Oral Health and Preventive Dentistry, 01/2018

Purpose: Human tooth enamel consists mostly of minerals, primarily hydroxyapatite, Ca10(PO4)6(OH)2, and thus synthetic hydroxyapatite can be used as a biomimetic oral care agent. This review describes the synthesis and characterization of hydroxyapatite from a chemist's perspective and provides an overview of its current use in oral care, with a focus on dentin hypersensitivity, caries, biofilm management, erosion, and enamel lesions. Sources: Reviews and original research papers published in English and German were included. Results: The efficiency of synthetic hydroxyapatite in occluding open dentin tubules, resulting in a protection for sensitive teeth, has been well documented in a number of clinical studies. The first corresponding studies on caries, biofilm management and erosion have provided evidence for a positive effect of hydroxyapatite either as a main or synergistic agent in oral care products. However, more in situ and in vivo studies are needed due to the complexity of the oral milieu and to further clarify existing results. Conclusions: Due to its biocompatibility and similarity to biologically formed hydroxyapatite in natural tooth enamel, synthetic hydroxyapatite is a promising biomimetic oral care ingredient that may extend the scope of preventive dentistry. Keywords: biofilm management, caries, erosion, dentin hypersensitivity, synthetic hydroxyapatite

Purpose: To clinically examine the effect of the type of ight-curing unit on the light intensity output and to assess different operator variables which affect light curing of photo-initiated restorative dental materials, in Damascus, Syria. Materials and Methods: A total of 185 private dental practices in the Damascus area were visited to invite the clinicians to participate in this study. The intensity of 163 light-curing units (LCUs) was assessed by radiometry in a standard protocol. The age of the curing unit, light tip direction, distance from restoration surface, time of exposure and the presence of adherent composite remnants on the tip of the light pipe were assessed. Independent samples t-tests and ANOVA with Bonferroni post-hoc tests were conducted (p = 0.05). Results: The light intensity was affected significantly by the type of the LCU (p < 0.001). The increased age of light-curing units significantly reduced the emitted light intensity in LED and QTH units (p < 0.05). The presence of adherent resin composite remnants on the pipe tip of the curing unit was monitored in 74 cases out of 163 (45%). The disinfection wipe was the most common method used to ensure infection control of the curing units. Conclusion: LED units exhibited a significantly better light intensity output at the tip when compared to the QTH units. It is important for dentists to consider all practical aspects which can influence the efficacy of LCUs in daily practice. Keywords: halogen, LED, light-curing unit, light-emitting diode, light intensity, photocuring

Purpose: To evaluate the efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) in the remineralisation of white-spot lesions in 80 anterior teeth of children aged 5-13 years enrolled in public schools of the city of Botucatu, São Paulo, Brazil. Materials and Methods: The study sample consisted of 36 individuals divided into 4 groups: G1. control (placebo paste); G2. fluoride gel; G3. CPP-ACP; G4: CPP-ACP + fluoride. Each product was applied twice by a calibrated examiner with a week of interval between. Lesions were monitored with a DIAGNOdent Pen before the first application, before the second application, and 1 and 3 months after the first application. To evaluate the lesion intensity, the Friedman test was applied, and to compare experimental groups, the Kruskal-Wallis test was applied. The analyses were complemented with the Dunn test and the level of significance was 5%. Results: At the end of the 90-day trial, the use of CPP-ACP and fluoride showed comparable results in terms of remineralisation. The best white-spot lesion remineralisation was observed when CPP-ACP and fluoride were combined. Conclusion: The use of CPP-ACP is a good alternative for the remineralisation of white-spot lesions. The effect can be improved when this product is applied in combination with fluoride. Keywords: CPP-ACP, dental enamel, fluoride, tooth remineralisation

