Oral Health and Preventive Dentistry, 02/2012

Purpose: In India, people chew tobacco either alone or in combination with pan or pan masala, which may cause tooth wear. The purpose of this study was to assess and compare tooth wear among chewers of various forms/combinations of tobacco products in the rural population of Davangere Taluk. Materials and Methods: A cross-sectional study was conducted on 208 subjects selected from four villages of Davangere Taluk. Tooth wear was recorded using the Tooth Wear Index by a calibrated examiner with a kappa score of 0.89. The chi-square test was used for statistical analysis. Results: The subjects chewing tobacco had significantly greater tooth wear as compared to the controls (P < 0.001). It was also observed that the frequency and duration of chewing tobacco was directly proportional to the number of pathologically worn sites. Conclusion: The abrasives present in the tobacco might be responsible for the increased tooth wear among tobacco chewers. Keywords: rural population, tobacco, tooth wear

Purpose: To determine the levels of daily consumption of soft drinks, sweets and cakes/pastries by schoolchildren in Kuwait and the possible background factors associated with these habits. In addition, the association between daily consumption of these sugar-rich products and other health-related habits was studied. Materials and Methods: A nationally representative sample of children from public schools was drawn for this study. Altogether, 1292 schoolchildren of an average age of 13 years (SD ± 1.04) participated by anonymously filling out a structured questionnaire in school classrooms. The questionnaire of the WHO Collaborative study (Health Behaviour in School-aged Children) was used after modifications for the Kuwaiti situation. Results: Daily consumption of soft drinks, sweets and cakes was very high, especially among the Kuwaiti schoolchildren. Very strong correlations were found between daily consumption of sweets and cakes/pastries (r = 0.60; P < 0.01), soft drinks and sweets (r = 0.50; P < 0.01) and between soft drinks and cakes/pastries (r = 0.42; P < 0.01). Among other unfavourable habits, late bedtime, watching TV often and smoking were strongly correlated with the daily use of sugary drinks and foods. Sociodemographic or socioeconomic factors were only weakly associated with the consumption of sugar-rich products. Conclusions: Daily consumption of sugar-rich products seems to be alarmingly high in Kuwait, higher than in any other of the 34 countries in the HBSC study. Other unhealthy habits were associated with the daily consumption of these sugar-rich products. Keywords: adolescents, Kuwait, soft drinks, sweets

Purpose: To evaluate the effect of cow's milk, milk plus sugar, milk plus honey and formula on plaque pH when compared to a 10% sucrose solution in 8- to 12-year-old children. Materials and Methods: Plaque pH was measured using a pH microelectrode at baseline to determine resting plaque pH and at intervals between 1 and 60 min after rinsing with the test liquids. Plaque pH data were analysed using repeated- measure ANOVA and paired t tests. Results: The study findings showed that 10% sucrose has the greatest cariogenic potential, followed by milk plus honey, milk plus sugar, formula and cow's milk. Except for the control group, the evaluated foods did not reduce the pH below 6. Conclusion: Although the test groups appear to be non-cariogenic as compared with sucrose, they still lead to considerable acidogenic response in the dental plaque. When bottle feeding is essential, it was confirmed that frequently use of these beverages may cause enamel demineralisation. Keywords: cariogenicity, children, early childhood caries, plaque pH

Purpose: The present study investigated the effects of dental anxiety and dental visits on oral hygiene practices, which included brushing, flossing and amount of time brushing. Materials and Methods: The study included a dental questionnaire developed to measure aspects of dental visits, oral hygiene and dental anxiety. A demographic questionnaire included questions pertaining to age, ethnicity and citizenship. Participants included 77 undergraduate students attending a diverse southern United States university enrolled in psychology courses. Results: Linear regression was conducted to explore the association between dental anxiety and oral hygiene practices. Results revealed the model explained a significant proportion of variance in oral hygiene practices, R2 = 0.141, F(1,76) = 12.441, P < 0.001. Specifically, higher dental anxiety was associated with poorer oral hygiene practices. A correlation was conducted to investigate the association between dental visits and oral hygiene practices. Results revealed a correlation between dental visits and brushing r(75) = 0.342, P = 0.002, and flossing frequency r(75) = 0.294, P = 0.009. There was no association between visits to the dentist and time spent brushing teeth. Conclusion: Results indicate that dental anxiety is associated with oral hygiene practices. Additionally, those who visit the dentist more often have somewhat better oral hygiene practices. The present study indicates that there may be a learned association between dental anxiety and oral hygiene practices. Methods of education can be developed to disassociate anxieties that may inhibit optimum oral hygiene practices. It may also be beneficial for dental professionals to emphasise the value of the amount of time patients spend brushing their teeth. Keywords: behavioural decision making, dental anxiety, dental visits, learned association, oral hygiene practices

