Preventive dentistry for the general dental practitioner

Physical and chemical properties of saliva and its role in Early Childhood caries - A systematic review and meta-analysis

Background

Early Childhood Caries is a chronic disease of childhood and salivary parameters are considered as one of the prime etiological factors of Early Childhood Caries.

Aim

To develop a systematic review based on the relation between physical and chemical properties of saliva and Early childhood caries by comparing children with and without Early childhood caries.

Methods

PubMed, Cochrane, Lilacs, Embase, Scopus, and additional manual search was done up to April 2021 to identify the original cross-sectional observational studies published in English. The risk of bias and quality of the included papers were assessed based on New castle Ottawa guidelines.

Results

From a total of 1709 identified studies, only 22 articles were included in this systematic review and 10 studies were qualified for meta-analysis. Eight studies were classified as ''moderate risk of bias'' and fourteen studies were classified as ''high risk of bias''.

Conclusion

There was a significant difference in physical and chemical properties of saliva in children with and without Early childhood caries. Since wide disparity were evident in available studies, further studies are needed to arrive to a definitive conclusion.

Impact of Dentistry Materials on Chemical Remineralisation/Infiltration versus Salivary Remineralisation of Enamel-In Vitro Study

The aim of this study is to evaluate salivary remineralisation versus chemical remineralisation/infiltration of enamel, using different dentistry materials. The enamel changes were studied using confocal laser scanning microscopy (CLSM), and the depth of lesions and demineralisation/remineralisation/infiltration percentage were calculated. Additionally, the macro elemental composition of the teeth was performed using atomic absorption spectroscopy (AAS). Two studies were performed: (i) demineralisation of enamel in 3% citric acid and infiltration treatment with infiltration resin (Icon, DMG), remineralisation with Fluor Protector (Ivoclar Vivadent) and artificial saliva pH 8; and (ii) enamel demineralisation in saliva at pH 3 and remineralisation at salivary pH 8. The results showed that, firstly, for the remineralisation of demineralised enamel samples, Fluor Protector (Ivoclar Vivadent) was very effective for medium demineralised lesions followed by saliva remineralisation. In cases of deep demineralisation lesions where fluoride could not penetrate, low viscosity resin (Icon, DMG, Hamburg) effectively infiltrated to stop the demineralisation process. Secondly, remineralisation in salivary conditions needed supplementary study over a longer period, to analyse the habits, diet and nutrition of patients in detail. Finally, demineralisation/remineralisation processes were found to influence the macro elemental composition of enamel demineralisation, with natural saliva proving to be less aggressive in terms of decreasing Ca and Mg content.

Effect of Chlorhexidine and Probiotics on Halitosis

Objective:

The purpose of this study was to analyze the effect of chemical method of oral hygiene practice, chlorhexidine (CHX) disinfection, and the followed consumption of probiotics on oral malodor in children. The effects of chemical and mechanical oral hygiene practice methods on the intensity of oral malodor were also evaluated.

Materials and Methods:

Organoleptic test (OLT) scores of 2 or more of 196 children were randomly allocated to four groups: 1: Conventional oral hygiene practices (COH) including flossing and tooth brushing, 2: COH + tongue scraping (TS), 3: COH + TS + CHX, and 4: COH + TS + CHX + probiotics. OLT was performed at 1-week and 3-month follow-ups.

Results:

A stable and significant number of individuals showed crucial and average levels of improvement in Group 4 OLT scores. The improvement of Group 3 OLT scores was also remarkable but not steady over the follow-ups. Neither remarkable nor steady improvements in the OLT scores was detected in Groups 1 and 2 through follow-ups.

Conclusion:

Oral disinfection followed by probiotic therapy with CHX may decrease the severity of oral malodor over a long period of time.

