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Ucuncu MK, Guven K, Yazicioglu O. Investigation of the constituents of commercially available toothpastes. Int J Dent Hyg 2024. [PMID: 38659161 DOI: 10.1111/idh.12805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/13/2024] [Accepted: 03/30/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES Toothpaste plays a pivotal role in oral and dental hygiene. This cross-sectional study not only investigates the constituents of toothpastes available in the market and their frequency across different brands but also delves into the potential side effects, irritations, or unfavourable outcomes of these constituents, emphasizing the broader health and environmental implications. METHODS The largest of the five major chain markets in each district of Istanbul was visited, and adult toothpastes were included in this study. All the constituents that make up the toothpaste were individually recorded in an Excel database. Subsequently, literature regarding the purposes, toxic and potential side effects of each ingredient was gathered using databases such as Google Scholar, PubMed and ScienceDirect. The percentages of these ingredients' occurrence among all the toothpastes were calculated, and the ingredients were categorized into 15 distinct groups based on their usage purposes. RESULTS There were 160 different varieties of toothpaste belonging to 19 different brands on the market shelves. Although a total of 244 different ingredients were identified, only 78 of them were included in the study. Among the analysed toothpaste types, 105 of them were found to contain 1450 ppm fluoride, whilst 26 toothpaste variants were discovered to have fluoride levels below this value. Among the various ingredients analysed, particular attention was drawn to commonly debated compounds in oral care products. Specifically, titanium dioxide was found in 68% (n = 111) of the varieties, sodium lauryl sulphate in 67% (n = 108) and paraben in 2% (n = 4), respectively. CONCLUSION Whilst certain ingredients may raise concerns for potential side effects and health considerations within the human body, the toothpaste has long been regarded as an indispensable tool for maintaining optimal oral and dental health. However, gaining a deeper understanding and conducting research on each constituent that comprises the toothpaste, as well as raising awareness in this regard, holds significant importance for human health.
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Affiliation(s)
- Musa Kazim Ucuncu
- Department of Restorative Dentistry, Faculty of Dentistry, Altinbas University, Istanbul, Turkey
| | | | - Oktay Yazicioglu
- Department of Restorative Dentistry, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
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2
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Yazicioglu O, Ucuncu MK, Guven K. Ingredients in Commercially Available Mouthwashes. Int Dent J 2024; 74:223-241. [PMID: 37709645 PMCID: PMC10988267 DOI: 10.1016/j.identj.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES Mouthwashes, a cornerstone of oral and dental hygiene, play a pivotal role in combating the formation of dental plaque, a leading cause of periodontal disease and dental caries. This study aimed to review the composition of mouthwashes found on retail shelves in Turkey and evaluate their prevalence and side effects, if any. METHODS The mouthwashes examined were sourced from the 5 largest chain stores in each district of Istanbul. A comprehensive list of the constituents was meticulously recorded. The research was supported by an extensive compilation of references from scholarly databases such as Google Scholar, PubMed, and ScienceDirect. Through rigorous analysis, the relative proportions of mouthwash ingredients and components were determined. RESULTS A total of 45 distinctive variations of mouthwashes, representing 17 prominent brands, were identified. Amongst the 116 ingredients discovered, 70 were evaluated for potential adverse effects and undesirable side effects. The aroma of the mouthwash (n = 45; 100%), as welll as their sodium fluoride (n = 28; 62.22%), sodium saccharin (n = 29; 64.44%), sorbitol (n = 21; 46.6%), and propylene glycol (n = 28; 62.22%) content were the main undesireable features. CONCLUSIONS The limited array of mouthwashes found on store shelves poses a concern for both oral and public health. Furthermore, the intricate composition of these products, consisting of numerous ingredients with the potential for adverse effects, warrants serious attention. Both clinicians and patients should acknowledge the importance and unwarranted side effects of the compnents of the mouthwashes.
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Affiliation(s)
- Oktay Yazicioglu
- Istanbul University, Faculty of Dentistry, Department of Restorative Dentistry, Istanbul, Turkey
| | - Musa Kazim Ucuncu
- Altinbas University, Faculty of Dentistry, Department of Restorative Dentistry, Istanbul, Turkey.
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3
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Janket SJ, Benwait J, Isaac P, Ackerson LK, Meurman JH. Oral and Systemic Effects of Xylitol Consumption. Caries Res 2019; 53:491-501. [PMID: 31060040 DOI: 10.1159/000499194] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/26/2019] [Indexed: 11/19/2022] Open
Abstract
Recent results of randomized trials testing the efficacy of xylitol in caries prevention have been conflicting. This narrative review reveals the sources of discrepancy. The following databases were searched for the terms "xylitol" or "artificial sweeteners" restricted to the English language: PubMed, Web of Science, Evidenced-Based Medicine, Scopus, and the Cochrane database. In a separate search, the terms "dental caries" or "cariogenicity" or "glucosyltransferase" or "low glycemic" or "low insulinemic" or "dysbiosis" or "gut microbiome" were used and then combined. In section I, findings regarding the role of xylitol in dental caries prevention, the appropriateness of research methods, and the causes for potential biases are summarized. In section II, the systemic effects of xylitol on gut microbiota as well as low-glycemic/insulinogenic systemic effects are evaluated and summarized. The substitution of a carbonyl group with an alcohol radical in xylitol hinders its absorption and slowly releases sugar into the bloodstream. This quality of xylitol is beneficial for diabetic patients to maintain a constant glucose level. Although this quality of xylitol has been proven in in vitro and animal studies, it has yet to be proven in humans. Paradoxically, recent animal studies reported hyperglycemia and intestinal dysbiosis with artificial sweetener consumption. Upon careful inspection of evidence, it was revealed that these reports may be due to misinterpretation of original references or flaws in study methodology. Any systemic benefits of xylitol intake must be weighed in consideration with the well-established adverse gastrointestinal consequences. The contribution of xylitol to gut dysbiosis that may affect systemic immunity warrants further research.
