Oral Health and Preventive Dentistry, 02/2018

Purpose: To elucidate the efficacy of strategies for preventing dental caries in Japanese children by examining trends over time in the prevalence of dental caries, the number of decayed, missing, or filled teeth (the DMFT index), and their association with factors affecting oral hygiene. Materials and Methods: Several national surveys performed between 1955 and 2015 were reviewed. The prevalence of dental caries in children aged 5-15 years, the DMFT index in children aged 9 or 14 years, individual consumption of added sugars and snacks, the number of dentists in Japan, and the percentage of children who received fluoride varnish were analysed. Additionally, the relative poverty rate among Japanese children was assessed. Results: The prevalence of caries and the DMFT index in Japanese children reflected the trend of individual added-sugar consumption from 1955 to 2015, and also seemed to decrease inversely with the number of dentists and the percentage of children who had received fluoride varnish since 1969. However, there seemed to be no relation to the relative poverty rate. Conclusion: The main preventive strategies for caries in Japan are to reduce sugar intake and educate school children and their caregivers about oral hygiene. Keywords: dentists, fluoride, poverty, school health, sugar

Purpose: This report intends to review the global burden of oral disease among older people and to examine their oral health needs. The evidence on the inter-relationships between poor oral health conditions of older people, general health and quality of life is highlighted. Finally, WHO strategies to improve oral health of older people are reviewed. Methods: The information relevant to this review was extracted from the WHO Global Oral Health Data Bank, the PubMed database, and the Cochrane Library. Surveys were carried out according to the criteria recommended by the WHO epidemiological manual Oral Health Surveys - Basic Methods. In addition, global data were sought on coverage of oral health care among older people. Finally, WHO policy documents on health care for aged people were gathered through the WHO website. Results: Across the globe, many older people suffer from oral pain or discomfort. Poor oral health during old age is mostly manifest in high caries experience, high prevalence rates of advanced periodontal disease, severe tooth loss, dry mouth, and oral pre-cancer/cancer. In both developing and developed countries, the burden of disease is particularly high among underprivileged and disadvantaged older people. In numerous countries, high proportions of the aged population are not covered by primary oral health care; this is mainly the case in low and middle income countries due to a critical shortage of dentists. Conclusions: In 2015, the WHO published the World Report on Ageing and Health, which outlines a framework for action to foster healthy ageing. The policies are highly relevant to the improvement of oral health. Transformation of oral health systems away from a disease-based curative model and towards disease prevention, as well as the provision of older-person-centred integrated care are required. Moreover, wide-ranging public health action on ageing is urgently needed. Keywords: older people, need for oral health care, primary health care, public health strategies, WHO approaches

Purpose: To assess the effectiveness of four in-office therapies used for the treatment of dentin hypersensitiviy (DH) after one single application. Materials and Methods: A randomised, controlled, split-mouth clinical trial was designed to evaluate the following treatments: 5% sodium fluoride varnish (positive control); 3% potassium oxalate; two-step self-etching adhesive; high power diode laser. Nineteen patients were selected and one tooth per quadrant was included in the study. After evaporative stimulation, pain was quantified by the Visual Analog Scale (VAS) at baseline, immediately after treatment, and after 15, 30 and 60 days. Results: Compared to the baseline values, fluoride varnish (p = 0.00) and potassium oxalate (p = 0.00) presented an immediate desensitising effect that remained constant at 15, 30 and 60 days. The high-power diode laser presented significant reduction in VAS scores after 15 days (p = 0.00), while in the self-etching adhesive group, a significant reduction in VAS scores was observed only after 60 days (p = 0.03). The change in VAS ([VAS x days] - VAS baseline) differed among the groups immediately after treatment, being higher in the fluoride varnish and lower in the adhesive groups, but no statistically significant difference was found at time intervals of 15, 30 and 60 days. Conclusion: When an immediate desensitising effect is desired after one single application, fluoride varnish and potassium oxalate should be used. High-power diode laser and self-etching adhesive may not be clinically considered an appropriate desensitising therapy after one single application. Keywords: dentinal desensitisers, dentin hypersensitivity, dentin permeability, diode lasers

