Oral Cancer Knowledge, Attitudes and Practices among Primary Oral Health Care Dentists in Kuwait

Background: Oral cancer signifies a public health concern of international importance. Early detection of oral cancer can improve the prognosis and the 5-year survival rate. Objective: The aim of this study was to assess the level of oral cancer knowledge, opinion, attitudes and practices among dentists working at the primary oral health care centers in Kuwait. Methods: In this cross-sectional study, self-reported questionnaire was distributed to the dentists working at the primary oral health care centers in Kuwait. A total of 289 dentists participated in the present study. The questionnaire included 23- questions on oral cancer knowledge, opinion, attitudes and practices. Results: The mean age of the dentists was 35.2 ± 10.9 years. Approximately, all dentists (99.7%) were aware of the major risk factors that were most likely associated with oral cancer. Overall, majority of the participants knew the most common form of oral cancer (80.6%), most common site (80.3%) and the likely lesions associated with oral cancer occurrence (87.9%). A large number of dental practitioners (81%) would routinely refer a patient with a suspicious lesion to a specialist. Nearly one-third (32%) reviewed their patients’ oral cancer risk factors. Approximately two-thirds (62%) assessed the use of tobacco in their practice. Almost, all (92.4%) were interested in attending continuing education courses on oral cancer. Conclusions: Majority of the participants presented good knowledge about various aspects of oral cancer. More continuing education programs on risk factors and diagnosis of oral cancer should be organized to train the dentists. Oral cancer screening should be a routine procedure for the high risk patients at the primary oral health care centers in Kuwait.

Salivary N1-Methyl-2-Pyridone-5-Carboxamide, a Biomarker for Uranium Uptake, in Kuwaiti Children Exhibiting Exceptional Weight Gain

In a longitudinal study of 6,158 Kuwaiti children, we selected 94 for salivary metabolomic analysis who were neither obese (by waist circumference) nor metabolic syndrome (MetS) positive (<3 diagnostic features). Half (43) remained healthy for 2 years. The other half (51) were selected because they became obese and MetS positive 2 years later. In the half becoming obese, metabolomic analysis revealed that the level of salivary N1-Methyl-2-pyridone-5-carboxamide (2PY) had the highest positive association with obesity (p = 0.0003, AUC = 0.72) of 441 salivary biochemicals detected. 2PY is a recognized uremic toxin. Also, 2PY has been identified as a biomarker for uranium uptake. Considering that a relatively recent military conflict with documented uranium contamination of the area suggests that this weight gain could be a toxicological effect of long-time, low-level uranium ingestion. Comparison of salivary 2PY in samples from the USA and Kuwait found that only Kuwait samples were significantly related to obesity. Also, the geographic distribution of both reported soil radioactivity from ²³⁸U and measured salivary 2PY was highest in the area where military activity was highest. The prevalence pattern of adult diabetes in Kuwait suggests that a transient diabetogenic factor has been introduced into the Kuwaiti population. Although we did not measure uranium in our study, the presence of a salivary biomarker for uranium consumption suggests potential toxicity related to obesity in children.

The salivary microbiome is altered in the presence of a high salivary glucose concentration

Background

Type II diabetes (T2D) has been associated with changes in oral bacterial diversity and frequency. It is not known whether these changes are part of the etiology of T2D, or one of its effects.

Methods

We measured the glucose concentration, bacterial counts, and relative frequencies of 42 bacterial species in whole saliva samples from 8,173 Kuwaiti adolescents (mean age 10.00 ± 0.67 years) using DNA probe analysis. In addition, clinical data related to obesity, dental caries, and gingivitis were collected. Data were compared between adolescents with high salivary glucose (HSG; glucose concentration ≥ 1.0 mg/d, n = 175) and those with low salivary glucose (LSG, glucose concentration < 0.1 mg/dL n = 2,537).

Results

HSG was associated with dental caries and gingivitis in the study population. The overall salivary bacterial load in saliva decreased with increasing salivary glucose concentration. Under HSG conditions, the bacterial count for 35 (83%) of 42 species was significantly reduced, and relative bacterial frequencies in 27 species (64%) were altered, as compared with LSG conditions. These alterations were stronger predictors of high salivary glucose than measures of oral disease, obesity, sleep or fitness.

