Saliva stimulation and caries prevention

Impact of Dairy Products and Plant-Based Alternatives on Dental Health: Food Matrix Effects

The impact of dairy products on dental health has been researched widely and shows an important role of various constituents, as well as the specific product matrix, in maintaining and improving dental health. These include, for instance, the position of lactose as the least cariogenic fermentable sugar, the high levels of calcium and phosphate, the presence of phosphopeptides as well as the antibacterial peptides lactoferrin and lysozyme and high buffering capacity. With plant-based alternatives for dairy products being developed and marketed these days, the specific benefits of dairy products in relation to dental health are often overlooked and most products contain more cariogenic carbohydrates, lack phosphopeptides, and have fewer minerals and less buffering capacity. Comparative studies performed to date indeed suggest that plant-based products do not match dairy counterparts when it comes to maintaining and improving dental health. Careful consideration of these aspects is required in relation to future developments of products and human diets. In this paper, we review the impact of dairy products and plant-based dairy alternatives on dental health.

Hijama (wet cupping therapy) enhances oral and dental health by improving salivary secretion volume and pH in adult patients at King Abdul Aziz University Hospital (KAUH), Jeddah, KSA: A controlled trial study

Objective

The aim of this study was to explore the potential effect of Hijama in promoting oral health by analyzing its effects in modulating saliva flow and pH.

Method

An open-label, non-randomized controlled trial design was conducted at the Hijama clinic of Y.A. Jameel Scientific Chair of Prophetic Medical Applications at King Abdul Aziz University Hospital (KAUH), Jeddah, KSA. Forty-one healthy volunteers were divided into two groups: Hijama (intervention, N = 21) and control (N = 20). Saliva volume and pH were measured in salivary samples collected in a standardized fashion, 1 h before admission to the Hijama room (pre-Hijama) and 30 min after the procedure (post-Hijama) in both groups. The Hijama group underwent an additional salivary collection 7 days after Hijama.

Result

Early post-Hijama assessment showed an increase in saliva volume by an average of 1 mL in the Hijama group, whereas that in the control group decreased by 0.6 mL (p < 0.001; large effect size, Cohen's d = 1.24). Saliva pH also increased in the Hijama group by an average 0.22 but decreased by 0.08 in controls (p < 0.001; large effect size, Cohen's d = 1.22). The multivariate model demonstrated that Hijama explained 48.8% of the variability of both pH and volume together (group × time effect, eta squared = 0.488, p < 0.001), whereas time and sex had no effect. At 7 days post-Hijama, both the volume and pH of saliva had increased in the Hijama group with respect to the early post-Hijama time point; however, only the volume increase was statistically significant.

Conclusion

Hijama enhanced salivary function and induced a significant increase in saliva volume and pH, which was maintained 7 days after the intervention. Further studies are warranted to identify other effects of Hijama on salivary glands and explore its long-term efficacy and clinical applications.

Association of Anthropometric Measurements, Hemoglobin Level and Salivary Parameters among Caries-free and S-ECC Children

Context

The implication of severe dental caries in children may have its effect on general health apart from affecting the orodental tissues. Many children reporting with severe caries have shown weighing less due to malnourishment resulting in anemia and modified somatic growth.

Aims

Study aimed to assess and compare anthropometric measurements, hemoglobin level, and salivary parameters among caries-free and severe early childhood caries (E-CCC) children.

Settings and design

For caries-free group [Group I] and S-ECC group [Group II] data were obtained from age-matched children with similar socioeconomic status.

Materials and methods

Children with severe caries and without caries from the age-group 3- 6 years participated in the study. Children were measured for height, weight, measurement of mid-upper arm circumference, and waist circumference. Hemoglobin level was recorded. The collected unstimulated saliva was assessed for flow rate, salivary pH, and its buffering capacity.

Statistical analysis used

Both descriptive and inferential statistical analyses were carried out using Windows software and SPSS (21). Tests of significance namely t-test and Chi-square test were used along with regression analysis.

Results

Caries experience showed no statistical difference for age and gender among the sample population. Significant difference was found for all anthropometric measurements. When comparison for hemoglobin was done for both groups I and II, significant difference was observed [p = 0.003].

