The primary and mixed dentition, post-eruptive enamel maturation and dental caries: a review

Association of parent-reported timing of first tooth emergence and ECC: a secondary analysis of a case-control study

PURPOSE

Tooth eruption is a dynamic process. Appearance of any part of the cusp through gingiva may be a clinical marker of eruption. Early childhood caries (ECC) is a public health problem globally. This study aimed to assess the relationship between parent-reported timing of first tooth emergence and ECC in toddlers.

METHODS

This study is a secondary data analysis of 627 toddlers involved in a case-control study on sleep-time feeding practises in children. The children were categorised into four groups based on the parent-reported timing of first primary tooth emergence (G1-when the first primary tooth emerged before 6 months of age, G2-between 7 and 9 months; G3-10 to 12 months and G4-when the first primary tooth emerged after 12 months of age). Univariate binary logistic regression analysis was performed to evaluate the association between timing of first tooth emergence and ECC.

RESULTS

The mean age of the children was 24.4 ± 7.3 months (cases, that is children with ECC-25.4 ± 6.9 months, controls, that is children without ECC-23.6 ± 7.5 months). Of 60 children, whose first tooth erupted before 6 months of age, 35 (12%) were cases compared to 25(8%) controls. Amongst the cases, boys had more caries than girls (p < 0.05). Of the anterior teeth, 22% of the emerged teeth were decayed in the first group, followed by 19%, 16% and 10% in the second, third and fourth groups, respectively (p < 0.05). Analysis of the posterior teeth showed a lower percentage of decayed teeth with delayed emergence of the first primary tooth (p < 0.05). Children whose teeth emerged before 6 months of age had an odds ratio of 3.5 (95% CI 1.49, 8.42) (p = 0.004).

CONCLUSION

This study concluded that the early emergence of the first primary tooth, as reported by the parent, was associated with an increased risk of developing ECC.

In-vivo evaluation of the effects of short-term dehydration and rehydration on the color differences of immature permanent incisor teeth

OBJECTIVE

It is aimed to evaluate the color changes of upper central incisor teeth with different root maturation levels after 15 min of dehydration and rehydration.

MATERIALS AND METHODS

Using the Cvek classification, 60 participants were divided into five groups. A spectrophotometer, equipped with a specially designed jig, was utilized for color measurements. Following isolation, color measurements were conducted at the dehydration process intervals of baseline, 1st, 2nd, 3rd, 5th, 7th, 10th, and 15th minutes. After mouth rinsing, measurements were repeated at the same time intervals during the rehydration process. CIEDE2000 (ΔE00) values and the Whiteness Index (WID) were obtained to compare the color changes between the initial readings and each interval. Friedman and Repeated Measures ANOVA were applied to compare classes by time during the dehydration and rehydration periods, as well as ANOVA and Kruskal-Wallis tests to compare by classes for each time (p < 0.05).

RESULTS

Significant differences emerged in the mean ΔE00 values during dehydration and rehydration periods across all Cvek Classes (p < 0.05). While no statistically significant differences were observed among Classes at different minutes during the rehydration period (p > 0.05), it was particularly noted that the mean ΔE00 values of Classes 2, 3, and 5 at the 2nd minute of dehydration were statistically significantly higher than the mean of Class 1 (p < 0.05). However, when evaluating the starting and ending measurements of both dehydration and rehydration processes, and the overall change in ΔE00 and ΔWID, no significant variations were detected across the Classes (p > 0.05).

CONCLUSIONS

In teeth that have just erupted and are still undergoing root development, dehydration in the initial minutes results in noticeable color changes. However, the change in ΔE00 and ΔWID of the teeth was found to be similar after the dehydration and rehydration processes.

CLINICAL SIGNIFICANCE

According to the Cvek classification, the lower color change in Class 1 teeth within the first 2 min of dehydration and the need for more than 15 min of rehydration for immature teeth with an open apex to return to their initial state after a 15-min dehydration are crucial for clinicians in terms of color assessment timing.

Knowledge and practices of Iranian students (13-16 age) regarding the use of fluoride toothpaste

INTRODUCTION

Fluoride is the main factor in reducing the prevalence of caries worldwide. However, there is insufficient knowledge about whether people in different age groups are aware of the benefits of fluoride toothpaste, as well as about people's daily oral care habits and whether they use fluoride. The purpose of this research is to investigate the knowledge and performance of Iranian students regarding the use of toothpaste containing fluoride.

METHOD

This study was conducted on the first- and second-year high school students of Kerman city. Questionnaires containing personal questions, general questions, and questions related to students' knowledge and performance regarding the use of fluoride toothpaste were provided to them and then they were asked to complete and submit it. The results obtained from the survey were analyzed by T-test, Mann-Whitney test, and Chi-Square test in SPSS Version 24. The significance level in data analysis was P < 0.05.

RESULTS

In this research, 681 forms including 252 boys and 429 girls were examined. The average age of the participants was 14.1 ± 0.4. 91.2% declared that they use toothpaste and 77.8% of them used toothpaste containing fluoride. 521 people stated that the price of toothpaste is important in using the type of toothpaste. 621 people used regular toothbrush and 609 people evaluated their oral health as good. 621 of the participants stated that toothpaste makes the mouth healthy. The average knowledge score was 16.7 ± 2.1 out of 24, which indicates the average knowledge of students in this field.

CONCLUSION

This study showed that students' knowledge and performance about using fluoride-containing toothpaste is average. There was no significant relationship between performance and knowledge with age and gender. There was also a positive correlation between knowledge and performance indicating that increasing knowledge leads to an increase in behavioral changes. Also, there was a positive correlation between knowledge and performance, and a correlation coefficient of 0.731 was obtained between knowledge and performance. It shows that increasing knowledge leads to increasing behavioral changes.

Posteruptive Loss of Enamel Proteins Concurs with Gain in Enamel Hardness

Tooth enamel maturation requires the removal of proteins from the mineralizing enamel matrix to allow for crystallite growth until full hardness is reached to meet the mechanical needs of mastication. While this process takes up to several years in humans before the tooth erupts, it is greatly accelerated in in the faster developing pig. As a result, pig teeth erupt with softer, protein-rich enamel that is similar to hypomineralized human enamel but continues to harden quickly after eruption.Proteins, such as albumin, that bind to enamel crystals and prevent crystal growth and enamel hardening have been suggested as cause for hypomineralized human enamel that does not naturally harden after eruption. However, albumin is abundant in pig enamel. It is unclear whether fast posteruptive enamel hardening in pigs occurs despite the high protein content or requires a facilitated protein loss to allow for crystal growth. This study asked how the protein content in porcine enamel changes after eruption in relation to saliva. Based on previous data demonstrating the high albumin content in erupted porcine enamel, we hypothesize that following pre-eruptive maturation, enamel and saliva derived enzymes facilitate protein removal from porcine enamel after eruption. We analyzed enamel and the saliva proteome at three critical timepoints: at the time of tooth eruption, 2 weeks after eruption, and enamel 6 weeks after eruption. We used only fourth deciduous premolars and saliva samples from animals sacrificed at the respective time points to determine the organic content in tooth enamel, saliva, and saliva proteins within enamel. We found a decrease in the number of proteins and their abundancy in enamel with posteruptive time, including a decrease in serum albumin within enamel. The rapid decrease in the first two weeks is in line with previously reported rapid increase in mineral density of porcine enamel after eruption. In addition to the enamel proteases KLK-4 and MMP-20, we identified serine-, cysteine-, aspartic-, and metalloproteases. Some of these were only identified in enamel, while almost half of the enzymes are in common with saliva at all timepoints. Our findings suggest that the fast posteruptive enamel maturation in the porcine model coincides with saliva exchange and influx of saliva enzymes into porous enamel.

An In Vitro Study to Evaluate the Antimicrobial Activity of a Zinc Citrate, Sodium Fluoride, Alum and Xylitol-Based Toothpaste Formulation

INTRODUCTION

Periodontitis is a prevalent condition significantly affecting oral health. Comorbid conditions, such as diabetes, can heighten the severity of periodontal disease and overall oral health. Therefore, to enhance oral health and manage comorbid conditions, comprehensive periodontal care is essential. This approach could involve using toothpaste containing antimicrobial ingredients in routine oral care. This paper presents the results of an in vitro study analysing the antimicrobial properties of the test formulation containing zinc citrate, alum, sodium fluoride, and xylitol-based toothpaste (Stolin-R). These ingredients work together to help in providing comprehensive oral care by controlling growth of bacteria majorly responsible for periodontal disease and thus maintaining optimal oral hygiene.

