Oral Health and Preventive Dentistry, 06/2017

Purpose: To investigate the impact of untreated malocclusion on different aspects of oral health-related quality of life (OHRQoL). Materials and Methods: All relevant literature published up to February 18, 2016 was collected from nine electronic databases. To make studies comparable, studies that used the dental aesthetic index (DAI), index of orthodontic treatment need (IOTN), or index of complexity, outcome and need (ICON) to measure malocclusion and oral health impact profile (OHIP) to measure OHRQoL were selected for systematic review. Meta-analysis, two independent-samples t-test and binary logistic regression were used to test whether different malocclusion severity groups had different OHIP scores. Results: A total of 564 non-duplicate publications were identified first. Of these, 13 studies were included in this review. All studies had a cross-sectional design and most of them used convenience samples. Eleven studies presented a significant result about the association of malocclusion and OHIP scores. Statistical analyses showed that malocclusion had an impact on all subscales scores, and more severe malocclusion indicated higher OHIP scores on the subscales of physical disability, physical pain, psychological discomfort, psychological disability, and social disability. Conclusion: Untreated malocclusion was significantly associated with OHRQoL. The more severe the malocclusion, the worse was the impact on some physical domains and all psychosocial domains of OHRQoL. There was a lack of longitudinal population-based studies to confirm this result. Keywords: oral health impact profile, oral health-related quality of life, systematic review, untreated malocclusion

Purpose: This cluster randomised controlled trial evaluated the effectiveness of a school-based xylitol chewing-gum programme on caries prevention among students with visual or hearing impairment. Materials and Methods: The study compared xylitol gum plus oral health education (intervention group, n = 93) with oral health education alone (control group, n = 81) among students aged 7-18 years in special needs schools in Khon Kaen, Thailand. The primary outcome was caries onset rate measured as the change in caries onset on tooth surfaces. The secondary outcome was plaque index. Between-group differences were determined using generalised estimated equations and a general linear model under the intention-to-treat approach. Results: After 1 year, there was a significantly lower caries rate in the primary dentition among the intervention group compared to the control group (0.08 vs 0.12 surfaces per surface-year, respectively; adjusted relative risk = 0.64, 95% confidence interval 0.44-0.96; p = 0.03), but there was no significant difference in the caries rates for the permanent dentition. Remineralisation also occurred more in the intervention vs the control group in the primary dentition only. Oral hygiene was significantly improved in the intervention but not in the control group (p = 0.001). Conclusion: This programme reduced the caries rate and enhanced remineralisation in primary dentition, and improved oral hygiene in students with disabilities. Keywords: chewing gum, dental caries, disabilities, randomised controlled trial, xylitol

Purpose: To compare the antiplaque, antigingivitis and antibacterial efficacy of chlorhexidine (CHX), XYL and a mouthwash combining CHX and XYL against Streptococcus mutans (S. mutans). Materials and Methods: A parallel design, randomised controlled trial was conducted among 75 dental students. Participants were randomised into CHX, CHX+XYL and XYL-only groups using the lottery method. Subjects were instructed to use 10 ml of the provided mouthwash for 15 s twice daily for 3 weeks. All the outcome measures, gingival index (GI), plaque index (PI) and number of salivary S. mutans CFU were recorded at baseline and 3 weeks post intervention. Nonparametric tests were used for inferential statistics. Results: All outcome variables (GI, PI scores and log10 salivary S. mutans counts) decreased significantly from baseline compared to post intervention among all three groups. Intergroup comparison demonstrated that reduction in GI was not significantly different among the three groups. The decrease in PI scores was found to be significantly higher in the XYL group, while the decrease in the log10 salivary S. mutans count was significantly higher in the CHX+XYL group. Conclusion: The present study provided sufficient data to suggest that all the three mouthwashes are effective against plaque, gingivitis and S. mutans load in saliva. Further investigations should be carried out to confirm the results and develop strategies for using such products to prevent tooth decay. Keywords: chlorhexidine, gingival index, plaque index, salivary S. mutans colony, xylitol

Purpose: To test the hypothesis that, in high caries-risk children, supervised toothbrushing (STB) reduces visible plaque levels and gingival bleeding to a greater extent than does unsupervised toothbrushing (USTB) in comparable children and in low caries-risk USTB children over 4 years. Materials and Methods: High caries-risk schoolchildren, ages 6 to 7, were allocated to three oral healthcare protocols using a cluster-randomised design: 1. Ultra-Conservative Treatment (UCT): small cavities in primary molars were restored using ART, while medium and large cavities were left open and cleaned under daily supervised toothbrushing together with the remaining dentition (UCT/STB); 2. Conventional Restorative Treatment (CRT): primary molars were restored with amalgam, while high caries-risk first permanent molars received resin sealants (CRT/USTB); 3. Atraumatic Restorative Treatment (ART): primary molars were restored using ART, while high caries-risk first permanent molars received ART sealants (ART/USTB). Low caries-risk children (dmft ≤ 1) formed the no-treatment/USTB group. 273 children were examined at baseline (T0) and after 4 years (T1) according to the VPI and GBI indices. Data were analysed using linear and logistic regression. Results: Mean VPI and mean GBI scores were statistically significantly lower at T1 than at T0. Reduction in mean VPI scores in UCT/STB children was statistically significantly higher than for CRT+ART/USTB children over 4 years (p = 0.03), but no difference was observed between UCT/STB and no-treatment/USTB children (p = 0.361). No statistically significant difference in the reduction of mean GBI scores was observed between UCT/STB and CRT+ART/USTB (p = 0.62) and no-treatment/USTB children (p = 0.74). Conclusion: In high caries-risk children, the protocol based on supervised toothbrushing presented greater reduction in visible plaque levels than did protocols based on restorations and sealants over 4 years. Keywords: caries prevention, dental caries, oral hygiene, toothbrushing

