and avoid antibiotic resistance.

Precision targeting of bacterial pathogen via bi-functional nanozyme activated by biofilm microenvironment

Human dental caries is an intractable biofilm-associated disease caused by microbial interactions and dietary sugars on the host's teeth. Commensal bacteria help control opportunistic pathogens via bioactive products such as hydrogen peroxide (H₂O₂). However, high-sugar consumption disrupts homeostasis and promotes pathogen accumulation in acidic biofilms that cause tooth-decay. Here, we exploit the pathological (sugar-rich/acidic) conditions using a nanohybrid system to increase intrinsic H₂O₂ production and trigger pH-dependent reactive oxygen species (ROS) generation for efficient biofilm virulence targeting. The nanohybrid contains glucose-oxidase that catalyzes glucose present in biofilms to increase intrinsic H₂O₂, which is converted by iron oxide nanoparticles with peroxidase-like activity into ROS in acidic pH. Notably, it selectively kills Streptococcus mutans (pathogen) without affecting Streptococcus oralis (commensal) via preferential pathogen-binding and in situ ROS generation. Furthermore, nanohybrid treatments potently reduced dental caries in a rodent model. Compared to chlorhexidine (positive-control), which disrupted oral microbiota diversity, the nanohybrid had significant higher efficacy without affecting soft-tissues and the oral-gastrointestinal microbiomes, while modulating dental health-associated microbial activity in vivo. The data reveal therapeutic precision of a bi-functional hybrid nanozyme against a biofilm-related disease in a controlled-manner activated by pathological conditions.

Clinical and economic analysis of caries prevention programs by mathematic modeling

Relevance. Underestimating the importance of economic analysis is the barrier to the implementation of cariesprevention programs.

The aim is to study with use of mathematic modeling method the clinical and economic effectiveness of dental caries prevention programs provided for schoolchildren.

Materials and methods. The method of mathematic modeling was used to evaluate the clinical and economic efficiency of the caries prevention programs (educational, fissure sealing, fluoride varnish). The cost of prevention program implementation and the expenses for caries treatment without prevention were calculated according to the rate of Volgograd territorial mandatory medical insurance Fund for 2018 year. The differences between the caries prevention program’s cost and the expenses needed for the treatment of “prevented caries” were considered as saving.

Results. It was revealed that the Educational Dental Program for the first grade schoolchildren has short duration (2 years) of clinical-economic efficiency. The Continuous Educational Dental Program applied for 6 years by dental hygienists or dentists led to saving (per 100 children) of 99.5-115.0 or 84.0-99.6 thousand roubles respectively. The economic effect of The First Permanent Molar Fissure Sealing Program was revealed after 2 years only when The Program was implemented by dental hygienists. After 6 years of working with this Program the saving were 181.3 or 146.2 thousand roubles per 100 children depending on who implemented the Program, dental hygienists or dentists. The cost of Fluoride Varnish Program implementation was higher than the treatment of “prevented caries”. However, the number of “prevented caries” after fluoride varnish application is higher than after the implementation of the Educational Dental Programs. Moreover, fluoride varnish, in contrast to fissure sealing, prevents caries of smooth surfaces of permanent teeth.

 

Conclusions. The method of mathematic modeling can be used for the development of the caries prevention programs in various regions considering the availability of personnel and financial resources, and for evaluation of the clinical and economic effectiveness of preventive programs implementation.

mOral Health in India: Current Scenario and Future Perspectives

Oral diseases affect half of the world's population and found to be the most common and preventable noncommunicable diseases worldwide. The World Health Organization Oral Health Programme work plan 2018–2020 is to prevent the burden of oral diseases using digital technology. With 5 billion mobile phone subscribers in the world, covering over 85% of the world's population, the utilization of technology-based interventions for oral health promotion is no different. In India, numerous medical applications such as eRaktkosh and mDiabetes have been developed for the improvement of general health, whereas few initiatives such as mCessation and National Quitline services for oral health have been undertaken. Digitalization and oral health forms a crucial component in the future of oral health, which should be utilized in ensuring oral health for all.

Correlation of pharmacy students' knowledge, attitude, and practices with their oral health status in Salem city-A cross-sectional survey

Background

Pharmacy is the health profession that links the health sciences with the basic sciences also contributes in health maintenance and promotion for the population.