Conclusions

HSG was associated with a reduction in overall bacterial load and alterations to many relative bacterial frequencies in saliva when compared with LSG in samples from adolescents. We propose that hyperglycemia due to obesity and/or T2D results in HSG and subsequent acidification of the oral environment, leading to a generalized perturbation in the oral microbiome. This suggests a basis for the observation that hyperglycemia is associated with an increased risk of dental erosion, dental caries, and gingivitis. We conclude that HSG in adolescents may be predicted from salivary microbial diversity or frequency, and that the changes in the oral microbial composition seen in adolescents with developing metabolic disease may the consequence of hyperglycemia.

Salivary Biomarkers in Pediatric Metabolic Disease Research

The increasing prevalence of childhood obesity and obesity-related metabolic disorders is now considered a global pandemic. The main goal of the pediatric obesity research community is to identify children who are at risk of becoming obese before their body mass index rises above age norms. To do so, we must identify biomarkers of metabolic health and immunometabolism that can be used for large-scale screening and diagnosis initiatives among at-risk children. Because blood sampling is often unacceptable to both parents and children when there is no direct benefit to the child, as in a community-based research study, there is a clear need for a low-risk, non-invasive sampling strategy. Salivary analysis is now well recognized as a likely candidate for this purpose. In this review, we discuss the physiologic role of saliva and its strengths and limitations as a fluid for biomarker discovery, obesity screening, metabolic disease diagnosis, and response monitoring after interventions. We also describe the current state of the salivary biomarker field as it pertains to metabolic research, with a special emphasis on studies conducted in children and adolescents. Finally, we look forward to technological developments, such as salivary "omics" and point of service diagnostic devices, which have the potential to accelerate the pace of research and discovery in this vitally important field.

Five-year Sealant Retention and Efficacy in a Multi-operated School-based Oral Health Programme in Kuwait

PURPOSE

To evaluate sealant retention in a multi-operator school-based oral health programme and sealant efficacy in preventing caries in a high caries-risk population.

MATERIALS AND METHODS

Sealant retention and caries status in previously placed sealants on permanent first molars were evaluated in 503 children ages 6 to 8 years at 20 primary schools. A total of 2538 sealants were applied on 876 first permanent molars and evaluated for retention and efficacy in preventing caries from 2002 to 2007. These sealants were placed on occlusal and buccal or palatal surfaces using a standard protocol after isolation with rubber-dam or cotton roll. Caries was scored in teeth in which the sealants were partially or completely lost.

RESULT

1752 sealants (69%) were examined at the end of the fifth year, with 58.3% of the sealants completely retained, 7.4% partially lost, 19% completely lost, 6.2% resealed and 9.1% restored. Only 3.1% of the previously sealed teeth were carious and 87.8% of previously sealed teeth were caries free. In multivariate analysis, occlusal surfaces were 2.0 times more likely to retain a sealant than were the buccal and palatal pits (p < 0.0001). No differences in sealant retention vs caries by arch, or teeth isolated using rubber-dam vs cotton roll were seen.

CONCLUSION

The present study shows the effectiveness of sealants in caries prevention in a multi-operator school sealant programme, and provides evidence supporting their use in such programmes for high-caries populations.

Unhealthy Phenotype as Indicated by Salivary Biomarkers: Glucose, Insulin, VEGF-A, and IL-12p70 in Obese Kuwaiti Adolescents

OBJECTIVE

Here, we investigated the relationships between obesity and the salivary concentrations of insulin, glucose, and 20 metabolic biomarkers in Kuwaiti adolescents. Previously, we have shown that certain salivary metabolic markers can act as surrogates for blood concentrations.

METHODS

Salivary samples of whole saliva were collected from 8,317 adolescents. Salivary glucose concentration was measured by a high-sensitivity glucose oxidase method implemented on a robotic chemical analyzer. The concentration of salivary insulin and 20 other metabolic biomarkers was assayed in 744 randomly selected saliva samples by multiplexed bead-based immunoassay.

RESULTS

Obesity was seen in 26.5% of the adolescents. Salivary insulin predicting hyperinsulinemia occurred in 4.3% of normal-weight adolescents, 8.3% of overweight adolescents, and 25.7% of obese adolescents (p < 0.0001). Salivary glucose predicting hyperglycemia was found in only 3% of obese children and was not predictive (p = 0.89). Elevated salivary glucose and insulin occurring together was associated with elevated vascular endothelial growth factor and reduced salivary interleukin-12.

CONCLUSION

Considering the surrogate nature of salivary insulin and glucose, this study suggests that elevated insulin may be a dominant sign of metabolic disease in adolescent populations. It also appears that a proangiogenic environment may accompany elevated glucose in obese adolescents.