Purpose: To assess the role of sociodemographic, dietary, and clinical factors in early mutans streptococci (MS) colonization in children aged 6 to 24 months who were followed for 18 months. Materials and Methods: Ninety-four children (mean age: 11.5 ± 4.99 months at baseline) were enrolled in the study from the Women, Infants and Children Supplemental Nutrition Program during 2003-2004. Salivary MS levels of the children were determined at baseline and at 18 months using a semi-quantitative method. Detailed information about the children's beverage consumption pattern, dietary behavior, and clinical information about oral health status was collected at baseline, 9 months, and 18 months. None of the children included in this study had detectable levels of MS at baseline. Results: Of the 94 children at baseline, 36 (38%) had acquired MS by the 18-month follow-up. The presence of >5 teeth [OR = 3.55 (1.46-9.04); p = 0.0062] was a significant risk factor for MS acquisition among the baseline variables. At 9 months, sports drinks consumption [OR = 5.56 (1.39-26.26); p = 0.0143] and presence of caries [OR = 9.36 (2.55-40.90); p < 0.0001] were significantly associated with MS colonization at 18 months. Higher maternal education [OR = 0.3 (0.07-1.36); p = 0.0351] was a protective factor at all the time points. Conclusion: Sugared beverage consumption, tooth-related factors, and lower maternal education can predict MS acquisition in young children. Keywords: behavior, children, diet, factors, mutans streptococci, WIC

Purpose: To evaluate the in vitro effect of different application frequencies of dentifrices containing CPP-ACP and fluoride on enamel demineralisation inhibition using a pH cycling model. Materials and Methods: One hundred twenty blocks of human enamel were divided into 8 groups according to the treatment and number of times that the dentifrice slurry was applied (3 or 5 times). Control: dentifrice without fluoride (CO3 and CO5); fluoride dentifrice (FD3 and FD5, commercial dentifrice 1100 ppm as NaF); MI Paste (MP3 and MP5, Recaldent) and MI Paste Plus (MPP3 and MPP5, Recaldent 900 ppm as NaF). After pH cycling, cross-sectional microhardness (CSH) measurements were taken. The demineralised enamel changes were analyzed on three blocks per group by MicroCT. Data were analyzed by ANOVA and Tukey's HSD post-hoc test (p = 0.05). Results: Statistically significantly higher CSH values (p < 0.05) were obtained for the surface layers (25 and 50 µm) for FD3, FD5, MP3 and MP5. The MP and FD groups showed similar results and had the least mineral loss. The MP increased the mineral density in enamel and decreased the depth of the lesion. Conclusion: Inhibition of subsurface enamel demineralisation is possible with MP and FD, independent of the application frequencies. However, the MP and MPP groups had higher mineral density when five applications were performed. Keywords: casein, dentifrice, fluoride, prevention

Purpose: To assess the presence of HNP1-3 in the gingival crevicular fluid (GCF) of patients suffering from aggressive periodontitis before and after nonsurgical periodontal therapy. Materials and Methods: Twenty patients, each with generalised aggressive periodontitis (GAP) were included in the study. After periodontal examination, one site with a probing depth (PD) ≥ 4 mm was selected. Patients received nonsurgical treatment (scaling and root planing [SRP]) with additional administration of systemic antibiotic therapy (amoxicillin 375 mg three times daily + metronidazole 250 mg three times daily for 7 days). Prior to therapy and 3 and 6 months after, the following parameters were evaluated from the same site: PD, gingival recession (GR), clinical attachment level (CAL), plaque index (PI), bleeding on probing (BOP), sulcus fluid flow rate (SFFR). The level of HNP1-3 in GCF was determined by means of a commercially available ELISA kit. Results: Compared to baseline, the level of HNP 1-3 did not show statistically significant differences at 3 and 6 months. The evaluated clinical parameters and SFFR showed statistically significant decreases compared to baseline. At 6 months, PD (median) decreased from 7 to 3.5 and CAL (median) decreased from 7 to 4. Conclusion: In patients with GAP, nonsurgical periodontal therapy in conjunction with systemic administration of amoxicillin and metronidazole had no effect on the level of HNP1-3 in GCF. Keywords: aggressive periodontitis, α-defensins, gingival crevicular fluid, HNP1-3