AIM

To determine the antimicrobial properties of zinc citrate, alum, sodium fluoride, and xylitol-based toothpaste formulation against key periodontal pathogens through in vitro analyses.

MATERIALS AND METHODS

The antimicrobial efficacy of test formulation is evaluated through minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and time-dependent antibacterial assessment against key periodontal pathogens, including Porphyromonas gingivalis, Tannerella forsythia, Fusobacterium nucleatum, Prevotella intermedia, Streptococcus mutans, and Bacteroides fragilis.

RESULTS

The test formulation demonstrated potent antimicrobial effectiveness against Bacteroides fragilis, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Streptococcus mutans, and Tannerella forsythia, by exhibiting low MIC and MBC. Additionally, significant bacterial reduction, exceeding 99.99%, was observed within five minutes, emphasising its potential as an effective adjunct in combating periodontal infection.

CONCLUSION

Zinc citrate, alum, sodium fluoride, and xylitol-based toothpaste formulation demonstrates significant antimicrobial activity against key periodontal pathogens, suggesting its potential as an effective agent for maintaining oral health and combating gingival infection.

Doses of fluoride toothpaste for children up to 24 months

AIM

The aim of this study was to test the dose of fluoride toothpaste by parents for their children aged up to 24 months.

METHODS

Parents who use fluoride toothpastes for their children were asked to dose two commercially available toothpastes (A and B) with 1000 ppm fluoride each for their children as they would normally do at home. The toothpaste amounts were weighed, and as reference, the weight of an 'optimal' grain of rice-size amount of each toothpaste was used.

RESULTS

61 parents dosed a mean of 0.263 ± 0.172 g toothpaste A and 0.281 ± 0.145 g toothpaste B. The parents' mean doses were 5.9 times higher for toothpaste A and 7.2 times higher for toothpaste B than an 'optimal' grain of rice-size amount (the reference dose as recommended). The difference between parent's and reference dose was statistically significant (p < 0.001). Moreover, 39.3% of parents were not aware about conditions of use and warnings that have to be printed on the package of fluoride toothpastes.

CONCLUSION

In this study, parents significantly overdosed the toothpaste for their children. To avoid fluoride intake from toothpaste, parents can choose fluoride-free alternatives for the oral care of their infants and toddlers.

Effect of Commercial Children's Mouthrinses and Toothpastes on the Viability of Neonatal Human Melanocytes: An In Vitro Study

In this study, we examined the cytotoxic effects of six commercial children's mouthrinses (designated as #1, #2, #3, #4, #5, and #6) and four commercial children's toothpastes (designated as #1, #2, #3, and #4) on primary human neonatal melanocytes that were used as a representative model for oral melanocytes. Mouthrinses diluted directly with culture medium (1:2, 1:5, 1:10, 1:100, and 1:1000) were added to monolayers of melanocytes for 2 min, followed by 24 h recovery, after which MTS cytotoxicity assay was conducted. The extracts of each toothpaste were prepared (50% w/v), diluted in culture medium (1:2, 1:5, 1:10, 1:50, 1:100, and 1:1000), and added to cell monolayers for 2 min (standard brushing time), followed by an analysis of cell viability after 24 h. Results showed that all mouthrinses except mouthrinse #4 showed significantly greater loss of cell viability, ascribed to cetylpyridinium chloride (CPC) that induced significant cytotoxicity to melanocytes (IC50 = 54.33 µM). In the case of toothpastes, the examination of cellular morphology showed that a 2 min exposure to all toothpaste extracts induced a concentration-dependent decline in cell viability, pronounced in toothpaste containing sodium lauryl sulfate (SLS) detergent. Further results suggested SLS to be the critical driver of cytotoxicity (IC50 = 317.73 µM). It is noteworthy that toothpaste #1 exhibited much lower levels of cytotoxicity compared to the other three toothpastes containing SLS. Taken together, these findings suggest that the melanocytotoxicity of children's mouthrinse (#4) and toothpaste (#1) is comparatively low. To the best of our knowledge, this is the first study to examine the impact of children's toothpastes and mouthrinses on neonatal primary human melanocytes. Future studies to investigate these findings in a realistic scenario replicating oral cavity conditions of the presence of microbiota, pellicle layer and saliva, and other cell types are warranted.

Prevalence and severity of dental caries in school children in Saudi Arabia: A nationwide cross-sectional study

Aim

This nationwide study assessed the prevalence and severity of dental caries in 6-, 12-, and 15-year-old school children across Saudi Arabia. This study examined differences between genders and among regions regarding the mean values of decayed, missing, and filled teeth (dmft/DMFT), the care index (CI), and the significant caries index (SiC index).

Materials and methods

Data from 19,870 participants, 10,435 males and 9435 females, were collected using stratified multistage cluster random sampling. The survey team divided Saudi Arabia into five regions (northern, eastern, western, southern, and middle). To represent each respective region, a large city, two random towns (peri-urban), and four random rural areas were selected for surveying. Lastly, the sampling technique was applied by choosing random schools and random classes within the selected schools. Dental caries were assessed using the dmft/DMFT score, CI, and the top 30% and 10% of the sample dmft/DMFT scores (SiC30 and SiC10, respectively).

Results

The overall prevalence of caries was 65.6%, with 72.1 occurring in primary teeth and 61.7% in permanent teeth. The percentages of individuals with missing teeth and filled teeth were 9.0% and 20.5%, respectively. The mean dmft was 3.93 ± 3.60, while the mean DMFT was 2.42 ± 2.52; most of the DMFT components were significantly higher in females than males, while the dmft components were higher in males. The northern region had the highest and worst DMFT/dmft ratios of the five regions. The mean SiC30 and SiC10 values were significantly higher than the overall average DMFT/dmft values (P < 0.001).

Conclusion

Dental caries remain a public health challenge among school children in Saudi Arabia. The SiC and CI analysis indicated that caries management had a high overall efficacy, but that certain groups of the population may need targeted management in the future.

Erosion behaviour of human, bovine and equine dental hard tissues

Dental hard tissues from different species are used in dental research, but little is known about their comparability. The aim of this study was to compare the erosive behaviour of dental hard tissues (enamel, dentin) obtained from human, bovine and equine teeth. In addition, the protective effect of the pellicle on each hard tissue under erosive conditions was determined. In situ pellicle formation was performed for 30 min on enamel and dentin samples from all species in four subjects. Calcium and phosphate release was assessed during 120 s of HCl incubation on both native and pellicle-covered enamel and dentin samples. SEM and TEM were used to examine surface changes in native enamel and dentin samples after acid incubation and the ultrastructure of the pellicle before and after erosive exposure. In general, bovine enamel and dentin showed the highest degree of erosion after acid exposure compared to human and equine samples. Erosion of human primary enamel tended to be higher than that of permanent teeth, whereas dentin showed the opposite behaviour. SEM showed that eroded equine dentin appeared more irregular than human or bovine dentin. TEM studies showed that primary enamel appeared to be most susceptible to erosion.

Modeled health economic and equity impact on dental caries and health outcomes from a 20% sugar sweetened beverages tax in Australia

Dental caries is the most prevalent oral disease across the life course. This study modeled the population health and economic impact of a 20% sugar sweetened beverages tax (SSB) for preventing dental caries compared to no intervention (societal and healthcare perspective). A cost-effectiveness analysis according to quintiles of area-level socioeconomic disadvantage was performed for the 2020 Australian population (0-100 years old) using a closed cohort Markov model. A qualitative assessment of implementation considerations (e.g., acceptability, equity, sustainability) was undertaken. Health outcomes were modeled as decayed teeth prevented and disability-adjusted life years (DALYs) averted. The 10-year and lifetime scenarios were modeled with probabilistic sensitivity analysis (Monte Carlo simulation, 2000 cycles). The 10-year scenario from a societal perspective yielded cost-savings of AUD$63.5M, healthcare cost-savings of AUD$42.2M, 510,977 decayed teeth averted and 98.1 DALYs averted. The lifetime scenario resulted in societal cost savings of AUD$176.6M, healthcare cost-savings of AUD$122.5M, 1,309,211 decayed teeth averted and 254.9 DALYs averted. Modeling indicated 71.5% and 74.5% cost-effectiveness for the 10-year and lifetime scenarios, respectively. A three-fold health benefit for the least advantaged was found compared to the most advantaged. A 20% SSB tax in Australia is cost-effective and promotes health equity.

Carious status and socio-behavioral risk factors among 12 year-old children in South-Central region in Romania

BACKGROUND

Regular screenings at children population level are necessary in order to assess communities' need for education, prevention, as well as early detection and intervention programs The study aims to assess dental caries experience and oral health-related behaviors among Romania children from the South and Central region.