Appetite, oral health and weight loss in community-dwelling older men: an observational study from the Concord Health and Ageing in Men Project (CHAMP)

Background

Unintended weight loss and the reduction in appetite are common phenomenon among older people. Reduced appetite has been linked to medication related reductions in saliva production, reduced taste ability and poor oral health. Poor appetite can result in reduced nutrient intake ensuing weight loss. It is possible that poor appetite is a mediating step on the causal pathway between oral health and weight loss. This study investigates whether poor oral health and loss of appetite are related to weight loss.

Methods

This is an observational study where data were obtained from the Concord Health and Ageing in Men Project (CHAMP). Information on socio-demographics, appetite and health related behavior was collected by self-completed questionnaire. Intraoral assessment was conducted by calibrated oral health therapists. Height and weight were measured by trained staff. Regression analysis investigated associations between oral health and appetite as risk factors for weight loss.

Results

Participants included 542 community dwelling older males. 99 older men (18.3%) experienced 5% or more weight loss over 3 years. Men who lost weight from baseline had lower BMI and lower body weight, had higher prevalence of frailty and depression, reported poorer appetite, and had fewer teeth (13.8 ± 9.5) than those who did not lose weight (16.3 ± 9.3). Before adjustment, the prevalence ratio (PR) for weight loss was 1.76 (95% Confidence Interval (CI), 1.19–2.59) for participants with 0–19 natural teeth present compared to those with 20 or more teeth. When adding appetite and other variables to the model, the PR for number of teeth and weight loss was unchanged: 1.78 (95% CI, 1.06–3.00). The mediation analysis showed that the indirect effect of appetite on the association between number of natural teeth on weight loss was not found to be significant.

Conclusion

This study found that number of natural teeth present and appetite are independently related to weight change among elderly men in Australia. Tooth loss can increase the risk of swallowing difficulty leading to change in food preference, avoidance of foods and a decrease in energy intake. Our study showed the importance of oral health interventions to encourage maintenance of 20 or more natural teeth in older people.

Acid Resistance of Glass Ionomer Cement Restorative Materials

In view of the need for aesthetics, restorations of teeth will typically be completed using tooth colored restorative materials. With the advent of biomimetic restorative materials, such as glass ionomer cements (GIC), much greater emphasis is now being placed on how well such materials can resist the challenge of acids that are present in foods and drinks, or gastric contents that are regurgitated. This laboratory study compared the dissolution and behavior of five GIC materials (GC Fuji® VII, GC Fuji® Bulk, GC Fuji® IX Fast, Fuji® IX Extra and GC Equia® Forte Fil) when exposed to three acids (citric acid, phosphoric acid and lactic acid), versus ultrapure deionized water, which was used as a control. Discs of each material GIC were submerged in solutions and percentage weight changes over time determined. Subsequently, the GIC materials were also placed as a part of standardized Class II sandwich restorations in bovine teeth (n = 20), and submerged in the solutions, and the extent of GIC dissolution and protection of the adjacent tooth was scored. Weight loss increased with time and with acid concentration. Overall, the most soluble material was GC Fuji® IX Extra, while GC Fuji® IX Fast and GC Fuji® Bulk were less soluble, and the least soluble material was GC Equia® Forte Fil. The most destructive solution for both the discs and for GIC restorations in teeth was 10% citric acid, while the least destructive acid was 0.1% lactic acid. The more recent GIC materials GC Fuji® Bulk and GC Equia® Forte Fil showed increased acid resistance over the older GIC materials, and this further justifies their use in open sandwich Class II restorations in more hostile environments.

Is there a place for Tooth Mousse in the prevention and treatment of early dental caries? A systematic review

Background

It is important for Dental Professionals to consider the evidence for the effectiveness of the preventive strategies used to maintain good oral health and reduce the risk of caries in their patients. Whilst many of the traditional preventive activities, including the recommendation and use of fluoride products and the placement of fissure sealants have a wealth of clinical evidence to support their use, some of the newer preventive agents have a more limited evidence base. In order to investigate the level of scientific support behind one such technology, a systematic literature review was carried out to assess the effectiveness of Tooth Mousse® (MI Paste®) and Tooth Mousse Plus® (MI Paste Plus®) in the prevention and treatment of early dental caries.