Conclusion

Children with severe dental caries in the present study had low hemoglobin which, if persisted, can lead to anemia. Though the anthropometric parameters may appear normal in children diagnosed with severe early childhood caries, pediatric dentist should ensure the hemoglobin level test, as iron deficiency can affect growth and development of the child, if left undiagnosed.

How to cite this article

Deshpande AN, Sudani U, Wadhwa M, et al. Association of Anthropometric Measurements, Hemoglobin Level and Salivary Parameters among Caries-free and S-ECC Children. Int J Clin Pediatr Dent 2022;15(S-2):S164-S171.

Surveillance of salivary properties of pre-orthodontic patients in relation to age and sex

Saliva plays an important role in masticatory function and protection from dental caries. Although studies have been conducted on saliva properties, their results vary widely depending on population settings. Hence, this study was performed to evaluate the results of saliva properties in individuals who attended their first visit for orthodontic treatment. A total of 619 participants were included (387 females and 232 males; mean age: 14.6 years). We conducted oral examinations and saliva (stimulated) tests and evaluated the saliva flow rate, pH, and buffering capacity, along with bacterial culture. Saliva flow rate, pH, and buffering capacity were significantly higher in males than in females. However, the Streptococcus mutans score was significantly higher in females than in males even though oral hygiene was better in females. Significant positive correlations were found between age and saliva flow rate and S. mutans score. On the contrary, significant negative correlations were found between age and pH and buffering capacity. These results were similar to other studies where the target population was children or teenagers. Saliva properties of patients starting orthodontic treatment were almost the same as in populations of similar ages.

Role of natural salivary defenses in the maintenance of healthy oral microbiota in children and adolescents

Aim

The present study served the purpose of assessing the levels of salivary immunoglobulin A (IgA), immunoglobulin G (IgG), proteins, calcium, inorganic phosphorus, and alkaline phosphatase levels in caries-free and caries active children.

Materials and Methods

Stratified randomized sampling method was used to include 40 subjects in the age group 12-15 years having a full complement of permanent dentition except for third molars. The selected pediatric subjects were further divided into two groups of 20 each based on DMFS score, Group-I - Caries free (DMFS score = 0) and Group-II - Caries active (DMFS score ≥10). Unstimulated midmorning saliva samples were collected and analyzed colorimetrically and by radial immunodiffusion method for constituents of saliva understudy.

Results

The mean salivary IgA levels in children in Group-I (caries-free children) was 10.63 ± 2.85 mg/dL which was statistically higher as compared to caries active children in Group-II (8.50 ± 1.43 mg/dL).The mean salivary protein level in children of Group-II was statistically higher at 3.28 ± 0.12 mg/dL as compared to Group-I (2.89 ± 0.11 mg/dL).

Conclusion

The present study showed decreased levels of salivary immunoglobulin A and high concentration of salivary protein in children with increased caries experience which is indicative of the protective role of salivary constituents in caries-free children.

Efficacy of a Calcium Sucrose Phosphate Based Toothpaste in Elevating the Level of Calcium, Phosphate Ions in Saliva and Reducing Plaque: A Clinical Trial

Aim:

To evaluate and compare the efficacy of “calcium sucrose phosphate” (CaSP) toothpaste (Enafix 5%) with ordinarily used calcium, phosphate-containing toothpaste in elevating the level of calcium, phosphate ions in saliva. Secondary aims were to evaluate substantivity and plaque-reducing ability of CaSP toothpaste.

Materials and Methods:

Thirty study participants of age group 6–13 years were divided into two groups: Group X (Control group) was made to continue brushing with their regularly used calcium, phosphate-containing toothpaste and Group Y (Test group) was allotted CaSP toothpaste. 1 ml of unstimulated saliva was periodically collected from both groups to determine any alteration in the salivary calcium, phosphate level. Parameters such as substantivity and plaque-reducing ability of CaSP toothpaste were also evaluated. Salivary mineral's intergroup comparison was evaluated by Student's t-test while its intragroup comparison along with the plaque amount variation in Group Y was evaluated by ANOVA and Tukey's post hoc test.

