Dental caries seen from the pulpal side: a non-traditional approach

Personal oral hygiene and dental caries: A systematic review of randomised controlled trials

OBJECTIVE

To conduct a systematic review of randomised trials assessing the association between personal oral hygiene and dental caries in the absence of the confounding effects of fluoride.

BACKGROUND

Dental caries continues to affect close to 100% of the global population. There is a century-old conflict on whether dental caries is caused by poor oral hygiene or poorly formed teeth (ie, teeth with dental defects). Resolving this conflict is of significant public health importance as these two hypotheses on dental caries aetiology can lead to different prevention strategies.

METHODS

A systematic search for randomised trials was conducted using predefined criteria in 3 databases. The impact of personal oral hygiene interventions on coronal dental caries incidence was evaluated using random-effects models.

RESULTS

Three randomised studies involving a total of 743 participants were included. Personal oral hygiene interventions failed to influence the incidence of dental caries (Δ Decayed, Missing and Filled Surfaces (DFMS) = -0.11; 95% confidence interval: (-0.91, 0.69; P-value < .79)) despite meticulous deplaquing of teeth. There was no significant heterogeneity in the trial results (heterogeneity chi-squared = 1.88, P = .39). The findings were robust to sensitivity analyses, including consideration of the results of nonrandomised studies.

CONCLUSION

Personal oral hygiene in the absence of fluorides has failed to show a benefit in terms of reducing the incidence of dental caries.

Enzymes, dentinogenesis and dental caries: a literature review

Objectives

Search in PubMed with keywords “enzymes, dentinogenesis, and dental caries” revealed only 4 items, but when combined with “enzymes, osteogenesis, and osteoporosis” as high as 404 items resulted. Dental caries was associated with an order of magnitude fewer studies than the chronic bone disease, osteoporosis. This observation motivated this review.

Material and Methods

A comprehensive review of the available literature on role of enzymes in dentinogenesis and dental caries was undertaken using MEDLINE (PubMed) and Scopus. Keywords for the search were: enzymes and odontoblasts, enzymes and different forms of dentinogenesis as well as dental caries.

Results

Search revealed studies which described odontoblasts harbouring numerous enzymes (hydrolases, including metalloproteinases, transaminases and dehydrogenases) during primary dentinogenesis. Alkaline phosphatase activity sharply decreased when odontoblasts turned into quiescent odontoblasts. Tertiary dentinogenesis was characterized first by reactionary dentine formation when alkaline phosphatase was highly reactivated. Then later some of these odontoblasts may die out and be replaced by other progenitor cells of pulpal origin. This tertiary dentine was called reparative dentine. Pulpal progenitor/stem cells revealed alkaline phosphatase activity in areas encircling inflamed pulp sections. Soft carious dentine revealed high hydrolase, transaminase and dehyrogenase activities that may have originated from invading microbes, saliva or were endogenous. Proteolytic activity was especially demonstrable using histochemical and biochemical means. Specifically, matrix metalloproteases may have originated partly from activated proenzymes of host origin.

Conclusions

Though dental studies are scanty when compared to bone, the active role of large spectrum of enzymes in healthy and carious dentine was given support.

The Effect of Perinatal TCDD Exposure on Caries Susceptibility in Rats

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD), the model compound of polychlorinated dibenzo-p-dioxins and furans, is a potent toxicant with the ability to hamper development. Accidental exposure to TCDD has been linked with various developmental dental aberrations in humans, and experimentally it has been shown that TCDD causes, among other defects, hypomineralization of dental hard tissues in rodents. Here, we studied the effect of very low perinatal TCDD exposure on dental caries susceptibility and mineral composition of tooth enamel in rats. Pregnant line C rats (rat line developed in our laboratory) were dosed 0.03-1.0 microg/kg TCDD on gestation day 15 and allowed to give birth and nurse until weaning on postnatal day 21. The offspring were challenged with cariogenic treatment including sugar-rich diet and three inoculations with Streptococcus mutans. Control groups involved animals with or without cariogenic challenge or TCDD treatment. The number of caries lesions in left lower molars was determined by Schiff's staining after 8 weeks of weaning. TCDD treatment increased cariogenic lesions in the enamel at the lowest maternal dose used, 0.03 microg/kg, and at the highest maternal dose, 1 microg/kg, the lesions extended through the enamel to dentin more frequently. Changes in mineral composition measured by electron probe microanalyzer, scanning electron microscopy, and energy-dispersive spectrometry could not explain the increased caries susceptibility. In conclusion, perinatal TCDD exposure can render rat molars more susceptible to caries.

Effects of protein deficiency induced by raw soy with and without sucrose on dentine formation and dentinal caries in young rats

OBJECTIVES

The effects of protein deficiency and sucrose on formation and mineralization of dentine and dental caries in the molars of young rats were investigated.

MATERIALS AND METHODS

Two groups of weaning Wistar rats received raw soy flour to induce protein deficiency with sucrose or starch as the carbohydrate source; the other two groups received skim milk powder as the protein source with sucrose or starch as the carbohydrate source. At the onset, tetracycline was injected to mark the dentine formed at that moment. After 6 weeks, lower molars were sectioned sagittally, and the areas of dentine formation and dentinal caries developed during the experiment were quantified separately in the first and second molars. Dental caries was also classified according to Schiff's reaction. Calcium (Ca), phosphorus (P) and total mineral elements were analyzed using an electron probe microanalyzer.

RESULTS

Rats in both protein-deficient groups and normal protein sucrose group had significantly larger areas of dentine formed compared with rats fed with normal protein starch diet. Ca, P and total mineral elements in dentine were significantly reduced by normal protein sucrose diet. P content was significantly reduced in dentine of rats in protein-deficient sucrose group. Rats in normal protein sucrose group had significantly more and larger dentinal caries lesions than in any other group.

CONCLUSION

This study suggests that protein deficiency induced by soy prevents the progression of dental caries even in highly cariogenic environment.