Methods

A broad search strategy using Medline via OvidSP and EMBASE was performed in order to capture all published studies to related Casein Phosphopeptide-Amorphous Calcium Phosphate. In addition to the above searches the terms “CPP ACP” and “casein phosphopeptide amorphous calcium phosphate” were searched using PREMEDLINE and the Cochrane Central Register of Controlled Trials. Inclusion criteria were clinical trials of participants of any age, comparing the use of Tooth Mousse® (MI Paste®) or Tooth Mousse Plus® (MI Paste Plus®) to a routine oral care regimen and reporting recognised clinical outcome measures for early caries lesions. Only research studies in English were selected.

Results

7576 articles were identified, but the majority were duplicates. Once these were removed 172 articles were inspected and the focus on ‘CPP-ACP formulations of Tooth Mousse® (MI Paste®) and Tooth Mousse Plus® (MI Paste Plus®) resulted in 29 articles being selected, and of these 12 studies met the inclusion criteria and were considered acceptable for the systematic review.

Discussion

The overall findings of this review did not show any significant benefits of using Tooth Mousse® (MI Paste®) products over brushing with a fluoride toothpaste for the prevention of early dental caries. With regard to the regression of white spot lesions in orthodontic patients there is a tendency towards a benefit for the use of Tooth Mousse® (MI Paste®) but the quality of evidence is limited. There is a lack of evidence to support the use of Tooth Mousse Plus® (MI Paste Plus®) over Tooth Mousse® (MI Paste®) at this time.

Conclusion

This review suggests that further well-designed randomized controlled trials are required prior to the widespread recommendation of Tooth Mousse® products for the prevention and treatment of early dental caries in the general population.

Electronic supplementary material

The online version of this article (doi:10.1186/s12903-015-0095-6) contains supplementary material, which is available to authorized users.

Oral manifestations of gastroesophageal reflux disease

Numerous case-control and other studies involving confirmation of gastroesophageal reflux disease (GERD) by esophageal pH-metry and the assessment of dental erosions have shown significant associations between the two conditions in both adults and children. By contrast, when asked to vote on whether GERD may cause dental erosions, only 42% of physicians strongly agreed that such an association existed in adults, and just 12.5% strongly agreed for children, respectively in two global consensus reports. Part of this divergence between the perceptions of physicians and the findings of research publications may reflect a general lack of oral health education during medical training, and cursory oral examinations being made under less-than-ideal conditions. Adequate salivary secretions are essential for the protection of the teeth and the oropharyngeal and esophageal mucosa. The quantity and quality of the saliva require monitoring as many drugs, including several of the proton pump inhibitors (PPIs), can cause hyposalivation. In addition, PPIs do not always result in adequate acid suppression. Therefore, collaboration between physicians and dentists is strongly advocated to prevent or ameliorate possible adverse oral effects from both endogenous and exogenous acids, and to promote adequate saliva production in patients with GERD.

A comparison of surface roughness after micro abrasion of enamel with and without using CPP-ACP: An in vitro study

AIM

The aim of this study was to evaluate the surface roughness of enamel after micro abrasion with and without using remineralization agent, CPP-ACP (Casein Phosphopeptide-Amorphous Calcium Phosphate).

MATERIALS AND METHODS

Thirty freshly extracted anterior teeth were collected. The samples were randomly assigned to two study and one control group. Group A (n = 10) containing teeth in which only micro abrasion was done, Group B (n = 10) containing teeth in which CPP-ACP (G C Tooth Mousse) was applied after micro abrasion for a period of 30 days, once daily for three minutes and Group C (n = 10) in which no preparation was done and which acted as the control group. The samples were stored in artificial saliva and evaluated after 30 days, using surface profilometer. The results were tabulated and statistically analyzed.

RESULTS

According to the results of this study, a combination of the micro abrasion procedure and CPP-ACP application reduced the enamel surface roughness significantly, when compared to micro abrasion done alone.