Results:

Group Y showed an increase in the salivary calcium level though not statistically significant. The increase was pronounced in samples collected on day 1. Group Y showed a consistent level of calcium, phosphate in samples collected immediately and 6 h postbrushing, indicating its substantivity. In addition, Group Y had an impact in reducing the plaque level when the 1^st-month plaque score was compared with the 12^th-month score.

Conclusion:

CaSP leads to an increase in the salivary calcium level though it was not statistically significant. Supervised brushing and dietary habits showed a positive effect on both the groups. CaSP toothpaste also showed substantivity and plaque-reducing ability.

Randomized clinical trial of the effect of NovaMin and CPP-ACPF in combination with dental bleaching

OBJECTIVE

This randomized, controlled, double-blind clinical study evaluated the effect of calcium sodium phosphosilicate (NovaMin) and casein phosphopeptide-amorphous calcium phosphate with fluoride (CPP-ACPF) on the prevention of post-operative sensitivity and on the effects of clinical bleaching treatment.

MATERIAL AND METHODS

Sixty volunteers were selected according to inclusion and exclusion criteria and were randomly assigned into three groups (n=20): CG (control group) patients, who were treated with 35% hydrogen peroxide; NOVAG (NovaMin group) patients, who were treated with 35% hydrogen peroxide followed by the application of NovaMin; and CPPG (CPP group) patients, who were treated with 35% hydrogen peroxide followed by the application of CPP-ACPF. Both bioactive agents were applied for five minutes. An evaporative stimulus associated with a modified visual scale was used to analyze sensitivity 24 hours after each bleaching session. The color evaluation was performed on the maxillary central incisors using a spectrophotometer. Associations between the intervention group, bleaching session, and reported sensitivity were tested using Chi-square partitioning.

RESULTS

Color change values (ΔE) were analyzed using analysis of variance (ANOVA). The significance level used for both tests was 5%. In the intragroup assessment, the Friedman test showed that only the CPP-ACPF group showed no statistically significant difference (p<0.05) between baseline and first bleaching session. In the intergroup assessment, the Kruskal-Wallis test showed that the CPPG had less postoperative sensitivity after the first session, when compared to the other groups (p<0.05). Color change analysis (ΔE) showed a significant difference between the means obtained in the different bleaching sessions in all groups (p<0.05).

CONCLUSIONS

This study showed that the combination of CPP-ACPF with 35% hydrogen peroxide significantly reduced post-operative sensitivity in the first session, compared with the other evaluated treatments. The association of CPP-ACPF and NovaMin did not affect the color change induced by tooth bleaching.

Unstimulated Saliva-Related Caries Risk Factors in Individuals with Cystic Fibrosis: A Cross-Sectional Analysis of Unstimulated Salivary Flow, pH, and Buffering Capacity

Salivary flow rate, pH, and buffering capacity are associated with dental caries, but studies from the cystic fibrosis (CF) literature are inconclusive regarding these salivary factors and caries. The aim of this study was to evaluate these factors and their associations with dental caries in individuals with CF. Unstimulated whole saliva was collected from individuals aged 6-20 years at Seattle Children's Hospital CF Clinic, USA (n = 83). Salivary flow rate was measured in milliliters per minute. Salivary pH was assessed using a laboratory pH meter. Buffering capacity was assessed by titration with HCl. The outcome measure was caries prevalence, defined as the number of decayed, missing, or filled primary and permanent tooth surfaces. Spearman's rank correlation coefficient and the t test were used to test for bivariate associations. Multiple variable linear regression models were used to (1) run confounder-adjusted analyses and (2) assess for potential interactions. There was no significant association between salivary flow rate or buffering capacity and caries prevalence. There was a significant negative association between salivary pH and caries prevalence, but this association was no longer significant after adjusting for age. There was no significant interaction between salivary flow rate and buffering capacity or between antibiotic use and the 3 salivary factors. Our results indicate that unstimulated salivary factors are not associated with dental caries prevalence in individuals with CF. Future studies should investigate other potential saliva-related caries risk factors in individuals with CF such as cariogenic bacteria levels, salivary host defense peptide levels, and medication use.