Continuous Metabolic Syndrome Scores for Children Using Salivary Biomarkers

Background

Binary definitions of the metabolic syndrome based on the presence of a particular number of individual risk factors are limited, particularly in the pediatric population. To address this limitation, we aimed at constructing composite and continuous metabolic syndrome scores (cmetS) to represent an overall measure of metabolic syndrome (MetS) in a large cohort of metabolically at-risk children, focusing on the use of the usual clinical parameters (waist circumference (WC) and systolic blood pressure (SBP), supplemented with two salivary surrogate variables (glucose and high density lipoprotein cholesterol (HDLC). Two different approaches used to create the scores were evaluated in comparison.

Methods

Data from 8,112 Kuwaiti children (10.00 ± 0.67 years) were used to construct two cmetS for each subject. The first cmetS (cmetS-Z) was created by summing standardized residuals of each variable regressed on age and gender; and the second cmetS (cmetS-PCA) was defined as the first principal component from gender-specific principal component analysis based on the four variables.

Results

There was a graded relationship between both scores and the number of adverse risk factors. The areas under the curve using cmetS-Z and cmetS-PCA as predictors for severe metabolic syndrome (defined as the presence of ≥3 metabolic risk factors) were 0.935 and 0.912, respectively. cmetS-Z was positively associated with WC, SBP, and glucose, but inversely associated with HDLC. Except for the lack of association with glucose, cmetS-PCA was similar to cmetS-Z in boys, but had minimum loading on HDLC in girls. Analysis using quantile regression showed an inverse association of fitness level with cmetS-PCA (p = 0.001 for boys; p = 0.002 for girls), and comparison of cmetS-Z and cmetS-PCA suggested that WC and SBP were main contributory components. Significant alterations in the relationship between cmetS and salivary adipocytokines were demonstrated in overweight and obese children as compared to underweight and normal-weight children.

Conclusion

We have derived continuous summary scores for MetS from a large-scale pediatric study using two different approaches, incorporating salivary measures as surrogate for plasma measures. The derived scores were viable expressions of metabolic risk, and can be utilized to study the relationships of MetS with various aspects of the metabolic disease process.

Salivary glucose concentration exhibits threshold kinetics in normal-weight, overweight, and obese children

BACKGROUND

Metabolic syndrome in childhood predicts the development of cardiovascular disease and type 2 diabetes (T2D) in adulthood. Testing for features of metabolic syndrome, such as fasting plasma glucose concentration, requires blood sampling which can be difficult in children. Here we evaluated salivary glucose concentration as a surrogate measurement for plasma glucose concentration in 11-year-old US children.

METHODS

Children from Portland, Maine, and Cambridge, Massachusetts, with a mean age of 10.6±0.2 years provided 6-hour fasting samples of both blood and whole saliva. Salivary glucose levels were measured with a high-sensitivity assay (sensitivity =0.002 mg/dL). Plasma glucose levels were determined by a commercial clinical laboratory. Blood pressure, salivary flow rate, height, and weight were also measured.

RESULTS

Of the 65 children enrolled, there were two underweight children (3.1%), 30 normal-weight children (46.2%), 12 overweight children (18.4%), and 21 obese children (32.3%). The mean overall glucose concentrations were 0.11±0.02 mg/dL in saliva and 86.3±0.8 mg/dL in plasma, and these did not differ significantly by body-weight groups. By regression analysis, the plasma concentration equaled 13.5 times the saliva concentration, with a threshold level of 84.8 mg/dL. Salivary glucose values less than threshold plasma concentration were essentially zero. Diagnostic analysis indicated a positive predictive value of 50%, a negative predictive value of 90%, and a sensitivity and specificity both of approximately 75%. The salivary glucose concentration did not vary with saliva flow rate.

CONCLUSION

Taking into account the threshold response characteristics of the salivary glucose concentration response, these results suggest that testing salivary glucose levels may be useful as a screening assay for high fasting plasma glucose levels. The low false positive value is important to assure a low fraction of missed diagnoses.

Metabolic disease risk in children by salivary biomarker analysis

Objective

The study of obesity-related metabolic syndrome or Type 2 diabetes (T2D) in children is particularly difficult because of fear of needles. We tested a non-invasive approach to study inflammatory parameters in an at-risk population of children to provide proof-of-principle for future investigations of vulnerable subjects.

Design and Methods

We evaluated metabolic differences in 744, 11-year old children selected from underweight, normal healthy weight, overweight and obese categories by analyzing fasting saliva samples for 20 biomarkers. Saliva supernatants were obtained following centrifugation and used for analyses.

