Oral Health and Preventive Dentistry, 01/2009

Periodontitis is a multifactorial disease involving bacterial biofilms and the generation of an inflammatory response. The latter causes the major part of the periodontal tissue breakdown. Alveolar bone resorption is a major component of the periodontal destruction observed in periodontitis. Novel treatment modalities of periodontitis intend to control and modulate the host response to bacterial aggression. Drugs such as bisphosphonates (BPs) are proven antiresorptive agents that can potentially inhibit the alveolar bone resorption. This review describes the potential use of BPs in periodontal treatment and could be said that BPs have an in vitro and in vivo capability of reducing bone resorption. Only a few studies have been carried out on the improvement of clinical periodontal parameters after the administration of BPs. Therefore, the published data are not sufficient to establish an evidence-based relevance for the use of these drugs in the treatment of periodontal diseases. Keywords: bisphosphonates, experimental periodontitis, host modulation, periodontal treatment

Purpose: The aim of this preliminary in vitro study was to evaluate the effect of a casein phosphopeptide and amorphous calcium phosphate (CPP-ACP) paste on untreated enamel surfaces that had previously been exposed to an erosive challenge. Materials and Methods: Over a period of 6 h, enamel samples from five fully erupted, caries-free molars were incubated with apple juice and later covered with CPP-ACP paste for 15 min. Enamel samples incubated with physiological sodium chloride solution or with apple juice alone served as controls. The quantitative elementary analysis for calcium and phosphorus in various depths ranging from 5 to 50 lm was performed using an electron-probe microanalyser. Results: Exposure to apple juice resulted in a loss of minerals down to a depth of 30 lm with a mean loss of 13% at 5 lm and 6% at 10 lm. After treatment with CPP-ACP paste, the mineral loss decreased to a mean of 9% at 5 lm and remained at 5% at a depth of 10 lm (not a statistically significant difference). At a depth of 20 lm, no further mineral loss was recorded. Conclusions: This study demonstrated that there is a slight gain in the mineral contents after the application of a CPP-ACP paste, mainly in the upper enamel layer. Within the limitations of this in vitro study, the application of CPP-ACP paste may enhance the remineralisation after an erosive challenge and thus offer some protection for patients who are at risk for erosion. Keywords: casein phosphopeptide and amorphous calcium phosphate, electron-probe microanalysis, enamel erosion, in vitro study, remineralisation

Purpose: The aim of this in situ double-blind randomised crossover study was to investigate the effect of calcium (Ca) pre-rinse on the composition of plaque and on enamel prior to the use of fluoride (F) dentifrice. Materials and Methods: During four phases (14 days each) of this study, 10 volunteers had agreed to wear dental appliances containing two healthy bovine enamel blocks. A fresh solution containing 20% weight/volume (w/v) sucrose was dripped on the enamel blocks ex vivo for 5 min three times a day. Subsequently, the appliances were replaced in the mouth, and the volunteers rinsed their mouth with 10 mL of a Ca (150 mmol/L) or a placebo rinse (1 min). In sequence, a slurry (1:3 w/v) of F (1030 ppm) or placebo dentifrice was dripped onto the blocks ex vivo for 1 min. During this time, the volunteers brushed their teeth with the respective dentifrice. The appliances were replaced in the mouth, and the volunteers rinsed their mouth with water. The plaque formed on the blocks was analysed for F and Ca. The enamel demineralisation as well as the incorporation of F on enamel was evaluated by cross-sectional microhardness and alkalisoluble F analysis, respectively. Data were tested using analysis of variance (P 0.05). Results: The Ca pre-rinse prior to the use of the F dentifrice led to a three- and sixfold increase in the plaque F and Ca concentrations, respectively. It also did not have any additive effect on the F content on the enamel and the demineralisation of the enamel, in comparison with the use of F dentifrice alone. Conclusions: A Ca lactate rinse used prior to the F dentifrice was able to change the mineral content in the plaque, but it was unable to prevent enamel demineralisation. Keywords: calcium, dental enamel, dental plaque, fluoride dentifrice, in situ