Radiation-induced dental caries, prevention and treatment - A systematic review

Treatment of head and neck cancers (HNCs) involves radiotherapy. Patients undergoing radiotherapy for HNCs are prone to dental complications. Radiotherapy to the head and neck region causes xerostomia and salivary gland dysfunction which dramatically increases the risk of dental caries and its sequelae. Radiation therapy (RT) also affects the dental hard tissues increasing their susceptibility to demineralization following RT. Postradiation caries is a rapidly progressing and highly destructive type of dental caries. Radiation-related caries and other dental hard tissue changes can appear within the first 3 months following RT. Hence, every effort should be focused on prevention to manage patients with severe caries. This can be accomplished through good preoperative dental treatment, frequent dental evaluation and treatment after RT (with the exception of extractions), and consistent home care that includes self-applied fluoride. Restorative management of radiation caries can be challenging. The restorative dentist must consider the altered dental substrate and a hostile oral environment when selecting restorative materials. Radiation-induced changes in enamel and dentine may compromise bonding of adhesive materials. Consequently, glass ionomer cements have proved to be a better alternative to composite resins in irradiated patients. Counseling of patients before and after radiotherapy can be done to make them aware of the complications of radiotherapy and thus can help in preventing them.

Higher Dental Caries Prevalence and Its Association with Dietary Habits and Physical Limitation in Epidermolysis Bullosa Patients: A Case Control Study

AIM

Epidermolysis bullosa (EB) represents a highly rare subgroup of skin diseases that affects skin and mucous membrane. The aim of the present study was to assess caries prevalence and its associated factors in EB subjects. Salivary status was also assessed.

MATERIALS AND METHODS

Ten subjects with EB who were under supervision were selected (cases) and matched by age and gender with unaffected individuals (controls). Dental caries were recorded using the World Health Organization (WHO) criteria. Oral hygiene and dietary habits were investigated by clinical examination and questionnaires. Both nonstimulated and stimulated saliva were collected and salivary pH, buffering capacity and mouth opening were evaluated.

RESULTS

The results showed that the median decay-missing-filled teeth was significantly higher (p = 0.0094) in EB cases 5 (3.9-20.3) than in controls 3 (2-3.25). The groups also differed when food consistency was analyzed. Individuals with EB have a higher intake of soft food. In addition, the median mouth-opening values from cases (0.84-2.84 cm) and controls (4.3-4.9 cm) have shown to be statistically different (p = 0.007). Considering the salivary parameters, none of them showed significant differences among groups.

CONCLUSION

Epidermolysis bullosa subjects present higher caries scores and might be related to their physical condition and dietary habits.

CLINICAL SIGNIFICANCE

There is a lack of information about oral status in EB subjects. Hence, our findings add useful information regarding the relationship between caries prevalence and associated risk factors in EB subjects.

Review of nanomaterials in dentistry: interactions with the oral microenvironment, clinical applications, hazards, and benefits

Interest in the use of engineered nanomaterials (ENMs) as either nanomedicines or dental materials/devices in clinical dentistry is growing. This review aims to detail the ultrafine structure, chemical composition, and reactivity of dental tissues in the context of interactions with ENMs, including the saliva, pellicle layer, and oral biofilm; then describes the applications of ENMs in dentistry in context with beneficial clinical outcomes versus potential risks. The flow rate and quality of saliva are likely to influence the behavior of ENMs in the oral cavity, but how the protein corona formed on the ENMs will alter bioavailability, or interact with the structure and proteins of the pellicle layer, as well as microbes in the biofilm, remains unclear. The tooth enamel is a dense crystalline structure that is likely to act as a barrier to ENM penetration, but underlying dentinal tubules are not. Consequently, ENMs may be used to strengthen dentine or regenerate pulp tissue. ENMs have dental applications as antibacterials for infection control, as nanofillers to improve the mechanical and bioactive properties of restoration materials, and as novel coatings on dental implants. Dentifrices and some related personal care products are already available for oral health applications. Overall, the clinical benefits generally outweigh the hazards of using ENMs in the oral cavity, and the latter should not prevent the responsible innovation of nanotechnology in dentistry. However, the clinical safety regulations for dental materials have not been specifically updated for ENMs, and some guidance on occupational health for practitioners is also needed. Knowledge gaps for future research include the formation of protein corona in the oral cavity, ENM diffusion through clinically relevant biofilms, and mechanistic investigations on how ENMs strengthen the tooth structure.