METHODS

The cross-sectional study conducted in 2019-2020 is part of the national survey "Romanian Oral Health Survey", under the endorsement of the World Health Organization (WHO). The stratified, randomized and representative sample included 98 children of 12 years of age. The assessment included a clinical examination, using International Caries Detection and Assessment System (ICDAS) and the Oral Health Questionnaire for Children recommended by the World Health Organization.

RESULTS

Results revealed that the frequency of caries-free children among 12 year-olds was 36.7% and the mean DMFT was 2.89. Regarding the oral health-related habits, 38.8% of children brushed twice daily; the consumption of sugary foods multiple times per day has been frequently met and 11.2% at the age of 12 never visited the dental office.

CONCLUSIONS

The findings revealed that caries prevalence was high and behaviors negatively influence oral health. The presented data are of utmost importance for Romanian policy makers to promote oral health education among children, to support consistent preventive oral health campaigns and to stimulate dental attendance, irrespective of children' living areas or gender.

Improving Oral Health with Fluoride-Free Calcium-Phosphate-Based Biomimetic Toothpastes: An Update of the Clinical Evidence

As the demand for clinically effective fluoride-free oral care products for consumers increases, it is important to document which types of toothpastes have been shown in clinical studies to be effective in improving oral health. In this review, we included different indications, i.e., caries prevention, improving periodontal health, reducing dentin hypersensitivity, protecting against dental erosion, and safely improving tooth whitening in defining what constitutes improvement in oral health. While there are several professional and consumer fluoride-containing formulations fortified with calcium-phosphate-based ingredients, this review focuses on fluoride-free toothpastes containing biomimetic calcium-phosphate-based molecules as the primary active ingredients. Several databases were searched, and only clinical trials in human subjects were included; in vitro and animal studies were excluded. There were 62 oral health clinical trials on biomimetic hydroxyapatite (HAP), 57 on casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), 26 on calcium sodium phosphosilicate (CSPS, or so called Bioglass), and 2 on β-tricalcium phosphate (β-TCP). HAP formulations were tested the most in clinical trials for benefits in preventing caries, dentin hypersensitivity, improving periodontal health, and tooth whitening. Based on the current clinical evidence to date, fluoride-free HAP toothpaste formulations are the most versatile of the calcium phosphate active ingredients in toothpastes for improving oral health.

Caries-preventing effect of a hydroxyapatite-toothpaste in adults: a 18-month double-blinded randomized clinical trial

Background

Dental caries is a worldwide challenge for public health. The aim of this 18-month double-blinded, randomized, clinical trial was to compare the caries-preventing effect of a fluoride-free, hydroxyapatite toothpaste (test) and a toothpaste with sodium fluoride (1450 ppm fluoride; positive control) in adults.

Methods

The primary endpoint was the percentage of subjects showing no increase in overall Decayed Missing Filled Surfaces (DMFS) index. The study was designed as non-inferiority trial. Non-inferiority was claimed if the upper limit of the exact one-sided 95% confidence interval for the difference of the primary endpoint DMFS between test and control toothpaste was less than the predefined margin of non-inferiority (Δ ≤ 20%).

Results

In total, 189 adults were included in the intention-to-treat (ITT) analysis; 171 subjects finished the study per protocol (PP). According to the PP analysis, no increase in DMFS index was observed in 89.3% of subjects of the hydroxyapatite group and 87.4% of the subjects of the fluoride group. The hydroxyapatite toothpaste was not statistically inferior to a fluoride toothpaste with regard to the primary endpoint.

Conclusion

Hydroxyapatite was proven to be a safe and efficient anticaries agent in oral care.

Clinical trial registration

NCT04756557.

Rapid post-eruptive maturation of porcine enamel

The teeth of humans and pigs are similar in size, shape, and enamel thickness. While the formation of human primary incisor crowns takes about 8 months, domestic pigs form their teeth within a much shorter time. Piglets are born after 115 days of gestation with some of their teeth erupted that must after weaning meet the mechanical demands of their omnivorous diet without failure. We asked whether this short mineralization time before tooth eruption is combined with a post-eruptive mineralization process, how fast this process occurs, and how much the enamel hardens after eruption. To address this question, we investigated the properties of porcine teeth at two, four, and sixteen weeks after birth (N = 3 animals per time point) through analyses of composition, microstructure, and microhardness. We collected data at three standardized horizontal planes across the tooth crown to determine the change of properties throughout the enamel thickness and in relation to soft tissue eruption. Our findings indicate that porcine teeth erupt hypomineralized compared to healthy human enamel and reach a hardness that is similar to healthy human enamel within less than 4 weeks.

Remineralization of Artificially Demineralized Human Enamel and Dentin Samples by Zinc-Carbonate Hydroxyapatite Nanocrystals

(1) Background: Decalcified enamel and dentin surfaces can be regenerated with non-fluoride-containing biomimetic systems. This study aimed to investigate the effect of a zinc carbonate-hydroxyapatite-containing dentifrice on artificially demineralized enamel and dentin surfaces. (2) Methods: Human enamel and dentin discs were prepared and subjected to surface demineralization with 30% orthophosphoric acid for 60 s. Subsequently, in the test group (n = 20), the discs were treated three times a day for 3 min with a zinc carbonate-hydroxyapatite-containing toothpaste (biorepair^®). Afterwards, all samples were gently rinsed with PBS (5 s) and stored in artificial saliva until next use. Samples from the control group (n = 20) received no dentifrice-treatment and were stored in artificial saliva, exclusively. After 15 days of daily treatment, specimens were subjected to Raman spectroscopy, energy-dispersive X-ray micro-analysis (EDX), white-light interferometry, and profilometry. (3) Results: Raman spectroscopy and white-light interferometry revealed no significant differences compared to the untreated controls. EDX analysis showed calcium phosphate and silicon dioxide precipitations on treated dentin samples. In addition, treated dentin surfaces showed significant reduced roughness values. (4) Conclusions: Treatment with biorepair^® did not affect enamel surfaces as proposed. Minor mineral precipitation and a reduction in surface roughness were detected among dentin surfaces only.

Streptococcus mutans carriage in the saliva of mothers and its association with dental caries and Streptococcus mutans carriage in the saliva of children between 6 and 30 months old in a low-income setting in Karachi, Pakistan

BACKGROUND

Early childhood caries poses a significant health issue in children under 6 years old. It is determined that Streptococcus mutans is a primary etiological agent, likely to be transferred through maternal contact.

OBJECTIVES

To determine the association of maternal S. mutans counts with S. mutans counts in their children between 6 and 30 months of age, and to determine the maternal and child DMFT (decayed, missing, and filled teeth) indices.

MATERIAL AND METHODS

A community-based cross-sectional study was conducted in Karachi, Pakistan. A sample of 193 dyads of mother-children (6-30 months of age) was selected via purposive sampling. Saliva samples of the dyads were collected to assess S. mutans count. Caries assessment was performed for both using the DMFT index. A pretested questionnaire was used. The association of bottle-feeding, oral hygiene measures, and other factors with S. mutans counts in children were also explored. Zero-inflated negative binomial regression model at a 5% level of significance was applied using STATA version 12.0.

RESULTS

Out of 193 children, 109 (56.47%) were males and 84 (43.52%) were females. The mean age of mothers and children was 29.4 ± 6.2 years and 19.54 ± 6.8 months, respectively. Maternal S. mutans counts were not statistically associated with child's S. mutans counts (Mean child's S. mutans count ratio: 1; 95% confidence interval [CI]: 1, 1.01; p = .882). Compared with children who were breastfed, S. mutans counts were higher in children who were bottle-fed (mean S. mutans count ratio= 4.85 [95% CI: 1.53, 15.41], p = .007). Age of mother and present caries status of mothers was significantly associated with the child's S. mutans count.

CONCLUSION

No association between maternal S. mutans and child S. mutans was observed. However, maternal age, children who were breastfed, children who did not use pacifiers, and children with mothers who did not have caries, exhibited low S. mutans counts in their saliva.

The environmental impact of community caries prevention - part 2: toothbrushing programmes

Introduction Community-level caries prevention programmes includes supervised toothbrushing in schools and the provision of toothbrushes and toothpaste. The environmental impact of these interventions is an important factor to consider when commissioning these services.Materials and methods A comparative life cycle assessment (LCA) was conducted to quantify the environmental impact of a five-year-old child receiving one of two toothbrushing programmes over a one-year period; supervised toothbrushing in school, or the provision of toothbrushes and toothpaste.Results Supervised toothbrushing had a lower environmental impact than provision of toothbrushes and toothpaste in all 16 impact categories measured. The water use needed for children to brush their teeth was the greatest contributing factor to the provision of toothbrushes and toothpaste, accounting for an average of 48.65% of the impact results.Discussion All community-level caries prevention programmes have an associated environmental cost. LCA is one way to quantify the environmental impact of healthcare services and can be used along with cost and clinical effectives data to inform public healthcare policy. Organisations responsible for these programmes could use the results of this study to consider ways to reduce the environmental impact of their services.

