Caries Research

Nelson, S.; Albert, J.M.; Lombardi, G.; Wishnek, S.; Asaad, G.; Kirchner, H.L.; Singer, L.T.

doi: 10.1159/000320160pmid: 20975268

Objectives: The purpose of this study was to examine developmental enamel defects and dental caries in very low birth weight adolescents with high risk (HR-VLBW) and low risk (LR-VLBW) compared to full-term (term) adolescents. Methods: The sample consisted of 224 subjects (80 HR-VLBW, 59 LR-VLBW, 85 term adolescents) recruited from an ongoing longitudinal study. Sociodemographic and medical information was available from birth. Dental examination of the adolescent at the 14-year visit included: enamel defects (opacity and hypoplasia); decayed, missing, filled teeth of incisors and molars (DMFT-IM) and of overall permanent teeth (DMFT); Simplified Oral Hygiene Index for debris/calculus on teeth, and sealant presence. A caregiver questionnaire completed simultaneously assessed dental behavior, access, insurance status and prevention factors. Hierarchical analysis utilized the zero-inflated negative binomial model and zero-inflated Poisson model. Results: The zero-inflated negative binomial model controlling for sociodemographic variables indicated that the LR-VLBW group had an estimated 75% increase (p < 0.05) in number of demarcated opacities in the incisors and first molar teeth compared to the term group. Hierarchical modeling indicated that demarcated opacities were a significant predictor of DMFT-IM after control for relevant covariates. The term adolescents had significantly increased DMFT-IM and DMFT scores compared to the LR-VLBW adolescents. Conclusion: LR-VLBW was a significant risk factor for increased enamel defects in the permanent incisors and first molars. Term children had increased caries compared to the LR-VLBW group. The effect of birth group and enamel defects on caries has to be investigated longitudinally from birth.

Meurman, P.K.; Pienihäkkinen, K.

doi: 10.1159/000320717pmid: 20975269

Background: Identifying the early determinants of risk for dental caries would be useful in its primary prevention. Subjects and Methods: All children at the age of 18 months in one health care area were invited in the screening test for mutans streptococci (MS) and their caretakers interviewed for the study purposes. The 366 children who met the inclusion criteria were clinically examined after 42 months. Results: At the age of 5 years ± 6 months, in 79 (21.6%) children the 42-month caries increment was >0. In the multivariate regression analysis, the strongest correlation was found with MS detected in the oral biofilm. Of the reported background factors the blue-collar occupation of the caretaker, child’s sugar use, night feeding, use of other thirst quenchers than water and father’s reported poor oral health were significantly correlated with the child’s caries increment. Conclusion: The oral health of a child is strongly related to the lifestyle and the oral health habits of the caretakers during the first years.

Hemingway, C.A.; White, A.J.; Shellis, R.P.; Addy, M.; Parker, D.M.; Barbour, M.E.

doi: 10.1159/000320984pmid: 20980757

The aim of this study was to investigate the effects of two common food proteins on human enamel erosion in vitro. Erosion was measured by non-contact profilometry in citric, malic and lactic acids at pH 2.8, 3.2 and 3.8 and five commercially available soft drinks, in the presence of a salivary pellicle. Whole milk casein or hen egg ovalbumin was added to the acid solutions and drinks at 0.2% w/v, and the effect on erosion was determined by comparison with the corresponding solution without protein. Casein significantly reduced erosion in all but two solutions. The effects of the individual subfractions of casein in citric acid at pH 3.2 were similar to that of whole casein. Ovalbumin reduced erosion in some solutions, but the magnitude of the reduction was less than that with casein. A greater proportional reduction in erosion was seen in citric acid than in malic or lactic acids. We postulate that the mechanism involves adsorption of proteins to the pellicle or the enamel surface, forming a protein film with enhanced erosion-inhibiting properties. The citrate ion may play an active stabilising role, since erosion reduction was less in the other acids. In conclusion, casein and, to a lesser extent, ovalbumin show promise as potential anti-erosive additives to drinks.

Vargas-Ferreira, F.; Piovesan, C.; Praetzel, J.R.; Mendes, F.M.; Allison, P.J.; Ardenghi, T.M.

doi: 10.1159/000321447pmid: 21051891

Background: Prevalence data about tooth erosion has attracted increasing attention in the dental community; however, no study has addressed the impact of this condition on child oral health-related quality of life (COHRQoL). This study assessed the impact of tooth erosion on COHRQoL. Methods: This study followed a cross-sectional design, with a multistage random sample of 944 11- to 14-year-old children representative of Santa Maria, a southern city in Brazil. They were examined for recording the prevalence and severity of tooth erosion by 2 examiners. Children completed the Brazilian version of Child Perceptions Questionnaire (CPQ_11–14) and data about socioeconomic variables of the target population were collected by means of a structured questionnaire. The Poisson regression model using robust variance was performed to assess the association between the predictor variables and the outcomes. Results: Prevalence of tooth erosion (7.2%) and severity were low. Poisson regression models showed a distinct gradient in mean CPQ_11–14 scores by socioeconomic indicators. Children with tooth erosion with low levels of severity did not report higher means in the total scores or domains of CPQ_11–14. Conclusion: The presence of tooth erosion of low severity did not have a significant negative impact on the children’s perception of oral health or on their daily performance.