Dynamic changes in saliva after acute mental stress

Stress-related variations of fluoride concentration in supernatant saliva and salivary sediment, salivary cortisol, total protein and pH after acute mental stress were assessed. The hypothesis was that stress reactions have no influence on these parameters. Thirty-four male students were distributed into two groups: first received the stress exposure followed by the same protocol two weeks later but without stress exposure, second underwent the protocol without stress exposure followed by the stress exposure two weeks later. The stressor was a public speech followed by tooth brushing. Saliva was collected before, immediately after stress induction and immediately, at 10, 30 and 120 min. after tooth brushing. Cortisol concentrations, total protein, intraoral pH, and fluoride content in saliva were measured. The data were analyzed statistically. Salivary sediment was ca 4.33% by weight of whole unstimulated saliva. Fluoride bioavailability was higher in salivary sediment than in supernatant saliva. The weight and fluoride concentration was not altered during 2 hours after stress exposure. After a public speech, the salivary cortisol concentration significantly increased after 20 minutes compared to the baseline. The salivary protein concentration and pH also increased. Public speaking influences protein concentration and salivary pH but does not alter the fluoride concentration of saliva.

Effect of incorporation of remineralizing agents into bleaching gels on the microhardness of bovine enamel in situ

AIM

This study evaluated the effect of adding calcium or fluoride to 35% hydrogen peroxide (HP) bleaching gel and the effect of human saliva on the microhardness of sound and demineralized enamel, using an in situ model.

MATERIALS AND METHODS

Cylindrical bovine enamel specimens (3 × 2 mm) were divided into two groups (n = 30): sound enamel (SE) and demineralized enamel (DE). Each group was divided into three subgroups, according to the bleaching gel: 35% HP; 35% HP + calcium; 35% HP + fluoride. After bleaching therapy, the specimens were fixed to intraoral devices worn by 10 volunteers for 7 days. Surface enamel microhardness (SMH) was measured before and after bleaching procedures, and after 1 and 7 days of saliva exposure. Data were analyzed by Repeated Measures ANOVA (5%).

RESULTS

The variable time resulted in significant differences for SE and DE groups (p = 0.001). For SE, significantly lower SMH was detected for control at post-bleaching period in comparison to the baseline and after 7 days. For DE, the lowest mean values were obtained before bleaching, and the addition of calcium to the peroxide significantly increased enamel SMH. The exposure to human saliva resulted in increased SMH.

CONCLUSION

The addition of potential remineralizing agents into bleaching gels might play an important role in maintaining the microhardness of sound enamel and in inducing remineralization of artificially demineralized enamel right after bleaching, and the remineralizing action of human saliva might minimize the deleterious effects of bleaching gels on enamel. Clinical significance: The incorporation of calcium into HP bleaching gel might be beneficial for the initial phases of the bleaching procedure.

Electrochemical Behavior of Titanium in Artificial Saliva: Influence of pH

Titanium is the most common material chosen for dental implants because it is highly corrosion resistant because it constantly reforms a protective passive film layer. The formation and composition of the passive film layer is dependent on the environmental conditions. If the stable oxide layer is damaged, the titanium surface underneath can corrode. The purpose of this study was to determine if basic corrosion of commercially pure titanium (CpTi) alloy in artificial saliva was affected by pH and to understand the corrosion kinetics/mechanisms of CpTi as a function of pH. In this study, titanium alloy discs were subjected to corrosion tests. Before the tests, all samples were cleaned and polished using standard metallographic preparation methods. Artificial saliva was used as the testing medium. The following pH values were tested: 3.0, 4.5, 6.0, 6.5, 7.5, and 9.0. Different pH values were achieved by adding lactic acid (acidic) or NaOH (basic) in appropriate amounts. Potentiodynamic curves indicated behavior change at each pH. In addition, the corrosion current density value determined from the potentiodynamic curve exhibited the poorest corrosion resistance for pH 7.5. The Nyquist plot (from the electrochemical impedance spectroscopy results) indicated that pH 7.5 had the poorest resistance. Scanning electron microscopy images indicated that pH levels of 6.5, 7.5, and 9.0 had considerable surface corrosion. The results showed that the media's pH significantly influenced the corrosion behavior of CpTi. The poor corrosion behavior at the neutral pHs invites some concerns and highlights the need for further study.