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Affiliation(s)
- Sok-Ja Janket
- Translational Oral Medicine, Forsyth Institute, Cambridge, Massachusetts, USA
| | - Jaspreet Benwait
- Boston University School of Public Health, Boston, Massachusetts, USA,
| | - Paul Isaac
- Research Externship,Edwin O. Smith High School, Storrs, Connecticut, USA
| | - Leland K Ackerson
- Department of Public Health, University of Massachusetts, Lowell, Massachusetts, USA
| | - Jukka H Meurman
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Fontana M, Gonzalez-Cabezas C. Evidence-Based Dentistry Caries Risk Assessment and Disease Management. Dent Clin North Am 2018; 63:119-128. [PMID: 30447787 DOI: 10.1016/j.cden.2018.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The objective of this article was to provide a summary of evidence-based recommendations for the assessment of caries risk and management of dental caries. The goal is to help clinicians manage the caries disease process using personalized interventions supported by the best available evidence, taking into account the clinician's expertise and the patient's needs and preferences, to maintain health and preserve tooth structure.
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Affiliation(s)
- Margherita Fontana
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, 1011 North University, Ann Arbor, MI 48109, USA.
| | - Carlos Gonzalez-Cabezas
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, 1011 North University, Ann Arbor, MI 48109, USA
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5
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Finlayson TL, Gupta A, Ramos-Gomez FJ. Prenatal Maternal Factors, Intergenerational Transmission of Disease, and Child Oral Health Outcomes. Dent Clin North Am 2018; 61:483-518. [PMID: 28577633 DOI: 10.1016/j.cden.2017.02.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article reviews maternal prenatal risk factors for caries in children and intergenerational transmission of caries, emphasizing early interventions for pregnant women and mother-infant pairs. A growing body of evidence focuses on maternal interventions. Studies suggest that early prenatal clinical and educational interventions are effective at reducing mother-child mutans streptococci (MS) transmission and delaying colonization and caries in young children. Dental screenings and anticipatory guidance about maternal and infant oral health should be included in prenatal care and pediatric well visits. Dental care during pregnancy is safe and recommended and can reduce maternal MS levels. Infants should visit a dentist by age 1.
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Affiliation(s)
- Tracy L Finlayson
- Division of Health Management and Policy, Graduate School of Public Health, Institute for Behavioral and Community Health, San Diego State University, 9245 Sky Part Court, Suite 221, San Diego, CA 92123, USA.
| | - Aarti Gupta
- Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221, San Diego, CA 92123, USA
| | - Francisco J Ramos-Gomez
- Section of Pediatric Dentistry, University of California Los Angeles (UCLA) School of Dentistry, 10833 Le Conte Avenue, Box 951668, CHS Room 23-020B, Los Angeles, CA 90095-1668, USA
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6
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Duangthip D, Chen KJ, Gao SS, Lo ECM, Chu CH. Managing Early Childhood Caries with Atraumatic Restorative Treatment and Topical Silver and Fluoride Agents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1204. [PMID: 28994739 PMCID: PMC5664705 DOI: 10.3390/ijerph14101204] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/02/2017] [Accepted: 10/07/2017] [Indexed: 11/17/2022]
Abstract
Early childhood caries (ECC) is a significant global health problem affecting millions of preschool children worldwide. In general, preschool children from families with 20% of the lowest family incomes suffered about 80% of the ECC. Most, if not all, surveys indicated that the great majority of ECC was left untreated. Untreated caries progresses into the dental pulp, causing pain and infection. It can spread systemically, affecting a child's growth, development and general health. Fundamental caries management is based on the conventional restorative approach. Because preschool children are too young to cope with lengthy dental treatment, they often receive dental treatment under general anaesthesia from a specialist dentist. However, treatment under general anaesthesia poses a life-threatening risk to young children. Moreover, there are few dentists in rural areas, where ECC is prevalent. Hence, conventional dental care is unaffordable, inaccessible or unavailable in many communities. However, studies showed that the atraumatic restorative treatment had a very good success rate in treating dentine caries in young children. Silver diamine fluoride is considered safe and effective in arresting dentine caries in primary teeth. The aim of this paper is to review and discuss updated evidence of these alternative approaches in order to manage cavitated ECC.