Purpose: To assess periodontal parameters of noncarious cervical lesions (NCCLs) restored with glass-ionomer cement (RM-GIC) and composite resin at baseline, three and six months. Materials and Methods: Eighteen patients with bilateral lesions were included in the study. Lesions (1 mm in depth) were randomly restored with each type of restorative material. Probing depth (PD), relative gingival recession (rGR), relative clinical attachment level (rCAL), visible plaque index (VPI) and gingival bleeding index (GBI) were measured. Results: No statistically significant differences were found when comparing within groups (p > 0.05). However, the intergroup analysis demonstrated a decrease in GR and rCAL gain for teeth restored with the resin-modified glass-ionomer cement (RM-GIC). Conclusion: Both materials behaved similarly when in close contact with periodontal tissues and did not influence periodontal parameters. Keywords: dentistry, glass-ionomer cements, nanoparticles, operative, periodontics

Purpose: To examine the caries status of pregnant women in southeast Hungary and compare the results with a similar study completed in the same region ten years earlier to determine whether any improvement has taken place in the past decade. Another objective was to assess the effects of age, socioeconomic status and number of pregnancies on oral health. Materials and Methods: The dental examination of 130 pregnant women was carried out at the Dental Clinic of University of Szeged, Faculty of Dentistry in 2011-2013 (group 1). Caries status was examined according to WHO guidelines. In order to compare demographic and socioeconomic factors with DMF indices, find the decisive influencing factors and compare the results with the results of the previous study (group 2), two-way ANOVA and regression analyses were conducted. Results: The number of highly educated, professional, urban participants included in the present group (group 1) was greater compared with that of group 2. Despite the higher age of the pregnant women in present study, statistically significantly lower DMFT (10.05 vs 12.57, p = 0.008) and DMFS (19.41 vs 26.26, p = 0.001) scores were found than ten years ago. In both studies, the regression analyses showed that women's age was the main contributing factor to caries status. Conclusion: The lower DMFT and DMFS values and the participants' willingness to participate in the dental screening in the present study group were probably the result of their higher educational background and that they worked as professionals. Keywords: caries status, DMF, pregnancy, oral health

Purpose: Evidence exists which suggests that a vegetarian diet is a predisposing factor to erosive tooth wear. The aim of this study was to assess the influence of dietary pattern (vegetarian, lacto-ovo vegetarian and omnivore) on erosive tooth wear. Materials and Methods: Two hundred seven subjects (29 vegetarians, 96 lacto-ovo vegetarians and 82 omnivores) underwent an oral assessment and were asked to answer questionnaires about diet and oral care. Results: Individuals who followed vegetarian and lacto-ovo vegetarian diets had statistically significantly more erosive tooth wear than did omnivores (p = 0.004). Conversely, omnivores presented more tooth loss than did lacto-ovo vegetarians (p = 0.027). Being a vegetarian or a lacto-ovo vegetarian entailed an increased risk (4 times and 2.5 times, respectively) of presenting erosive tooth wear than being omnivorous. Conclusion: Vegetarian and lacto-ovo vegetarian dietary patterns seem to favour the loss of dental structure by erosion. Vegetarian patients should thus be informed about preventive measures and treated accordingly. Keywords: diet, food habits, oral health, vegetarian