Purpose: The aim of this study was to evaluate the surface roughness and the in vitro adherence of Streptococcus mutans to indirect aesthetic restorative materials that are uncoated with saliva. Materials and Methods: Four groups of restorative materials were evaluated according to material type: (1) microparticulate feldspathic ceramic; (2) leucite-reinforced feldspathic ceramic; (3) microhybrid resin composite and (4) microfilled resin composite. Twenty standardised samples of each material were produced. Roughness analysis (Ra, n = 10) was performed using a roughness analyser. Adhesion tests (n = 10) were carried out in 24-well plates; colony-forming units (CFU/mL) were evaluated. The mean values of roughness (lm) and adherence (CFU/mL) for each group were subjected to an analysis of variance and a Tukey test. Results: The leucite-reinforced feldspathic ceramic was rougher and presented higher bacterial adherence than the microparticulate feldspathic ceramic. The resin composites were similar with regard to surface roughness and bacterial adherence. Conclusions: The microhybrid and microfilled resin composites were similar and the leucite-reinforced feldspathic ceramic was rougher and presented higher bacterial adherence than the microparticulate feldspathic ceramic. Keywords: ceramic, resin composite, Streptococcus mutans, surface roughness

Purpose: The aim of this study was to assess the perceptions and concerns about dental fluorosis among high school children in an area that is endemic to fluorosis, and to correlate the children's perceptions of dental fluorosis with different scores of tooth surface index of fluorosis. Materials and Methods: The study was conducted among 155 children affected with fluorosis, aged between 12 and 16 years, studying in all four high schools of Kaiwara, Karnataka, India. Fluorosis was assessed on labial surfaces of maxillary anterior teeth using tooth surface index of fluorosis, and the data were collected using a self-administered pretested questionnaire that was given to the study subjects. Analysis was performed using frequency distribution, chisquare test and Spearman's correlation coefficients. Results: Significant high correlations were found between tooth surface index of fluorosis scores and the perception of the importance of the condition (r = 0.226, χ2 = 72.065, P 0.01), considering the condition to be a disadvantage in the future (r = 0.166, χ2 = 73.097, P 0.05) and also the last visit to the clinician for the condition (r = -0.184, χ2 = 14.252, P 0.05). Conclusion: Perceptions and concerns of dental fluorosis among this age group of children appear to be of aesthetic concern making it essential to focus on this issue and to intervene. Keywords: aesthetic concerns, dental fluorosis, perceptions, TSIF

Purpose: The aim of this study was to identify the prevalence and severity of caries and of early childhood caries (ECC) in preschool children from the municipality of Capivari de Baixo, Brazil. Furthermore, the aim was to ascertain the association between these prevalences and the level of maternal schooling. Materials and Methods: A cross-sectional study was performed involving all children aged 3 to 5 years enrolled in all municipal schools of Capivari de Baixo, Brazil. The clinical information was obtained using the World Health Organization criteria. For ECC, it was observed if the child presented with lesions with acute evolution, whitening clinical aspect and softened consistency. Non-clinical data were obtained by means of interviews with the child's mothers, by investigating the child and through questions relating to the maternal age, the maternal level of schooling and the time of weaning. Tests of association were performed using the chi-square test followed by unconditional multiple logistic regression analysis to test the independence of the association between the outcomes and the explanatory variables. Results: The prevalence of caries was 64.3%, the mean dmft was 1.24 and the prevalence of ECC was 4.9%. A child was more likely to present with severe caries (dmft ≥ 2) if aged 47 months or above. Low maternal schooling made the occurrence of both severe caries and ECC more likely. Conclusions: The population that was studied presented levels of oral health better than those found in other Brazilian population groups, although groups remain with a high severity of caries associated with low maternal schooling. Keywords: dental caries, early childhood caries, infectious disease, schooling, socioeconomic status

Purpose: This laboratory study assessed the influence of surface roughness and contact time on the formation of a multi-species biofilm on dental materials (adhesive patch, composite, amalgam and enamel). Materials and Methods: Rough and smooth specimens of each material were prepared and the mean surface roughness was assessed profilometrically. The biofilms were then allowed to grow either for 15 min or 15 h respectively on salivapreconditioned specimens of each material, and colony-forming units on blood agar were counted (N = 9/group). Surface morphology was assessed using a scanning electron microscope. Results: No difference was found in the biofilm formation rate among all the materials that were tested. After a short incubation period, a statistical significant difference between smooth and rough samples could be detected on amalgam and on the resin composite material (P ≤ 0.001). Conclusions: Surface roughness may influence the initial biofilm adherence, but differences vanish following growth and maturation. The multi-species biofilm offers a reliable laboratory model for studying plaque formation. Keywords: dental materials, multi-species biofilm, SEM, surface roughness