Objectives

The primary objective was to assess knowledge, attitude, and practice (KAP) among pharmacy students in Salem toward oral health. Secondary objectives are to correlate KAP with their oral health status.

Methods

A descriptive cross-sectional study was carried out using self-administered 16-item pretested and pre-validated questionnaire and oral health status data were collected using the WHO oral health assessment form (1997) targeting pharmacy students Vinayaka Missions College of pharmacy. Six, four, and six questions were used to assess pharmacy students' knowledge, attitude, and practice, respectively. Data analysis was done using SPSS version 20.0 to perform the Chi-square test, Mann-Whitney, Kruskal-Wallis, Spearman's correlation, and linear regression analysis.

Results

386 participated in the survey (263 males and 123 females). The highest mean for knowledge was among 17-21 years of age group students (18.07 ± 3.07) and this was statistically significant when compared to another age group (P < 0.05). The gender difference was seen with males having a significantly (P < 0.001) more positive mean ± SD oral health KAP compared to their female counterparts. KAP scores upon correlation revealed a positive relationship between knowledge-attitude (r = 0.015), knowledge-practice (r = 0.016), and attitude-practice (r = 0.069).

Results

386 participated in the survey (263 males and 123 females). The highest mean for knowledge was among 17-21 years of age group students (18.07 ± 3.07) and this was statistically significant when compared to another age group (P < 0.05). The gender difference was seen with males having a significantly (P < 0.001) more positive mean ± SD oral health KAP compared to their female counterparts. KAP scores upon correlation revealed a positive relationship between knowledge-attitude (r = 0.015), knowledge-practice (r = 0.016), and attitude-practice (r = 0.069).

Conclusion

Results of this study suggest that oral health KAP of students is inadequate and needs to be improved as they play an important role in the patients' counseling toward oral care.

Comparison between conventional and chemomechanical approaches for the removal of carious dentin: an in vitro study

The present study aimed to evaluate the efficiency, effectiveness, and biocompatibility of two agents used for the chemomechanical removal of carious dentin. Sixty extracted carious human teeth were treated with a conventional bur (CBG) or chemomechanical agents – Papacarie Duo (PG) and Brix 3000 (BG). Treatment efficiency and effectiveness were assessed by the working time for carious dentin removal and Knoop microhardness values, respectively. Human pulp fibroblasts (FP6) were used to evaluate cytotoxicity by incorporating MTT dye, and genotoxicity was evaluated with the micronuclei test. The carious tissue was removed in a shorter time with CBG (median = 54.0 seconds) than the time required for chemomechanical agents (p = 0.0001). However, the time was shorter for Brix 3000 (BG) than that for Papacarie Duo (PG), showing mean values of 85.0 and 110.5 seconds, respectively. Regarding microhardness testing, all approaches tested were effective (p < 0.05). The final mean microhardness values were 48.54 ± 16.31 KHN, 43.23 ± 13.26 KHN, and 47.63 ± 22.40 KHN for PG, BG, and CBG, respectively. PG decreased cell viability compared to that of BG, but it presented no genotoxicity. Brix 3000 may be a good option for chemomechanical dentin caries removal due to its reduced removal time and lower cytotoxicity compared to the other treatment options.

Antimicrobial photodynamic therapy compared to systemic antibiotic therapy in non-surgical treatment of periodontitis: Systematic review and meta-analysis

BACKGROUND

Periodontitis is one of the most prevalent inflammatory diseases in humans. It is associated with the presence of bacteria and is mediated by the host's immune response This study represents a systematic review and meta-analysis trying to answer the following question: "What is the effect of antimicrobial photodynamic therapy (aPDT) as an adjunct to scaling and root planing (SRP) compared to systemic antibiotic therapy with amoxicillin plus metronidazole (AMX+MTZ) on the non-surgical treatment of periodontitis?".

METHODS

Clinical studies comparing aPDT with systemic use of AMX+MTZ were searched until January of 2020 using the databases: PubMed, MEDLINE, SCOPUS, EMBASE, Cochrane Central, Web of Science and Scielo, as well manual searches in related journals. Periodontal clinical parameters such as probing depth (PD), clinical attachment level (CAL) and bleeding on probing (BOP) were statistically analyzed.

RESULTS

Five randomized clinical studies (RCTs) were included within the eligibility criteria, and served as a basis for qualitative and quantitative analyzes. All the studies reported an improvement in the clinical parameters with both therapies, although in a direct comparison, our analyzes did not find statistical differences that indicate the superiority of one supporting treatment in relation to the other.