Hydroxyapatite as Remineralization Agent for Children's Dental Care

Children are prone to develop dental caries. This is supported by epidemiological data confirming early childhood caries (ECC) as a highly prevalent disease affecting more than every second child worldwide. ECC is known to result from an imbalance between re- and demineralization where demineralization dominates due to frequent acid production by cariogenic bacteria present in oral biofilms. The application of oral care formulations containing remineralizing agents helps to prevent dental caries. As young children are sensitive and usually swallow (intended or unintended) a majority of toothpaste or other oral care products during daily dental care, all ingredients, especially the actives, should be non-toxic. Biomimetic hydroxyapatite [HAP; Ca5(PO4)3(OH)] is known to have favorable remineralizing properties combined with an excellent biocompatibility, i.e., it is safe if accidently swallowed. Several clinical trials as well as in situ and in vitro studies have shown that HAP remineralizes enamel and dentin. Remineralization occurs due to deposition of HAP particles on tooth surfaces forming mineral-mineral bridges with enamel crystals, but also indirectly through calcium and phosphate ions release as well as HAP's buffering properties in acidic environments (i.e., in plaque). HAP induces a homogenous remineralization throughout the subsurface enamel lesions. This review summarizes the current evidence showing HAP as an effective remineralizing agent in oral care products for children. Additional studies showing also further beneficial effects of HAP such as the reduction of biofilm formation and the relief of hypersensitivity in children with molar incisor hypomineralization (MIH). It can be concluded that HAP is an effective and safe remineralizing agent for child dental care.

Title Cross-Sectional Study to Evaluate Knowledge and Attitudes on Oral Hygiene of Romanian Students

Background and Objectives: the purpose of this study was to evaluate students’ level of knowledge and attitude towards oral hygiene. Materials and Methods: the evaluation was carried out by a questionnaire, with 30 Q (questions) as follows: demographic data (Q1–Q5), oral hygiene knowledge data (Q6–Q23) and oral hygiene attitude data (Q24–Q30). The study included students from Romanian schools and the selection of the study group was made following selection criteria in accordance with ethical issues. A descriptive statistical analysis was performed and a value of p ≤ 0.05 was considered statistically significant. Results: the study included a number of 718 subjects with a mean age of 14.54 (±2.22), male 250 (34.8%) and female 468 (65.2%), MS (middle school students) 354 (49.4%) and HH (high school students) 364 (50.6%). Most of the subjects 292 (MS = 160; HS = 132) know a toothbrushing technique, p = 0.009, r = 0.091 and 587 (MS = 278; HS = 309) know that brushing removes the bacterial plaque p = 0.027, r = −0.082 but only 147 (MS = 71; HS = 76) know that (by) brushing can re-mineralize hard dental structures. The duration of the toothbrushing is variable, for 2- or 3-min p = 0.058, r = 0.043. Criteria for choosing the toothbrush were based mainly on the indications of the dentist, respectively, for toothpaste on its properties. The frequency of toothbrushing is mainly twice a day 428 (MS = 234; HS = 248), p = 0.079, r = 0.037, 73 (MS = 33; HS = 40) after every meal. p = 0.099, r = 0.095. Mouthwash is used by 421 (MS = 199; HS = 222) p = 0.111, r = −0.048, and 228 (MS = 199; HS = 222) after each brushing. Dental floss is used by 240 (MS = 106; HS = 134), p = 0.031, r = −0.073 and only 74 (MS = 41; HS = 33) after each brushing. Conclusions: there are differences in the level of knowledge and attitudes regarding the determinants of oral hygiene depending on the level of education.

Caries prevalence and severity in association with sociodemographic characteristics of 9-to-12-year-old school children in Al-Madinah, Saudi Arabia

Aim

This study was conducted to estimate the prevalence and severity of dental caries in 9-to-12-year-old schoolchildren in Al-Madinah, Saudi Arabia (SA); to compare its expression by mean of decayed, missing and filled teeth (dmft/DMFT) and the Significant Caries Index (SiC Index); to examine the association between caries experience and sociodemographic factors; and to determine whether schoolchildren in Al-Madinah are at greater risk for high levels of dental caries.

Materials and methods

Data of 1,000 schoolchildren aged 9–12 years old from a cross-sectional oral health survey in Al-Madinah, SA was obtained and analysed. Dental caries was measured using dmft/DMFT and the SiC Index which was computed into two groups: highest 30% DMFT scores (SiC³⁰) and highest 10% DMFT scores (SiC¹⁰). Sociodemographic variables included age, gender, nationality, school type (public or private) and family income. Descriptive and inferential were calculated to estimate caries prevalence and severity and its association with sociodemographic factors.

Results

Caries prevalence in primary or permanent teeth was 85.1%, with untreated caries of 76.1%. The mean dmft was 2.66 ± 2.63 while the mean DMFT was 1.43 ± 1.73. Caries severity was significantly higher among males, Saudis, those from low-income families and those from public schools (p < 0.05). The mean values of SiC³⁰ (3.52 ± 1.57) and SiC¹⁰ (4.98 ± 1.77) were considerably higher than the overall average DMFT value.

Conclusion

Dental caries persists as a public health challenge among schoolchildren in Al-Madinah, SA, with a very high prevalence and severity among schoolchildren. The use of the SiC Index highlighted the subgroups with more severe caries experience.

Knowledge, Attitudes, and Practices of Parents on Early Childhood Caries in Qatar-A Questionnaire Study

OBJECTIVES

 The aims of the present study were to evaluate the level of knowledge, attitudes, and practices (KAP) toward early childhood caries (ECC) in a group of Qatari parents and to assess the association of sociodemographic factors on their KAP.

MATERIALS AND METHODS

 A cross-sectional study which was based on a piloted self-administered questionnaire was conveniently distributed to parents who attended the Pediatric Dentistry Section, Hamad Dental Center (HDC), Doha, Qatar. The questionnaire comprised four parts which asked about sociodemographic characteristics, knowledge, attitudes, and practices. A score for each domain was given based on the percentage of correct answers.

STATISTICAL ANALYSIS

 Descriptive and analytical statistics were employed. For descriptive statistics, frequency of distribution in relation to sociodemographic characteristics and responses to items of the questionnaire were presented. For analytical statistics, associations between independent variables and KAP were employed using Chi-squared tests.

RESULTS

 The overall mean scores of KAP were 60.8%, 65.6% and 72.7%, respectively. Females had significantly higher percentages of correct answers than males (p = 0.001). Only 20% of females had poor knowledge, while it was 40% in males. Parents with university or higher degrees had significantly higher percentage of good attitudes than parents with preparatory or less education (p = 0.05). Areas that necessitated improvement by parents included the following: the amount of toothpaste needed for brushing, signs of tooth demineralization, bacteria that causes tooth decay can be transmitted from mother to her child, and tooth decay can be transmitted by sharing utensils (i.e., spoons, forks).

CONCLUSIONS

 The overall KAP of parents toward ECC was relatively fair. However, certain socioeconomic factors (SEF) seemed to influence each domain, and areas of improvement are needed. Areas of improvement are needed in each domain. Mothers were significantly more knowledgeable than fathers regarding oral health issues of their children. Highly educated parents demonstrated better attitudes than the less educated. Continuous educational programs coordinated by health regulatory bodies should be introduced to improve parents' KAP regarding ECC risk factors and prevention.

Biomimetic hydroxyapatite and caries prevention: a systematic review and meta-analysis

Dental caries is still one of the most prevalent diseases worldwide. Research has shown that fluoride has a role in caries prevention. For many reasons there are concerns about young children using fluoride-containing oral care products. Consequently, there is a need to identify effective fluoride-free products. A large body of literature now exists on the use of biomimetic hydroxyapatite (HAP) as an active ingredient in oral care products to combat caries.

AIM

To conduct a systematic review of the clinical evidence of the effects of HAP-based fluoride-free oral care products in caries reduction and conduct a meta-analysis of available randomized clinical trials (RCTs).