Purpose: The aim of this study was to investigate the effect of two types of occlusal accommodation on the arch separation in centric and eccentric arch positions and to assess the opposing tooth contacts in professionally made, thermoformed sports mouthguards. Materials and Methods: Maxillary and mandibular alginate impressions, a wax interocclusal record of centric occlusion together with maxillary/condylar face-bow registrations, were recorded clinically for 10 undergraduate dental students who are sports activist volunteers of the School of Medicine and Dentistry, Queen's University Belfast. Two ethylene vinyl acetate thermoformed maxillary mouthguards were made for each player (N = 20) using a standardised procedure. Ten mouthguards served both as the control (i.e. the non-accommodated) group and also the accommodated, occlusally 'imprinted' group. The other 10 mouthguards served as the accommodated, occlusally 'ground' group. Casts were articulated, each non-accommodated and accommodated mouthguard was seated and the extent of the interocclusal opening was recorded in all three arch relationships. The number of mouthguard and mandibular tooth contacts were also recorded in each position. Results: The increased vertical occlusal dimension that was found in the presence of non-accommodated mouthguards equated to the full-sheet thickness of the material that was used to form the mouthguards. Only mouthguards accommodated by grinding retained high levels of occlusal contact in all arch relationships that were tested. Conclusions: Within the limitations of this study, the modification of the occlusal surface made by flat grinding reduced the arch separation in eccentric movements and increased the opposing tooth contacts in custom-made mouthguards. This may contribute to increased comfort, compliance and the protective effect of these appliances thus resulting in a reduction of injuries to the teeth, arches and soft tissues. Keywords: dental materials, dental thermoforming, mouthguards, occlusion, prevention

Purpose: The objective of this study was to assess the periodontal treatment needs and the dental status in relation to smoking indicators with special emphasis on lifelong exposure to smoking among 35- to 44-year-old Iranian dentate subjects. Materials and Methods: Data (N = 8276) were collected as part of a national survey using the World Health Organization criteria for sampling and for using the data as clinical indicators. Gender, age, place of residence and level of education served as sociodemographic information, and community periodontal index (CPI) and number of teeth served as clinical measurements. The smoking indicators comprised smoking, duration of smoking (years), daily smoking (cigarettes/day) and lifelong exposure to smoking. Results: In total, 81% of the subjects were non-smokers, and 32% of the males and 5% of the females were current smokers. Maximal CPI = 2 was found among 40% of the subjects, and 53% had maximal CPI ≥ 3. Higher periodontal treatment needs were associated with smoking (P 0.01) in males; CPI = 4 was more frequent (P 0.01) and the mean number of teeth was lower (P 0.01) among groups with higher levels of smoking. Heavy smokers were the most likely to have maximal CPI ≥ 3 (odds ratios, OR = 2.9; 95% confidence intervals, 95% CI = 1.8 to 4.7) and to have 20 teeth (OR = 2.3; 95% CI = 1.5 to 3.6). Conclusions: Smoking and lifelong exposure to smoking with a dose-dependent effect seem to be associated with higher periodontal treatment needs and poorer dental status among the middle-aged, particularly in males and in low socioeconomic groups in Iran. Keywords: dental health surveys, middle-aged, oral health, smoking

Purpose: The aim of this study was to investigate the diagnostic delay and its determinants among oral cancer patients in Tehran, Iran. Materials and Methods: This study was conducted between September 2004 and September 2006 in three university hospitals, and included 100 consecutive patients with primary oral squamous cell carcinoma (international classification of disease, ICD-10 sites C01 to C06). Data were obtained through questionnaire interviews and medical records of the patients were reviewed to obtain information on the date of diagnosis, primary tumour site and the stage of the tumour at the time of diagnosis. Statistical analysis was performed by t test, ANOVA and logistic regression. Results: The mean diagnostic delay was 7.2 months (SD 7.5, range 1 to 36 and median 4). The most important determinants of longer diagnostic delay were being single (OR = 4.8; 95% CI = 1.5 to 14.8; P 0.05) and being at advanced tumour stages (OR = 5.3; 95% CI = 1.8 to 15.6; P 0.01). The mean patient and professional delays were 5.3 months (SD 6.1 and median 2) and 2.1 months (SD 2.1 and median 1), respectively. Patients at advanced tumour stages were more likely to have longer patient and professional delays than those at early stages (OR = 5.6; 95% CI = 1.8 to 17.3 and OR = 3.4; 95% CI = 1.2 to 9.4, respectively; P 0.05). Living alone was also a determinant of longer patient and professional delays (OR = 7.1; 95% CI = 2.0 to 24.7, OR = 3.5; 95% CI = 1.2 to 10.3, respectively; P 0.05). Conclusions: Developing preventive programmes that focus on the enhancement of public and professional awareness about oral cancer is essential to promote earlier diagnosis in Iran. Keywords: diagnostic delay, early diagnosis, Iran, Middle East, oral cancer