CONCLUSION

Although the limited number of RCTs and the great heterogeneity between them, it can be concluded that aPDT presents similar clinical results compared to antibiotic therapy with AMX+MTZ as adjuvants in the non-surgical treatment of periodontitis.

Integrating Competency-Based Didactic and Experiential Global Health Learning for Dental Students: The Global Health Learning Helix Model

The aim of this study was to evaluate the feasibility and preliminary outcomes of immersive integrated experiential and didactic courses in strengthening competency-based global health learning in dental education. To address global inequities in oral health and student interest in global health, the Harvard School of Dental Medicine introduced two global health courses in 2017-18. The first was a didactic course in the core predoctoral curriculum, and the second, in collaboration with the Inter-American Center for Global Health, was a five-day elective experiential learning course in rural Costa Rica. The experiential course was an extension of the didactic course. All 33 second-year dental students completed the didactic course, and three of those students completed the experiential course. A pre-post survey and a six-month follow-up survey on self-reported knowledge based on course learning objectives were administered. The experiential course students also completed journals and interviews for qualitative analysis. Thirty-two students completed the pre-post didactic course surveys, for a response rate of 94%. There was a 100% response rate on the pre-post didactic surveys by those students who participated in the experiential learning course. While the experiential learning group scored similarly to the class average before the didactic course, they had higher scores than the class averages both immediately after and at the six-month follow-up. All three students reported that the experiential learning course was "extremely effective" in building on what they learned in the didactic course. Qualitative analysis of the journals and interviews suggested enhanced learning from the combination of didactic and experiential methods. These preliminary results support the Global Health Learning Helix Model, a theoretical competency-based teaching model for ethical student global health engagement to better prepare the future generation in tackling oral health disparities both locally and worldwide.

Functional and aesthetic rehabilitation in posterior tooth with bulk-fill resin composite and occlusal matrix

The restorative procedure in posterior teeth involves clinical steps related to professional skill, especially when using the incremental technique, which may fail in the long term. A recent alternative is bulk-fill resins, which can reduce polymerization shrinkage, decreasing clinical problems such as marginal leakage, secondary caries, and fracture. This scientific study aims to report a clinical case using bulk-fill resin with an occlusal matrix. As determined in the treatment plan, an acrylic resin matrix was produced to establish an improved oral and aesthetic rehabilitation of the right mandibular first molar, which presented a carious lesion with dentin involvement. The occlusal matrix is a simple technique that maintains the original dental anatomy, showing satisfactory results regarding function and aesthetic rehabilitation.

A rapid chair-side method for the estimation of oral bacterial colonization density

AIMS

Caries and periodontal disease are associated with inadequate control of oral bacteria. Since conventional microbiological evaluations are impractical in dental clinics or public engagement activities, a rapid test for the quantification of oral bacteria represents a useful tool. We describe the development of a colour change test to rapidly estimate bacterial colonisation density in the mouth.

METHODS AND RESULTS

Volunteers rinsed with milk or milkshake. Viability indicators were added and colour changes quantified during incubation. Using milkshake and the resazurin-based solution PrestoBlue (9% v/v), the method distinguished between samples before and after brushing within 5 min. Colour changes were quantified and viable counts were obtained using oral rinses. Measured colour changes strongly correlated with total counts of both anaerobes and streptococci (Spearman's correlation coefficient of 0·782 and 0·769, respectively, P ≤ 0·001) and with perceived changes, as determined by volunteers (n = 10) visually ranking images.

CONCLUSIONS

The resazurin milkshake test can rapidly and visually quantify viable bacteria in oral samples.

SIGNIFICANCE AND IMPACT OF THE STUDY

The resazurin milkshake test could serve as a sensitive semi-quantitative method for measuring oral bacteria in human oral rinse samples.

Oral health care: The experience of Australian paediatricians

AIM

Many Australian children have dental decay in their deciduous teeth. Poor oral health can negatively impact a child's ability to eat, speak, sleep and socialise, with adverse impacts later in life. Paediatricians are well placed to examine children's teeth and to provide advice and education about oral health. Using a sample of Australian paediatricians, we aimed to determine: (i) self-reported oral health knowledge and skills, (ii) frequency of office-based oral health-related discussions, (iii) perceived role of paediatricians and (iv) barriers to oral health-related discussions.