Influence of pH on the tribocorrosion behavior of CpTi in the oral environment: synergistic interactions of wear and corrosion

Dental implants made of titanium alloys have been used as a predictable therapy approach to replace missing teeth. The oral environment subjects titanium implants to varying conditions like changes in pH, temperature, and saliva contamination leading to chemical corrosion together with mastication process.

OBJECTIVE

In this study, the combined effect of chemical corrosion and wear (so-called tribocorrosion) in the degradation of dental implant material (CpTi) under varying pH oral environment was investigated.

METHODS

Titanium (CpTi) discs were subjected to sliding tests in artificial saliva at varying pHs: 3.0, 6.0, and 9.0. A custom made tribocorrosion apparatus was used to perform the tests. The tribological system consisted of a ceramic ball of 28 mm diameter articulating against the flat face (titanium).

RESULTS

Electrochemical impedance spectroscopy results indicated an increase in electrochemical double layer capacitance (C(dl)) at pH 3.0 and 6.0 after sliding. Surprisingly, in the presence of tribological stresses, the measured current evolution was highest and fluctuated the most at pH 6.0. In addition, the greatest weight loss was measured at pH 6.0.

CONCLUSIONS

Despite reports of CpTi being electrochemically stable down to pH 2.0, this study suggests degradation peaks at near neutral pH values in the presence of motion. At pH 6.0, the passive film layer, typically protecting the surface of titanium may not be reformed cohesively, resulting in more tribocorrosion products at the surface, which are easily sheared off. These findings elevate concern with regard to dental implants because the average pH of the oral cavity is 6.3.

Salivary parameters in Brazilian individuals with cerebral palsy who drool

BACKGROUND

Although drooling of saliva is considered abnormal in a child over 4 years of age, it has been estimated to occur in approximately in 10-37% of children with cerebral palsy.

AIM

The aim of this study was to evaluate the flow rate, pH and buffering capacity in saliva of Brazilian individuals with cerebral palsy who drool.

METHODS

Cross-sectional assessment of saliva from 139 individuals with cerebral palsy (3-16 years old) enrolled in a specialized rehabilitation centre in Sao Paulo, Brazil, divided into two groups, according to the presence (G1) or absence (G2) of drooling and controls (G3): G1 consisted of 63 individuals who drool; G2 consisted of 76 who do not drool; and G3 consisted of 47 individuals with no neurological damage of similar age and sex. Unstimulated whole saliva was collected and salivary flow rate (mL/min), initial pH and buffering capacity, by titration of saliva with a constant amount of 0.01 N HCl, were evaluated. The results from G1, G2 and G3 were compared by one-way anova and the χ(2) -test.

RESULTS

A higher percentage of severe drooling (60.3%) was observed compared with moderate (27.0%) and mild (12.7%) in the cerebral palsy individuals who drool and the prevalence of drooling was highest among children and adolescents with spastic quadriplegia. Significant reductions in salivary flow rate, initial pH, buffering capacity of whole saliva in pH range 6.0-6.9 and total buffering capacity occurred in G1 and G2 compared with G3.

CONCLUSION

All individuals with cerebral palsy present lower flow rate, pH and buffering capacity of saliva, which increases the risk of oral diseases.

A review of the current literature on management of halitosis

Halitosis is an unpleasant or offensive odour, emanating from the oral cavity. In approximately 80% of all cases, halitosis is caused by microbial degradation of oral organic substrates. Major degradation products are volatile sulphur-containing compounds. In this review, the available management methods of halitosis and their effectiveness and significance are presented and discussed. Undoubtedly, the basic management is mechanically reducing the amount of micro-organisms and substrates in the oral cavity. Masking products are not, and antimicrobial ingredients in oral healthcare products are only temporary effective in reducing micro-organisms or their substrates. Good short-term results were reported with chlorhexidine. Triclosan seems less effective, essential oils and cetylpyridinium chloride are only effective up to 2 or 3 h. Metal ions and oxidizing agents, such as hydrogen peroxide, chlorine dioxide and iminium are active in neutralizing volatile sulphur-containing compounds. Zinc seems to be an effective safe metal at concentrations of at least 1%. The effectiveness of active ingredients in oral healthcare products is dependent on their concentration and above a certain concentration the ingredients can have unpleasant side effects. Tonsillectomy might be indicated if (i) all other causes of halitosis are managed properly; (ii) halitosis still persists and (iii) crypts in tonsils are found to contain malodorous substrates.