Stensson, M.; Wendt, L.-K.; Koch, G.; Oldaeus, G.; Lingström, P.; Birkhed, D.

doi: 10.1159/000321566pmid: 21051892

The aim of the present case-control study was to investigate dental caries, various caries-related factors as well as gingival condition, in 12- to 16-year-olds with long-term asthma (n = 20) and a matched healthy control group (n = 20). Data on dietary and oral hygiene habits, numbers of mutans streptococci and lactobacilli in saliva were also obtained. The plaque pH drop after a sucrose rinse was measured up to 40 min at 2 approximal tooth sites. A lower salivary flow rate was found in the asthma group compared to the control group (p < 0.05). The mean (± SD) of DFS, including manifest and initial caries, was 4.9 ± 5.5 in the asthma and 1.4 ± 2.3 (p < 0.01) in the control group. Only 1 adolescent in the asthma group was caries free compared to 13 in the control group. Concerning pH in plaque, adolescents with asthma had a lower initial value (p < 0.01) and final pH (p < 0.05) than the control group. The Cariogram data showed that 55% of the subjects in the control group had ‘a high chance of avoiding caries’ compared to 10% in the asthma group (p < 0.01). The asthmatic adolescents had higher numbers of sites with gingival bleeding (p < 0.01). To conclude, adolescents with long-term asthma had a higher total DFS and caries risk (according to Cariogram), decreased salivary rate, more gingival bleeding and lower plaque pH than adolescents without asthma.

Gordan, V.V.; Garvan, C.W.; Ottenga, M.E.; Schulte, R.; Harris, P.A.; McEdward, D.; Magnusson, I.

doi: 10.1159/000321139pmid: 21071940

This study investigated the relationship of arginine deiminase (ADS) and urease activities with dental caries through a case-control study. ADS and urease activities were measured in dental smooth-surface supragingival plaque and whole saliva samples from 93 subjects, who were in three different groups: caries-free (n = 31), caries-active (n = 30), and caries-experienced (n = 32). ADS activity was measured by quantification of the ammonia generated from the incubation of plaque and saliva samples in a mixture containing 50 mM arginine-HCl and 50 mM Tris-maleate buffer, pH 6.0. ADS-specific activity was defined as nanomoles of ammonia generated per minute per milligram of protein. Urease activity was determined by quantification of ammonia produced from 50 mM urea. For bacterial identification and enumeration real-time qPCR analysis was used. Groups were compared using Kruskal-Wallis tests. Spearman correlations were used to analyze plaque metabolic activity and bacterial relationships. The results revealed significantly higher ammonia production from arginine in saliva (1.06 vs. 0.18; p < 0.0001) and plaque samples (1.74 vs. 0.58; p < 0.0001) from caries-free subjects compared to caries-active subjects. Urease levels were about 3-fold higher in the plaque of caries-free subjects (p < 0.0001). Although higher urease activity in saliva of caries-experienced and caries-free subjects was evident, no significant difference was found between the groups.

Stenhagen, K.R.; Hove, L.H.; Holme, B.; Taxt-Lamolle, S.; Tveit, A.B.

doi: 10.1159/000321536pmid: 21071941

The aim of this study was to compare the precision and accuracy of 5 different methods applied to assess surface substance loss or changes in surface microhardness (SMH) on the same enamel surfaces after repeated acid exposures. Ground specimens from human molars were exposed to 0.01 M HCl (pH 2.2) for 6 min × 2 and measurements performed 3 times to estimate precision. The accuracies (systematic errors) were calculated against the manufacturer’s calibration standard. Lesion depth progression was from 94 to 110%, related to repeated acid exposure. The precisions/accuracies were: WLI (white light interferometry), 0.5/0.4%; SP (stylus profilometry), 4.7/0.7%; OP (optical profilometry), 1.4/12%; AAS (atomic absorption spectroscopy), 0.4/17% (measured calcium loss was converted to lesion depth). The correlation between WLI and SP was R² = 0.98, and between WLI and OP it was R² = 0.85. SMH gave information on qualitative changes of the surface (precision: 5.5%, accuracy: 4.0%). WLI performed best in precision and accuracy, but SP, OP and AAS are all relevant methods for analysing lesion depths and progression, SMH seems suitable for analysing minor changes in surface enamel only.