METHODS

Members of a national network of paediatricians - the Australian Paediatric Research Network - completed a multi-topic survey, which included questions designed to assess oral health knowledge, current practice and barriers to oral health-related discussions.

RESULTS

Of 430 active members, 178 (41%) completed the survey. Few paediatricians reported very good/excellent ability to assess plaque build-up (8%) and dental caries (17%). Only 10% reported broaching the issue of oral health with all patients. Significant barriers included lack of professional training (52%) and other more pressing issues needing to be addressed (67%).

CONCLUSIONS

The increasing (and inequitable) rates of dental decay in Australian children mean that paediatricians should play a key role in the management of children's oral health. Many paediatricians reported a lack of specific training in oral health and limited ability to assess children and educate families. Despite the traditional divide between medicine and oral health, this study highlights the opportunity for Australian paediatricians to improve oral health through early intervention in the consultation room and beyond.

Association between periodontal pathogens and systemic disease

A growing body of literature suggests that there is a link between periodontitis and systemic diseases. These diseases include cardiovascular disease, gastrointestinal and colorectal cancer, diabetes and insulin resistance, and Alzheimer's disease, as well as respiratory tract infection and adverse pregnancy outcomes. The presence of periodontal pathogens and their metabolic by-products in the mouth may in fact modulate the immune response beyond the oral cavity, thus promoting the development of systemic conditions. A cause-and-effect relationship has not been established yet for most of the diseases, and the mediators of the association are still being identified. A better understanding of the systemic effects of oral microorganisms will contribute to the goal of using the oral cavity to diagnose and possibly treat non-oral systemic disease.

Thermal Magnetic Field Activated Propolis Release From Liquid Crystalline System Based on Magnetic Nanoparticles

Intra-periodontal pocket drug delivery systems, such as liquid crystalline systems, are widely utilized improving the drug release control and the therapy. Propolis is used in the treatment of periodontal diseases, reducing the inflammatory and infectious conditions. Iron oxide magnetic nanoparticles (MNPs) can improve the treatment when an alternating external magnetic field (AEMF) is applied, increasing the local temperature. The aim of this study was to develop a liquid crystalline system containing MNPs for intra-periodontal pocket propolis release. MNPs were prepared using iron salts and the morphological, size, thermal, x-ray diffraction, magnetometry, and Mössbauer spectroscopy analyses were performed. Cytotoxicity studies using Artemia salina and fibroblasts were also accomplished. The systems were prepared using polyoxyethylene (10) oleyl ether, isopropyl myristate, purified water, and characterized by polarized optical microscopy, rheometry, and in vitro drug release profile using a periodontal pocket simulator apparatus. The antifungal activity of the systems was investigated against Candida spp. using an AEMF. MNPs displayed nanometric size, were monodisperse, and they displayed very low cytotoxicity. Microscopically homogeneous formulations were obtained displaying important physicochemical and biological properties. The system displayed prolonged release of propolis and important in vitro fungicide activity, which was increased when the AEMF was applied, indicating a potentially alternative therapy for the treatment of the periodontal disease.

Periodontal disease susceptible matrilines in the Cayo Santiago Macaca mulatta macaques

OBJECTIVE AND BACKGROUND

The expression of periodontitis, including age of onset, extent, and severity is considered to represent an interaction of the individual's oral microbiome and host response to the microbial challenge that is modified by both genetics and environmental factors. The aim of this study was to determine the distribution of periodontitis in a population of nonhuman primates, to document features of familial distribution that could reflect heritability and transmission of microbes with enhanced virulence.

MATERIAL AND METHODS

This report presents our findings from evaluation of periodontal disease bone defects in skulls from 569 animals (5-31 years of age) derived from the skeletons of the rhesus monkeys (Macaca mulatta) of Cayo Santiago derived from eight matrilines over 6-9 generations. The distance from the base of alveolar bone to the cemento-enamel junction on 1^st /2^nd premolars and 1^st /2^nd molars from all four quadrants was evaluated as a measure of periodontal disease. Additionally, we documented the presence of periodontitis in 79 living descendants within these matrilines.