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Affiliation(s)
| | - Kitty Jieyi Chen
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
| | | | | | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
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Salli KM, Gürsoy UK, Söderling EM, Ouwehand AC. Effects of Xylitol and Sucrose Mint Products on Streptococcus mutans Colonization in a Dental Simulator Model. Curr Microbiol 2017; 74:1153-1159. [PMID: 28717846 PMCID: PMC5596035 DOI: 10.1007/s00284-017-1299-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/04/2017] [Indexed: 12/15/2022]
Abstract
Few laboratory methods exist for evaluating the cariogenicity of food ingredients. In this study, a dental simulator was used to determine the effects of commercial sucrose and xylitol mint products on the adherence and planktonic growth of Streptococcus mutans. Solutions (3% w/v) of sucrose, xylitol, sucrose mints, xylitol mints, xylitol with 0.02% peppermint oil (PO), and 0.02% PO alone were used to test the levels of planktonic and adhered S. mutans. A dental simulator with continuous artificial saliva flow, constant temperature, and mixing was used as a test environment and hydroxyapatite (HA) discs were implemented into the model to simulate the tooth surface. Bacterial content was quantified by qPCR. Compared with the artificial saliva alone, sucrose and sucrose mints increased the numbers of HA-attached S. mutans, whereas xylitol decreased them. Similarly, planktonic S. mutans quantities rose with sucrose and declined with xylitol and xylitol mints. Versus sucrose mints, xylitol mints significantly reduced the counts of HA-bound and planktonic S. mutans. Similar results were observed with the main ingredients of both types of mints separately. PO-supplemented artificial saliva did not influence the numbers of S. mutans that attached to HA or planktonic S. mutans compared with artificial saliva control. In our dental simulator model, xylitol reduced the counts of adhering and planktonic S.mutans. The mints behaved similarly as their pure, main ingredients-sucrose or xylitol, respectively. PO, which has been suggested to have antimicrobial properties, did not influence S. mutans colonization.
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Affiliation(s)
- Krista M. Salli
- DuPont Nutrition and Health, Global Health and Nutrition Science, Danisco Sweeteners Oy, 02460 Kantvik, Finland
- Department of Periodontology, Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, 20520 Turku, Finland
| | - Ulvi K. Gürsoy
- Department of Periodontology, Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, 20520 Turku, Finland
| | - Eva M. Söderling
- Department of Periodontology, Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, 20520 Turku, Finland
| | - Arthur C. Ouwehand
- DuPont Nutrition and Health, Global Health and Nutrition Science, Danisco Sweeteners Oy, 02460 Kantvik, Finland
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Khoroushi M, Kachuie M. Prevention and Treatment of White Spot Lesions in Orthodontic Patients. Contemp Clin Dent 2017; 8:11-19. [PMID: 28566845 PMCID: PMC5426141 DOI: 10.4103/ccd.ccd_216_17] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Decalcification of enamel, appearing as white spot lesions (WSLs), around fixed orthodontic appliances is a major challenge during and after fixed orthodontic treatment by considering the fact that the goal of orthodontic treatment is to enhance facial and dental esthetic appearance. Banded or bonded teeth exhibit a significantly higher rate of WSLs compared to the controls with no braces as fixed appliances and the bonding materials promote retention of biofilms. These lesions are managed in the first step by establishing good oral hygiene habits and prophylaxis with topical fluorides, including high-fluoride toothpastes, fluoride mouthwashes, gels, varnishes, fluoride-containing bonding materials, and elastic ligatures. Recently, other materials and methods have been recommended, including the application of casein phosphopeptides-amorphous calcium phosphate, antiseptics, probiotics, polyols, sealants, laser, tooth bleaching agents, resin infiltration, and microabrasion. This article reviews the currently used methods to manage enamel demineralization during and after orthodontic treatment and the risk factors and preventive measures based on the latest evidence.
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Affiliation(s)
- Maryam Khoroushi
- Dental Materials Research Center, Department of Operative Dentistry, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzie Kachuie
- Dental Materials Research Center, Department of Orthodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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Lari GM, Gröninger OG, Li Q, Mondelli C, López N, Pérez-Ramírez J. Catalyst and Process Design for the Continuous Manufacture of Rare Sugar Alcohols by Epimerization-Hydrogenation of Aldoses. CHEMSUSCHEM 2016; 9:3407-3418. [PMID: 27739630 DOI: 10.1002/cssc.201600755] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/02/2016] [Indexed: 06/06/2023]
Abstract
Sugar alcohols are applied in the food, pharmaceutical, polymer, and fuel industries and are commonly obtained by reduction of the corresponding saccharides. In view of the rarity of some sugar substrates, epimerization of a readily available monosaccharide has been proposed as a solution, but an efficient catalytic system has not yet been identified. Herein, a molybdenum heteropolyacid-based catalyst is developed to transform glucose, arabinose, and xylose into less-abundant mannose, ribose, and lyxose, respectively. Adsorption of molybdic acid onto activated carbon followed by ion exchange to the cesium form limits leaching of the active phase, which greatly improves the catalyst stability over 24 h on stream. The hydrogenation of mixtures of epimers is studied over ruthenium catalysts, and it is found that the precursor to the desired polyol is advantageously converted with faster kinetics. This is explained by density functional theory on the basis of its more favorable adsorption on the metal surface and the lower energy barrier for the addition of a hydrogen atom to the primary carbon atom. Finally, different designs for a continuous process for the conversion of glucose into mannitol are studied, and it is uncovered that two reactors in series with one containing the epimerization catalyst and the other containing a mixture of the epimerization and hydrogenation catalysts increases the mannitol/sorbitol ratio to 1.5 from 1 for a single mixed-bed reactor. This opens a prospective route to the efficient valorization of renewables to added-value chemicals.
