Oral Health and Preventive Dentistry, 03/2019

Purpose: To assess the prevalence of periodontitis in young populations (previously termed aggressive periodontitis - AgP) and report on the earliest known occurrence of this disease. Materials and Methods: A search was performed covering the last 18 years utilising the following databases: Medline (Ovid), PubMed and Embase. Four reviewers evaluated each study. Review findings were summarised using the PRISMA Statement for reporting and Joanna Briggs Institute (JBI) Critical Appraisal tools for quality assessment, respectively. Twenty-two articles were included in this systematic review, consisting of 6 prevalence studies and 16 case reports. Only prevalence studies were considered for prevalence estimates. Results: The average reported prevalence of periodontitis in young populations was 1.7% (ranging from 0.66% in Argentina to 5.9% in Israel). The prevalence was higher for the localised form of this disease. Permanent teeth were the most common dentition affected (114 out of 115 affected patients). In terms of age, the prevalence was 0.6%, 0.8% and 1.6% for the age groups 2-12, 20-25 and 13-20, respectively. There was no significant difference noted between males and females. The earliest age diagnosed with periodontitis was 3 years 7 months. Conclusion: The prevalence of periodontitis in young patients is ranges widely, which could indicate populational predispositions, underdiagnosing or lack of standardisation in diagnosis. Keywords: aggressive periodontitis, demographics, epidemiology, misdiagnosis

Purpose: The objectives of this scoping review were: first, to pose a research question; second, to identify relevant studies to answer the research question; third, to select and retrieve the studies; fourth, to chart the critical data; and finally, to collate, summarise, and report the results from selected articles on the dental management of children affected with autism. Materials and Methods: Relevant articles (randomised controlled trials, reviews, observational studies, and clinical case reports) published over an 11-year period were identified and retrieved from five internet databases: PubMed, Embase/Ovid, Cochrane Library, Google Scholar, and EBSCO. Results: By title and abstract screening and after removing duplicates, 25 articles were finally included in the present scoping review. According to the extracted data, the following four clinical issues were found to be most important: patient behavioural control, prevalence/incidence of dental caries, adverse effects and interactions with medications, and orthodontic management. Additionally, several useful clinical recommendations are provided. Conclusions: Paediatric dentists should bear in mind that early diagnosis and treatment, effective communication skills, and a long-term follow-up of children with autism continue to be the best approaches for achieving enhanced patient psychological well-being and consequently a better quality of life. Keywords: autism, general management, paediatric dentistry, review

Purpose: This study aimed to elicit willingness to pay (WTP) values for fluoride varnish application from participants using the publically-funded health services in Brazil and the UK, and to identify differences in the variables impacting these values. A secondary aim was to compare WTP values from parents for their own preventive treatment and their child's. Materials and Methods: This was a cross-sectional analysis of quantitative data collected from participants attending routine dental appointments. The clinics were hosted by the Pontifical Catholic University of Rio Grande do Sul (PUCRS), Brazil and Newcastle Dental Hospital, UK. Results: The mean WTP for Brazilian adults was R$60.37 (=£15.97). WTP was highly variable and factors affecting it were difficult to identify. UK parents valued fluoride varnish at mean values of £28.21 and £28.12 for themselves and their child, respectively. Regression modelling found those with higher incomes had higher WTP in both samples. In the UK, parental and child WTP increased when parents had higher self-perceived need for dental treatment, had experienced recent dental pain, or their child had received restorations in the last 2 years. Conclusions: WTP for fluoride varnish varied dramatically between individuals. In both countries, it was difficult to predict this variance, as factors which would likely impact upon on WTP had a limited effect and were sometimes counter-intuitive. WTP values for a parent and their child were not statistically significantly different. Keywords: dentistry, economics, fluorides, preference-based measures

Purpose: To identify and assess the predictors of oral impacts on daily performance among adolescents in Zanzibar, Tanzania. Materials and Methods: This was a cross-sectional study among primary school pupils. A single stage cluster sampling design was used. Data were collected using a structured questionnaire which inquired about sociodemographics, oral impacts on daily performance and oral health related behaviours. The Statistical Package for Social Sciences version 20.0 was used for data analysis using chi-squared statistics and standardized logistic regression. The level of significance was set at p ˂ 0.05. Results: A total of 682 pupils aged 12 to 17 years participated in the study. 45.6% of the participants had at least one oral impact, the most common being difficulties in eating (27.9%). Statistically significantly more participants who reported eating between-meal sugared snacks (52.8%) or those who had visited a dentist (55.6%) reported oral impacts on daily performance, compared to their complimentary groups, which did not. The participants who reported having visited a dental clinic were 1.7 times more likely to report having an impact on daily performance than those who had not been to a dentist. Conclusion: The prevalence of oral impacts on daily performance was high among the adolescents in the current study. The oral impacts were associated more with behaviour than social differences. Having had a dental visit influenced the oral impacts on daily performances. Keywords: adolescents, oral health determinants, quality of life