RESULTS

The results demonstrated an increased extent and severity of periodontitis with aging across all matrilines. Extensive heterogeneity in disease expression was observed among the animals and this was linked to specific periodontitis susceptible matrilines. Moreover, we identified some matrilines in which the members appeared to show some resistance to more severe disease, even with aging.

CONCLUSION

Linking these disease variations to multigenerational matriarchal family units supported familial susceptibility of periodontitis. This familial disease relationship was reinforced by the distribution of naturally-occurring periodontitis in the living descendants.

Common dental diseases in children and malocclusion

Malocclusion is a worldwide dental problem that influences the affected individuals to varying degrees. Many factors contribute to the anomaly in dentition, including hereditary and environmental aspects. Dental caries, pulpal and periapical lesions, dental trauma, abnormality of development, and oral habits are most common dental diseases in children that strongly relate to malocclusion. Management of oral health in the early childhood stage is carried out in clinic work of pediatric dentistry to minimize the unwanted effect of these diseases on dentition. This article highlights these diseases and their impacts on malocclusion in sequence. Prevention, treatment, and management of these conditions are also illustrated in order to achieve successful oral health for children and adolescents, even for their adult stage.

Quantification of carious pathogens in the interdental microbiota of young caries-free adults

Background

The majority of caries lesions in adults occur on the proximal tooth surfaces of the posterior teeth. A comprehensive study of the composition of the oral microbiota is fundamental for a better understanding of the etiology of interdental caries.

Methods

Twenty-five caries-free subjects (20–35 years old) were enrolled in the study. The interdental biofilm of four interdental sites were collected. The real-time polymerase chain reaction (PCR) methodology were used to quantify (i) the following bacteria: Streptococcus spp., Streptococcus mutans, Lactobacillus spp., Enterococcus spp., and Enterococcus faecalis; (ii) the fungus Candida albicans; and (iii) total bacteria.

Results

Streptococcus spp. was the most abundant species, followed by Lactobacillus spp. and Enterococcus spp. Streptococcus spp. and Lactobacillus spp. were detected at all tested sites and Enterococcus spp. at 99% of sites. S. mutans was detected at only 28% of the tested sites and C. albicans was detected at 11% of sites. E. faecalis was never detected. In 54.5% of the biofilm inhabited by C. albicans, S. mutans was present. Moreover, 28% of the ID sites co-expressed S. mutans and Lactobacillus spp. The studied pathogens were organized into two correlated groups of species. Strikingly, the fungus C. albicans and the bacteria Enterococcus spp. cluster together, whereas Streptococcus spp., S. mutans and Lactobacillus spp. form one distinct cluster.

Conclusion

The interdental biofilm of young caries-free adults is comprised of pathogens that are able to induce interproximal caries. That several of these pathogens are implicated in heart disease or other systemic diseases is an argument for the disruption of interdental biofilms using daily oral hygiene.

Global burden of dental condition among children in nine countries participating in an international oral health promotion programme, 2012-2013

The Live.Learn.Laugh. phase 2 programme is a unique global partnership between FDI World Dental Federation and Unilever Oral Care which aims to provide measurable improvement of oral health on a global scale through encouraging twice-daily brushing with a fluoride toothpaste. It was based on international recommendations using the principles of health promotion within school for the implementation of preventive health strategies. This paper is an overview of the dental caries condition of children from 2012 to 2013 in nine countries included in four World Health Organisation (WHO) regions. A cross-sectional study was conducted in each country before the implementation of health-promotion measures focused on twice-daily toothbrushing with fluoride toothpaste. The sample was based on stratified sampling according to the WHO pathfinder recommendations. From a total of 7,949 children examined, there were 517 children (1-2 years of age), 1,667 preschool children (3-5 years of age) and 5,789 schoolchildren (6-13 years of age). The prevalence and severity of primary dental caries, early childhood caries and temporary dental caries were described using decayed, filled teeth (dft), permanent decayed, missing, filled teeth (DMFT) indices and the significant caries index (SCI). The major findings were a high prevalence of caries, identification of high-risk groups and inequality in the distribution of the severity of dental conditions. Aggregated data from this overview should provide justification for implementing an oral health programme. The main point is the need to retain and expand the community fluoridation programme as an effective preventive measure. At the individual level, the aggregated data identify the need for more targeted efforts to reach children early - especially among specific high-risk groups.

