Management of periodontal health in children: pediatric dentistry and periodontology interface

Discriminant validity of the current gingivitis classification in adolescents: a cohort study

OBJECTIVES

To compare the prevalence of gingivitis estimated by the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) classification with the other case definitions and assess the ability of this classification system in discriminating sociodemographic and clinical factors associated with the presence of gingivitis in a cohort study.

MATERIALS AND METHODS

A multistage random sample of 1134 12-year-old adolescents was submitted to a full-mouth examination according to the Community Periodontal Index. Socioeconomic and clinical variables were collected at baseline. Gingivitis was considered according to the following criteria: (a) ≥ 10% of bleeding sites (the 2018 EFP/AAP criteria); (b) ≥ 15% of bleeding sites; and (c) the mean full-mouth bleeding sites. Adjusted multilevel Poisson regression assessed the association between independent variables at baseline and each definition of gingivitis at 2-year follow-up.

RESULTS

Seven hundred forty-two 14-year-old adolescents were re-revaluated at follow-up. The prevalence of gingivitis was 28.7% according to 10% of bleeding threshold. The 2018 EFP/AAP criteria and other definitions showed higher prevalence and mean of gingivitis for low-household income adolescents and for those with higher levels of dental plaque and untreated dental caries. Nonetheless, the highest strengths of association were observed for the threshold of ≥ 15% of bleeding sites.

CONCLUSION

The 2018 EFP/AAP case definition of gingivitis showed a similar discriminant validity compared to the 15% threshold and the mean full-mouth bleeding sites.

CLINICAL RELEVANCE

The 2018 EFP/AAP classification allows the discrimination of important risk factors and should be used for the establishment of priorities for large-scale therapeutic programs.

Investigation of the oral microbiome of children associated with dental caries: A systematic study

OBJECTIVE

The present study aims to investigate the variations in dental caries (DC) related microbiome abnormality and metabolomics shift in children.

DESIGN

The patients were divided into two groups healthy control (C) and highly affected DC children based on inclusion and exclusion criteria. Saliva samples were collected and used for the taxonomic and functional characterization of oral microbiota.

RESULTS

Metatranscriptomics analysis revealed the alterations and composition of oral microbiota in the C and DC groups. Relative abundance in the C group was associated with Firmicutes, Actinobacteria, and Bacteroidetes. Whereas, the microbial composition in the DC group was found to be considerably altered with increases in the abundance of the Proteobacteria (25%), Fusobacteria (15%), and Cyanobacteria (8%) while decreases in the abundance of Firmicutes (10%) and Bacteroidetes (23%). Alterations in the phylum composition were positively and negatively correlated with several metabolites of sugars (such as fructose, sorbose, ribose, allose, and mannose) and amino acids (such as arginine, lysine, tryptophan, and proline). Moreover, in comparison with the C group, the metabolic shift of the DC group was different with an increase in certain tricarboxylic acid cycle intermediates levels, and a decrease in fatty acid. Such alterations can enhance the growth of oral pathogens and contribute to DC development.

CONCLUSIONS

The findings of this study suggest that an altered abundance of Actinobacillus, Fusobacterium, and Shuttleworthia can serve as biomarkers of DC in children.

High prevalence of periodontitis in children and adolescents with type 2 diabetes

BACKGROUND

The aim of the present study was to determine the prevalence of periodontitis in children and adolescents with type 2 diabetes, and if poor glycemic control is associated with increasing prevalence of the disease.

METHODS

This is a cross-sectional study involving children and adolescents with type 2 diabetes. A questionnaire related to oral health care history and oral health behaviors was administered to each participant and they then underwent a full-mouth oral evaluation. In addition, clinical and metabolic parameters were extracted from the clinical chart.