Purpose: This questionnaire survey aimed to analyse management strategies for erosive tooth wear and to identify factors influencing dentists' decision-making. Materials and Methods: A questionnaire presenting clinical cases with erosive tooth wear on anterior and posterior teeth (BEWE scores 1 to 3) was sent electronically to German dentists (n = 13.683). Statistical analysis was performed by Wilcoxon signed-rank tests, Kruskal-Wallis-tests and Fisher's exact tests (p 0.05). Results: Only 455 dentists (3.3%, mean age: 52.3 ± 9.6) participated. Suggested therapeutic measures were statistically significantly different between BEWE 1, 2 and 3 (p 0.001) and between anterior and posterior teeth with BEWE scores 1 or 2 (p ≤0.025). Initial erosive lesions (BEWE 1) were mainly treated by information about the main causes and/or preventive measures (posterior teeth: 75.6%, anterior teeth: 64.4%), only 20.0% and 31.3% considered restorative treatment for posterior and anterior teeth, respectively. For teeth presenting score 2, a very high proportion of dentists considered restorative treatment (posterior teeth: 60.6%) additionally to prevention, especially when anterior teeth (91.0%) were affected. In case of severe erosive lesions (BEWE 3), the vast majority of dentists considered restorative treatment (posterior teeth: 98.3%, anterior teeth: 99.8%). The decision-making was mainly dependent on the lesion depth, size of affected surfaces and the presence of pain. Fluoride agents and agents containing tin chloride or tin fluoride were most frequently recommended as preventive measures. If distinct defects (BEWE 2) were treated restoratively, mainly composite restorations were performed (posterior teeth: 72.0%, anterior teeth: 90.5%). Severe defects (BEWE 3) were mostly restored with ceramic restorations (posterior teeth: 66.1%, anterior teeth: 66.6%). Conclusion: Stepwise management of erosive tooth wear was observed. Dentists' decision-making was related to severity and localisation of erosive tooth wear and to various patient-related factors (e.g. depth of lesion and size of affected surface per tooth). Keywords: Basic Erosive Wear Examination, decision-making, erosive tooth wear, questionnaire, survey

Purpose: To assess 1) how socioeconomically disadvantaged parents receive information about their child's oral health, 2) how they prefer to access information and 3) whether their gender, age, ethnicity/race, education, income and the number of children in their family affect oral health-related information use. Materials and Methods: Survey data were collected from 506 parents/guardians at a pediatric community dental clinic. The majority of the respondents were female (87%) and African American (54%). They ranged in age from 16 to 73 years. Results: The most frequently used sources for oral health-related information were family members (75%), the child's doctor (74%), other parents (57%) and the child's nurse (54%). The majority of the parents (84%) indicated that the paediatric community dental clinic should have a website with oral health-related information. A total of 79% would use such a website in their own home (73%), at a library (29%), at school (16%) or at work (16%). In addition, 86% also wanted to receive printed information from the community dental clinic. The data showed that European-American parents were more likely than African-American parents to have received information from the child's caregivers, parent support groups, the child's doctor, e-mail groups or books. The respondents' age, income and educational background affected which sources of information they used. Conclusions: The majority of socioeconomically disadvantaged parents/guardians would like to have access to web-based information about children's oral health and reported that they would use such information. Keywords: age groups, child, dental health education, ethnic groups, gender, information seeking behavior, oral health, parents, socioeconomic factors, socioeconomic status

Purpose: Only a few studies have presented long-term trends in the prevalence of periodontitis and periodontal treatment needs. The aim of this study was to report the changes in periodontal treatment needs of an adult population in Ljubljana, Slovenia, over a 30-year period. Materials and Methods: This study included 88 45- to 95-year-old subjects who had attended the previous three studies 10, 20 and 30 years ago. We used the CPITN for assessing periodontal treatment needs, as the same index had been used in the previous three studies. Results: None of the examined subjects had healthy periodontal tissues, all needed oral hygiene instruction, 96.6% needed scaling and root planing as well as oral hygiene instruction, 47.7% needed complex periodontal treatment as well as oral hygiene instruction plus scaling and root planing. Periodontal treatment needs in Ljubljana adults increased in thirty years in the total study population as well as among 45- to 65-year-olds. Conclusion: Periodontal treatment needs in an adult population of Ljubljana are high and have increased in the last thirty years. More effective primary and secondary preventive measures are needed to decrease the prevalence of periodontal disease and periodontal treatment needs in the adult population of Ljubljana, Slovenia. Keywords: periodontal disease, periodontal treatment needs, Ljubljana citizens