Purpose: To determine whether self-perceived oral health impact and satisfaction measure oral health in the same way as do clinical indicators in adults and older adults. Materials and Methods: The population consisted of adult patients aged 20 to 59 years receiving care at "Juan Pablo II" Health Care Centre and older adult patients aged 60 or more years from the home for the elderly "Virgen del Amor Hermoso", Lima, Peru. The indices Oral Impacts on Daily Performance (OIDP) and Oral Satisfaction Scale of 0-10 (OSS 0-10) were used to evaluate perceived impact of and satisfaction with oral health. In addition, the following internationally validated criteria established by the World Health Organization (WHO) were used as clinical indicators: Decayed-Missing-Filled Teeth (DMFT) Index, O'Leary's Hygiene Index, Community Periodontal Index, Motivation to Hygiene Index, Denture Situation Index, Need for Denture Index, Denture Hygiene Index and Oral Mucosal Lesion Index. Results: Forty-four adults and 53 older adults participated. OIDP showed that the greatest perceived difficulty in daily performance was "eating and enjoying food" (adults: 77.3% and older adults: 79.2%). The OSS 0-10 showed that among adults, 43.1% were dissatisfied, 20.5% were neutral and 36.4% were satisfied, while among older adults, 45.3% were dissatisfied, 22.6% were neutral and 32.1% were satisfied. A statistically significant association was found between OSS 0-10 and 1. DMFT index in adults; 2. upper denture situation in older adults; and 3. denture hygiene in older adults. A highly significant inverse linear correlation was found between OIDP and OSS 0-10 in adults and older adults. Conclusion: The perceived impact of oral health does not have a demonstrable association with oral health problems when used as an instrument for measuring oral health status, whereas perceived satisfaction with oral health has a better association with the clinical indicators. Keywords: oral health, perception, quality of life

Purpose: To determine and compare oral health status, knowledge and attitude among siblings of mentally disabled with siblings of normal healthy children. Materials and Methods: 240 study subjects consisting of 120 each of siblings of mentally disabled and normal, healthy children (control group) matched for age and gender were selected by convenience sampling. Oral health was assessed using the WHO-1997 proforma. A pretested questionnaire (30 items) was used for oral health knowledge and attitude assessment. Statistical analysis was performed using the chi-squared and Mann-Whitney tests. Results: Caries prevalence among the siblings of mentally disabled and control group was 82% (mean DMFT 1.68 ± 1.18) and 45% (mean DMFT 0.58 ± 0.72), respectively (p < 0.05). The siblings of mentally disabled children also showed good oral health knowledge (mean 7.1 ± 1.4) and a positive attitude (p < 0.05). Conclusion: Siblings of mentally disabled children showed higher caries experience. Knowledge and attitude towards oral health was comparatively good among siblings of mentally disabled children. They exhibited favourable attitudes and involvement in helping their sibling to maintain oral health. Keywords: disabled, oral health, siblings

Purpose: To evaluate the perception of treatment needs and the use of dental services for children/adolescents with sickle cell disease. Materials and Methods: A cross-sectional study was conducted with 250 children/adolescents with sickle cell disease at a reference center in the city of Recife, Brazil. Data on the use of dental services were collected using a 13-item questionnaire administered to parents/guardians. The examiner in charge of determining l caries and periodontal status had previously undergone a training and calibration exercise. Descriptive statistics and Poisson regression analysis were also performed (α = 5%). Results: A total of 47.2% of the children/adolescents with sickle cell disease were diagnosed with caries and 14.0% were diagnosed with some periodontal problems. The following variables were statistically significantly associated with the perceptions of parents/guardians regarding the treatment needs of their children: caries (PR = 1.24; 95%CI: 1.09-1.42), periodontal problems (PR = 1.10; 95%CI 1.01-1.20) and history of toothache in the previous six months (PR = 1.17; 95%CI 1.06-1.29). Only a lower level of mothers' schooling (PR = 1.64; 95%CI 1.06-2.53) was statistically significantly associated with the mean number of caries among the children/adolescents with sickle cell disease. Mean dmft/DMFT indices were higher among children/adolescents who sought dental care. Conclusion: Based on our results, a predomination of curative treatment was found, as seeking out dental treatment was more frequent among children/adolescents with a greater number of caries. Keywords: dental caries, dental health services, disease, oral health, sickle cell