METHODS

Using the PICO question "In individuals of all ages (P), do fluoride-free oral care products containing HAP as the anti-caries agent (I), compared to products with fluoride or without caries control products (C), reduce the risk of dental caries (O)?" Ovid MEDLINE (PubMed), Scopus, EMBASE, and Web of Science databases were searched using the following keywords: apatite, hydroxyapatite, caries, dental decay, dentin(e), enamel, toothpaste, dentifrice, mouthwash, gels, biofilm, (dental) plaque, ero(de, ded, sion), (de, re)mineral(ise, ized, ised, ization, isation). Reviews, tooth whitening, tooth sensitivity, and in vitro studies were excluded. PRISMA was used for the search and GRADE was used to assess quality. Clinical trials were subjected to the Cochrane Risk of Bias assessment followed by meta-analysis.

RESULTS

291 studies were retrieved; 22 were suitable for systematic review, 5 were clinical caries trials and 4 were RCTs. A meta-analysis of 3 RCTs was possible showing HAP provided 17% protection against caries. The other 17 trials had simpler proxy outcomes for anticaries effects. Some trials showed non-inferior performance of HAP products compared to those with fluoride.

CONCLUSION

There is good evidence that hydroxyapatite in oral care products in the absence of fluoride effectively reduces caries.

Validity and reliability of the Turkish version of the Child Perceptions Questionnaire 8-10

BACKGROUND

A reliable measurement tool is needed to gain more knowledge about Turkish children's oral health status that affects the quality of life.

AIM

To develop a translated version of CPQ_8-10 into Turkish language and evaluate its reliability, validity, and reproducibility.

DESIGN

The intra-class correlation coefficient (ICC) was used for the test-retest reliability in the 50 children. For the internal consistency, 418 children aged 8-10 years were evaluated using Cronbach's alpha Coefficient. Construct validity and discriminant validity were calculated using Spearman's correlation analysis, and exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) was also employed.

RESULTS

The mean CPQ_8-10 score was 13.3 ± 9.2. The translated Turkish version of CPQ_8-10 showed high test-retest reliability (ICC = 0.90) and internal consistency (Cronbach's alpha = 0.82). A statistically significant correlation was observed between the scores of the CPQ_8-10 and oral health and overall well-being, which revealed good construct validity (r = 0.50; P < .001 and r = 0.47; P < .001, respectively). Seven factors identified from EFA were statistically verified using CFA. Discriminant validity was supported by significant differences between CPQ and OHIS scores (P < .001).

CONCLUSIONS

The translated version of CPQ_8-10 to the Turkish language is reliable, valid, and reproducible for use in the Turkish culture in this age group.

Detection of Dental Caries' and Dermatoglyphics' Association with Relative Enamel Thickness Using CBCT Images in Saudi Subpopulation: A Novel Approach

Background

Dental caries is the localized destruction of dental hard tissues (enamel and dentine). Decayed, Missing, and Filled Teeth (DMFT) index is the most commonly used dental caries index. Thickness of the outermost part of the tooth called the enamel is determined by the rate of deposition of enamel proteins. Relative enamel thickness (RET) gives a measure of enamel thickness with respect to dentine. Dental caries is influenced by a genetically determined factor called dermatoglyphics (DG). As the genes responsible for RET and DG lie on the same chromosome and develop during the same time of intrauterine life, it is biologically plausible to correlate RET and DG.

Aims

This study consists of two primary aims: (1) to assess RET using cone beam computed tomography images and correlate it with caries and (2) to correlate RET with DG.

Materials and Methods

148 dental subjects were assessed for DMFT caries score and were categorized as Group 1 with DMFT = 0 and Group 2 with DMFT ≥ 1. Following this, their DG pattern was recorded digitally. The CBCT images of these subjects were assessed for RET, and the data were analyzed statistically.

Results

Mean RET in our sample population is 18.45 (SD 3.79) while mean DMFT is 5.34 (SD 5.13). Mean RET in Group 1 subjects was 19.82 (SD 4.05) while that in the Group 2 was 17.68 (SD 3.43). RET and DMFT showed a statistically significant negative correlation (p = 0.007). The “Single Loop” DG characteristic showed a statistically significant difference between males and females (p = 0.031). The “Simple Arch” type of DG was positively correlated with RET.

Conclusion

This is the first in vivo study to assess RET using CBCT images and correlate with DMFT and DG. RET is inversely related to DMFT while directly proportional to the “Simple arch” DG pattern. Males and females differed in their “Single Loop” DG characteristic.

Association between sugary drinks consumption and dental caries incidence among Taiwanese schoolchildren with mixed dentition

OBJECTIVES

Dental caries is a multifactorial disease, and a sugary diet can generate an acidic plaque environment that advances its development. However, the specific effect of sugary drinks on the subsequent oral health of schoolchildren with mixed dentition is unclear. In this study, we investigated the association between the consumption of sugary drinks and 1 year incidence rate of caries in permanent teeth among Taiwanese schoolchildren with mixed dentition.

METHODS

A longitudinal 1 year follow-up study was conducted among Taiwanese schoolchildren aged 8-9 years. A questionnaire collected information regarding the parents' oral health status and their children's demographic background, oral health-related behaviours and consumption habits of sugary drinks, including handmade drinks (specifically bubble tea and pearl milk tea) and carbonated drinks. Dental caries was recorded through standardized oral examinations. The number of dental services received was retrieved from the Taiwan National Health Insurance Research Database. Multivariate Cox proportional hazards models and zero-inflated negative binomial models were used to estimate the association between the consumption of sugary drinks and the incidence rate of caries in permanent teeth after 1 year.

RESULTS

The study involved 494 children. During the 1 year follow-up period, 117 children developed new dental caries in their permanent teeth, yielding a caries incidence rate of 0.183 per person-year. After adjustments for confounding factors, children who preferred having sugar-rich beverages were associated with having a 4.3 times higher (95% confidence interval [CI] = 1.2-15.7) risk of developing caries than did those who preferred nonsugary drinks (P < .05). Additionally, children who often consumed handmade drinks were associated with having a 1.7 times higher (95% CI = 1.1-2.9) risk of developing caries than those who seldom consumed (P < .05).

CONCLUSIONS

The findings suggest that the consumption of sugary drinks during the mixed dentition stage might be a major etiological factor for caries in permanent teeth. These findings could be valuable to paediatricians, dentists, nutritionists and policymakers.

Fluoridation cessation and children's dental caries: A 7-year follow-up evaluation of Grade 2 schoolchildren in Calgary and Edmonton, Canada

Objectives

We examined the effect of fluoridation cessation on children's dental caries experience in the Canadian cities of Calgary (cessation in 2011) and Edmonton (still fluoridated).

Methods

We used a pre‐post cross‐sectional design with comparison group. We studied Grade 2 schoolchildren (approximately 7 years old) 7‐8 years after fluoridation cessation in Calgary, thus capturing children born after cessation occurred. Data collection included a dental examination conducted in school by calibrated dental hygienists, a questionnaire completed by parents, and fingernail clippings for a small subsample. Our overall analytic approach was twofold. We first examined differences in dental caries experience (deft and DMFT, and smooth surface caries based on defs and DMFS) between Calgary and Edmonton and over time (comparing 2018/2019 data to pre‐cessation and early post‐cessation surveys in our setting). Second, we evaluated whether differences were likely to reflect fluoridation cessation in Calgary, rather than other factors.

Results

The prevalence of caries in the primary dentition was significantly higher (P < .05) in Calgary (fluoridation cessation) than in Edmonton (still fluoridated). For example, crude deft prevalence in 2018/2019 was 64.8% (95% CI 62.3‐67.3), n = 2649 in Calgary and 55.1% (95% CI 52.3‐57.8), n = 2600 in Edmonton. These differences were consistent and robust: they persisted with adjustment for potential confounders and in the subset of respondents who were lifelong residents and reported usually drinking tap water; they had widened over time since cessation; and they were corroborated by assessments of dental fluorosis and estimates of total fluoride intake from fingernail clippings. Findings for permanent teeth were less consistent, which likely reflects that 7‐year‐olds have not had the time to accumulate enough permanent dentition caries experience for differences to have become apparent.

Conclusions

Our findings are consistent with an adverse impact of fluoridation cessation on children's dental health in Calgary and point to the need for universal, publicly funded prevention activities—including but not limited to fluoridation.

Oro-Dental Health and Primary Nephrotic Syndrome among Vietnamese Children

Primary nephrotic syndrome (PNS) is common in children, affecting the soft and hard tissues of the oral cavity. This study aimed to investigate the percentage of dental caries, gingivitis, hypertrophic gingivitis, and developmental defects of enamel (DDE) in children with PNS. The association of PNS with these diseases and oral care behavior was also assessed. A total of 407 children with PNS and 407 age- and gender-matched controls were recruited. PNS was diagnosed based on blood and urinary tests. The Simplified Oral Hygiene Index (OHI-S), the Gingival Index (GI), the Gingival Overgrowth Index (GOI), the Decayed, Missing, and Filled Teeth Index (dmft/DMFT), and DDE were collected. The PNS patients showed significantly higher scores of OHI-S, GI, and dmft, and higher proportions of dental caries and DDE than those of the controls (p < 0.001). It is necessary to establish a periodic dental protocol for PNS patients to improve their oral health status.