CONCLUSION

Application of CPP-ACP after micro abrasion procedure significantly reduces the enamel surface roughness thereby decreasing the risk of caries.

Changes in the oral cavity might reflect psychological disorders in some patients

AIM

The treatment of oral dysesthesias, such as burning mouth syndrome, can be challenging. Patient acceptance of the role of psychological etiological factors might be improved if there are clinical signs that patients could confirm themselves, which could be used as reinforcement of clinical discussions. Published associations between psychological disorder and various oral signs and symptoms are not suited to this purpose, as they are ambiguous in origin and implication. Others, used clinically in this situation, are not supported by published literature. Therefore, the purpose of this study was to determine if a demonstrable relationship could be established between psychological profile and the appearance and function of the oral cavity.

METHODS

Seventy-nine participants underwent an oral examination and completed a Depression Anxiety Stress Scale-21 questionnaire. Correlations were calculated between clinical variables and the raw Depression Anxiety Stress Scale scores. Univariate analyses determined variables with significant differences between a high-risk and normal group, and multiple logistic regression models were calculated for these.

RESULTS

Various oral signs and symptoms were found to correlate with depression, anxiety, and/or stress, with some predictive of psychological disturbance.

CONCLUSIONS

These signs and symptoms might be used to reinforce the psychological aspects of an oral dysesthesia.

Sodium bicarbonate solution as an anti-erosive agent against simulated endogenous erosion

This study investigated whether sodium bicarbonate solution, applied on enamel previously exposed to a simulated intrinsic acid, can control dental erosion. Volunteers wore palatal devices containing enamel slabs, which were exposed twice daily extra-orally to hydrochloric acid (0.01 M, pH 2) for 2 min. Immediately afterwards, the palatal devices were re-inserted in the mouth and volunteers rinsed their oral cavity with a sodium bicarbonate solution or deionized water for 60 s. After the washout period, the palatal devices were refilled with a new set of specimens and participants were crossed over to receive the alternate rinse solution. The surface loss and surface microhardness (SMH) of specimens were assessed. The surface loss of eroded enamel rinsed with a sodium bicarbonate solution was significantly lower than the surface loss of eroded enamel rinsed with deionized water. There were no differences between treatments with sodium bicarbonate and deionized water for SMH measurements. Regardless of the solution used as an oral rinse, eroded enamel showed lower SMH than uneroded specimens. Rinsing with a sodium bicarbonate solution after simulated endogenous erosive challenge controlled enamel surface loss but did not alter the microhardness.

Clinical assessment and management of the oral environment in the oncology patient

The dental care of oncology patients is an important component of general dental practice. Oncology patients have additional requirements for their outpatient care in the dental office. Intense involvement of the general dental practitioner in the patient's overall plan of care is essential so that appropriate preventive and therapeutic strategies are followed prior to chemotherapy, radiation and other medical treatments. This paper provides an overview of the role of the dental practitioner in the pre-treatment workup and post-treatment maintenance of oncology patients, and discusses the complications which occur during the intensive and in-hospital phases of care, in the context of approaches that show promise for reducing or preventing these. The role of the general dental practitioner in the maintenance of oral health for the remainder of the patient's life is stressed, with evidence-based recommendations given for optimal use of home care products which support oral health and improve quality-of-life.

Sugar-free chewing gum and dental caries: a systematic review

Objective:

To appraise existing evidence for a therapeutic / anti-cariogenic effect of sugar-free chewing gum for patients.

Method:

9 English and 2 Portuguese databases were searched using English and Portuguese keywords. Relevant articles in English, German, Portuguese and Spanish were included for review. Trials were excluded on lack of randomisation, control group, blinding and baseline data, drop out rate >33%, no statistical adjustment of baseline differences and no assessment of clinically important outcomes. Reviews were excluded on lack of information, article selection criteria, search strategy followed, search keywords, searched databases or lack of study-by-study critique tables. In cases of multiple reports from the same study, the report covering the longest period was included. Two reviewers independently reviewed and assessed the quality of accepted articles.