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Affiliation(s)
- Giacomo M Lari
- Institute for Chemical and Bioengineering, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 1, 8093, Zurich, Switzerland
| | - Olivier G Gröninger
- Institute for Chemical and Bioengineering, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 1, 8093, Zurich, Switzerland
| | - Qiang Li
- Institute of Chemical Research of Catalonia, ICIQ, The Barcelona Institute of Science and Technology, Av. Països Catalans 16, 43007, Tarragona, Spain
| | - Cecilia Mondelli
- Institute for Chemical and Bioengineering, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 1, 8093, Zurich, Switzerland
| | - Núria López
- Institute of Chemical Research of Catalonia, ICIQ, The Barcelona Institute of Science and Technology, Av. Països Catalans 16, 43007, Tarragona, Spain
| | - Javier Pérez-Ramírez
- Institute for Chemical and Bioengineering, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 1, 8093, Zurich, Switzerland
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10
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de Matos BM, Brighenti FL, Do T, Beighton D, Koga-Ito CY. Acidogenicity of dual-species biofilms of bifidobacteria and Streptococcus mutans. Clin Oral Investig 2016; 21:1769-1776. [PMID: 27660160 DOI: 10.1007/s00784-016-1958-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/05/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the acidogenicity of dual-species biofilms of bifidobacteria and Streptococcus mutans. MATERIALS AND METHODS The following strains were tested: Bifidobacterium dentium DSM20436, Parascardovia denticolens DSM10105, and Scardovia inopinata DSM10107. Streptococcus mutans UA159 and Lactobacillus acidophilus ATCC4356 were used as control. Bifidobacteria were studied planktonically as they were not able to form monospecies biofilm, they were grown in biofilms associated with S. mutans. Endogenous polysaccharide reserves of cultures at log phase were depleted. Standardized suspensions of the microorganisms were incubated in growth media supplemented with 10 mM glucose, lactose, raffinose, glucose, or xylitol. S. mutans biofilms were grown on glass cover slips for 24 h to which bifidobacteria were added. After 24 h, the dual-species biofilms were exposed to the same carbon sources, and after 3 h, the pH of spent culture media and concentrations of organic acids were measured. Statistical analyses were carried out using ANOVA and Tukey's test (α = 0.05). RESULTS A higher pH drop was observed when S. mutans was associated with P. denticolens or S. inopinata, in either planktonic or biofilm cultures, than with S. mutans alone. Bifidobacteria showed a higher pH drop in the presence of raffinose than S. mutans or L. acidophilus. CONCLUSIONS Dual-species biofilms of bifidobacteria and S. mutans produced more acid and greater pH drops than biofilms of S. mutans alone. CLINICAL RELEVANCE New insights on the complex process of caries pathogenicity contribute to the establishment of preventive and therapeutic measures, in particular in specific cases, such as in early childhood caries.
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Affiliation(s)
- Bruno Mello de Matos
- Environmental Engineering Department, São José dos Campos Institute of Science and Technology, UNESP, Univ. Estadual Paulista, Avenida Engenheiro Francisco Jose Longo 777, São José dos Campos, 12245-000, São Paulo, Brazil.,UNIVASF, Univ. Federal do Vale do São Francisco, Rua da Alvorada, General Dutra, Paulo Afonso, BA, 48607-190, Brazil
| | - Fernanda Lourenção Brighenti
- Araraquara School of Dentistry, UNESP, Univ. Estadual Paulista, Rua Humaitá, 1680, Centro, Araraquara, SP, 14801-385, Brazil
| | - Thuy Do
- School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, UK.,Division of Oral Biology, Wellcome Trust Brenner Building, Level 7, St James's University Hospital Campus, Leeds, LS9 7TF, UK
| | - David Beighton
- Dental Institute, King's College London, Bessemer Rd., Denmark Hill, London, SE5 9RW, UK
| | - Cristiane Yumi Koga-Ito
- Environmental Engineering Department, São José dos Campos Institute of Science and Technology, UNESP, Univ. Estadual Paulista, Avenida Engenheiro Francisco Jose Longo 777, São José dos Campos, 12245-000, São Paulo, Brazil. .,Oral Biopathology Graduate Program, São José dos Campos Institute of Science and Technology, Avenida Engenheiro Francisco Jose Longo 777, São José dos Campos, 12245-000, Brazil.