Purpose: To evaluate the knowledge, opinions, and behaviours of physicians in the field of internal medicine and gynecology regarding periodontal disease and its systemic implications. Methods: A questionnaire was distributed by hand and via e-mail to internists and gynecologists working in hospitals and community clinics. The questionnaires included items regarding personal and professional status, subject-related characteristics, dental history and knowledge in periodontal medicine. All completed questionnaires were reviewed and analysed according to discipline and personal experience. Statistical differences were tested using the chi-squared analysis. Results: A total of 97 questionnaires were reviewed and included 56 internists and 41 gynecologists. The mean age was 39.7 years (range 29-82) and the percentage of females was 54%. Overall, general knowledge regarding periodontitis differed significantly between internists and gynecologists (80% vs 32% correct answers per group, respectively). Nearly 60% of responders (both internists and gynecologists) knew the correct cause of periodontal disease. Although half of the responders had personal experience in the field of periodontology, this experience was not noticeable regarding their knowledge in periodontal medicine. The majority of responders (58%) agreed that there is a need for more periodontal education in general medicine. Conclusions: The present study indicates a clear lack of knowledge of both internists and gynecologists regarding periodontitis and its systemic complications. Personal periodontal experience did not change the degree of familiarity with periodontal medicine. Keywords: dental education, medical knowledge, periodontal medicine

Purpose: This laboratory study investigated the effects of PVP-iodine solutions with varying pH and calcium concentrations on enamel remineralization and fluoridation by subsequent treatment with fluoride varnish. Materials and Methods: Caries-like lesions were created in bovine enamel specimens (n = 15 per group) and characterized using Vickers surface microhardness (VHN). Specimens were treated with 10% PVP-iodine solutions varying in calcium concentration (0/10/100 mM) and pH (3.0/4.0/5.0), followed by 5% sodium fluoride varnish. A fluoride varnish-only control group was included. Specimens were then placed into artificial saliva for 16 h. The varnish was removed, hardness measured and enamel fluoride uptake (EFU) determined using the microbiopsy technique. Data were analyzed with one-way ANOVA. Results: Groups receiving PVP-iodine pre-treatments exhibited directionally greater rehardening (range: p = 0.0001 - 0.7008) and EFU (p = 0.0001-0.2670) than the control group. The presence of calcium in the pre-treatment enhanced rehardening. the groups '10mM Ca/pH 3.0' (∆VHN = 10.5 ± 6.3), '100mM Ca/pH 3.0' (∆VHN = 9.7 ± 4.1) and '10mM Ca/pH 5.0' (∆VHN = 8.7 ± 7.0) displayed the highest numerical gain vs the control (∆VHN=3.6±2.2). Different pH values had a minor effect on rehardening and EFU. The calcium effect was more pronounced for EFU than for rehardening with all three '100 mM Ca' groups exhibiting higher EFU (7.0 - 7.2 µg F/cm2) than all other groups (6.1 - 6.9 µg F/cm2). Conclusion: PVP-iodine pre-treatments can be modified to enhance the rehardening and fluoridating effect of fluoride varnishes, thereby potentially improving their ability to prevent caries in vivo. Although numerical differences between groups were small, the addition of high concentrations of calcium paired with a low pH appears most favorable under the present conditions. Keywords: calcium, dental caries, fluoride varnish, PVP-iodine, remineralization

Purpose: To analyse the caries experience in preschool children at two moments 10 years apart. Materials and Methods: Two cross-sectional epidemiological studies, the first in 2006 (n = 275) and the second in 2016 (n = 258), were carried out with samples composed of children from 3 to 6 years of age. All children were enrolled in the municipal schools of basic education of a municipality in northwest São Paulo state, and they attended an annual and continuous oral health education programme. Caries experience was calculated for deciduous and permanent teeth using the dmft and DMFT indices, according to the World Health Organization (WHO). Statistical analysis was performed using Epi info 7.1 and Bioestat 5.0 software. Results: In 2006, the mean dmft index was 1.88, with 7.59% of teeth having caries experience. In 2016, the mean dmft index was 0.99, with 5.15% of teeth showing caries experience. In contrast, in 2006, the mean DMFT index was 0.08 (n = 509), with 4.1% of teeth with caries experience; in 2016, the mean DMFT index was 0.06 (n = 381) and 3.6% of teeth showed caries experience. The proportions of teeth with caries experience differed statistically significantly (p = 0.435). In the last study, 78.2% of the children were caries free, below the WHO target for 2020. The Significant Caries Index (SiC Index) was 0.2. Conclusion: A decline of caries experience in the deciduous dentition was found in the study population. Keywords: epidemiological surveys, oral health, preschoolers