Results

Salivary C-reactive protein (CRP) was 6 times higher, salivary insulin and leptin were 3 times higher, and adiponectin was 30% lower in obese children compared to healthy normal weight children (all P<0.0001). Categorical analysis suggested that there might be three types of obesity in children. Distinctly inflammatory characteristics appeared in 76% of obese children while in 13%, salivary insulin was high but not associated with inflammatory mediators. The remaining 11% of obese children had high insulin and reduced adiponectin. Forty percent of the non-obese children were found in groups which, based on biomarker characteristics, may be at risk for becoming obese.

Conclusions

Significantly altered levels of salivary biomarkers in obese children from a high-risk population, suggest the potential for developing non-invasive screening procedures to identify T2D-vulnerable individuals and a means to test preventative strategies.

Caries prevalence, oral hygiene, and oral health habits of Kuwaiti infants and toddlers

OBJECTIVE

The purpose of this study was to describe the oral health, oral hygiene, and oral health habits of Kuwaiti infants and toddlers.

SUBJECTS AND METHODS

This cross-sectional study of a convenience sample included 336 infants and toddlers (156 females and 180 males). The teeth of the infants and toddlers were examined using a mirror and a light source. Oral hygiene was recorded, and then all teeth were cleaned with gauze and examined for caries. Parents were interviewed regarding their children's feeding habits, brushing or tooth cleaning, and night feeding. The evaluation criteria for caries were sound teeth, noncavitated lesions, cavitated lesions, filled teeth, and missing teeth.

RESULTS

The mean age was 11.1 ± 2.4 months (range 2-23). Of the 336 subjects, 247 (73%) had good oral hygiene, 64 (19%) had parents who brushed or cleaned their infants' and toddlers' teeth; 288 (86%) were bottle-fed, and 290 (86%) were also night fed. The mean number of teeth upon examination was 4.6 ± 2.7 (range 2-8). Three percent of the infants and toddlers had caries. Cavitated lesions were present in 6 patients (1.8%), while 4 (1.2%) had noncavitated lesions. The mean d1d2t (caries teeth: noncavitated lesions and cavitated lesions) was 0.03 ± 0.3, and the mean d1d2s (carious surfaces) was 0.07 ± 0.5.

CONCLUSION

The caries prevalence and severity was low in infants and toddlers. However, poor oral health practices and habits as well as unhealthy feeding practices that could affect the future caries prevalence were noted.

Obesity and dental decay: inference on the role of dietary sugar

OBJECTIVE

To evaluate the relationship of children's obesity and dental decay.

METHODS

We measured parameters related to obesity and dental decay in 8,275 4(th) and 5(th) grade Kuwaiti children (average age = 11.36 years) in a cross-sectional study. First to determine body weight, height, age for computation of BMI . Second, to determine numbers of teeth, numbers of fillings and numbers of untreated decayed teeth to determine extent and severity of dental disease. From these measurements, we computed measures of dental decay in children from four body weight categories; obese, overweight, normal healthy weight and underweight children.

RESULTS

The percentage of children with decayed or filled teeth varied inversely with the body weight category. The percentage of decayed or filled teeth decreased from 15.61% (n=193) in underweight children, to 13.03% (n=4,094) in normal healthy weight children, to 9.73% (n=1,786) in overweight children to 7.87% (n=2,202) in obese children. Differences between all groups were statistically significant. Male children in this population had more dental decay than female children but the reduction of tooth decay as a function of BMI was greater in male children.

CONCLUSIONS

The finding of an inverse obesity-dental decay relationship contradicts the obesity-sugar and the obesity-dental decay relationship hypotheses. Sugar is well recognized as necessary and sufficient for dental decay. Sugar is also hypothesized to be a leading co-factor in obesity. If the later hypothesis is true, one would expect dental decay to increase with obesity. This was not found. The reasons for this inverse relationship are not currently clear.

Oral hygiene status of Kuwaiti schoolchildren

A national epidemiological survey of children aged 5-14 years was conducted in all 5 governorates of Kuwait in 2001 to determine the oral hygiene status of Kuwait in schoolchildren. Clinical examinations were carried out by calibrated dentists according to World Health Organization criteria. The debris index simplified (DI-S) score was used to assess oral hygiene status. Of the 3294 children, 3.9% were judged to have good oral hygiene (DI-S score: 0.3-0.6), 67% fair (score 0.7-1.8) and 29.1% poor (score 1.9-3.0). The overall level of oral hygiene in the schoolchildren surveyed was fair (mean score 1.5). DI-S scores were significantly higher for boys than girls (mean score 1.6 versus 1.5) but DI-S did not vary much by age. There were variations in DI-S scores across different governorates. Oral hygiene measures need to be reinforced for the schoolchildren in Kuwait and should form part of the school curriculum.