RESULTS

One hundred and twenty one children and adolescents (8-17 years, 11 months) participated. Overall, 45.5% presented some degree of periodontitis, with 10 (8.3%) mild, 36 (29.8%) moderate, and nine (7.4%) severe. The periodontitis group (PD-group) had higher mean gingival and plaque indexes, periodontal probing depth, and clinical attachment loss than the group without periodontitis (NoPD-group) (p<0.05). A statistically significant relationship between the prevalence of periodontitis and glycosylated hemoglobin (HbA1c) was verified in the bivariate (odds ratio [OR] 1.31 [95% CI, 1.13-1.53], p = 0.001) and multivariate (OR, 1.29 [95% CI, 1.03-1.61], p = 0.03) analysis. For the adjustment variables, associations were verified for duration of diabetes, age, body mass index z-score, lack of running water, insulin use, and acanthosis nigricans.

CONCLUSIONS

Children and adolescents with type 2 diabetes presented high rates of periodontitis comparable with that seen in previous studies in youth with diabetes. Uncontrolled HbA1c influences prevalence of periodontal disease. The lack of matched control group and radiographs are limitations of the study. Comprehensive periodontal examination is essential for children and adolescents with type 2 diabetes to prevent, identify, and treat periodontitis early.

Express Diagnostics of Proteolytic Activity of Periodontopathogens-Methodological Approach

The species spectrum of the oral microbiome is considered to be the key factor in the development and progression of periodontal inflammatory disorders. The “red complex” including Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola has the highest pathogenic potential. These bacteria have several biochemical mechanisms that allow them to colonize and destroy periodontal tissues. Proteolytic enzymes play a crucial role in this process. Early diagnosis of pathological conditions induced by microbial contamination allows for the timely treatment of periodontitis. Otherwise, the development of the disease may lead to tooth loss. A total of 48 patients aged 18 to 65 years old who required professional oral hygiene were recruited for this clinical study. Microbial content analysis of dental plaque from the interdental space and the back of the tongue was performed using real-time PCR. To determine the proteolytic activity of oral bacteria, the new express diagnostic method was applied (diagnostic sensitivity, 0.875; specificity, 0.928). The results demonstrate a strong and significant correlation between the new method and the PCR analysis (r = 0.785, p < 0.001). These results show that the new express method can be valuable as an early diagnostic method for periodontal inflammatory disorders caused by the “red complex” bacteria.

Self-perception of periodontal health and pain experience during periodontal examination in 14- to 15-year-old Danish adolescents

OBJECTIVE

To evaluate different aspects of periodontal examination among Danish adolescents.

MATERIALS AND METHODS

In all, 521 Danish adolescents underwent a periodontal examination and answered a questionnaire concerning their self-perception of periodontal health (PH). Furthermore, 107 participants reported their pain experience during periodontal examination using a visual analog scale. The self-perception of PH and the pain experience were correlated with plaque score (PS), bleeding on probing (BOP), probing pocket depth (PPD), and interdental clinical attachment loss (CAL).

RESULTS

Good PH was reported by 424 (81%) of the participants. However, the association between PH and PS, BOP, PPD, and CAL was small (sensitivity: 7.7, 7.8, 12.0, and 0.0%, respectively). Only 57 (11%) of the participants reported bleeding gums (BG) during tooth brushing, but the correlation with BOP showed a sensitivity of 11.7%. The specificity of both self-perception of PH and BG was high. Sixty-seven (66.6%) of the participants experienced 'mild pain' during periodontal examination. There were no differences in periodontal outcomes between the pain groups (p > .05).

CONCLUSIONS

The adolescents showed a poor ability to identify themselves as having poor PH and BG, and 67 (66.6%) of the adolescents experienced mild pain during periodontal examination. The findings emphasize the need for dental staff to monitor the PH of Danish adolescents and advise them as necessary.