Purpose: To assess the oral health status and concordance between monozygotic and dizygotic twin pairs. Materials and Methods: After obtaining prior consent, a cross-sectional descriptive study was conducted among 9 monozygotic and 21 dizygotic twin pairs who were reared together. Perception towards oral health practices was assessed using a pre-tested questionnaire. The WHO oral health assessment form (1997) was employed to assess the oral health status. Zygosity determination was determined using the medical records, dermatoglyphics and details about chorionicity and number of placental cords. Pearson's correlation was calculated to determine the correlation among the monozygotic and dizygotic twin pairs. Results: The monozygotic twin pairs showed a greater correlation compared to the dizygotic twin pairs in dental caries, periodontal disease and malocclusion. Conclusion: In the present study, monozygotic twin pairs showed a higher correlation rate than the dizygotic twin pairs, suggesting considerable evidence that genes play a significant role in the aetiology of dental caries, periodontal disease and malocclusion. Keywords: dental diseases, environment, genetics, monozygotic twins

Purpose: Preterm children may not be prepared for extra-uterine life and thus need neonatal intensive care, such as artificial ventilation through orotracheal intubation. Oral tissue development changes as a result of the use of an orotracheal tube and its mechanical influence in preterm neonates has not been intensively studied. The purpose of the present study was to determine the association of orotracheal intubation with incidence of oral alterations in preterm infants. Materials and Methods: A retrospective cohort of 117 subjects who were born during the period 2002-2003 in Brazil were evaluated and the data were analysed using the Fisher and Mann-Whitney exact tests. A 95% confidence interval was calculated for observed oral conditions. Results: The cohort revealed that the most frequent oral conditions included anterior crossbite, superior alveolar contour and palatal deformation. Conclusions: The association between the intubated-infant group and the non-intubated-infant group suggested that mechanical trauma had an influence on the oral structure development. Keywords: malocclusion, oral development, orotracheal intubation, preterm infants

Purpose: To determine the prevalence of oral mucosal lesions associated with tobacco among patients visiting the dental hospital. Materials and Methods: A selection of 1525 patients visiting the Department of Oral Medicine and Radiology were interviewed regarding tobacco habits. Examination of the oral cavity was performed by trained examiners under good illumination using diagnostic instruments. Oral mucosal lesions were diagnosed based on the clinical features. Results: The patients were divided into groups based on their tobacco habits. Out of 1525 patients, 359 patients (23.5%) had the habit and 265 (73.8%) of them had oral mucosal lesions. Leukoedema was the most prevalent lesion. Leukoplakia was found in 3.5% of the patients. Malignancy was found only among chewers. Conclusion: Nearly three-quarters of the patients with the tobacco habit had oral mucosal lesions. This emphasises that routine examination of oral mucosa is important and that the patients must be motivated to quit this harmful habit. Keywords: leukoplakia, malignancy, mucosal lesions, tobacco