Oral Myofunctional and Articulation Disorders in Children with Malocclusions: A Systematic Review

BACKGROUND

Relationships between malocclusion and orofacial myofunctional disorders (OMD), as well as malocclusions and articulation disorders (AD) have been described, though the exact relationships remain unclear. Given the high prevalence of these disorders in children, more clarity is needed.

SUMMARY

The purpose of this study was to determine the association between OMD (specifically, bruxism, deviate swallowing, caudal resting tongue posture, and biting habits), AD, and malocclusions in children and adolescents aged between 3 and 18 years. To conduct a systematic review, 4 databases were searched (MEDLINE, Embase, Web of Science, and Scopus). The identified articles were screened for the eligibility criteria. Data were extracted from the selected articles and quality assessment was performed using the tool of Munn et al. [Int J Health Policy Manag. 2014;3:123-81] in consensus. Using the search strategy, the authors identified 2,652 articles after the removal of duplicates. After reviewing the eligibility criteria, 17 articles were included in this study. One of the included articles was deemed to have an unclear risk of bias, whereas all other articles were considered to have a low risk of bias. The articles showed a relationship between anterior open bite and apico-alveolar articulatory distortions, as well as between anterior open bite and deviate swallowing. For the biting habits, bruxism, and low tongue position no clear conclusions could be drawn. Key Messages: The current review suggests a link between specific types of malocclusion and OMD and AD. However, more high-quality evidence (level 1 and level 2, Oxford Levels of Evidence) is needed to clarify the cooccurrence of other OMD, AD, and malocclusions.

MEASUREMENT OF THE ACTIVITY CONCENTRATIONS OF GAMMA EMITTING RADIONUCLIDES IN TOOTHPASTE SAMPLES AND ASSESSMENT OF THE CORRESPONDING ANNUAL EFFECTIVE DOSES

It is inevitable that we are exposed to radiation daily from various sources and products that we consume on daily basis. The use of toothpaste for oral hygiene is one of the most common daily practices by humans and yet very little data are available regarding its radiation content. In this work, we investigated the concentrations of gamma emitting radionuclides in toothpaste samples consumed in Jordan. 40K and 226Ra were detected in almost one-third of the samples, whereas 228Ra was detected in nearly half of them. The corresponding activity concentrations in the detected samples were in the ranges of 68.7-154.2, 4.6-14.1 and 1.3-10.0 Bq/kg, respectively. Dose assessment of accidental ingestion of toothpaste for children and adults was made, and its contribution to the annual effective dose was found to be very minimal with maximum doses of ~2.9 and 1.3 μSv for children and adults, respectively.

Acquisition and establishment of the oral microbiota

Acquisition and establishment of the oral microbiota occur in a dynamic process over various stages and involve close and continuous interactions with the host and its environment. In the present review, we discuss the stages of this process in chronological order. We start with the prenatal period and address the following questions: ‘Is the fetus exposed to maternal microbiota during pregnancy?’ and ‘If so, what is the potential role of this exposure?’ We comment on recent reports of finding bacterial DNA in placenta during pregnancies, and provide current views on the potential functions of prenatal microbial encounters. Next, we discuss the physiological adaptations that take place in the newborn during the birth process and the effect of this phase of life on the acquisition of the oral microbiota. Is it really just exposure to maternal vaginal microbes that results in the difference between vaginally and Cesarian section‐born infants? Then, we review the postnatal phase, in which we focus on transmission of microbes, the intraoral niche specificity, the effects of the host behavior and environment, as well as the role of genetic background of the host on shaping the oral microbial ecosystem. We discuss the changes in oral microbiota during the transition from deciduous to permanent dentition and during puberty. We also address the finite knowledge on colonization of the oral cavity by microbes other than the bacterial component. Finally, we identify the main outstanding questions that limit our understanding of the acquisition and establishment of a healthy microbiome at an individual level.

Causal Effect of Tooth Loss on Functional Capacity in Older Adults in England: A Natural Experiment

BACKGROUND/OBJECTIVES

Tooth loss is associated with reduced functional capacity, but so far, there is no relevant causal evidence reported. We investigated the causal effect of tooth loss on the instrumental activities of daily living (IADL) among older adults in England.

DESIGN

Natural experiment study with instrumental variable analysis.

SETTING

The English Longitudinal Study of Aging (ELSA) combined with the participants' childhood exposure to water fluoride due to the community water fluoridation.

PARTICIPANTS

Five thousand six hundred and thirty one adults in England born in 1945-1965 participated in the ELSA wave seven survey (conducted in 2014-2015; average age: 61.0 years, 44.6% men).

MEASUREMENTS

The number of natural teeth predicted by the exogenous geographical and historical variation in exposure to water fluoride from age 5 to 20 years old (instrumental variable) was used as an exposure variable. The outcome, having any limitations in IADL (preparing a hot meal, shopping for groceries, making telephone calls, taking medications, doing work around the house or garden, or managing money), was assessed by self-reported questionnaires.

RESULTS

Linear probability model with Two-Stage Least Squares estimation was fitted. Being exposed to fluoridated water was associated with having more natural teeth in later life (coefficient: 0.726; 95% confidence interval (CI) = 0.311, 1.142; F = 11.749). Retaining one more natural tooth reduced the probability of having a limitation in IADL by 3.1 percentage points (coefficient: -0.031; 95% CI = -0.060, -0.002).

CONCLUSION

Preventing tooth loss maintains functional capacity among older adults in England. Given the high prevalence of tooth loss, this effect is considerable. Further research on the mechanism of the observed causal relationship is needed.

Identifying heterogeneity in the risk factors of dental caries status in Chinese adolescents using Poisson mixture regression

OBJECTIVE

The purpose of this study was to cluster individuals into groups with different dental health characteristics and make statistical inferences on the effect differences among different groups simultaneously to identify the heterogeneity of risk factors in Chinese adolescents by analysing the data from the 4th Chinese National Oral Health Survey.

METHODS

For decayed, missing and filled permanent teeth (DMFT), mean values were statistically analysed for their relationships with different categories of all involved variables. As DMFT scores only have discrete values, Poisson mixture regression was adopted to model the heterogeneity and complex patterns in the association and to detect the subgroup. The Bayesian information criterion (BIC) was used to determine the optimal number of subgroups. A series of Wald tests were used to explore the relationship between risk factors including the interaction effects and the number of DMFT.

RESULTS

A total of 100 986 individuals aged 12-15 years old were analysed. The model clustered different individuals into three subgroups and built three submodels for detailed statistical inference simultaneously. The number of individuals in the three subgroups were 52 576 (52.1%), 41 969 (41.5%) and 6441 (6.4%), respectively. The mean (SD) of DMFT of the three subgroups was 0.50 (1.05), 0.99 (1.21), 5.59 (2.50). The model fitting results indicated that the effects of all risk factors on DMFT appear to be different in three subgroups. Controlling the confounding effects, our analysis implied that the regional inequality was the main contributing factor to dental caries among adolescents in Chinese mainland.

CONCLUSIONS

The risk factors of dental caries exhibited heterogeneity in groups with different characteristics. The Poisson mixture regression model could cluster individuals into groups and identify the heterogeneous effects of risk factors among different groups. The findings support the need for different targeted interventions and prevention measures in groups with different dental health characteristics.

Oral health status, behaviours, food and beverage consumption of aboriginal children in Australia

ISSUE ADDRESSED

Dental decay is prevalent among Australian Aboriginal children, yet little is known about their oral health-related behaviours. This study explored the oral health status, behaviours, food and beverage consumption of Aboriginal school children aged 7-9 years in Sydney, Australia.

METHODS

Parents who were part of an existing longitudinal birth cohort ("Gudaga") were surveyed when their child was between 7 and 9 years. Children (n = 110) also received oral health screening by a trained nurse.

RESULTS

A number of children (62%-91%) had at least one visible oral health problem across the 2 years. Around two thirds (62%-67%) of parents rated their child's oral health as excellent/very good and less than half the children (32%-45%) had received dental check-ups. Most children (79%-90%) brushed their teeth and drank water (97%) but more than half (57%-70%) also drank sugar sweetened beverages daily.

