Oral Health and Preventive Dentistry, 01/2019

Purpose: To compare the effect of three custom-made probiotic chocolates and conventional chocolates on plaque pH, salivary pH and buffering capacity of saliva in children. The study also evaluated its antimicrobial efficacy against S. mutans. Materials and Methods: A parallel randomised double-blinded trial was conducted in two phases. For the phase І trial, 90 children were randomly divided into 3 groups: milk (MC), white (WC) and dark chocolate (DC). Salivary pH, plaque pH and buffering capacity were assessed at baseline, 10 min, 30 min and 60 min after consumption of the chocolates. After a washout period of 20 days, the children were assigned to their respective probiotic chocolate groups and the assessments were repeated. In the phase ІІ trial, 60 children were divided into 3 groups (n = 20): probiotic milk (PMC), white (PWC) and dark chocolate (PDC). They were given probiotic chocolates for 5 consecutive days in a week. S. mutans colony count was measured at baseline, post intervention, 15 days and 30 days. Results: All probiotic chocolates were less acidogenic than their counterparts. PWC was found to be the least acido-genic. DC was found to be the least acidogenic among plain chocolates. All probiotic chocolates were effective in reducing the S. mutans colony count. Conclusion: Chocolates can serve as a vehicle for delivering probiotics with the added advantage of making them tooth-friendly. Keywords: chocolates, plaque, probiotics, Streptococcus mutans

Purpose: To evaluate the clinical performance of high viscosity GIC sealant applied with or without additional light curing in children with early childhood caries (ECC). Materials and Methods: A split-mouth clinical trial was conducted in a total of 111 3- to 5-year-old children with ECC. 180 pairs of non-carious primary second molars were selected and divided into two groups: study and control. On the basis of the application technique, selected teeth in the study group were further allotted to group A (sealant application with additional light curing) and group B (sealant application without additional light curing). Caries incidence was observed for 1 year in the anatomical pits and grooves, along with sealant retention and marginal discolouration at various intervals over the 1-year period. Results: Group A (GIC sealant with additional light curing) (44.2%) showed sealant retention similar to that of group B (GIC sealant without additional light curing) (43.0%) (p = 0.885). Caries incidence was significantly higher in the control group (26%) than the sealant groups (1%) (p 0.001). No marginal discolouration adjacent to the sealant was observed in either anatomical grooves or pits in both sealant groups for the duration of the study. Conclusion: Retention and caries prevention by high-viscosity GIC sealant applied with or without additional light curing was found to be similar. At the 12-month assessment, mean dmfs scores and caries incidence in primary second molars were higher in the control than in both study groups. Keywords: ECC, GIC sealants, high viscosity GIC sealant, primary molars

Purpose: To assess the prevalence of and factors associated with the use of public Unified Health System-based dental services by pregnant women and recent mothers. Materials and Methods: In this cross-sectional study, face to face interviews were conducted to collect data on the outcome of interest (prevalence of use of dental care) and independent variables (sociodemographic, pregnancy, and prenatal care data). A total of 302 pregnant women seen at public dental services in the municipality of Canoas, southern Brazil, were interviewed. Statistical analysis was performed using the chi-squared test and hierarchical Poisson regression with robust variance (p 0.05). Results: The prevalence of use of dental care among pregnant women was 50% (n = 151). Pregnant women who initiated prenatal care in the first trimester showed a 34% higher likelihood of using dental care (prevalence ratio [PR] 1.34; 95% confidence interval [95%CI] 1.27-1.61); this likelihood was 12% higher among multiparous women (PR 1.12; 95%CI 1.03-1.23), and 40% higher among women who received guidance to seek dental care (PR 1.40; 95%CI 1.30-1.51). Conclusion: The present findings suggest that starting prenatal care in the first trimester, being multiparous, and receiving guidance to seek dental care significantly contributed to the use of public dental services during pregnancy in the population assessed. These factors should be considered when planning public health policies for this population. Keywords: access to health care, dental care, oral health, maternal and child health, pregnant women

Purpose: To evaluate dental anxiety from the dentist's perspective. Materials and Methods: A cross-sectional study was performed on a convenience sample. Data were gathered using questionnaires that included general information and specific questions concerning dentally anxious patients. Results: Three hundred ten practicing dentists completed the survey. Participants estimated that 27% of their adolescent/adult patients and 35% of their child patients suffer from dental anxiety. Dentists reported devoting about a quarter of their weekly work hours to treating such patients. The most common anxiety management techniques used for adults and children alike were nitrous oxide and/or behavioural techniques (such as distraction, reinforcement, gradual exposure, and relaxation). Dentists generally agreed that it is their responsibility to help dentally anxious patients. Eighty-one percent expressed interest in taking part in dental anxiety management courses. The consensus was that treating dentally anxious patients involves long treatment times, insufficient payment, and frequent appointment cancellations. Conclusions: According to practicing dentists, over one-quarter of their patients suffer from dental anxiety. Most dentists perceive themselves as responsible for treating these patients and are willing to receive appropriate training. Incorporating behavioural and pharmacological management techniques in the undergraduate dental curriculum and expanding postgraduate training programmes in this field are important issues that can improve the well-being of both dentally anxious patients and their dentists. Keywords: dental anxiety, dentist-patient relations, behavioural, management, public health