Purpose: The aim of this study was to assess the use of oral piercings and their possible associated complications among students aged 14 to 18 years. Materials and Methods: A total of 927 students from private and state schools were invited to participate in this study. The participants were subjected to clinical examination, and a questionnaire was provided for collecting the following data: gender, piercing location, oral complications or alterations, and cleaning frequency. Results: Among the students who were analysed, 33 had oral piercings (3.6%); 69.70% were from state schools and 30.30% were from private schools. There was a slight predominance of males (54.55%) compared with females (45.45%). The tongue was the most common location for piercing (66.6%). The complications and alterations associated with the use of piercing were observed in 74.3% of the cases. Conclusions: In the population that was studied, oral piercing was observed in a small percentage of teenage students (3.6%) and there were local complications associated with its use. Keywords: body piercing, dental plaque, infection

Purpose: The aim of this study was to investigate the occlusion, the demand for orthodontic treatment and the reasons for this among Chinese young adults in Hong Kong. Materials and Methods: A questionnaire was used to study previous orthodontic experience and to evaluate the orthodontic treatment demand and the reasons for this in Chinese university students. Among those who had no orthodontic treatment, 120 participants were invited for an occlusal assessment. Their treatment need was graded using the index of orthodontic treatment need. Results: A total of 240 students, aged 18 to 27 years, completed the questionnaire survey. Thirty-one students (13%) had orthodontic treatment. Sixty-seven (28%) students had orthodontic treatment demand, and their common reasons were to improve appearance (78%), self-image (36%), self-confidence (34%) as well as to follow parental advice (24%). The reasons for those students who would not consider having orthodontic treatment included no perceived need (64%), long treatment time (18%) and high treatment fee (14%). All 120 invited participants who had no orthodontic treatment attended the occlusal assessment. One-fifth had a normal occlusion. Most malocclusions were manifested as Angle Class I (48%) followed by Class III (21%) malocclusion. Fifty-six students (47%) had moderate and 40 students (33%) had 'great' or 'extremely great' treatment need. Conclusions: The most prevalent malocclusion among this group of Chinese young adults was Angle Class I malocclusion. Although the majority of the Chinese young adults had malocclusion with a high treatment need, their demand for orthodontic treatment was relatively low. Apart from consideration of dental health needs, the common reasons for orthodontic treatment demand were influenced by the desire for improvement in appearance. Keywords: adult, occlusion, orthodontic, treatment demand

Purpose: The objective of this study was to assess the practicability and effectiveness of group oral hygiene instruction for adults in comparison with individual oral hygiene instruction. Materials and Methods: A total of 104 male subjects aged 18 to 54 (mean age: 29.7) years were randomly assigned to one of four groups: group A was given individual oral hygiene instruction; group B was given group oral hygiene instruction; group C was given a combination of individual and group oral hygiene instructions; and group D received no oral hygiene instruction (the control group). The success of each form of instruction was evaluated on the basis of four parameters: (1) the Quigley-Hein plaque index (QHI), (2) the approximal plaque index (API), (3) a modified sulcus bleeding index (SBI) and (4) the community periodontal index of treatment needs (CPITN). All participants had professional tooth cleaning at the end of the baseline examination. The final examinations were conducted 13 weeks later. Results: All subjects showed a poor oral health status at the beginning of the study, and the mean QHI score was 2.2. In addition, 92% of all subjects had an API score of more than 70%. Moderate-to-severe gingival inflammation (modified SBI) was observed in 67.3% of the subjects. CPITN scores of 2 or 3 were calculated for 82% of all sextants. At the end of the study, all groups showed a significant improvement in their oral health status and periodontal parameters (P 0.0001). The majority of the subjects achieved an API score between 25% and 70%, and they had a mean QHI score of 1.2. A CPITN score of 0 or 1 was recorded for most sextants (62%). There was no significant difference between the various groups. Conclusions: This study demonstrated that group oral hygiene instruction and conventional individual instruction have similar beneficial effects in adults. Keywords: adults, group prophylaxis, individual prophylaxis, oral hygiene instruction