CONCLUSIONS

Parents are instilling good oral health behaviours, however, the oral health screening suggests children are experiencing oral health issues of which parents may be unaware. Parents also seem to be unaware of beverage consumption practices that can increase the risk of childhood decay. SO WHAT?: The findings highlight the need for greater oral health awareness among Aboriginal families on how to recognise early symptoms dental decay and risk factors like sugar sweetened beverages among school going children. This suggests that existing health promotion strategies may not be reaching many Aboriginal families in the urban areas and more culturally appropriate programs may be needed.

Dental Caries Pattern and Treatment Needs among Ugandan Adolescent Students: A Cross-Sectional Study

Dental caries is still a major public health problem owing to its high prevalence and incidence in several regions. Planning and development of effective preventive and treatment modalities for the management of dental caries demand information on disease pattern and treatment needs of the populations. However, there is a paucity of this information in Uganda. The aim of the present study was to identify the dental caries pattern and treatment needs among Ugandan adolescent students. This was a descriptive cross-sectional study conducted among 11- to 19-year-old adolescents attending two secondary schools in Kampala and Mukono districts of Uganda. At both schools, random sampling was used to select the participating classes and the adolescents. Decayed teeth and treatment needs were recorded using the World Health Organization Basic Oral Health Survey criteria. A total of 406 adolescents comprising of 249 female and 157 male students participated in the study. Data were analysed using STATA, version 12.0. The prevalence of decayed teeth (DT) was expressed as a percentage of individuals with DT score ≥1. The treatment needs were categorised into three groups. Associations between dependent and independent variables were evaluated using cross-tabulation, chi-square test, and Poisson regression analysis. The overall prevalence of decayed teeth was 62.6% and mean DT was 1.7 ± 2.3. A total of 696 decayed teeth were observed, and the molar teeth, particularly the second molar (50.6%), were the most significantly affected. The prevalence of caries was higher in the mandible (51.4%) compared to the maxilla though the difference was not statistically significant. Decayed teeth were significantly (p < 0.05) associated with difficulty in chewing, history of dental pain in the past 12 months, poor perception of tooth state, and the female participants. Majority (59.4%) of the study participants required restorations of teeth. About 83.2% (n = 579) of the teeth needed restorations, while 44 needed extractions. In conclusion, the prevalence of decayed teeth was high among the study population. It is recommended that school health programmes should include oral health preventive and curative interventions to achieve optimum health.

Maternal anxiety, social status, and dental caries formation in children: a cross-sectional study

Objective

We sought to evaluate the association of maternal anxiety and social status with caries formation in children.

Methods

Participants comprised 258 pairs of children and their mothers. We collected information regarding age, sex, birth order of children, and mothers’ education and marital status using a questionnaire. The Spielberger Trait Anxiety Inventory was used to determine maternal trait anxiety levels. The children underwent oral examination. Total values for decayed, missing, filled, and total permanent/primary teeth (DMFT/dmft) were evaluated according to standards of the World Health Organization.

Results

No significant relationship was found between the mother's anxiety level and DMFT/dmft scores in their children. A negative correlation was observed between the child’s age and dental caries in children. The sex of the child, mother's education level, and marital status of the mother showed a weak negative correlation with the number of dental caries observed in their children.

Conclusion

Although social, economic, and environmental factors might contribute substantially to the development of dental caries, we failed to demonstrate a clear relationship between maternal anxiety and social status and dental caries in children. We can therefore conclude that biological factors are decisive in the formation of dental caries among children.

Low birth weight and the delay on the eruption of deciduous teething in children

Abstract Objectives: To analyze the association between low birth weight (LBW) and the occurrence of the delay on the eruption of deciduous teething (DEDT) in children from 04 to 30 months, living in Salvador, Bahia. Methods: A cross-sectional study involved 520 children at four to thirty months of age, from public, private and philanthropic daycares from two districts in Salvador. A descriptive analysis and unconditional logistic regression were done to estimate the odds ratios (ORs), using the Confidence Interval of 95% as a criterion for accepting associations. Poisson regression was used as an analytical strategy to obtain the prevalence ratio. Results: the prevalence of the delay on the eruption was 10.29%. There was a positive association between LBW and occurrence of DEDT among children with less than 24 months, both in the unadjusted model (PR=2.07, 95%CI= 0.96 4.44) as in the adjusted (adjusted PR=2, 27, 95%CI= 1.02 5.07). Conclusions: the variables of development and nutritional at birth and during the early life may be important predictors of the chronology of eruption. Further investigations should be carried out towards the adequate evaluation of the LBW role in the occurrence of the delay on the eruption.

Contribution of Oral Hygiene and Cosmetics on Contamination of Gluten-free Diet: Do Celiac Customers Need to Worry About?

OBJECTIVES

The only available treatment for celiac disease (CD) is the gluten-free diet. It is unclear whether the presence of gluten in oral hygiene products and cosmetics that are applied on the mouth is a reason of concern for CD patients. The aim of this study was to test the level of gluten contamination in oral hygiene and cosmetic products available in the Italian market.

METHODS

A total of 66 products (toothpastes = 37; dental tablets = 2; mouthwashes = 5; lip-balms = 10; lipsticks = 12) labelled gluten-free or with unknown gluten content were randomly collected from different supermarkets and pharmacies. The gluten quantification was determined by the R5 ELISA method approved by EU regulations.

RESULTS

Out of 66 oral hygiene and cosmetics, 62 products (94%) were found to be gluten-free (gluten level <20 ppm), while 4 (6%) (toothpastes = 3; lipsticks = 1) showed a gluten level >20 ppm (toothpastes: 20.7, 31.4, and 35 ppm; lipstick: 27.4 ppm). None of the selected products had ingredient derived from wheat, barley, or rye.

CONCLUSIONS

Gluten contamination is currently not an issue in a wide array of cosmetic and oral hygiene products that are commonly in the market.

Secular trends 2013-2017 in overweight and visible dental decay in New Zealand preschool children: influence of ethnicity, deprivation and the Under-5-Energize nutrition and physical activity programme

Early-life intervention to reduce obesity and poor dental health through early-life nutrition will improve health outcomes in later life. This study examined the prevalence of overweight and obesity and visual dental decay in 4-year old children in New Zealand between 2013 and 2017, and the impact of a nutrition and physical activity intervention programme, Under-5-Energize (U5E), on prevalence of these conditions within ethnic groups and by deprivation. The data set included 277,963 4-year-old children, including 25,140 from the Waikato region children of whom 8067 attended one of the 121 early childhood centres (ECC) receiving the U5E programme from 2014. Purposively the U5E-ECC selected were attended by higher proportions of indigenous Māori children and children living in higher deprivation areas than non-U5E-ECC. From 2013 to 2017, the overall prevalence of obesity, as defined by World Health Organisation criteria, declined slightly but rates of dental decay did not change. In the Waikato region, the prevalence of obesity declined in non-Māori children from 2015 to 2017 and children attending U5E-ECC had lower rates of dental decay than non-U5E children. Binary logistic regression showed that between 2015 and 2017 visible dental decay was more likely in children who were Māori (3.06×3.17), living in high deprivation (1.54×1.66) and male (1.10) but less likely if attending an U5E-ECC (0.83×0.79). Early-life intervention had efficacy at reducing dental decay, and demonstrated that the origins of disparities in health such as ethnicity and deprivation need to be addressed further to break the intergenerational cycles of poor health.

Consortium-based genome-wide meta-analysis for childhood dental caries traits

Prior studies suggest dental caries traits in children and adolescents are partially heritable, but there has been no large-scale consortium genome-wide association study (GWAS) to date. We therefore performed GWAS for caries in participants aged 2.5-18.0 years from nine contributing centres. Phenotype definitions were created for the presence or absence of treated or untreated caries, stratified by primary and permanent dentition. All studies tested for association between caries and genotype dosage and the results were combined using fixed-effects meta-analysis. Analysis included up to 19 003 individuals (7530 affected) for primary teeth and 13 353 individuals (5875 affected) for permanent teeth. Evidence for association with caries status was observed at rs1594318-C for primary teeth [intronic within ALLC, odds ratio (OR) 0.85, effect allele frequency (EAF) 0.60, P 4.13e-8] and rs7738851-A (intronic within NEDD9, OR 1.28, EAF 0.85, P 1.63e-8) for permanent teeth. Consortium-wide estimated heritability of caries was low [h2 of 1% (95% CI: 0%: 7%) and 6% (95% CI 0%: 13%) for primary and permanent dentitions, respectively] compared with corresponding within-study estimates [h2 of 28% (95% CI: 9%: 48%) and 17% (95% CI: 2%: 31%)] or previously published estimates. This study was designed to identify common genetic variants with modest effects which are consistent across different populations. We found few single variants associated with caries status under these assumptions. Phenotypic heterogeneity between cohorts and limited statistical power will have contributed; these findings could also reflect complexity not captured by our study design, such as genetic effects which are conditional on environmental exposure.