Dental caries experience of Kuwaiti kindergarten schoolchildren

OBJECTIVE

The aim of the present study was to determine the caries free proportions, caries experience and restorative care received in Kuwaiti kindergarten schoolchildren. METHODS; A national epidemiologic survey of the 4- and 5-year-old kindergarten schoolchildren (n = 1,277) was conducted in the five govemorates of Kuwait. Five trained and calibrated dentists examined the children. Dental caries was scored using WHO diagnostic criteria.

RESULTS

The percentage of 4- and 5-year-old children with dft = 0 was 32% and 24% respectively. The corresponding mean dft/dfs for 4- and 5-year-olds were 3.7/6.9 and 4.8/9.6. The decayed score was the major component in the mean scores. There was a significant difference in caries experience by governorate, but no difference by gender. The restorative index for 4- and 5-year-olds was 9.4% and 14.1% respectively.

CONCLUSIONS

Caries levels are lower or similar to those in neighbouring and other Middle East countries. A high percentage of carious maxillary incisors indicate an early childhood caries pattern in these children. An extensive prevention programmme in preschool and kindergarten children is now in place.

Retention and effectiveness of fissure sealants in Kuwaiti school children

OBJECTIVES

To evaluate the retention and effectiveness of fissure sealants in permanent first molars in a public programme.

METHODS

Sealant retention in permanent first molars was evaluated in 452 children aged 6-8 years in 20 primary schools under the care of the School Oral Health Programme, Kuwait-Forsyth. The sealants were placed using rubber dam or cotton roll isolation, after cleaning with pumice and rubber cup, and 15 seconds etching. Sealant retention was evaluated at one and two years and scored as complete, partial or complete loss of sealant. Caries was scored when sealant was partially or completely lost.

RESULTS

A total of 2,744 sealants were applied, with 2,324 and 2,288 sealants examined at the end of the first and second year respectively. In two years, 75% of the sealants were completely retained, 2.9% partially lost, 7.3% completely lost, and 14.8% resealed or restored. A small proportion of teeth (0.9%) were carious. Multivariate analyses showed that occlusal surfaces were 2.8 times more likely to retain a sealant than the buccal and palatal pits (95% CI 2.7-3.9, p<0.0001), and maxillary teeth were 1.3 times more likely to retain their sealant than the mandibular teeth (95% CI 1.01-1.5, p=0.04). Maxillary teeth were less likely to be carious (OR=0.6, 95% CI 0.4-0.97), p=0.03) and occlusal surfaces were 2.8 times more likely to be carious (95% CI 1.9-4.3), p<0.0001). No differences in sealant retention (p=0.24) and caries (p=0.19) were seen between teeth isolated using rubberdam or cotton roll.

CONCLUSIONS

Sealant retention was high, and sealants were effective in preventing caries.

Effectiveness of primer and bond in sealant retention and caries prevention

PURPOSE

The purpose of this clinical trial was to test the use of a primer and bonding agent to increase the retention of a fissuresealant in a group of Kuwaiti children.

METHODS

In 78 6- to 9-year-old children who required sealants in all 4 permanent frst molars, sealants were placed in 2 teeth using a primer and bond (3M Scotch Bond) and in 2 teeth without primer and bond. Sealant retention was evaluated 1 and 2 years later. Sealant retention was scored as: (1) complete retention; (2) partial loss of sealant; and (3) complete loss of sealant Caries was scored for those teeth in which the sealant was partially or completely lost

RESULTS

At the 2-year examination, in teeth sealed with primer and bond (a) 64% of the sealants were completely retained; (b) 23% were partially lost; and (c) 13% were completely lost. In teeth sealed without primer and bond: (a) 68% of the sealants were completely retained; (b) 20% were partially lost; and (c) 12% were completely lost There was no difference in sealant retention (P=.22) and caries (P=.56) in teeth sealed with and without bond. In multivariate analyses after controlling for age, gender, tooth surface, and arch, no differences in sealant retention and caries were seen.

CONCLUSION

If a proper technique is used in sealant placement, primer and bond does not enhance sealant retention.

Dental caries experience of Kuwaiti schoolchildren

OBJECTIVE

This study was designed to measure the dental caries experience of Kuwaiti schoolchildren.