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Wessel SW, van der Mei HC, Maitra A, Dodds MWJ, Busscher HJ. Potential benefits of chewing gum for the delivery of oral therapeutics and its possible role in oral healthcare. Expert Opin Drug Deliv 2016; 13:1421-31. [DOI: 10.1080/17425247.2016.1193154] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Stefan W. Wessel
- Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Henny C. van der Mei
- Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Henk J. Busscher
- Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
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12
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Al-Sudani FYH, Vehkalahti MM, Suominen AL. Association of current employment status with oral health-related behaviors: findings from the Finnish Health 2000 Survey. Eur J Oral Sci 2016; 124:368-76. [DOI: 10.1111/eos.12276] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Fouad Y. H. Al-Sudani
- Department of Oral Public Health; Institute of Dentistry; University of Eastern Finland; Kuopio Finland
| | - Miira M. Vehkalahti
- Department of Oral and Maxillofacial Diseases; Faculty of Medicine; University of Helsinki; Helsinki Finland
| | - Anna L. Suominen
- Department of Oral Public Health; Institute of Dentistry; University of Eastern Finland; Kuopio Finland
- The Living Environment and Health Unit; National Institute for Health and Welfare (THL); Kuopio Finland
- The Health Monitoring Unit; National Institute for Health and Welfare (THL); Helsinki Finland
- Department of Oral and Maxillofacial Surgery; Kuopio University Hospital; Kuopio Finland
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13
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Gold J. Consumption of Xylitol Gummy Bears May not Provide Additional Caries Prevention for School Children. J Evid Based Dent Pract 2016; 16:70-2. [DOI: 10.1016/j.jebdp.2016.01.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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Molecule Targeting Glucosyltransferase Inhibits Streptococcus mutans Biofilm Formation and Virulence. Antimicrob Agents Chemother 2015; 60:126-35. [PMID: 26482298 DOI: 10.1128/aac.00919-15] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 09/30/2015] [Indexed: 02/05/2023] Open
Abstract
Dental plaque biofilms are responsible for numerous chronic oral infections and cause a severe health burden. Many of these infections cannot be eliminated, as the bacteria in the biofilms are resistant to the host's immune defenses and antibiotics. There is a critical need to develop new strategies to control biofilm-based infections. Biofilm formation in Streptococcus mutans is promoted by major virulence factors known as glucosyltransferases (Gtfs), which synthesize adhesive extracellular polysaccharides (EPS). The current study was designed to identify novel molecules that target Gtfs, thereby inhibiting S. mutans biofilm formation and having the potential to prevent dental caries. Structure-based virtual screening of approximately 150,000 commercially available compounds against the crystal structure of the glucosyltransferase domain of the GtfC protein from S. mutans resulted in the identification of a quinoxaline derivative, 2-(4-methoxyphenyl)-N-(3-{[2-(4-methoxyphenyl)ethyl]imino}-1,4-dihydro-2-quinoxalinylidene)ethanamine, as a potential Gtf inhibitor. In vitro assays showed that the compound was capable of inhibiting EPS synthesis and biofilm formation in S. mutans by selectively antagonizing Gtfs instead of by killing the bacteria directly. Moreover, the in vivo anti-caries efficacy of the compound was evaluated in a rat model. We found that the compound significantly reduced the incidence and severity of smooth and sulcal-surface caries in vivo with a concomitant reduction in the percentage of S. mutans in the animals' dental plaque (P < 0.05). Taken together, these results represent the first description of a compound that targets Gtfs and that has the capacity to inhibit biofilm formation and the cariogenicity of S. mutans.
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Brambilla E, Ionescu AC, Cazzaniga G, Ottobelli M, Samaranayake LP. Levorotatory carbohydrates and xylitol subdueStreptococcus mutansandCandida albicansadhesion and biofilm formation. J Basic Microbiol 2015; 56:480-92. [DOI: 10.1002/jobm.201500329] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 09/13/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Eugenio Brambilla
- Department of Biomedical, Surgical and Dental Sciences, IRCCS Galeazzi Institute; University of Milan; Milan Italy
| | - Andrei C. Ionescu
- Department of Biomedical, Surgical and Dental Sciences, IRCCS Galeazzi Institute; University of Milan; Milan Italy
| | - Gloria Cazzaniga
- Department of Biomedical, Surgical and Dental Sciences, IRCCS Galeazzi Institute; University of Milan; Milan Italy
| | - Marco Ottobelli
- Department of Biomedical, Surgical and Dental Sciences, IRCCS Galeazzi Institute; University of Milan; Milan Italy
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16
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Duangthip D, Jiang M, Chu CH, Lo ECM. Non-surgical treatment of dentin caries in preschool children--systematic review. BMC Oral Health 2015; 15:44. [PMID: 25888484 PMCID: PMC4403709 DOI: 10.1186/s12903-015-0033-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 03/26/2015] [Indexed: 11/10/2022] Open
Abstract
Background Untreated dentin caries in primary teeth is commonly found in preschool children worldwide. Recently, the use of simple non-surgical approaches to manage the situation has been advocated. The aim of the study was to systematically review and evaluate the literature on effectiveness of non-surgical methods in arresting or slowing down the progression of active dentin caries in primary teeth in preschool children. Methods A systematic search of the main electronic databases (Pubmed, Cochrane Collaboration, EMBASE) was conducted to identify peer reviewed papers published in English in the years 1947–2014. Keywords and MeSH terms used in the search were “dental caries”, “primary dentition” and various non-surgical treatments (fluoride, sealant, resin infiltration, xylitol, chlorhexidine, CPP-ACP, ozone, etc.). The inclusion criteria were clinical studies conducted in children under 6 years old, and reported findings on caries arrest or caries progression in primary teeth. Retrieved papers were read by two reviewers independently to assess suitability for inclusion, and the final decision was made by consensus. Quality of the included studies was assessed and data were extracted for analysis. Results The search identified 323 papers for screening. Among these, 290 papers did not satisfy the study inclusion criteria. Consequently, 33 full papers were retrieved and reviewed. Finally, 4 studies were included. Three studies reported that topical applications of silver diammine fluoride (SDF) solution could arrest dentin caries in preschool children. One study supported that having a daily toothbrushing exercise in kindergarten using toothpaste with 1000 ppm fluoride could stabilize the caries situation in young children. Conclusions There is limited evidence to support the effectiveness of SDF applications or daily toothbrushing with fluoride toothpaste in arresting or slowing down the progression of active dentin caries in primary teeth in preschool children. More well-designed randomized controlled trials are required to confirm these findings.