Purpose: Systematic dental check-ups play a vital role in maintaining good oral health. When oral examinations are performed as regularly as recommended, the dentist may be the first health care provider to diagnose a health problem in its early stages. The aim of the study was to identify and assess determinants of dental check-up among students of Suwałki (Poland), Grodno (Belarus) or Lviv (Ukraine) universities taking sociodemographic variables into account. Materials and Methods: Data were collected from 2013 to 2016 among freshman students of Polish (n = 1245), Belarusian (n = 1012) and Ukrainian universities (n = 688). The study was performed with the diagnostic survey method, using a questionnaire designed by the authors. In order to identify the determinants of dental check-ups, logistic regression analysis was applied. Results: A majority of students visited a dentist for a check-up at least once a year (32.7% twice a year; 41.0% once a year). Women from Belarus (OR 1.690; 95% CI: 1.256-2.273) or Poland (OR 1.832; 95% CI: 1.374-2.442) underwent dental check-ups with a higher frequency, as did students whose financial situation was very good or good (Belarus: OR 1.574; 95% CI: 1.184-2.093 or Poland OR 1.604; 95% CI: 1.227-2.096). Variables related to students' health behaviours, i.e. smoking, alcohol consumption or drug use, were not statistically significant. Conclusions: The frequency of stomatological control examinations among students from Polish, Belarusian or Ukrainian universities is high. The frequency of dental examination among students is conditioned by sociodemographic factors. Regular check-ups at the dentist are more prevalent for women and those students from Polish or Belarusian universities who rated their financial situation as good or very good. In Belarusian or Ukrainian respondents, maintaining healthy eating habits was a positive predictor of dental check-up attendance, while in Polish students self-evaluation of health was a negative one. Keywords: dental check-up, dental prophylaxis, oral health

Purpose: To assess the antibacterial effect of orthodontic cements containing 1% insoluble antibacterial polycat-ionic nanoparticles against Streptococcus mutans. Materials and Methods: Polycationic polyethyleneimine (PEI)-based nanoparticles were incorporated into GC Fuji Ortho LC (GC), CX-plus (Shofu) orthodontic cements and in Neobond Transbond plus (Denstply) and Transbond XT (3M) orthodontic adhesives. The samples were evaluated immediately after setting, as well as after two weeks and one month of aging. The antibacterial effect against S. mutans was evaluated with the direct contact test and the agar diffusion test. In addition, the antibacterial properties of the eluate from the examined materials was tested. Four-way ANOVA followed by Tukey's test was used to determine bacterial growth rates. Results: S. mutans outgrowth was substantially reduced (p 0.05) following direct contact with the surface of Neobond adhesives (95%, i.e. 5-6 log reduction) and GC Fuji Ortho LC cement samples (97% reduction) containing PEI nanoparticles. CX-plus cement, Transbond plus and Transbond XT adhesives with and without PEI showed no antibacterial effect, and S. mutans outgrowth was similar to that of the controls. Conclusions: Neobond adhesive and GC Fuji Ortho LC cement with 1% incorporated insoluble antibacterial polycat-ionic nanoparticles exhibited stable antibacterial properties, particularly after immediate contact between the cement and the adhesive, and thus may prevent S. mutans outgrowth adjacent to orthodontic appliances. Further studies are needed to evaluate the efficacy, physical properties and possible side effects of the PEI nanoparticles in vivo. Keywords: antibacterial, direct contact test, orthodontic cement, quaternary ammonium polyethyleneimine, S. mutans 

Purpose: To apply titanium tetrafluoride (TiF4) in an aqueous solution or incorporated into the primer of a self-etching adhesive (Clearfil SE Bond) as dentin pre-treatment and evaluate its antimicrobial effect, determine the minimum bactericidal concentraion (MBC) against Streptococcus mutans and Lactobacillus casei and analyse its potential to inhibit the development of carious lesions at the restoration interface. Materials and Methods: For MBC, an aqueous solution or primer with different concentrations (in %) of TiF4 were used (from 0.0 to 4.0). Also, 50 cavities were prepared at the enamel/dentin junction of third molars and received the following dentin pre-treatments (n = 10): Clearfil SE Bond (CL); aqueous solution of 2.5% TiF4 + CL (T2.5%); aqueous solution of 4% TiF4 + CL (T4%); 2.5% TiF4 incorporated into the primer (P2.5%); 4% TiF4 incorporated into the primer (P4%). Cavities were restored and submitted to pH cycling to create artificial caries lesions. Microhardness tests were performed after sectioning the restorations to assess the demineralisation at margins. Results: ANOVA and Tukey's tests showed that TiF4 in aqueous solution presented MBC against S. mutans and L. casei of over 2.0%. TiF4 in the primer of a self-etching adhesive presented MBC of over 1% for L. casei. For enamel, CL showed no significant differences in microhardness between the depths. Conclusions: The aqueous solution had an antimicrobial effect against Streptococcus mutans and Lactobacillus casei of over 2.0%. Pretreatment with the aqueous solution or primer did not inhibit demineralisation at enamel or dentin restoration interfaces. Keywords: adhesive system, microhardness, microorganism, secondary caries, titanium tetrafluoride