Salvadora persica’s Biological Properties and Applications in Different Dental Specialties: A Narrative Review

Salvadora persica is a tree that belongs to the salvadorecea family. It is also known as Miswak, which is a popular natural toothbrush that was used centuries ago in oral hygiene by Muslims in all parts of the world, especially in the Middle East. Numerous researchers highlighted the biological activity of this plant in medicine, dentistry, and pharmacology. The purpose of this article is to narratively review the biological properties of Salvadora persica. In addition, it expresses variant applications of this herb in different dental specialties. Materials and Methods. The search of the literature was based on PubMed, MEDLINE, and Google Scholar using keywords: Salvadora persica, S. persica, Miswak, Dentistry, and Dental. All relevant articles were reviewed to check if they would fit within the scope of this review, and then, the information was extracted. Results. Multiple biological effects of S. persica have been reported including antibacterial, antiviral, antifungal, antibiofilm, antioxidant, and even antiulcer effects. Dental effects were discussed and presented. Conclusion. The wide biological range of Salvadora persica's effects is promising for dental and nondental fields and allows for an expanded clinical application that has otherwise not been discussed in the literature.

Impact of Adverse Childhood Experiences on Oral Health Among Women in the United States: Findings From the Behavioral Risk Factor Surveillance System

It is well established that adverse childhood experiences (ACEs) negatively impact physical and mental health. There is a paucity of research examining the impact of ACEs on oral health. Therefore, the aim of this study was to better understand how ACEs may impact oral health utilizing a nationally representative sample of females. Data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) were utilized. The sample comprised 36,249 females. Chi-square tests were used to examine associations between multiple forms of ACEs and oral health, mental health, smoking, and health-related quality of life. Logistic regression models were generated for the outcomes of interest: last dental cleaning, significant tooth loss, smoking, and health-related quality of life. Post-hoc analyses were conducted to examine whether smoking and dental cleaning moderated the relationship between ACEs and significant tooth loss. All ACE categories were significantly associated with poor health-related quality of life, being a current or former smoker, last dental cleaning >1 year, and significant tooth loss even after adjusting for demographic variables. Last dental cleaning and being a current or former smoker moderated the relationship between ACEs and significant tooth loss. This study affirms other findings that women with a history of ACEs were more likely to engage in health-risk behaviors, specifically cigarette smoking, which has been strongly associated with ACEs. These findings underscore the importance of including oral health in future studies given it has implications for disease development. Furthermore, dental visits may provide a window of opportunity for trauma-informed care.

Polysaccharide-Based Micro- and Nanosized Drug Delivery Systems for Potential Application in the Pediatric Dentistry

The intensive development of micro- and nanotechnologies in recent years has offered a wide horizon of new possibilities for drug delivery in dentistry. The use of polymeric drug carriers turned out to be a very successful technique for formulating micro- and nanoparticles with controlled or targeted drug release in the oral cavity. Such innovative strategies have the potential to provide an improved therapeutic approach to prevention and treatment of various oral diseases not only for adults, but also in the pediatric dental practice. Due to their biocompatibility, biotolerance and biodegradability, naturally occurring polysaccharides like chitosan, alginate, pectin, dextran, starch, etc., are among the most preferred materials for preparation of micro- and nano-devices for drug delivery, offering simple particle-forming characteristics and easily tunable properties of the formulated structures. Their low immunogenicity and low toxicity provide an advantage over most synthetic polymers for the development of pediatric formulations. This review is focused on micro- and nanoscale polysaccharide biomaterials as dental drug carriers, with an emphasis on their potential application in pediatric dentistry.

An Innovative Strategy for Oral Biofilm Control in Early Childhood Based on a Resveratrol-Cyclodextrin Nanotechnology Approach

The purpose of this randomized controlled study was to evaluate the clinical efficacy of a novel oral spray containing resveratrol (RV) in controlling bacterial biofilm and gingival inflammation in early childhood. RV, a natural polyphenol, known for its anti-inflammatory and anti-infective activities, was included in a nanovector of 2-hydroxypropyl-beta-cyclodextrins (HPβCD) to improve its bioavailability. A total of 64 children between two and five years of age with plaque-induced gingivitis were randomly included in two equal groups. Both groups were enrolled in a mechanical plaque control program for a period of four weeks, while the test group was also instructed to use the RV-HPβCD mouthwash (in spray formulation) once daily, after toothbrushing. All children underwent three oral hygiene motivation sessions, 14 days apart, during which the full-mouth presence of bacterial plaque, gingival inflammation, dental stain and salivary pH were recorded. At two-week appointment, they also received professional plaque removal. The use of RV-based oral spray significantly reduced the amount of dental plaque and the percentage of bleeding sites and improved salivary pH compared to the control group at both two- and four-week examinations. Based on these promising results, the local delivery of RV-HPβCD via oral spray could enhance the control of dental biofilm in early childhood, when antiseptic mouthwashes are not recommended.