Martignon, S.; Tellez, M.; Santamaría, R.M.; Gomez, J.; Ekstrand, K.R.

doi: 10.1159/000321986pmid: 21088401

Background: The prevalence of proximal caries in primary molar teeth is high in many countries. Aims: (1) To study by means of a split-mouth design the 1- and 2.5-year efficacy of sealing proximal lesions vs. flossing instructions (control) on primary molar teeth. (2) To assess children’s behaviour and pain perception during the procedure. Methods: Ninety-one 4- to 6-year-old children from Bogotá, Colombia participated. Participants had to have at least two proximal lesions scored according to the following radiographic classification system: radiolucency (1) in enamel outer half, (2) restricted to enamel-dentine junction, or (3) restricted to dentine outer third. Baseline, 1- and 2.5-year follow-up bitewing radiographs were taken. Test and control lesions were randomly selected. After temporary separation test lesions were sealed (adhesive). Parents/caregivers received a flossing leaflet for their children. Progression of the lesions was assessed by means of independent reading of conventional bitewing radiographs. Results: One-year (n = 73) test vs. control lesion progression was 27.4 vs. 50.7%, respectively (p < 0.01, McNemar’s test), and 2.5-year (n = 56) test vs. control lesion progression was 46.4 vs. 71.4%, respectively (p < 0.01). The dropouts did not differ from those who remained in the study regarding relevant caries baseline data. More than 88% of the participants presented positive to definitively positive behaviour and very low or low pain intensity at both first and second appointments. Conclusion: The sealing technique was superior to flossing instructions both after 1 and 2.5 years of follow-up and the majority of the participants had no anxiety or pain during the treatment.

Tschoppe, P.; Siegel, A.; Meyer-Lueckel, H.

doi: 10.1159/000321656pmid: 21088402

Hyposalivation is often associated with high caries activity, in particular in patients undergoing irradiation in the head/neck area. Besides the use of saliva substitutes to relieve the oral symptoms, daily application of fluoride gels or toothpaste (5,000 µg F^–/g) is recommended for caries prevention. The aim of this study was to evaluate potentially remineralising effects of these fluoride agents in combination with saliva substitutes on enamel subsurface lesions. Demineralised bovine specimens were either stored in mineral water [control; saturation with respect to octacalcium phosphate (S_OCP): 0.8], a demineralising saliva substitute (Glandosane; S_OCP: 0.3) or in a modified (with respect to S_OCP) saliva substitute [Saliva natura (SN); S_OCP: 1.9] for 5 weeks (37°C). The following treatments were applied twice daily (11–13/group): no treatment (0), ProSchmelz fluoride gel (PS; 10 min application), Duraphat toothpaste (DP; 10 s; brushing with toothpaste/storage solution slurry), combination of DP+PS. Mineral parameters before/after storage were evaluated from microradiographs. Storage in Glandosane led to significant demineralisation (p < 0.05; paired t test), whereas additional use of fluoride agents neutralised the demineralising effect (p > 0.05). Storage in water alone resulted in no changes in mineral parameters (p > 0.05), whereas in combination with fluorides remineralisation could be shown (p < 0.05). For SN alone, remineralisation was observed (p < 0.05), but no additional beneficial effects of fluorides were detected. Under the conditions chosen, the fluoride agents reduce the demineralising effects of Glandosane and promote the remineralisation of specimens stored in water. Remineralising effects of SN could not be enhanced by the fluorides.

Ijaz, S.; Croucher, R.E.; Marinho, V.C.C.

doi: 10.1159/000322132pmid: 21150202

This paper aims to assess systematic reviews on the caries-preventive effect of topical fluorides, identifying key content and reporting quality issues to be considered by researchers planning a review in this area. Published systematic reviews and meta-analyses of any topical fluoride intervention for caries control were included. Relevant databases were searched (December 2009), along with reference lists of included publications. Thirty-eight reports were identified and assessed. A majority of these focused on the child/adolescent population, fluoride toothpastes, no treatment/placebo comparisons, and had caries increment as the main outcome. Complete reporting of eligibility criteria (PICOS) was uncommon, except in Cochrane reviews. Less than half reported searching multiple sources and only one third reported a search strategy. Duplicate study selection and data extraction was reported in 27 (71%) and 16 (42%) reviews, respectively; quality assessment of included studies was not reported in one third of the reviews. Meta-analysis was reported in 20 (52%) reviews, with six not reporting the methods of synthesis used, 17 formally assessing heterogeneity, and 12 reporting analyses for its exploration. This study shows that some content features have been covered more often than others in existing fluoride reviews, while some relevant features are yet to be addressed. Also, reporting of several methodological aspects are below an acceptable level, except for Cochrane reviews. Current reporting guidelines for systematic reviews of interventions (e.g. PRISMA) and sources of high-quality existing reviews (e.g. The Cochrane Library) should be closely followed to enhance the validity and relevance of future topical fluoride reviews.