Purpose: To describe oral health behaviours and problems among elderly Vietnamese as well as determine their prevalence of caries and periodontal disease. Materials and Methods: This cross-sectional study examined 258 elderly persons aged 65-74 years living in Danang, Vietnam. All subjects self-reported oral health behaviour and problems. Dental caries was assessed using the DMFT index. Periodontal status was evaluated with the modified Community Periodontal Index, whereby all teeth were examined for gingival bleeding and periodontal pocket depth (PPD), and the index teeth were assessed for clinical attachment loss (CAL). Results: 48.4% of the elderly brushed their teeth at least twice a day; 34% had never visited a dentist; 27.8% often had difficulty chewing foods. Of the sample, mean DMFT was 14.3 ± 8.7 (DT = 6.4 ± 5.5, MT = 7.7 ± 7.1, and FT = 0.2 ± 0.9), 88.8% had untreated caries, 21.0% had at least one tooth with a PPD ≥ 6 mm, and 49.8% had at least one sextant with CAL ≥ 6 mm. The mean number of teeth per person was 22.0, of which 19.5 teeth (88.6%) had gingival bleeding, 7.7 teeth (37.1%) with a PPD 4-5 mm, and 0.8 teeth (5.0%) with a PPD ≥ 6 mm. The mean number of sextants with CAL 4-5 mm and CAL ≥ 6 mm were 2.5 ± 2.0 and 1.3 ± 1.7, respectively. Rural residence was found to be negatively associated with MT, FT, and healthy periodontal status (p 0.05). Conclusions: Dental diseases are prevalent among elderly Vietnamese owing to a lack of awareness of oral health self-care behaviours, especially among those living in rural areas. This suggests that an oral health care programme is required to improve the oral health status of elderly Vietnamese. Keywords: dental caries, elderly, health behaviour, periodontal disease

Purpose: To estimate the prevalence and severity of malocclusion and test a possible association with negative impacts on quality of life of schoolchildren in Tubarão, Brazil. Materials and Methods: A cross-sectional study was conducted on a representative sample (n = 389) of schoolchildren. Data on oral health-related quality of life were obtained through the Oral Impacts on Daily Performance (OIDP) scale. The malocclusion indicator was the Dental Aesthetic Index (DAI). Prevalence ratios were estimated using log-linear Poisson regression with a robust estimator. Results: The prevalence of class II, III, and IV malocclusion was 57.3%. The most common dental condition was overjet greater than 3 mm. Girls and older schoolchildren showed statistically significantly higher prevalence of all classes of malocclusion. There were no statistically significant associations between the most frequent malocclusions and dimensions of the impact indicator, except for the presence of overjet greater than 3 mm that was associated the 'cleaning teeth' dimension. Conclusion: The prevalence of malocclusion was high, but was not statistically significantly associated with impact on oral health-related quality of life. Keywords: epidemiology, impact, malocclusion, oral health, schoolchildren

Purpose: To assess and compare the salivary pH reversal phenomenon and calcium concentration in subjects consuming paneer and cheese after an acidogenic challenge and also to compare the salivary pH measurements using pH strips and a portable pen-type pH meter. Material and Methods: Sixty caries free undergraduate students were randomly selected and divided into two group: 1. paneer; 2. cheese. After determining the resting salivary pH using pH strips and a pen-type pH meter, participants were subjected to an acidogenic challenge (10% sucrose). Following consumption of test foods (10-gram cubes), salivary pH was measured at intervals of 5, 10, 15, 30 and 60 min to record the time taken for the salivary pH to return to baseline. Colorimetric salivary calcium concentration was estimated (Biochemical Analyzer) at baseline and after 60 min of test food consumption. The statistical tests used were Shapiro-Wilk's test for normality, repeated measures ANOVA, and the independent t-test. Results: Test meals reversed the fall in pH after acidogenic challenge starting at 5 min and returning to baseline values after 30 min in both groups (p = 1.000). Colorimetric estimates showed higher salivary calcium concentrations with paneer (p 0.001). The pen-type pH meter showed superior efficiency in terms of time (p 0.001) compared to pH strips. Conclusion: The salivary pH reversal phenomenon was evident after consumption of both paneer and cheese following the acidogenic challenge. Consumption of paneer significantly increased salivary calcium concentration. The pen-type pH meter proved to be more efficient. Keywords: calcium concentration, cheese, paneer, pH meter, salivary pH