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Affiliation(s)
- Duangporn Duangthip
- Faculty of Dentistry, University of Hong Kong, 3/F, Prince Philip Dental Hospital, 34 Hospital Road, Hong Kong, SAR, China.
| | - Ming Jiang
- Faculty of Dentistry, University of Hong Kong, 3/F, Prince Philip Dental Hospital, 34 Hospital Road, Hong Kong, SAR, China.
| | - Chun Hung Chu
- Faculty of Dentistry, University of Hong Kong, 3/F, Prince Philip Dental Hospital, 34 Hospital Road, Hong Kong, SAR, China.
| | - Edward C M Lo
- Faculty of Dentistry, University of Hong Kong, 3/F, Prince Philip Dental Hospital, 34 Hospital Road, Hong Kong, SAR, China.
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Riley P, Moore D, Ahmed F, Sharif MO, Worthington HV. Xylitol-containing products for preventing dental caries in children and adults. Cochrane Database Syst Rev 2015; 2015:CD010743. [PMID: 25809586 PMCID: PMC9345289 DOI: 10.1002/14651858.cd010743.pub2] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Dental caries is a highly prevalent chronic disease which affects the majority of people. It has been postulated that the consumption of xylitol could help to prevent caries. The evidence on the effects of xylitol products is not clear and therefore it is important to summarise the available evidence to determine its effectiveness and safety. OBJECTIVES To assess the effects of different xylitol-containing products for the prevention of dental caries in children and adults. SEARCH METHODS We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (to 14 August 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2014, Issue 7), MEDLINE via OVID (1946 to 14 August 2014), EMBASE via OVID (1980 to 14 August 2014), CINAHL via EBSCO (1980 to 14 August 2014), Web of Science Conference Proceedings (1990 to 14 August 2014), Proquest Dissertations and Theses (1861 to 14 August 2014). We searched the US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We included randomised controlled trials assessing the effects of xylitol products on dental caries in children and adults. DATA COLLECTION AND ANALYSIS Two review authors independently screened the results of the electronic searches, extracted data and assessed the risk of bias of the included studies. We attempted to contact study authors for missing data or clarification where feasible. For continuous outcomes, we used means and standard deviations to obtain the mean difference and 95% confidence interval (CI). We used the continuous data to calculate prevented fractions (PF) and 95% CIs to summarise the percentage reduction in caries. For dichotomous outcomes, we reported risk ratios (RR) and 95% CIs. As there were less than four studies included in the meta-analysis, we used a fixed-effect model. We planned to use a random-effects model in the event that there were four or more studies in a meta-analysis. MAIN RESULTS We included 10 studies that analysed a total of 5903 participants. One study was assessed as being at low risk of bias, two were assessed as being at unclear risk of bias, with the remaining seven being at high risk of bias.The main finding of the review was that, over 2.5 to 3 years of use, a fluoride toothpaste containing 10% xylitol may reduce caries by 13% when compared to a fluoride-only toothpaste (PF -0.13, 95% CI -0.18 to -0.08, 4216 children analysed, low-quality evidence).The remaining evidence on children, from small single studies with risk of bias issues and great uncertainty associated with the effect estimates, was insufficient to determine a benefit from xylitol products. One study reported that xylitol syrup (8 g per day) reduced caries by 58% (95% CI 33% to 83%, 94 infants analysed, low quality evidence) when compared to a low-dose xylitol syrup (2.67 g per day) consumed for 1 year.The following results had 95% CIs that were compatible with both a reduction and an increase in caries associated with xylitol: xylitol lozenges versus no treatment in children (very low quality body of evidence); xylitol sucking tablets versus no treatment in infants (very low quality body of evidence); xylitol tablets versus control (sorbitol) tablets in infants (very low quality body of evidence); xylitol wipes versus control wipes in infants (low quality body of evidence).There was only one study investigating the effects of xylitol lozenges, when compared to control lozenges, in adults (low quality body of evidence). The effect estimate had a 95% CI that was compatible with both a reduction and an increase in caries associated with xylitol.Four studies reported that there were no adverse effects from any of the interventions. Two studies reported similar rates of adverse effects between study arms. The remaining studies either mentioned adverse effects but did not report any usable data, or did not mention them at all. Adverse effects include sores in the mouth, cramps, bloating, constipation, flatulence, and loose stool or diarrhoea. AUTHORS' CONCLUSIONS We found some low quality evidence to suggest that fluoride toothpaste containing xylitol may be more effective than fluoride-only toothpaste for preventing caries in the permanent teeth of children, and that there are no associated adverse-effects from such toothpastes. The effect estimate should be interpreted with caution due to high risk of bias and the fact that it results from two studies that were carried out by the same authors in the same population. The remaining evidence we found is of low to very low quality and is insufficient to determine whether any other xylitol-containing products can prevent caries in infants, older children, or adults.