METHODS

A national epidemiologic survey of the 5-14 year old children (n = 4,588) was conducted in the 5 governorates of Kuwait in 2001. Eight trained and calibrated dentists examined the children. Dental caries was scored using WHO criteria.

RESULTS

In the primary dentition, the percentage of 5- and 6-year-old children with dft = 0 was 12.6% and 14.4% respectively. The corresponding mean dft/dfs for 5- and 6-year-olds were 4.6/9.7 and 4.6/9.9. For the permanent dentition, the percentage of 12- and 14-year-old children with DMFT = 0 was 26.4% and 21.7% respectively. The corresponding mean DMFT/DFS figures for 12- and 14-year-olds were 2.6/3.4 and 3.9/4.2. The d/D component was the major contributor to these mean scores. Poor oral hygiene (OR = 2.0; 95% CI = 1.7 - 2.4) and increasing age (OR = 1.4; 95% CI = 1.3 - 1.5) were significantly associated with caries risk in the permanent dentition.

CONCLUSIONS

Caries levels are similar to those in neighbouring and other Middle East countries. There is a clear need for expanding the national school oral health programme to reach those children who are not yet receiving systematic preventive and curative services. Further studies are required to monitor the effect of the extensive caries preventive programme now in place in Kuwait.

Plaque removal using a battery-powered toothbrush compared to a manual toothbrush

OBJECTIVE

To evaluate the effectiveness of battery-powered tooth brushing in removing plaque in Kuwaiti children.

METHODOLOGY

The subjects were 30 boys, aged 9-11 years. Prior to the start of the study, the children had never used a battery-powered toothbrush. At baseline, plaque accumulation was assessed for manual tooth brushing and battery-powered tooth brushing (Oral-B Kids battery-powered). All subjects then used the battery-powered toothbrush for two weeks at home. Plaque accumulation was again assessed for both manual and battery-powered tooth brushing. Plaque accumulation was assessed using the Soparkar modification of the Quigley-Hein Plaque Index. Differences in pre- and post-tooth brushing plaque, and change from baseline, were the outcome measures evaluated.

RESULTS

At baseline, there was no difference in plaque removal between battery-powered tooth brushing and manual tooth brushing, either in difference between pre- and post-tooth brushing plaque measures (p = 0.44) or in percentage change (p = 0.51). After two weeks of use, there was a statistically significant difference in plaque removal between battery-powered tooth brushing and manual tooth brushing, both in the difference between pre- and post-tooth brushing plaque measures (p = 0.01) and in percentage change (p = 0.006). Mean plaque removal by manual tooth brushing was 0.97 +/- 0.45, and mean plaque removal by battery-powered toothbrush was 1.23 +/- 0.56. Mean percentage change in plaque removal by manual tooth brushing was 33.5 +/- 16.05, and mean plaque removal by battery-powered tooth brushing was 43.0 +/- 18.82, which represented a 9.5% improvement for battery-powered tooth brushing compared to manual tooth brushing.

CONCLUSION

After two weeks use of a battery-powered toothbrush, the plaque removal was enhanced compared to baseline and to manual tooth brushing. Battery-powered tooth brushing also enhanced manual tooth brushing ability.

Comparative tooth whitening and extrinsic tooth stain removal efficacy of two tooth whitening dentifrices: six-week clinical trial

OBJECTIVE

The objective of this six-week, examiner-blind clinical study was to assess the tooth whitening and extrinsic tooth stain removal efficacy of a new dentifrice delivering 1.0% hydrogen peroxide, 0.243% sodium fluoride, and sodium tripolyphosphate in a high-cleaning silica base (Test Dentifrice), relative to that of commercially available hexametaphosphate-containing whitening dentifrice (Positive Control Dentifrice).

METHODOLOGY

Following a baseline oral soft tissue examination and scoring of extrinsic tooth stain and tooth shade, qualifying adult male and female subjects from the Harrisburg, Pennsylvania area were randomized into either the Test or Positive Control Dentifrice group. The two groups were balanced for gender, extrinsic tooth stain, and tooth shade scores. All subjects were provided their assigned dentifrice and a soft-bristled adult toothbrush for home use. Subjects were instructed to brush their teeth for two minutes twice daily (morning and evening) using only the dentifrice provided, and to refrain from using any other oral hygiene products for the entire six weeks of the study. There were no restrictions regarding diet or smoking habits during the course of the study. Oral soft tissue, extrinsic tooth stain, and tooth shade assessments for each subject were repeated after two and six weeks of product use. All statistical tests were two sided and employed a level of significance of alpha = 0.05.