Purpose: To evaluate the antimicrobial effect of Egyptian propolis vs New Zealand propolis on Streptococcus mutans and lactobacilli in saliva. Materials and Methods: The strains used for the experiment were isolated from 12 patients having a high caries index. The ethanolic extract (EEP) of pure Egyptian propolis was obtained by dissolving 20 g of propolis in 70% aqueous ethanol to a final volume of 100 ml. The commercial New Zealand propolis, combined with antibacterial agents, was an ethanolic extract of propolis in lozenge form; this was dissolved in distilled water to obtain an EEP. The EEP was further fractioned using a liquid-liquid extraction technique with hexane and chloroform solvents. The antimicrobial properties of the two propolis types and their fractions on Streptococcus mutans and lactobacilli were examined separately by determining minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC). Twelve clinical isolates were obtained from the collected saliva of all patients, one (Streptococcus mutans and Lactobacilli) from each patient, for susceptibility testing. Results: The MIC values of the New Zealand propolis were lower than the MIC values of the Egyptian propolis, indicating that the New Zealand propolis and hexane fractions (H-fr) in general had stronger antimicrobial effects. In addition, its antimicrobial action was greater on S. mutans than on lactobacilli, except with H-fr they were the same. Conclusion: The commercial New Zealand propolis hexane fraction had the strongest antimicrobial action. The EEP had a more potent antimicrobial effect on S. mutans than on lactobacilli. Keywords: bactericidal effect, lactobacilli, propolis, Streptococcus mutans

Purpose: To determine whether variation in glucan synthesis by Streptococcus mutans isolates is associated with caries development in children receiving a fluoride mouth rinse (FMR). Materials and Methods: Of 122 children (aged 9 to 10 years), 64 had received FMR (FMR(+) group) and the remaining 58 children had not (FMR(-) group). The number of decayed and filled teeth (DFT) and increases in the number of DFT in 1 year (dDFT) were recorded. Saliva samples were collected to isolate the clinical S. mutans strains. The isolates were incubated in heart infusion broth supplemented with 1% sucrose, then the amount of water-insoluble glucan (WIG) formed on a glass tube surface was evaluated. Results: In the FMR(-) group, children carrying S. mutans had a higher DFT (P = 0.039) and tended to have a higher dDFT (P = 0.080) than the others. In the FMR(+) group, although the differences between children with and without S. mutans were not significant, children carrying S. mutans that produced a high amount of WIG had higher dDFT than the other S. mutans-positive children (P = 0.034). Conclusions: This study revealed that the variation in glucan synthesis by S. mutans is associated with caries development in children receiving a FMR. Keywords: child, dental caries, glucans, Streptococcus mutans

Purpose: To describe the different patterns of the intraoral distribution of enamel fluorosis in permanent dentition. Materials and Methods: This cross-sectional analysis was conducted in Nalgonda district of Andhra Pradesh, India. A group of 1000 school children aged 13-15 years were selected by stratified cluster sampling from four different areas with different levels of naturally occurring fluoride in the drinking water. Fluorosis was recorded using the Thylstrup and Fejerskov index (TFI). Results: The prevalence of fluorosis (TFI score >=1) was 100% at all four fluoride levels. This study revealed two patterns of fluorotic enamel changes in dentition. In high fluoride areas, incisors exhibited lower TFI values than canines, premolars and molars, with the maximum affected being second molars followed by first molars. In low fluoride areas, a steeper profile of dental fluorosis, starting from incisors and first molars through canine and premolars to second molars, was noticed. Conclusion: With the exception of permanent second molars and permanent first molars in high fluoride communities, the intraoral distribution of different degrees of dental fluorosis was related to the completion of primary enamel formation. Keywords: dental fluorosis, TF index

Purpose: To assess and compare the periodontal health status among permanent residents of low, optimum and high fluoride areas in Kolar District, India. Materials and Methods: A house-to-house survey was conducted in a population consisting of 925 permanent residents aged 35 to 44 years in three villages having different levels of fluoride concentrations in the drinking water. The fluoride concentrations in selected villages were 0.48 ppm (low), 1.03 ppm (optimum) and 3.21 ppm (high). The ion selective electrode method was used to estimate the fluoride concentration in the drinking water. Periodontal status was assessed using the Community Periodontal Index (CPI) and loss of attachment (LOA). Results were analysed using the chi-square test and logistic regression. The chi-square test was used to find the group differences and logistic regression to find association between the variables. Results: The overall prevalence of periodontitis was 72.9%; specifically, prevalences were 95.4%, 76.3% and 45.7% in low, optimum and high fluoride areas, respectively. The number of sextants with shallow or deep pockets decreased (shallow pockets: 525, 438, 217; deep pockets: 183, 81, 34) from low to high fluoride areas (odds ratio: 71.3). The low fluoride area had a 7.9-fold higher risk of periodontitis than the optimum fluoride area and a 30-fold higher risk than the high fluoride area, which was highly significant (χ2 = 53.5, P < 0.0001 and χ2 = 192.8, P < 0.001, respectively). Conclusions: The severity of periodontal disease is inversely associated with the fluoride concentrations in drinking water. This relation can provide an approach to fluoride treatments to reduce the prevalence or incidence of this disease. Keywords: CPI, endemic areas, fluoride, loss of attachment, periodontal health, periodontitis