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Affiliation(s)
- Philip Riley
- School of Dentistry, The University of ManchesterCochrane Oral Health GroupJR Moore BuildingOxford RoadManchesterUKM13 9PL
| | - Deborah Moore
- School of Dentistry, The University of ManchesterOxford RoadManchesterUKM13 9PL
| | - Farooq Ahmed
- University of Manchester Dental HospitalOrthodonticsHigher Cambridge StreetManchesterUKM15 6FH
| | - Mohammad O Sharif
- Eastman Dental HospitalSchool of Dentistry256 Gray's Inn RoadLondonUKWC1X 8LD
| | - Helen V Worthington
- School of Dentistry, The University of ManchesterCochrane Oral Health GroupJR Moore BuildingOxford RoadManchesterUKM13 9PL
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Affiliation(s)
- Jaana Gold
- A.T. Still University, College of Graduate Health Studies, Department of Public Health, USA; Department of Community Dentistry and Behavioral Science, University of Florida College of Dentistry, 1329 SW 16th Street, Room 5180, P.O. Box 103628, Gainesville, FL 32610-3628, USA.
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Morrier JJ. [White spot lesions and orthodontic treatment. Prevention and treatment]. Orthod Fr 2014; 85:235-244. [PMID: 25158746 DOI: 10.1051/orthodfr/2014016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 02/13/2014] [Indexed: 06/03/2023]
Abstract
Decalcification of the enamel surface adjacent to fixed orthodontic appliances, in the form of white spot lesions, is a common and frequent well-known side-effect of orthodontic treatment. Fixed appliances and the bonding materials increase the retention of biofilm and encourage the formation of white spot lesions. Management of these lesions begins with a good oral hygiene regime and needs to be associated with use of fluoride agents (fluoridated toothpaste, fluoride containing mouth rinse, gel, varnish, bonding materials, elastic ligature), CPP-ACP, antiseptics, LASER, tooth whitening, resin infiltration, micro-abrasion. The purpose of this review is to access the direct evidence regarding the prevention and management of white spot lesions during and after orthodontic treatment.
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Söderling E, ElSalhy M, Honkala E, Fontana M, Flannagan S, Eckert G, Kokaras A, Paster B, Tolvanen M, Honkala S. Effects of short-term xylitol gum chewing on the oral microbiome. Clin Oral Investig 2014; 19:237-44. [PMID: 24663814 DOI: 10.1007/s00784-014-1229-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 02/17/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to determine the effects of short-term xylitol gum chewing on the salivary microbiota of children. MATERIALS AND METHODS The study was a randomised, controlled, double-blind trial. Healthy children used xylitol chewing gum (xylitol group, n = 35) or sorbitol chewing gum (control group, n = 38) for 5 weeks. The daily dose of xylitol/sorbitol was approximately 6 g/day. At baseline and at the end of the test period, unstimulated and paraffin-stimulated saliva were collected. The microbial composition of the saliva was assessed using human oral microbe identification microarray (HOMIM). Mutans streptococci (MS) were plate cultured. RESULTS As judged by HOMIM results, no xylitol-induced changes in the salivary microbiota took place in the xylitol group. In the control group, Veillonella atypica showed a significant decrease (p = 0.0001). The xylitol gum chewing decreased viable counts of MS in both stimulated (p = 0.006) and unstimulated (p = 0.002) saliva, but similar effects were also seen in the control group. CONCLUSIONS The use of xylitol gum decreased MS, in general, but did not change the salivary microbial composition. CLINICAL RELEVANCE Short-term consumption of xylitol had no impact on the composition of the salivary microbiota, but resulted in a decrease in the levels of MS.
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Affiliation(s)
- Eva Söderling
- Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, 20520, Turku, Finland,
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Sun FC, Engelman EE, McGuire JA, Kosmoski G, Carratello L, Ricci-Nittel D, Zhang JZ, Schemehorn BR, Gambogi RJ. Impact of an anticaries mouthrinse on in vitro remineralization and microbial control. Int J Dent 2014; 2014:982071. [PMID: 24648842 PMCID: PMC3933167 DOI: 10.1155/2014/982071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 09/09/2013] [Accepted: 09/15/2013] [Indexed: 11/20/2022] Open
Abstract
Objective. The objective of this research was to evaluate the caries control potential of a new fluoride mouthrinse that also contained antimicrobial agents and a biofilm disrupting agent using different in vitro models. Methods. Four in vitro studies were conducted to assess the performance of this three pronged approach to caries control: (1) traditional enamel fluoride uptake, (2) surface microhardness study using pH cycling model and subsequent fluoride uptake, (3) a salivary biofilm flow-through study to determine the anti-microbial activity, and (4) a single species biofilm model measuring effect on biofilm matrix disruption. Results. The data showed that a LISTERINE rinse with fluoride, essential oils and xylitol was superior in promoting enamel fluoride uptake and in enhancing antimicrobial activity over traditional commercially available fluoridated products. An increase of the surface microhardness was observed when the LISTERINE rinse was used in combination with fluoridated toothpaste versus the fluoridated toothpaste alone. Finally, it was demonstrated that xylitol solutions disrupted and reduced the biovolume of biofilm matrix of mature Streptococcus mutans. Conclusion. These in vitro studies demonstrated that a fluoride mouthrinse with antimicrobial agent and biofilm matrix disrupting agent provided multifaceted and enhanced anti-caries efficacy by promoting remineralization, reducing acidogenic bacteria and disrupting biofilm matrix.