Purpose: To assess the responsiveness of the Family Impact Scale (FIS) to describe changes in quality of life (QoL) after traumatic dental injury (TDI), and compare the efficacy of subscales. Materials and Methods: Parents of 110 children aged 7-15 admitted to the Gazi University Faculty of Dentistry Department of Paediatric Dentistry for dental trauma were included in this study. A three-part questionnaire was distributed to the participants: questions regarding personal information, TDI and QoL. The types of TDI were classified according to Andreasen et al.3 Quality of life was measured using the FIS. The questionnaires were translation into Turkish, and QoL was measured using the Turkish Family Impact Scale (T-FIS) total score and scores for subscales. The Kolmogorov-Smirnov test was used to assess normal distribution of the data. After this procedure, the nonparametric Kruskal-Wallis test was used. Results: Traumatic dental injuries exhibited a negative impact on parents' QoL, as shown by the total T-FIS score and subscales (p < 0.001). In this study, the determined values for parental emotions > parental/family activity > financial burden > family conflict had a negative impact on the parents' QoL. Parental emotional values were statistically different from those of parental/family activity, financial burden and family conflict values (p < 0.001). Conclusion: Traumatic dental injuries in children present a negative impact on Turkish parents' QoL. Parental emotions were the most affected subscale. Keywords: family impact scale, quality of life of family, traumatic dental injuries

Purpose: Widely used in caries prevention, fluoridated varnish (FV) is also capable of remineralising carious lesions. However, the retention time of FV needed on enamel to ensure the maximum benefit is unclear. This study aimed to determine whether an increase in the retention time of 5% sodium fluoride (NaF) varnishes on enamel carious lesions enhances remineralisation. Materials and Methods: Carious lesions were generated on bovine enamel slabs and treated with one of three 5% NaF commercial varnishes: Duraphat, Durashield or FlorOpal. After application, the varnishes were maintained on the slabs for 8, 12, 18, 24, 36 or 48 h while immersed in artificial saliva. Remineralisation efficacy was calculated and expressed as the percentage of surface microhardness recovery (%SHR). Untreated carious lesions served as negative controls. Data from each timepoint for each product were compared by ANOVA, followed by a post-hoc test (p < 0.05). Results: There was a trend for increased remineralisation over time, reaching maximum %SHR values of about 30% after 18 to 24 h. No significant differences were detected after 18 h (p > 0.05). This remineralisation dynamic was similar among the three tested products. Conclusion: Remineralisation of enamel lesions using 5% NaF varnish appears to be initially dependent on the retention time of the product. Higher remineralisation was observed upon 18 h of varnish retention on the lesions. Keywords: enamel, fluoridated varnish, fluoride, remineralisation, time

Purpose: To assess the one-year outcome of glass-ionomer cement (GIC) restorations with partial carious dentin removal in primary molars using digital subtraction radiographs. Materials and Methods: Children ages 6-8 years were recruited. Forty-nine primary molars with deep carious lesions were studied. The carious dentin was removed at the dentoenamel junction (DEJ) and restored with GIC. Digital radiographs were taken immediately after restoration, and at 6 and 12 months after restoration. The sets of digital radiographs were subtracted and analysed using Image-Pro Plus software. Results: At the 12-month follow-up, 38 of the original 49 primary molars were analysed. No postoperative pain or signs of pulp pathology were reported. 76% and 87% of molars showed an increase in density of the studied areas compared to control areas at 6- and 12- month follow-ups, respectively. The density of digital subtraction radiographs increased to 5.3 and 8.2 at 6 and 12 months from baseline, respectively. The mean density of the areas under restoration at 6 months and 12 months was statistically significantly higher than at baseline (paired t-test; p < 0.05). Conclusion: Using digital subtraction radiographs, GIC restorations with partial carious dentin removal in primary molars showed a high potential for dentin remineralisation after 1 year. Keywords: digital subtraction radiography, partial removal of carious dentin, primary teeth

Purpose: To compare 2-year cumulative survival rates in first permanent molars (FPM) with and without MIH and to investigate risk factors associated with caries incidence. Materials and Methods: A total of 142 children aged 5 to 6 years were recruited from all public schools in Botelhos, Minas Gerais, Brazil and 536 FPM were examined. A questionnaire was designed to collect sociodemographic background and behavioural information about children and their parents. Caries in FPM was recorded per surface in accordance with WHO methodology at baseline and once every 6 months over a period of two years. The survival analysis was conducted using the Weibull regression model with cure fraction. Results: MIH was present in 16.19% of children. The 2-year cumulative survival rates for FPM with and without MIH showed statistically significant differences, and visible plaque on anterior teeth had an effect on the survival rates. Conclusion: Children with MIH and visible plaque on anterior teeth at baseline had a high risk for developing new caries lesions in their FPM over the course of two years. These variables should be considered in caries risk assessment in paediatric dental care. Keywords: dental caries, tooth abnormalities, tooth hypomineralisation