Oral Health and Preventive Dentistry, 03/2005

This review shows that there is consensus in the literature that (meticulous) tooth brushing once per day is sufficient to maintain oral health and to prevent caries and periodontal diseases. Tooth brushing is also regarded as an important vehicle for application of anti-caries agents, such as fluorides. However, most patients are not able to achieve sufficient plaque removal by performing oral hygiene measures at home. Therefore, tooth brushing twice daily is recommended by most of the dentists in order to improve plaque control. This rule is followed by most of the patients taking care for their oral health and has shown to be effective in maintenance of oral health in numerous studies. Study of the literature gives no clear evidence as to the optimal time-point of tooth brushing (before or after meals). However, in order to eliminate food impaction and to shorten the duration of sucrose impact by tooth cleaning after meals seems to be recommendable. Although - with our current knowledge of potential harm due to brushing of erosively altered and softened tooth surfaces - giving advice on a more individual basis is recommended for patients suffering from erosion. Keywords: Tooth brushing, frequency, time point

Objectives: To evaluate the efficacy of weekly supervised tooth-brushing with a toothpaste and a 1.23% acidulated phosphate fluoride gel (APF) gel on white lesion reversal to treat incipient enamel lesions. Design: A double-blind and randomized controlled trial. Sample and Methods: Three-hundred seven to 12-year-old Brazilian schoolchildren who presented with white spots on the buccal surfaces of permanent upper incisors were randomly allocated to three groups. In group I, children underwent supervised tooth-brushing and APF gel (1.23%) for one minute once a week. In group II, children were subjected to a weekly supervised tooth-brushing and a topical application of placebo, whereas group III (control) received no intervention. An expert dental examiner performed all intra-oral examinations for dental caries (DMF-s and dmf-s) and oral hygiene (Visible Plaque Index, Gingival Blood Index). Results: After three months, 258 children and 460 lesions were analyzed. The results of the clinical evaluation of arrested white spots did not differ significantly (p = 0.95) between the two experimental groups (57.9% in group I and 56.8% in group II) but differed significantly between them and the control group (p = 0.022). Logistic regression analysis identified gingival blood index (OR = 1.70, CI = 1.13 - 2.55), DMF - s2 (OR = 1.61, CI = 1.07 - 2.43) and number of white spot lesions (OR = 1.76, CI = 1.04 to 2.98) as independent 'risk' factors for white spot lesion activities. On the other hand, supervised tooth-brushing with APF (OR = 0.55, CI = 0.34 - 0.91) or without APF (OR = 0.58, CI = 0.35 - 0.94) was a protective factor. Conclusions: These results suggest that the weekly supervised tooth-brushing was able to arrest enamel white spots and that poor oral hygiene increases the probability of keeping white spots active. Keywords: acidulated phosphate fluoride, dental caries, enamel demineralization, randomized controlled trial

Purpose: To identify the primary reasons for tooth extraction in a Brazilian adult population. Materials and Methods: Interviews and oral examinations were conducted with 466 subjects aged from 18-76 years in the city of Maceió, Brazil. Frequency distributions, means and medians were calculated and the chi-square test was used to determine the level of significance. A logistic regression model was used to evaluate the variables associated with reasons for tooth extraction. Results: Of the 466 extractions, 295 (63.3%) were due to dental caries, 61 (13.1%) due to periodontal disease, 56 (12.0%) for orthodontic reasons, 32 (6.9%) at the patient's request, 15 (3.2%) for pre-prosthetic reasons, four (0.9%) due to pericoronitis, two (0.4%) due to trauma and one (0.2%) for other reasons. Tooth extraction due to caries and other causes (excluding periodontal disease) shows a significant association with family income, toothache, type of health centre (public or private), educational level (P < 0.001) and marital status (P = 0.002). The logistic regression model has shown that patients undergoing treatment at a public health centre, those suffering from toothache or with an incomplete secondary education were more likely to lose their teeth due to caries, with educational level as the strongest indicator. For tooth extraction due to periodontal disease and other causes (excluding dental caries) the variables age, family income, type of health centre, tooth types (anterior or posterior), educational level (P < 0.001) and toothache (P = 0.006) were statistically significant, and age was the only associated variable in the logistic regression model. Conclusion: Dental caries was the main cause of tooth extraction in the study group, following tooth extraction due to periodontal disease. Keywords: tooth extraction, adults, dental caries

Purpose: Individuals with cognitive impairments have an increased caries risk. Methods to prevent caries based on home care use of fluorides (F) presuppose a person's ability to cooperate and follow instructions. The aim of the present investigation was therefore to develop and evaluate an F-containing mucosa adhesive paste, which can be applied in home care by nursing staff. Materials and Methods: A cross-over, double-blind study design was used. The F concentrations were studied in whole saliva and interproximal fluid samples after application of a paste with 0.1% F based on the mucosa adhesive Orabase™. A placebo product without F was used as control. In six healthy adults the paste was applied before sleep in the vestibulum in the region of the first molar in each quadrant. The application was repeated during four nights. Results: Six hours after the application of the F paste the F concentrations in the interproximal areas and whole saliva had increased by 12-160 times compared to samples collected before the applications. The lower increase of the interproximal F concentrations was observed in the front region. Conclusions: The results suggest that an F-containing mucosa adhesive paste may be a promising vehicle for caries prevention in subjects unable to follow traditional home care recommendations. Keywords: fluoride, adhesive paste, home care, oral mucosa