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Affiliation(s)
- Frank C. Sun
- Johnson & Johnson Consumer & Personal Product Worldwide, Skillman, NJ, USA
| | - E. Eric Engelman
- Johnson & Johnson Consumer & Personal Product Worldwide, Skillman, NJ, USA
| | - James A. McGuire
- Johnson & Johnson Consumer & Personal Product Worldwide, Skillman, NJ, USA
| | - Gabrielle Kosmoski
- Johnson & Johnson Consumer & Personal Product Worldwide, Skillman, NJ, USA
| | - Lauren Carratello
- Johnson & Johnson Consumer & Personal Product Worldwide, Skillman, NJ, USA
| | | | - Jane Z. Zhang
- Johnson & Johnson Consumer & Personal Product Worldwide, Skillman, NJ, USA
| | - Bruce R. Schemehorn
- Dental Product Testing, Therametric Technologies, Inc., 9880 Douglas Floyd Parkway, Noblesville, IN, USA
| | - Robert J. Gambogi
- Johnson & Johnson Consumer & Personal Product Worldwide, Skillman, NJ, USA
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Bradshaw DJ, Lynch RJ. Diet and the microbial aetiology of dental caries: new paradigms. Int Dent J 2013; 63 Suppl 2:39-47. [DOI: 10.1111/idj.12072] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Fontana M, Gonzalez-Cabezas C. Xylitol Lozenges Were Not Effective in Overall Dental Caries Prevention in Adults. J Evid Based Dent Pract 2013; 13:97-9. [DOI: 10.1016/j.jebdp.2013.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Banerjee A, Doméjean S. The contemporary approach to tooth preservation: minimum intervention (MI) caries management in general practice. Prim Dent J 2013; 2:30-37. [PMID: 24340496 DOI: 10.1308/205016813807440119] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The minimum intervention (MI) approach summarises a clinical, evidence-based rationale for the preventive and cause-related approach to oral diseases in general and to caries in particular. MI oral care with respect to the management of patients suffering from dental caries is a concept based on an updated understanding of the histopathological carious process as well as the development of diagnostic technologies and adhesive, bioactive restorative materials. A patient-centred MI care plan for use in general dental practice is described, detailing the four phases of identifying disease, controlling/preventing disease, refurbishing/repairing tooth surfaces/restorations and recall consultations.
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Affiliation(s)
- Avijit Banerjee
- King's College Dental Institute at Guy's Hospital, King's Health Partners, London
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Mäkinen KK, Järvinen KL, Anttila CH, Luntamo LM, Vahlberg T. Topical xylitol administration by parents for the promotion of oral health in infants: a caries prevention experiment at a Finnish Public Health Centre. Int Dent J 2013; 63:210-24. [PMID: 23879257 DOI: 10.1111/idj.12038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This demonstration programme tested topical use of xylitol as a possible oral health promoting regimen in infants at a Finnish Public Health Centre in 2002-2011. METHODS Parents (usually mothers) began once- or twice-daily administration of a 45% solution of xylitol (2.96 m) onto all available deciduous teeth of their children at the age of approximately 6-8 months. The treatment (xylitol swabbing), which continued till the age of approximately 36 months (total duration 26-28 months), was carried out using cotton swabs or a children's toothbrush; the approximate daily xylitol usage was 13.5 mg per each deciduous tooth. RESULTS At the age of 7 years, caries data on the deciduous dentition of 80 children were compared with those obtained from similar, untreated children (n = 90). Xylitol swabbing resulted in a significant (P < 0.001) reduction in the incidence of enamel and dentine caries compared with the comparison subjects (relative risk 2.1 and 4.0, respectively; 95% confidence intervals 1.42-3.09 and 2.01-7.98, respectively). Similar findings were obtained when the children were 5 or 6 years old. The treatment reduced the need of tooth filling relative risk and 95% confidence intervals at 7 years: 11.86 and 6.36-22.10, respectively; P < 0.001). Compared with untreated subjects, the oral counts of mutans streptococci were reduced significantly (P < 0.001). CONCLUSIONS Considerable improvement in dental health was accomplished in infants participating in a topical at-home xylitol administration experiment, which was offered to families in the area by the Public Health Centre as a supplement to standard oral health care. Caregiver assessment of the programme was mostly rated as high or satisfactory.
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Affiliation(s)
- Kauko K Mäkinen
- Institute of Dentistry, University of Turku, Turku, Finland.
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Abstract
Although the use of fluorides has been successful in reducing dental caries, the need remains to develop and evaluate new approaches and promising products for caries prevention. Comprehensive caries-prevention protocols should encompass fluoride and other agents affecting the de-/remineralization balance but also antimicrobial strategies. Different from the traditional restorative approach, the current opinion is that caries should be detected and monitored in its earliest stages, when a nonsurgical reversal can still be achieved. This paradigm shift has implications for methods of caries diagnosis, the choice of preventative materials and the design of randomized clinical trials. This article summarizes the highlights of a special conference dedicated to the topic of novel anticaries and remineralizing agents (ICNARA 2), and identifies the current consensus and remaining questions on pivotal issues in this field.
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Affiliation(s)
- J M Ten Cate
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Free University Amsterdam, Amsterdam, The Netherlands.
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