Multicenter randomized trial of chewing gum for preventing oral mucositis in children receiving chemotherapy

The properties of saliva led us to hypothesize that the salivary flow increase induced by gum chewing might protect the oral mucosa from lesions due to cancer chemotherapy. We conducted a multicenter randomized trial to evaluate the efficacy of chewing gum in preventing oral mucositis in 145 children receiving chemotherapy regimens expected to induce WHO grade 3-4 oral mucositis in at least 30% of patients. Patients were allocated at random to standard oral care with or without 5 gum pieces per day. No overall reduction in severe oral mucositis occurred in the gum arm (51%) compared with the standard arm (44%). VIDE, COPADM, and multidrug intensive chemotherapy caused severe oral mucositis in 75% of patients in both arms. In patients receiving less toxic regimens, a decrease in WHO grade 1-4 oral mucositis was noted in the gum arm compared with the standard arm (49% vs. 72%, P=0.03). In the multivariate analysis, the risk of oral mucositis was related only to the type of chemotherapy regimen, suggesting that further strategies for preventing oral mucositis could be mainly based on these criteria.

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.

A role of salivary carbonic anhydrase VI in dental plaque

OBJECTIVE

Carbonic anhydrase (CA) VI is a unique secreted isozyme of CA, which catalyzes the reversible reaction CO2 +H2O<-->H+ +HCO3-. CA VI has been thought to provide a greater buffering capacity to fluids into which it is secreted. This study was performed to confirm this in saliva.

DESIGN

Nine healthy subjects participated in the study. The pH of the dental plaque from each subject was monitored after a mouth rinse with 10% sucrose with or without 10(-5)M acetazolamide, a specific inhibitor of CA. Also CA was examined in plaque by enzyme histochemistry, immunohistochemistry and Western blot analysis.

RESULTS

Though sucrose and sucrose plus inhibitor yielded Stephan curves with a similar temporal pattern, the pH values of the latter were significantly lower than those of the former. Plaque exhibited CA activity by enzyme histochemistry. Immunohistochemistry and Western analysis demonstrated that the activity was due to CA VI but not to CA I or CA II.

CONCLUSIONS

The results indicate that CA VI in saliva penetrates plaque and facilitates acid neutralization by salivary bicarbonate. Therefore, CA VI may be considered an anti-caries protein in saliva.

Sjögren's syndrome: the diagnostic potential of early oral manifestations preceding hyposalivation/xerostomia

Sjögren's syndrome (SS) is a systemic autoimmune exocrinopathy that affects mainly the salivary and lacrimal glands, leading to progressive reduction in saliva and tear flow. Although the underlying immuno-mediated glandular destruction is thought to develop slowly over several years, a long delay from the start of the symptoms to final diagnosis has been frequently reported. A limited knowledge concerning SS natural history is among the major causes of the actual diagnostic delay. Although very few studies have been focused on the analysis of SS early clinical onset, a series of oral features preceding xerostomia/hyposalivation development in patients eventually diagnosed as having SS have been reported. Sialochemistry alterations, salivary gland swelling, early dental loss and sialorrhea have been observed before the onset of typical signs and symptoms (namely xerostomia and/or hyposalivation), which usually lead to SS clinical presentation and diagnosis. Here we suggest, after evaluating available data, that the traditional 'untouchable' association between SS and xerostomia/hyposalivation might probably be reconsidered, and that astute clinicians should not underestimate the possible presence or development of SS in patients without xerostomia/hyposalivation and presenting these atypical early oral features.

Health benefits of saliva: a review

OBJECTIVE

The aim is to present a review of the literature on human saliva composition, flow rates and some of the health benefits of saliva, with emphasis on studies from our laboratory that have looked at effects of age and age-related diseases on saliva output and composition.