Purpose: Fluctuations in female sex hormones result in changes in the gingival and periodontal tissues. The purpose of this study was to compare the periodontal status of premenopausal women at different time points during their menstrual cycle and to find the associated subgingival microbiota. Materials and Methods: One hundred premenopausal women participated in the study and were divided into two groups: group I consisted of 50 subjects with clinically healthy gingival, and group II consisted of 50 subjects with chronic gingivitis. Group II was further divided into group IIa and group IIb. Group IIa consisted of 25 subjects who did not receive any periodontal therapy during the study period. All the examinations were performed at three points during the menstrual cycle: ovulation (OV), pre-menstruation (PM) and menstruation (M). Plaque Index (PI), Gingival Index (GI), Papillary Bleeding Index (PBI), probing depth (PD), subgingival temperature (ST) recording, gingival crevicular fluid (GCF) collection, and estimation and microbiological examination using the benzoyl-DL-arginine-naphthylamide (BANA) test was carried out. For group IIb subjects, all the examinations were performed again during the next menstrual cycle, which followed 4 weeks after periodontal therapy. Results: Women with clinically healthy gingiva exhibited negligible changes throughout the menstrual cycle, whereas women with gingivitis showed aggravated inflammation during ovulation and pre-menstruation as compared to menstruation. However, there was no alteration in subgingival microbiota. After treating gingivitis, the next menstrual cycle following 4 weeks after periodontal therapy was monitored, and no periodontal changes were detected. Conclusion: Ovarian hormones have a negligible effect on clinically healthy periodontium. However, these hormones may exaggerate pre-existing inflammation in gingival tissues, but the clinical significance of these changes remains uncertain. Keywords: gingival crevicular fluid, gingivitis, inflammation, menstrual cycle, periodontium, sex steroid hormones

Purpose: To compare phagocytic activity of peripheral blood neutrophils from subjects with and without periodontal disease and evaluate the effects of periodontal therapy in individuals with similar levels of resolution of inflammation at the end of treatment. Materials and Methods: To compare the phagocytic activity of neutrophils, peripheral blood was collected from 27 control subjects with a healthy periodontium and 28 periodontitis subjects before and after treatment. The phagocytosis of killed Saccharomyces cerevisiae, pre-sensitised or non-sensitised with fresh serum from the donor, was quantified and a phagocytic index was calculated as the mean number of yeast cells phagocytised by the percentage of neutrophils involved in phagocytosis. Results: Prior to periodontal treatment, subjects with periodontitis exhibited significantly lower neutrophil phagocytic activity than control subjects with a healthy periodontium. Periodontal treatment significantly improved in clinical periodontal status and resulted in significantly increased phagocytosis of both pre-sensitised (from 113.0 pre- to 157.0 post-treatment, P = 0.02) and non-sensitised S. cerevisiae (from 1.5 pre- to 3.5 post-treatment, P = 0.001), to levels observed in control subjects. Conclusions: The phagocytic activity of peripheral blood neutrophils from subjects with periodontal disease was lower than that of healthy controls. Subjects who underwent non-surgical periodontal treatment and strict supportive therapy for 6 months showed improved phagocytic activity in peripheral blood neutrophils. The phagocytic index values from subjects with periodontal disease after treatment achieved those found in the control group. Keywords: neutrophils, periodontal therapy, periodontitis, phagocytosis