Purpose: This double-blind, clinical, cross-over study evaluated the antibacterial effect of three toothpastes (ASF, HTP and STP) and a chlorhexidine mouthrinse (0.2%; CHX; positive control) after a single application on established biofilm over a period of 24 h (substantivity). Materials and Methods: Twenty-four subjects refrained from all oral hygiene measures for a period of 72 h. After 48 h, a baseline biofilm sample was taken and vitality of the biofilm flora was examined (baseline, VF0). Then they rinsed for 1 min with one of the randomly allocated, freshly prepared toothpaste slurries (ASF, HTP, STP) or CHX. Further biofilm samples were taken every second hour up to 14 h as well as 24 h after rinsing, and biofilm vitality was assessed (VF2-24). After a wash-out period of 4 days, a new test cycle was started. Results: All subjects (18 female, 6 male) finished the four test cycles. At VF2, all products showed a statistically significant reduction in vitality compared to VF0 (p0.05). CHX and ASF revealed the most pronounced effect (49% and 40% reduction), while the other toothpastes (HTP: 24%, STP: 11%) reached lower but still statistically significant effects. At each further time point CHX and ASF showed the lowest biofilm vitality. ASF demonstrated a significant antibacterial effect on dental biofilm over a 24-h period compared to baseline and superiority over both other toothpastes at time points VF2-VF14. Conclusion: ASF toothpaste showed a significant antibacterial action on biofilm and a high substantivity which was maintained up to 24 hours. Keywords: amine fluoride, biofilm vitality, chlorhexidine, substantivity, stannous fluoride, toothpaste

Purpose: To create and investigate artificial mucin-based saliva substitutes with properties similar to natural saliva. Materials and Methods: Natural saliva and six saliva preparations were tested. Saliva substitutes were made using phosphate buffered saline (PBS) prepared in deionised water or plasma-treated water (PBSPT) with addition of porcine gastric mucin and guar gum or poloxamer 407. A wide range of properties were characterised: physicochemical (changes of pH, conductivity and surface tension over time: 1, 24, 96, 168 h after mixing ingredients), rheological (viscosity and viscoelasticity), tribological (coefficient of friction for titanium alloy Ti-6Al-7Nb kinematic couple) and corrosive (open circuit potential, corrosion potential, polarisation resistance). Results: Saliva preparations based only on mucin had pH, viscosity, coefficient of friction and corrosion parameters similar to those of natural saliva. Guar gum increased the values of viscosity, viscoelasticity and the coefficient of friction. Similar results were obtained for poloxamer 407, whereas it decreased the surface tension of tested preparations. Plasma-treated PBS enhanced the corrosion resistance of saliva substitutes with guar gum and poloxamer 407. Conclusion: Among the tested compositions, saliva substitutes based only on mucin were found to have parameters similar to human whole saliva. Mucin saliva preparations may have wide applicability for patients with e.g. xerostomia or patients using a metal prosthesis. Keywords: corrosion, mucin, physicochemical properties, plasma-treated water, saliva substitute, tribological properties

Purpose: To evaluate the fluoride release from different fissure sealants sold mainly in non-Western countries via a curve-fitting method, and to investigate the ability of these materials to be recharged with fluoride. Materials and Methods: Four different fissure sealants which the manufacturers claim to release F- were tested; glass-ionomer cement Argecem (AC), the composite resins Fisskhim (FK), Fissulight (FL), Helioseal F (HF). Helioseal (HS), a composite resin not declared to release F, was used as a negative control. Of each material, 10 disks 8.0 mm in diameter and 1.8 mm thick were produced. For fluoride measurements, a fluoride-ion specific electrode was used. On day 21, the specimens were recharged with fluoride by immersion in toothpaste slurry. Fluoride release was evaluated and statistically compared by fitting an exponential curve through the cumulative release values and statistically comparing curve parameters (t½, AUC and plateau value) among each other as well as before and after recharging. Results: Two materials (AC and HF) released a considerable amount of F- in the first 3 weeks after sample production. Furthermore, the increase of F- release after F- recharge was statistically significant (p 0.05) for the materials AC, FL and HF, but not for FK and HS. Conclusion: Fluoride release of Fisskhim and Fissulight was negligible, while Helioseal F and Argecem noticeably released fluoride and thus can enhance the caries preventive effect of fissure sealants. Comparing release curve parameters simplifies statistical procedures. Keywords: composite resin, fluoride, glass-ionomer cements, release curves, sealants