RESULTS

Fifty-six (56) subjects complied with the protocol and completed the entire study. Compared to baseline at both the two- and six-week examinations, the Test Dentifrice group had statistically significant reductions in extrinsic tooth stain area and intensity, and statistically significant mean shade rank reductions, with a six-week reduction of 4.81. In contrast, at six weeks, the Positive Control dentifrice had a statistically significant increase in tooth stain area, a non-significant increase in tooth stain intensity, and a statistically significant mean 1.40 shade rank score reduction. At both the two- and six-week examinations, the Test Dentifrice group had statistically significantly lighter tooth shades and statistically significantly lower levels of extrinsic tooth stain area and intensity than the Positive Control Dentifrice group.

CONCLUSION

A new whitening dentifrice delivering 1.0% hydrogen peroxide, 0.243% sodium fluoride, and sodium tripolyphosphate in a high-cleaning silica base has significant efficacy in tooth whitening and extrinsic stain removal, and provides a statistically significantly greater level of efficacy for both tooth whitening and extrinsic tooth stain removal than the commercially available Positive Control Dentifrice.

Effects of a Baking Soda Gum on extrinsic dental stain: results of a longitudinal 4-week assessment

An evaluation of the effects of ARM & HAMMER DENTAL CARE The Baking Soda Gum (AHDC) on extrinsic dental stain was made in 48 subjects presenting with measurable extrinsic stain. The subjects were randomized to use either the baking soda gum or a non-baking soda placebo gum for 20 minutes twice daily after lunch and dinner while brushing once daily. The procedure of limited brushing was chosen to simulate the level of hygiene normally practiced by participants entering a clinical study. After 4 weeks, the reduction in measurable extrinsic stain in the baking soda gum group was statistically significant (P = .0044) relative to baseline. Statistical analysis of the placebo gum group revealed no significant change in extrinsic stain from baseline. The magnitude of the unadjusted longitudinal reduction in extrinsic stain in the baking soda gum group was 29.7% at 4 weeks.

A clinical investigation to evaluate reduction in dental stain provided by the once-daily use of a breath mint or chewing gum

An evaluation of the effects of ARM & HAMMER DENTAL CARE The Baking Soda Gum on extrinsic dental stain was performed on 85 subjects presenting with measurable extrinsic stain. The subjects were randomized to use either the baking soda chewing gum or a breath mint placebo once daily after lunch while brushing once daily. The chewing gum was chewed for 20 minutes for each use and the breath mint was kept in the mouth until completely dissolved. The subjects were instructed to brush once daily to simulate the level of hygiene normally practiced by subjects, thereby avoiding the well-reported Hawthorne effect experienced in clinical trials instituting twice-daily brushing. Examinations postbaseline were performed after 2 and 4 weeks. The reduction in measurable extrinsic stain in the baking soda gum group vs the breath mint control was statistically significant at 2 weeks (P < .0002) and at 4 weeks (P < .0008). Statistical analysis of the data revealed a significant change in extrinsic stain from baseline for both groups. The magnitude of the unadjusted longitudinal reduction in extrinsic stain in the baking soda gum group was 51% at 4 weeks.

Using a fluoride-releasing resin to reduce cervical sensitivity

Significant research indicates that dental hypersensitivity is caused by open dentinal tubules. A review of such research is presented as well as results of a study using fluoride resin in a composite restoration to reduce sensitivity.

Humoral IgG antibodies to oral microbiota in a population at risk for root-surface caries

Mutans streptococci have been strongly implicated in the initiation of dental caries on coronal surfaces. Their role in development of root-surface caries is less clear. The etiologic agents of both types of dental caries are likely to elicit systemic immune responses. The objective of the present study, therefore, was to study the association of clinical variables of disease with humoral IgG antibodies to nine oral micro-organisms in 314 adult subjects, aged 45-65 years, who were at risk for root-surface caries. Antibody activity to Streptococcus mutans strain Ingbritt, S. mutans/S. sobrinus GTFs, S. faecalis strain 19433, Actinomyces viscosus strain WVU 626, Actinomyces naeslundii strain 12, Lactobacillus casei, Actinobacillus actinomycetemcomitans strain Y4, Porphyromonas gingivalis strain 381, Eikenella corrodens strain 1073, and Wolinella recta strain 371 was measured by ELISA. Pearson correlation coefficients among log10 antibody levels within subjects revealed marked positive correlations among subgingival bacteria, generally weak positive correlations among supragingival micro-organisms, and no correlations between elements of the supragingival battery with the subgingival battery. IgG antibody levels to mutans streptococcal antigens were significantly correlated with subject DMF scores (r = 0.23; p less than 0.0001). No significant correlation was seen between DMF scores and antibody to any other supragingival micro-organism tested. Further relationships between levels of S. mutans antibody and individual clinical variables were analyzed by step-wise multiple linear regression, resulting in a model that was highly significant (p = 0.0001), with an r2 = 0.14. Numbers of missing teeth, coronal caries, root-surface caries, and root-surface restorations were each positively associated with antibody levels to mutans streptococci.(ABSTRACT TRUNCATED AT 250 WORDS)