Radiologic assessment of quality of root canal fillings and periapical status in an Austrian subpopulation - An observational study

Background/Objective

Progress in endodontic techniques and methodological advances have altered root canal therapy over the last decades. These techniques and methods need periodical documentation. This observational study determined the current prevalence of endodontic treatments, and investigated the relationship of various factors with the periapical status in a Lower Austrian subpopulation.

Methodology

One thousand orthopantomograms of first-time university adult patients radiographed at an outpatient clinic were evaluated. For each tooth, the presence of periradicular pathosis and/or endodontic treatment was recorded, as was the quality of (post-)endodontic treatment (homogeneity and length of root canal fillings; preparation failures; posts/screws; apicoectomies; coronal restorations). Two evaluators, blinded to each other, scored all teeth. In cases of disagreement, they joined for a consensus score.

Results

In all, 22,586 teeth were counted. Of these, 2,907 teeth (12.9%) had periapical pathosis, while 2,504 teeth had undergone root canal treatment. Of the endodontically treated teeth, 52% showed no radiographic signs of apical periodontitis, while 44.9% had overt apical lesions, and 3,1% revealed widened periodontal ligament space. The majority of the root canal fillings was inhomogeneous (70.4%); 75.4% were rated too short, and 3.8% too long. The presence of apical pathosis was significantly correlated (odds ratio (OR) 2.556 [confidence interval (CI) 2.076–3.146]; P<0.0001) with poor root canal fillings (length and homogeneity). Posts or screws positively affected periapical status (OR 1.853 [CI 1.219–2.819]; P = 0.004), but endodontically treated posterior teeth were infrequently restored (posts, 7.5%; screws, 2.7%). Best results were found for teeth with both appropriate endodontic treatment and adequate coronal restoration.

Conclusion

A high prevalence of periradicular radiolucencies was observed with root canal filled teeth, along with high numbers of unmet treatment needs. Periapical health was associated with adequate root canal obturation and high-grade postendodontic restorations, and quality regarding these latter aspects is considered mandatory to promote periapical health.

Oral health behavior and factors associated with poor oral status in Qatar: results from a national health survey

OBJECTIVES

Oral health is a crucial determinant of quality of life. We aimed to determine oral health condition and factors associated with poor oral status in the adult national population of Qatar.

METHODS

We used data from the World Health Organization supported STEPS (STEPwise approach to Surveillance) Survey conducted by the Supreme Council of Health, Qatar in 2012. A total of 2,496 Qataris (1,053 men, 1,443 women) answered the national survey. The Rao-Scott Chi-Square test was used to analyze oral health characteristics and multinomial logistic regression to assess risk factors.

RESULTS

The self-perceived oral status of approximately 40 percent of respondents was either "average" or "poor" rather than "good." Poor oral status was more often reported by women (OR = 1.93; 95%CI = 1.30-2.80), by older (OR = 3.38; 95%CI = 1.59-7.19) and less educated respondents (OR = 3.58; 95%CI = 2.15-5.96). Other risk groups included people with diabetes (OR = 1.87; 95%CI = 1.24-2.81), smokeless tobacco users (OR = 3.90; 95%CI = 1.75-8.68), or ever tobacco users (OR = 1.66; 95%CI = 1.03-2.67). Oral health status appeared to be independent of diet, BMI status, and history of hypertension. Difficulties and behaviors related to oral health were more frequently reported by women than by men. These included pain (P < 0.001), difficulty chewing (P < 0.001), and discomfort over appearance of teeth (P < 0.001). Participants used toothbrushes, toothpicks, dental floss, and miswak to maintain oral hygiene.

CONCLUSION

Our results provide evidence that oral health remains a public health concern in Qatar.

Titanium ions form particles that activate and execute interleukin-1β release from lipopolysaccharide-primed macrophages

BACKGROUND AND OBJECTIVE

Peri-implantitis is a destructive inflammatory process characterized by destruction of the implant-supporting bone. Inflammasomes are large intracellular multiprotein complexes that play a central role in innate immunity by activating the release of proinflammatory cytokines. Although inflammasome activation has previously been linked to periodontal inflammation, there is still no information on a potential association with peri-implantitis. The aim of this study was to examine cytotoxic and proinflammatory effects, including inflammasome activation, of metals used in dental implants, in an in vitro model, as well as from clinical tissue samples.