DATA

Saliva influences oral health both through its non-specific physico-chemical properties, as well as through more specific effects. The proline-rich proteins, statherin and the histatins are salivary proteins that influence calcium phosphate chemistry, initial plaque formation and candida infection. Increases or decreases in mastication may affect saliva output. Our cross-sectional studies of saliva in a large population-based study cohort (N=1130) indicate that there is an age-related decline in saliva output for unstimulated whole, stimulated parotid, unstimulated submandibular/sublingual and stimulated submandibular/sublingual saliva, as well as some compositional alterations in anti-microbial and other proteins. Some of these alterations also appear to be specific for certain age-related medical conditions, such as diabetes mellitus.

CONCLUSIONS

These studies and data presented confirm the importance of saliva in maintaining a healthy oral environment; the practitioner is encouraged to consider saliva output and medical conditions that may compromise it as part of routine dental treatment planning.

Acid resistance of human enamel in vitro after bicarbonate application during remineralization

OBJECTIVES

The aim of this study was to investigate the acid resistance of subsurface enamel lesions remineralized with bicarbonate solutions during remineralization.

METHODS

Two experiments were carried out. In experiment 1, mineral uptake and acid resistance of remineralized enamel lesions were analyzed quantitatively by microradiography for mineral changes. Bicarbonate solutions of 0.5, 5.0 and 50.0 mM were used. In experiment 2, to clarify acid resistance mechanisms, the pH changes in demineralizing solutions on the remineralized enamel surfaces were measured continuously. Only a bicarbonate solution of 5.0 mM was used.

RESULTS

In experiment 1, the bicarbonate-treated groups were more acid resistant than the non-treated groups (p<0.05). However, no statistically significant difference was observed among the different concentrations of bicarbonate. In experiment 2, the pH rise of the bicarbonate group was greater than the other groups.

CONCLUSION

It was found that bicarbonate-treated enamel lesions were resistant to acid. It would suggest that bicarbonate ions applied during remineralization may have penetrated into the subsurface lesions. These ions may have worked as buffer agents against the acid challenge and inhibited the decrease in pH.

Nutritional implications of xerostomia and rampant caries caused by serotonin reuptake inhibitors: a case study

Serotonin reuptake inhibitors, such as fluoxetine, fenfluramine, and dexfenfluramine, are frequently used to treat obesity, depression, and bulimia. A common side effect of these medications is xerostomia, or dry mouth. A case study demonstrating the impact of drug-induced xerostomia on oral health and subsequent nutrition implications is presented. Rampant caries can result from a combination of xerostomia and inappropriate dietary and oral hygiene habits. Preventive dietary and dental guidelines are presented to assist nutrition and dental professionals in treating and counseling patients with xerostomia.

No relationship of salivary flow rate or secretory immunoglobulin A to dental caries in children

To investigate the relationship between dental caries and the salivary flow rate, secretory immunoglobulin A (sIgA) or other components in children, nonstimulated whole saliva was collected and teeth status was examined in 138 boys and 134 girls aged 11-12 years. The subjects were apparently healthy. The mean salivary flow rate was faster in boys than in girls (0.29 vs 0.18 ml/min, p < 0.001). In both sexes, secretion of salivary sIgA and three other components (total protein, calcium and amylase activity) was markedly dependent on salivary flow rates. These results suggest that basal components of resting saliva are secondarily secreted with the flow of saliva fluid. The mean erupted permanent teeth was 21.0 teeth (range: 10-28 teeth) in boys, and 23.0 teeth (13-28 teeth) in girls (sex-difference: p < 0.001). The means of DMFT, the DMFT ratio (% of DMFT to erupted permanent teeth) and DT+dt (sum of decayed permanent and milk teeth, an index for active caries) were 3.4 DMFT (range: 0-11 DMFT), 16.0% (0-40.0%) and 0.5 DT+dt (0-7 DT + dt) in boys, and 3.8 DMFT (0-12 DMFT), 16.2% (0-44.4%) and 0.8 DT+dt (0-5 DT+dt) in girls, respectively (sex-differences: p>0.05 in all). The salivary flow rate or the four salivary components (either concentration or secretion rate) used here had no relationship to the DMFT ratio or to DT+dt in either sex. Variation in the flow rate or in the basal components of resting saliva may not influence caries development in healthy children.