Results:

Thirty-nine articles were included for review. Thirty were excluded and 9 accepted. Of the 9 accepted, 2 trials of reasonable and good evidence value did not demonstrate any anti-cariogenic effect of sugar-free chewing gum. However, 7 articles, with 1 of strong, and 6 of good evidence value, demonstrated anti-cariogenic effects of chewing Sorbitol, Xylitol or Sorbitol/Xylitol gum. This effect can be ascribed to saliva stimulation through the chewing process, particularly when gum is used immediately after meals; the lack of sucrose and the inability of bacteria to metabolize polyols into acids.

Conclusion:

The evidence suggests that sugar-free chewing gum has a caries-reducing effect. Further well-designed randomised trials are needed to confirm these findings.

Effects of Oral Health Care on Salivary Flow Rate in Patients With Type 2 Diabetes

The purpose of this study is to evaluate the effects of the authors' oral health care program on the stimulated whole salivary flow rate and buffer capacity before and after a 6-month intervention. The authors conducted the intervention study among 25 participants with diabetes. The salivary flow rate and buffer capacity were evaluated before and after this intervention. Overall, the results showed a significant increase in salivary flow rate and no significant change in buffer capacity. Also, it was likely that salivary flow rate significantly increased among patients with more than 20 remaining teeth and patients with well-controlled diabetes. The findings suggest that this program for type 2 diabetes led to an increase in the stimulated whole salivary flow rate.

Defining, classifying, and placing incipient caries lesions in perspective

A caries lesion begins with the introduction of a disease state, likely due to bacterial strains, in the oral cavity. If accompanied or followed by alterations to salivary flow, frequent periods of reduced salivary pH, or frequent intake of refined carbohydrates, the demineralization of tooth structure is likely to begin. The subsequent lesions first will be visible as white spot lesions, which if ignored, eventually will cavitate. Modern dentistry is capable of testing for the presence of caries lesions before cavitation, and it is suggested that routine testing should be mandatory for all patients who are at risk. If the disease is to be identified and treated before cavitation, it is desirable to adopt a new classification for the recognition and recording of caries lesions.

Dental health of dentists' children in Mongolia

OBJECTIVES

To describe the dental health of dentists' children, to evaluate its association with their dentist-parents' background and work-related characteristics and to compare it with that of children in the general population in Mongolia.

DESIGN

Cross-sectional survey, questionnaire-based data.

SUBJECTS

Dentists' children, aged 3-13 years.

SAMPLE

All dentists (n = 250) actively practising in the capital city of Mongolia.

RESULTS

The dentists' children's dmft ranged from 0 to 12, and DMFT from 0 to 8; 50% were caries-free. The younger the children, the higher was their total caries experience expressed as the sum of DMFT + dmft scores (r = -0.22; P = 0.001). Dentist-parents' background and work-related factors were not associated with their children's caries status (P > 0.05). When dentists' children were compared with their counterparts at the population level, mean dmft for 6-year-olds was 2.6 for (urban) dentists' children, 6.5 for children in the urban population and 0.9 for those in rural population of equivalent age. Mean DMFT for 12-year-olds were 1.0, 1.8 and 1.2, respectively, in the same three groups. In general, (urban) dentists' children in all age groups had better dental health than did their urban counterparts at the population level. Among 5-7-year-olds, dentists' children had worse dental health than did their counterparts in the rural population.

CONCLUSIONS

Despite the dentists' knowledge and awareness, their children demonstrated higher rates of dental caries than expected. This suggests that Mongolian dentists may have insufficient preventive orientation. In particular, the primary dentition of younger children seems to be poorly valued. In Mongolia, dentists should have better training and education in modern methods of caries prevention and their advantages. Appreciation and care of the primary dentition need to be improved at all levels of oral health promotion in Mongolia.