MATERIAL AND METHODS

Human macrophages were exposed to different metals [titanium (Ti), cobalt, chromium and molybdenum] in a cell-culture assay. Cytotoxicity was determined using the neutral red uptake assay. Cytokine secretion was quantified using an ELISA, and the expression of genes of various inflammasome components was analysed using quantitative PCR. In addition, the concentrations of interleukin-1β (IL-1β) and Ti in mucosal tissue samples taken in the vicinity of dental implants were determined using ELISA and inductively coupled plasma mass spectrometry, respectively.

RESULTS

Ti ions in physiological solutions stimulated inflammasome activation in human macrophages and consequently IL-1β release. This effect was further enhanced by macrophages that have been exposed to lipopolysaccharides. The proinflammatory activation caused by Ti ions disappeared after filtration (0.22 μm), which indicates an effect of particles. Ti ions alone did not stimulate transcription of the inflammasome components. The Ti levels of tissue samples obtained in the vicinity of Ti implants were sufficiently high (≥ 40 μm) to stimulate secretion of IL-1β from human macrophages in vitro.

CONCLUSION

Ti ions form particles that act as secondary stimuli for a proinflammatory reaction.

Fusobacterium nucleatum infection of gingival epithelial cells leads to NLRP3 inflammasome-dependent secretion of IL-1β and the danger signals ASC and HMGB1

Fusobacterium nucleatum is an invasive anaerobic bacterium that is associated with periodontal disease. Previous studies have focused on virulence factors produced by F. nucleatum, but early recognition of the pathogen by the immune system remains poorly understood. Although an inflammasome in gingival epithelial cells (GECs) can be stimulated by danger-associated molecular patterns (DAMPs) (also known as danger signals) such as ATP, inflammasome activation by this periodontal pathogen has yet to be described in these cells. This study therefore examines the effects of F. nucleatum infection on pro-inflammatory cytokine expression and inflammasome activation in GECs. Our results indicate that infection induces translocation of NF-κB into the nucleus, resulting in cytokine gene expression. In addition, infection activates the NLRP3 inflammasome, which in turn activates caspase-1 and stimulates secretion of mature IL-1β. Unlike other pathogens studied until now, F. nucleatum activates the inflammasome in GECs in the absence of exogenous DAMPs such as ATP. Finally, infection promotes release of other DAMPs that mediate inflammation, such as high-mobility group box 1 protein and apoptosis-associated speck-like protein, with a similar time-course as caspase-1 activation. Thus, F. nucleatum expresses the pathogen-associated molecular patterns necessary to activate NF-κB and also provides an endogenous DAMP to stimulate the inflammasome and further amplify inflammation through secretion of secondary DAMPs.

Prevalence of caries and malocclusion in an indigenous population in Chiapas, Mexico

OBJECTIVES

To assess the prevalence of caries and malocclusion in Mayan Mexican adolescents, 14-20 years of age, living in Chiapas, Mexico.

METHODS

This was a cross-sectional, population-based, quantitative, epidemiological study. Sites were chosen to capture subjects representative of the state's Mayan population. A total of 354 subjects were recruited. Caries experience was quantified, via visual inspection, using the Decayed, Missing and Filled Surface (DMFS) index. Malocclusion was quantified using the Index of Complexity, Outcome and Need (ICON).

RESULTS

Our data showed that 99% of the population had caries experience, with a median DMFS score of 8. Of the 99% with caries experience, over half had caries affecting more than five tooth surfaces. Thirty-seven per cent of the students had unmet orthodontic treatment need, and 46.46% presented a Class II, and 39.09% a Class III, anterior-posterior relationship.

CONCLUSIONS

Less than 1% of the population had any exposure to orthodontics, demonstrating the lack of access to care. Likewise, only 1% of the population was found to have no caries experience, exhibiting a large unmet treatment need. The median DMFS score of 8 was also high in comparison with the median DMFS in the USA of 6. Our data suggest a correlation between the lack of access to care and high prevalence of caries and malocclusion in Mexican Mayans who inhabit Chiapas, Mexico.

Antibacterial and anti-biofilm activity of mouthrinses containing cetylpyridinium chloride and sodium fluoride

Background

Cetylpyridinium chloride (CPC) and sodium fluoride augment oral hygiene by inactivating bacteria and inhibiting enamel demineralisation, respectively. However, there are few reports in the literature documenting the antibacterial efficacy of their combined use in mouthrinses. We have used six experimental systems to compare the antibacterial effects of mouthrinses containing 0.075 % CPC (test rinse, TR) or 0.075 % CPC with sodium fluoride (test fluoride rinse, TFR).