Oral health and caries/gingivitis-associated factors of adolescents aged 12-15 in Shandong province, China: a cross-sectional Oral Health Survey

Background

We aimed to analyse the oral health status of adolescents in Shandong province, including dental caries and gingivitis, and their associated factors.

Methods

Adolescents aged 12–15-years in Shandong province were recruited. Caries and gingival status were assessed following the World Health Organisation diagnostic criteria. Information including the sociodemographic, oral hygiene knowledge, attitudes and practices were collected through the questionnaire. Chi-square test and multivariate logistic regression analysis were used to investigate the oral diseases associated factors.

Results

In total, 3868 students (50.2% males) were enrolled. Of these, 39.9% of the participants experienced caries, and 81.7% and 31.3% had calculus and bleeding gingival, respectively. Multivariate logistic regression analysis revealed that there was an association between dental caries and toothaches, dental visits and sleeping troubles caused by oral problems (P < 0.024). A low-frequency of brushing, high sugar consumption and no flossing were more associated with calculus formation and gingival bleeding (P < 0.008).

Conclusion

Compared to caries, worse gingival condition was more prevalent among adolescents in Shandong province. Brushing behaviour is associated with gingivitis, while dental visits and toothaches are associated with caries. Hence, prevention-oriented dental visits and oral hygiene training are strongly recommended to improve oral health status.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01640-x.

Oral Diseases and Quality of Life between Obese and Normal Weight Adolescents: A Two-Year Observational Study

This study aimed to investigate the association between oral disease burden and oral health related quality of life (OHRQoL) among overweight/obese (OW/OB) and normal weight (NW) Malaysian adolescents. A total of 397 adolescents were involved in the two-year prospective observational cohort study. OHRQOL was measured through a self-administered questionnaire containing the short version of the Malaysian Oral Health Impact Profile (OHIP[M]). Body mass index (BMI) was used for anthropometric measurement. Whilst, decayed, missing, and filled teeth (DMFT) index, Significant Caries Index (SiC), simplified basic periodontal examination (S-BPE), and gingival bleeding index (GBI) were used for clinical assessment tools. Higher dental caries prevalence was observed in the NW group while higher SiC was reported in the OW/OB group. Regardless of the obesity status, the prevalence of gingivitis (BPE code 1 and 2) was high in this study. A reduction of GBI prevalence was observed in the two-year follow-up results with an increased prevalence of OHRQoL impact in the OW/OB group compared to the NW group (p > 0.05). The findings from this study suggested that obesity status did not have influence over the burden of oral diseases and OHRQoL. It offers insights referring to the changes in adolescents’ oral diseases burden and OHRQoL.

Impact of Oral Health on the Quality of Life of Preschoolers and Their Families

The aim of this study was to evaluate how the oral hygiene condition can influence the Oral Health-Related Quality of Life (OHRQoL) of preschoolers and their families. A cross-sectional study was conducted involving 446 children aged 2 to 6 years from public schools located in Rio de Janeiro, Brazil. The groups were dichotomized: regular/poor oral hygiene condition (RPOH) or good oral hygiene condition (GOH). The caregivers answered the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS). The average score in the RPOH group was 6.36 (6.35 DP) and GOH was 4.43 (5.35 SD) (P < .01). In the child subscale, the average of the RPOH and GOH group were, respectively, 4.12 (4.14 DP) and 3.13 (3.66 DP) (P = .01). In the family subscale, RPOH and GOH group were, respectively, 2.24 (3.12 DP) and 1.29 (2.52 DP) (P = .01). RPOH group had the greatest impact on OHRQoL.