Purpose: Using the ICDAS (International Caries Detection and Assessment System), to assess caries experience in the primary dentition of preschool children living in a socioeconomically poor area with a nonfluoridated water supply, and to compare the stages of caries manifestation between children from private and public schools. Materials and Methods: This census included all children aged 3 to 5 years from public and private schools from Teixeira, Brazil. Clinical examinations were carried out by two calibrated examiners using ICDAS, the results of which were converted into components of dmf-s and dmf-t. Results: The majority of children had caries; the prevalence of enamel and dentin lesions was 81.7%. The prevalence of dentin lesions alone was 62.1%. The mean values of the d2mf2-s/d2mf2-t indices (enamel and dentin lesions) and d3mf3-s/d3mf3-t indices (dentin lesions) were 13.5 ± 14.9/6.8 ± 5.8 and 7.4 ± 10.9/3.0 ± 3.6, respectively. There was no significant difference between the dmf-s/dmf-t indices of children from private vs public schools (p > 0.05). Conclusion: Caries was highly prevalent in the primary dentition of this Brazilian population, and the presence of noncavitated lesions was the most prevalent condition. Children from private and public schools showed similar caries experience. Keywords: dental caries, ICDAS, oral health, preschool children, primary teeth

Purpose: This study was designed to assess (i) the prevalence of extrinsic stains in preschool children (ii) the correlation between extrinsic stains and the occurrence of early childhood caries (ECC) (iii) to compare the distribution of caries in pits and fissures, smooth surfaces or both among children with and without extrinsic stains. Methods: A cross-sectional study was carried out among 1,486 children aged 0-3 years. Extrinsic stain and ECC were scored by two calibrated examiners. Correlation between ECC pattern and extrinsic stains was analysed by logistic regression. Caries distribution in fissures, smooth surfaces or both were analysed using Mann Whitney test and Pearson chi-squared test. Results: The prevalence of extrinsic stains among 0-3 years children was 6.2%. Children with extrinsic stain had a 1.13-fold greater chance of exhibiting ECC (OR = 1.132, 95% CI: 0.739-1.733). Statistically significant differences were found for fissure caries (p 0.0002) and both smooth surface and fissure caries (p 0.0328) among children in both groups. Conclusions: Occurrence of ECC appears to have surface-specific variations in children with and without extrinsic stains. However, the interaction of these individual factors and their impact on oral health outcomes needs to be identified through further research. Keywords: cross-sectional study, early childhood caries, epidemiology, extrinsic stain, public dental health

Purpose: This study evaluated carious tissue removal by mechanical and chemomechanical methods (Carisolv and Papacárie) through colony-forming unit (CFU) counts of Streptococcus mutans and Lactobacillus sp. Treatment acceptability, presence and level of pain, use of anesthesia, time required for caries removal and pain 24 h after treatment were also compared. Materials and Methods: A clinical trial with 32 individuals who had at least two deciduous molars with active occlusal caries lesions were selected and randomly divided into two groups (I and II). One lesion in each individual was excavated with hand excavator only. The remaining lesions were excavated using modified hand excavation and Carisolv in group 1 or modified hand-excavation and Papacárie in group 2. Bacterial samples were taken from each caries lesion before and after treatment. Results: All the methods reduced the amount of cultivable Streptococcus mutans and Lactobacillus sp. after treatment (p 0.05) and no statistically significant difference was found between the groups (p > 0.05). There was 97% acceptability of treatments, and anesthesia was used in 14% of teeth. Pain was present 24 h after treatment in 6% of teeth. The mean times for caries removal by the mechanical and chemomechanical treatments were not statistically significantly different (p > 0.05). Conclusions: All treatments were found to effectively reduce bacterial counts (p 0.05). There were no statistically significant differences (p > 0.05) among treatments or between clinical variables (p > 0.05). Keywords: deciduous teeth, dental atraumatic restorative treatment, dental caries, pain, papain