Purpose: To determine the influence of plaque and progesterone on periodontitis in pregnant women and their relationship with inflammatory mediators. Materials and Methods: A longitudinal observational study of 60 pregnant women was undertaken in two observation periods. During the third trimester, plaque Index (PI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were assessed, and the basal levels of progesterone, CRP, IL-6 and TNF-α in plasma were measured. The second observation phase was carried out 6 weeks after childbirth, when periodontal indices, progesterone and serum levels of CRP were again evaluated. Results: Periodontal disease was moderate in 18.3%. PI and toothbrushing proved to have a correlation with the severity of periodontitis. High levels of CRP were significantly correlated (p 0.05), with a greater BOP (r = 0.360) and PPD (r = 0.321). There was no correlation between IL-6 or TNF-α with periodontal parameters. After childbirth, progesterone was drastically reduced, BOP and PPD improved and CRP showed a significant reduction of 2.63 mg/l (p 0.05). Conclusions: Periodontal disease is prevalent during pregnancy. PI and frequency of toothbrushing are correlated with the severity of periodontitis in pregnant women. Pregnancy showed an increased in the level of CRP, which was positively correlated with BOP and PPD. All periodontal indices and CRP level statistically significantly decreased after childbirth, together with a marked reduction of progesterone and without changes in PI. Keywords: anti-inflammatory agents, gynecology, periodontitis, pregnancy, obstetrics

Purpose: This randomized clinical trial tested whether a novel bristleless toothbrush design is more effective in preventing gingival recession in adults receiving periodontal maintenance than is a soft toothbrush with nylon bristles. Materials and Methods: Twenty-three subjects with gingival recession were recruited who received regular periodontal maintenance care at Western University of Health Sciences Dental Center, and who did not exhibit signs of acute dental or systemic disease, occlusal discrepancies or parafunctional habits. These subjects were randomly assigned to to two groups, one using a soft nylon-bristled toothbrush, and the other using the experimental toothbrush that contains a brush head with short, soft, rubbery cones. Both groups received regular periodontal maintenance and periodontal exams by blinded examiners every 3-4 months, measuring probing depth, bleeding on probing, and plaque indices. Gingival recession was assessed clinically and through use of a stent on diagnostic casts obtained at each visit. Results: Average probing depths, plaque levels, and the number of sites with bleeding on probing did not change over at least 9 months. After 9 months, there was a small but statistically significant improvement in gingival recession (0.4 mm, p 0.01) at sites with gingival recession in the experimental toothbrush group compared to the control group. Conclusion: In periodontal maintenance patients, the bristleless toothbrush used in this study was as effective in plaque removal and prevention of gingival inflammation than a conventional toothbrush with soft nylon bristles, while increasing the possibility of gingival tissue rebound over denuded root surfaces. Keywords: gingival recession, oral hygiene, toothbrushing

Purpose: To assess children's oral health-related quality of life (OHRQoL) three years after implementation of three treatment protocols for managing cavitated carious dentine lesions in primary molars by parent proxy report with the Brazilian Early Childhood Oral Health Impact Scale (B-ECOHIS) and to assess the level of agreement between the children's self-reporting and the parents' reporting of the children's OHRQoL. Materials and Methods: Schoolchildren aged 6 to 7 were included in a clinical trial that compared three treatment protocols for managing cavitated carious dentine lesions: CRT (Conventional Treatment); ART (Atraumatic Restorative Treatment) and UCT (Ultraconservative Treatment). Before treatment (baseline), the OHRQoL of 273 children was assessed by B-ECOHIS using the parents'/caregivers' proxy report. Three years later, 147 parents/caregivers filled in the questionnaire while the children, ages 9 to 10, were interviewed. The t-test and one-way ANOVA were used for statistical analysis. Results: No difference was observed between treatment protocols in regard to the children's OHRQoL (p = 0.41). A significant reduction in the parent distress domain was observed when baseline and parents'/caretakers' responses after three years (p = 0.01) were compared. The level of agreement between the parents'/caregivers' and children's scores was low. Children scored lower on the impact of oral health on their quality of life than their parents/caregivers did (p 0.0001). Conclusion: The use of UCT, a largely non-restorative protocol, leads to a perception of OHRQoL by parents/caregivers that is similar to the ART and CRT protocols after three years. Parent distress decreased over time. Children and parents/caregivers disagreed about children's OHRQoL. Keywords: atraumatic restorative treatment, conventional restorative treatment, ECOHIS, quality of life, ultra-conservative treatment