Purpose: The purpose of this case-control study was to assess the association between ear infection and dental caries. Materials and Methods: The sample consisted of 126 children (range: two to five years) with no major medical problems or craniofacial anomalies. Ear infection history, demographic, dental, health and diet history of each child was determined using a questionnaire administered to the parent/guardian of the child. Dental charts were used to abstract dmft (decayed, missing and filled teeth) scores for children with dental caries (DC: dmft >= 1) and without caries (NDC: dmft = 0), and oral hygiene index (OHI) scores. Results: Chi-square analysis indicated no differences in ear infection history between the 71 DC and 55 NDC (past year: 35% vs. 40%; lifetime: 30% vs. 31%) children. However, there was a trend (p = 0.07) for the mean number of ear infections to be higher in DC versus the NDC group. Baby bottle use was highest among those who had both ear infection and caries. Multivariate regression model revealed that OHI scores, reason for dental visit, and frequency of visits were the best predictors of dmft scores. Conclusion: An association between dental caries and ear infection was not observed in this sample. Future investigations should explore common risk factors in increasing the risk of both diseases simultaneously. Keywords: dental caries, ear infection, children

Purpose: To investigate the relationship between water pipe and cigarette smoking and the prevalence and severity of vertical periodontal bone defects. Material and Methods: A study sample of 355 individuals in the age range 17 to 60 years was recruited from Jeddah, Saudi Arabia. Full sets of intra-oral radiographs for each individual were assessed with regard to the presence or absence of vertical bone defects. A vertical defect was defined as an angular resorption of the interdental marginal bone of 2 mm or more at either the mesial or distal aspect of the root. Results: The overall prevalence of vertical defects was 39%, with a specific prevalence of 47% in water pipe smokers, 54% in cigarette smokers, and 23% in non-smokers. The prevalence was significantly elevated in both types of smokers compared with non-smokers (p < 0.001). Expressed as the proportion of sites with vertical defects per person, the severity was 2.6% for water pipe smokers, 2.8% for cigarette smokers, and 1.3% for non-smokers. The association between smoking and severity of vertical defects was statistically significant (p < 0.001). The severity of vertical defects was significantly greater in heavy exposure compared to light exposure smokers in water pipe as well as cigarette smokers (p < 0.001). The relative risk associated with water pipe and cigarette smoking was 2.9-fold and 6.6-fold increased, respectively, compared to non-smoking. Conclusion: The present observations suggest that prevalence and severity of vertical periodontal bone defects are increased in tobacco smokers. The association of vertical bone loss with water pipe smoking is comparable to the association with cigarette smoking. Keywords: angular bone loss, cigarette smoking, periodontal disease, Saudi Arabia, tobacco smoking, vertical bone defect, water pipe smoking

Purpose: To study barriers to providing oral health education (OHE) to their patients among Mongolian dentists. Subjects and Methods: A questionnaire survey was carried out in 2000 among practising dentists (n = 250) in the capital city of Mongolia. The response rate was 98%. Barriers to OHE were measured by six statements describing problems that might interfere with dentists' OHE activities and attitudes towards it by a statement about its importance; all answers were rated on a 5-point Likert scale (strongly agree-strongly disagree). Self-perceived competency in providing OHE was measured by means of a 4-point scale of competency (very to not at all competent) and preventive knowledge by 14 statements related to preventive dentistry. Dentists' work-related backgrounds were work experience in years, type of practice (state or private) and field of practice (general practice or speciality field). Statistical evaluation was carried out by chi-square test and logistic regression analysis. Results: Poor appreciation of OHE by patients (85%) followed by insufficient teaching materials (73%) and time constraint due to the huge demand for curative care (59%) were the most commonly agreed-upon barriers. Concerning their attitudes towards and competency in providing OHE, 88% of the dentists agreed that OHE should be statutory, and 85% perceived themselves at least quite competent. Dentists' years of work experience were positively, but preventive knowledge score negatively associated with their agreeing about barriers to OHE activities. Conclusion: Despite appreciation of OHE, Mongolian dentists seem to face practical barriers to providing OHE activities. Keywords: oral health education, health promotion, dentists, Mongolia

This study reviews the peripheral effects of methamphetamine on the salivary acini, the pathogenesis of methamphetamine-induced xerostomia, and its anecdotal relationship to dental caries. Methamphetamine is a sympathomimetic central stimulant which is abused for its euphoric effects. Its pharmacological action is exerted indirectly by sustaining high levels of catecholamines in the synaptic cleft and directly by binding to the postsynaptic adrenergic receptors. Methamphetamine abusers report subjective perception of xerostomia, which cannot be explained by the direct peripheral action of methamphetamine on the secretory acini. The drug may cause a decrease in salivary flow rate by centrally inhibiting salivatory nuclei via stimulation of alpha-2 receptors in the brain. Drug mediated dehydration state may influence the perception of dry mouth in abusers. The decreased salivary flow rate, either due to a central inhibitory action of methamphetamine or generalised dehydration, likely contributes to the increased occurrence of dental caries. Five cases of methamphetamine abuse are presented, three of whom experienced rampant dental caries. A direct association between methamphetamine abuse and the occurrence of rampant caries was not clear. Keywords: methamphetamine, xerostomia, dental caries, sympathetic, meth