Effects of Papacarie on children with dental caries in primary teeth: a systematic review and meta-analysis

BACKGROUND

Caries in primary teeth hinder the child to bite and chew and influence their development. Papacarie has the characteristics of selective removal of decayed tissue and can preserve healthy dentine to the maximum, but its efficiency has not been critically evaluated compared to conventional method.

AIM

This review is aiming at comparing the Papacarie and traditional method in caries removal in primary dental caries with children.

DESIGN

Comprehensive literature searching at PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science to January 2018.

RESULTS

Six randomized controlled trials (RCTs) and four prospective controlled clinical trials (CCTs) were included. The microbiota in caries dentine was significantly reduced using the Papacarie treatment (MD = 0.57, 95% CI 0.04 to 1.09, P = 0.03), and the anxiety feeling declined more in the Papacarie group (MD = -1.01, 95% CI -1.72 to -0.30, P < 0.005). There was a greater 200.79 (MD = 200.79, 95%CI 152.50 to 249.09, P < 0.00001) increase in time taken for the Papacarie treatment compared with the conventional method.

CONCLUSION

Papacarie exerts a positive effect in reducing the bacteria and decreases the pain during caries removal in primary teeth although it costed a longer treatment time compared with the conventional method.

Dental Caries Status and Caries Risk Factors in Students Ages 12-14 Years in Zhejiang, China

Background

An accurate and valid caries prevention policy is absent in Zhejiang because of insufficient data. Therefore, the aim of this study was to investigate oral health status and related risk factors in 12- to 14-year-old students in Zhejiang, China.

Material/Methods

Using multi-stage, stratified, random sampling, we recruited a total of 4860 students aged 12 to 14 years old from 6 regions in Zhejiang in this cross-sectional study. Dental caries was measured using the Decayed, Missing and Filled Teeth (DMFT) index and the Significant Caries Index (SiC). Information concerning family background and relevant behaviors was collected in a structured questionnaire. Logistic regression analysis was used to study risk factors related to dental caries.

Results

The overall prevalence of dental caries was 44% and the mean DMFT and SiC scores were 1.14 and 3.11, respectively. Female students had a higher level of dental caries than male students (P<0.01). The annual increase in caries prevalence was 3% with increasing age, and the DMFT score was 0.15. The results of logistic regression analysis showed that female sex, older age, snacks consumption once or more per day, fair or poor self-assessment of dental health, toothache experience, and dental visits were the most significant risk factors for dental caries, with odds ratios ranging from 1.24 to 2.25 (P<0.01).

Conclusions

The prevalence of dental caries in 12- to 14-year-old students in Zhejiang was low, with a tendency to increase compared with previous oral surveys. Female sex, older age, increased sugar intake, poor oral health self-assessment, and bad dental experience were the most important factors increasing dental caries risks.

Enamel Microcracks Induced by Simulated Occlusal Wear in Mature, Immature, and Deciduous Teeth

Enamel wear, which is inevitable due to the process of mastication, is a process in which the microcracking of enamel occurs due to the surface contacting very small hard particles. When these particles slide on enamel, a combined process of microcutting and microcracking in the surface and subsurface of the enamel takes place. The aim of this study was to detect microscopic differences in the microcrack behavior by subjecting enamel specimens derived from different age groups (immature open-apex premolars, mature closed-apex premolars, and deciduous molars) to cycles of simulated impact and sliding wear testing under controlled conditions. Our findings indicated that the characteristics of the microcracks, including the length, depth, count, orientation, and relation to microstructures differed among the study groups. The differences between the surface and subsurface microcrack characteristics were most notable in the enamel of deciduous molars followed by immature premolars and mature premolars whereby deciduous enamel suffered numerous, extensive, and branched microcracks. Within the limitations of this study, it was concluded that enamel surface and subsurface microcracks characteristics are dependent on the posteruptive age with deciduous enamel being the least resistant to wear based on the microcrack behavior as compared to permanent enamel.

Does dental caries affect dental development in children and adolescents?

Although a link between dietary changes, caries, and dental development has been observed, the literature provides little insight about this relationship. The aim of our study was to investigate the association between dental caries and dental development in a clinical sample of Albanian children and adolescents. In total, 118 children and adolescents, born between 1995 and 2004 and aged 6-15 years, were included. Dental caries in the deciduous dentition was assessed using the Decayed, Filled Teeth (dft) index and dental caries in the permanent dentition was assessed using the Decayed, Missing, Filled Teeth (DMFT) index. Dental development during the permanent dentition was determined using the Demirjian method. Linear and ordinal regression models were applied to analyze the associations of dental caries with dental age and developmental stages of each left mandibular tooth. Dental caries in the deciduous dentition, estimated as a median dft of 2.0 (90% range, 0.0-9.1), was significantly associated with lower dental age (β = -0.21; 90% CI: -0.29, -0.12) and with delayed development of the canine, both premolars, and the second molar. Untreated dental caries (dt) was associated with lower dental age (β = -0.19; 90% CI: -0.28, -0.10). Dental caries in the permanent dentition, estimated as a median DMFT of 1.0 (90% range, 0.0-8.0), was not significantly associated with dental age (β = 0.05; 90% CI: -0.04, 0.14). However, the DMFT was associated with the advanced stages of development of both premolars and the second molar. The untreated dental caries in the deciduous dentition delays the development of permanent teeth.

A microCT Study of Three-Dimensional Patterns of Biomineralization in Pig Molars

Domestic pig molars provide an interesting system to study the biomineralization process. The large size, thick enamel and complex crown morphology make pig molars relatively similar to human molars. However, compared to human molars, pig molars develop considerably faster. Here we use microCT to image the developing pig molars and to decipher spatial patterns of biomineralization. We used mineral grains to calibrate individual microCT-scans, which allowed an accurate measure of the electron density of the developing molars. The microCT results show that unerupted molars that are morphologically at the same stage of development, can be at markedly different stage of enamel biomineralization. Erupted molars show increased electron density, suggesting that mineralization continues in oral cavity. Yet, our comparisons show that human enamel has slightly higher electron density than pig enamel. These results support the relatively low hardness values and calcium level values that have been reported earlier in literature for pig teeth. The mineral calibration was an efficient method for the microCT-absorption models, allowing a relatively robust way to detect scanning artifacts. In conclusions, whereas thin sections remain the preferred way to analyze enamel features, such as incremental lines and crystal orientation, the microCT allows efficient and non-destructive comparisons between different teeth and species.

Factors Associated with Dental Caries in Primary Dentition in a Non-Fluoridated Rural Community of New South Wales, Australia

Dental caries persists as one of the most prevalent chronic diseases among children worldwide. This study aims to determine factors that influence dental caries in primary dentition among primary school children residing in the rural non-fluoridated community of Lithgow, New South Wales, Australia. A total of 495 children aged 5–10 years old from all the six primary schools in Lithgow were approached to participate in a cross-sectional survey prior to implementation of water fluoridation in 2014. Following parental consent, children were clinically examined for caries in their primary teeth, and parents were requested to complete a questionnaire on previous fluoride exposure, diet and relevant socio-demographic characteristics that influence oral health. Multiple logistic regression analysis was employed to examine the independent risk factors of primary dentition caries. Overall, 51 percent of children had dental caries in one or more teeth. In the multiple logistic regression analysis, child’s age (Adjusted Odd’s Ratio (AOR) = 1.30, 95% CI: 1.14–1.49) and mother’s extraction history (AOR = 2.05, 95% CI: 1.40–3.00) were significantly associated with caries experience in the child’s primary teeth. In addition, each serve of chocolate consumption was associated with 52 percent higher odds (AOR = 1.52, 95% CI: 1.19–1.93) of primary dentition caries.

Risk factors for dental problems: Recommendations for oral health in infancy

Primary care providers, gynaecologists and paediatricians have to be aware of the importance of oral health in infancy and possible consequences for child's development, growth, health and quality of life. Oral diseases, particularly dental caries, developmental defects of the dental tissues and periodontal or orthodontic issues have a complex and interrelated aetiology with common, primarily behavioral based risk factors. A sugar-rich diet is the key risk factor with detrimental consequences for general and oral health, particularly in combination with an insufficient oral hygiene. Therefore, daily tooth brushing with fluoride toothpaste and reducing of sugar intake are the key pillars to prevent oral diseases, including a positive effect on numerous chronic diseases. Future preventive approaches should focus on pregnant women and mothers of infants with a common vision of health and a shared responsibility for children's oral health care to promote healthy lifestyles and self-care practices in families.