The prevalence of root caries in a diabetic population

The objective of this study was to assess the level of root caries in a population of diabetic adults. Diabetics are of special interest because they are alleged to be periodontally compromised and have atypical patterns of refined carbohydrate ingestion. Diabetic subjects were patients of the Joslin Diabetic Center in Boston and had significantly elevated blood glucose and glycosylated hemoglobin levels over at least a ten-year period. Eligible subjects had to be between the ages of 45 and 65 and have a minimum of ten teeth and three sites with recession. Data were collected on coronal caries, oral hygiene, gingivitis, pocket depth, recession, and root caries and were compared with data from control subjects from a larger non-diabetic study group. There were 88 diabetics and 185 controls with mean ages of 55.7 and 56.3 years, respectively. The groups were found to be similar with respect to the numbers of buccal surface sites with gingival recession and the numbers of carious root lesions. There was a distinct difference, however, with respect to restored root surfaces: 1.76 mean filled surfaces were observed in the controls, as compared with 0.49 in the diabetics. A Katz Root Caries Index (for which lesions are calculated as a percentage of the numbers of exposed root surfaces) was determined to be 15.2 for the controls and 7.1 for the diabetics. A reasonable inference is that these differences are the result of a restricted ingestion of refined carbohydrates by the diabetic group. This was confirmed by a dietary survey of subsamples from the diabetic and non-diabetic groups.

Severity of nursing-bottle syndrome and feeding patterns in Kuwait

On the basis of extensive clinical experience, a classification scheme for nursing-bottle syndrome (NBS) has been empirically constructed to reflect the progression and severity of the disease. Patients who do not have NBS are assigned a score of zero. Patients with NBS are given a score of 1 if they have caries on the facial or lingual surface of at least one of the primary maxillary incisors and optionally the primary maxillary first molars, a 2 if the buccal surface of one or both of the primary mandibular first molars are also involved, or a 3 if specific multiple surfaces are involved. The feeding pattern classification is as follows: 0 = non abusive, 1 = mildly, 2 = moderately, and 3 = severely abusive. The scoring depends upon the number of feeding times/day, the frequency with which the bottle or breast feeding is given during the might, and the duration of the feeding pattern (in months). Eighty-six cases were reviewed for classification. A chi-square test of a two-way contingency table showed a strong and significant relationship between disease severity and degree of feeding abuse. The findings support the validity of the classification schemes, illustrate the general pattern of NBS progression, and indicate that disease severity is a function of specific combinations of factors.

Effect of high-concentration ammonium and sodium fluoride rinses on dental caries in schoolchildren

A double-blind clinical trial was conducted in a non-fluoridated community to determine the effect on enamel fluoride and caries experience of daily rinsing in school with 1,000 parts/10(6) solutions of ammonium fluoride or sodium fluoride at pH 4.4. Subjects were 10- to 12-year-old children (n approximately equal to 200/group at baseline), about one-half of whom reported the usage of fluoride supplements. Dental caries (DFS index) and enamel fluoride (in vivo biopsy) were evaluated at baseline, 12 months, and 24 months. Supplement users had higher enamel fluoride levels and less caries experience initially, as well as generally lower caries increments over the study. In year 1, the overall caries reductions (supplement users and non-users combined) were 23 % (ammonium fluoride) and 33 % (sodium fluoride), P less than 0.01. For year 2, treatment effects were significantly greater: 54 % (ammonium fluoride) and 47 % (sodium fluoride). In newly erupted teeth, the effects of the ammonium fluoride (70 % DFS reduction) was significantly greater (P = 0.013) than that of the sodium fluoride (48 % DFS reduction). Enamel fluoride levels at the end of 2 years were 3,124 parts/10(6) (ammonium fluoride), 2,771 parts/10(6) (sodium fluoride), and 2,603 parts/10(6) (placebo), P = 0.025.