Results

Effects against planktonic bacteria were determined using viable counting (for Streptococcus mutans and salivary bacteria), a redox dye (for Actinomyces viscosus and salivary bacteria) and viable counting (for ex vivo oral rinses). Effects against saliva-derived biofilms were quantified using confocal microscopy and differential viable counting. Inhibition of biofilm formation was evaluated by pre-treating hydroxyapatite coupons with mouthrinses prior to inoculation. Otherwise-identical controls without CPC (control rinse and control fluoride rinse, CR and CFR, respectively), were included throughout. Compared to the controls, TFR and TR demonstrated significant antimicrobial effects in the redox assays, by viable counts (>3 log reductions) and in oral rinse samples (>1.25 log reductions, p < 0.05). TFR and TR also significantly reduced the viability of oral biofilms. Pre-treatment of hydroxyapatite with TFR and TR significantly inhibited biofilm formation (>3 log difference, p < 0.05). Overall, there were no consistent differences in the activities of TR and TFR.

Conclusions

Sodium fluoride did not influence the antibacterial and anti-biofilm potency of CPC-containing formulations, supporting the combined use of CPC and sodium fluoride in mouthrinses to control oral bacteria and protect tooth enamel.

Comparison of temperature rise in pulp chamber during polymerization of materials used for direct fabrication of provisional restorations: An in-vitro study

OBJECTIVE

The purpose is to compare temperature rise in the pulp chamber during fabrication of provisional crowns using different materials and on different types of teeth using direct technique.

MATERIALS AND METHODS

An extracted, sound, caries free maxillary central incisor and a mandibular molar were selected for the study and crown preparations of all ceramic and all metal were done on central incisor and mandibular molar, respectively. Materials tested were DPI tooth molding self-curing material and protemp-4. Addition silicone putty was used as a matrix and 80 provisional crowns were fabricated, of which 40 were on central incisor and 40 on mandibular molar. Depending on the type of material used, they were further divided into two subgroups: Each comprising 20 provisional crowns. Temperature readings were recorded using K type of thermocouple with 0.1°C precision digital thermometer.

STATISTICAL ANALYSIS USED

Analysis of variance, Tukey honest significant difference and Kruskall-Wallis H-test.

RESULTS

Statistically significant difference exists between two materials tested on the basis of peak temperature achieved and time taken by a particular material to reach peak temperature. Peak temperature achieved was highest for provisional crowns with DPI tooth molding self-curing material on maxillary central incisor (40.39 + 0.46), followed by DPI tooth molding self-curing material on mandibular molar (40.03 + 0.32), protemp-4 on maxillary central incisor (39.46 + 0.26) and least with protemp-4 on mandibular molar (39.09 + 0.33). The time taken to reach peak temperature was almost double in DPI tooth molding self-curing material (5 min) than in protemp-4.

CONCLUSION

Polymethyl methacrylate resin produced higher intra-pulpal rise when compared to newer generation bis-acrylic composite.

Familial periodontal disease in the Cayo Santiago rhesus macaques

Substantial ongoing research continues to explore the contribution of genetics and environment to the onset, extent and severity of periodontal disease(s). Existing evidence supports that periodontal disease appears to have an increased prevalence in family units with a member having aggressive periodontitis. We have been using the nonhuman primate as a model of periodontal disease for over 25 years with these species demonstrating naturally occurring periodontal disease that increases with age. This report details our findings from evaluation of periodontal disease in skulls from 97 animals (5-31 years of age) derived from the skeletons of the rhesus monkeys (Macaca mulatta) on Cayo Santiago. Periodontal disease was evaluated by determining the distance from the base of the alveolar bone defect to the cemento-enamel junction on 1st/2nd premolars and 1st/2nd molars from all four quadrants. The results demonstrated an increasing extent and severity of periodontitis with aging across the population of animals beyond only compensatory eruption. Importantly, irrespective of age, extensive heterogeneity in disease expression was observed among the animals. Linking these variations to multi-generational matriarchal family units supported familial susceptibility of periodontitis. As the current generations of animals that are descendants from these matrilines are alive, studies can be conducted to explore an array of underlying factors that could account for susceptibility or resistance to periodontal disease.