Purpose: To assess the oral health related quality of life (OHRQoL) among older people residing in old-age homes in Delhi, India. Materials and Methods: Oral health related quality of life was measured by using the Hindi version of Geriatric Oral Health Assessment Index (GOHAI) which was tested for its reliability and validity. Sociodemographic data were collected and questions regarding the self-perception of general health, oral health and perceived need for dental treatment were put forward. Clinical assessment was also performed. Results: The mean additive-GOHAI score of the study population was found to be 41.57 ± 6.07. Statistically significant associations were found between GOHAI and perceived measures. GOHAI scores decreased with a decrease in the number of teeth present and a decrease in the number of teeth having coronal and root caries. Those subjects who were in need of multi-unit prostheses or full prostheses had significantly poorer OHRQoL compared to those without any prosthetic need or need of single-unit prostheses. Conclusion: This study revealed the extent of dental problems in old-age home residents and may help to plan appropriate preventive measures. Keywords: elderly, gerodontology, GOHAI, oral health, quality of life

Purpose: This study evaluated the colour changes of demineralized enamel after treatment with coloured fluoride gel. Materials and Methods: Enamel blocks obtained from bovine incisors were submitted to artificial caries induction by pH cycling followed by fluoride gel applications (2% sodium fluoride, pH 6.8) using a colourless gel (control group), pink or blue gels. The enamel optical properties were evaluated by spectrophotometry, using the CIE L*a*b* system at baseline (sound enamel), after artificial caries induction (demineralised enamel) and after each of the five fluoride gel applications (weekly intervals). Changes in enamel optical properties (ΔE) were analysed by two-way ANOVA and Tukey's test (α = 0.05). Results: No significant differences were found among fluoride gels (p = 0.476) regardless of the presence of pigments in the gel. ΔE values were significantly different (p < 0.001) between baseline evaluation and treated enamel (after fluoride gel application). Conclusion: This in vitro study demonstrated that colour changes in enamel do not occur during fluoride gel treatment, regardless of the presence or absence of coloured pigments in the gel. Keywords: bovine teeth, demineralization, dental enamel, fluoride, spectrophotometry

Purpose: To investigate salivary parameters of caries susceptibility in men and women in order to identify potential variations due to sexual dimorphism. Materials and Methods: A total of 46 female and 24 male patients, aged 18-40 years, participated in this study. Unstimulated saliva was collected for the evaluation of flow rate, pH, secretory IgA, Snyder test scores, and Streptococcus mutans counts (confirmed by PCR assay). Statistical analysis included the Mann-Whitney, Kruskal-Wallis and Bonferroni tests, one-way ANOVA, and the Spearman correlation at a 5% significance level, followed by a general linear model and multiple linear regressions. Results: Female participants presented lower salivary pH values compared to males (p < 0.05), and different patterns of correlation among salivary parameters were found in men (p < 0.05) and women (p < 0.001). When comparing the variables according to Snyder test scores in men and women, there was a significant difference for S. mutans levels in the male group, and for pH and IgA in the female group (p < 0.05). Gender was found to be a predictor of salivary flow (R2 = 0.05; p < 0.05) and pH (R2 = 0.16; p < 0.001). In the female group, multiple regression showed several predictors for salivary flow rate, pH, IgA and Snyder test scores (p < 0.05), whereas no predictor was found in the male group (p > 0.05). Conclusion: Different salivary patterns were observed in men and women, thus the implications of such findings for caries susceptibility require further investigation. Keywords: dental caries, gender, saliva

Chronic kidney disease (CKD) has become a worldwide public health problem. It is estimated that nearly 90% of patients with chronic renal failure manifest some symptoms of oral disease. With advances in medical treatment, CKD patients are living longer and require oral care. Chronic kidney disease is often accompanied by disturbances in mineral metabolism which are classified as their own clinical entity known as CKD-mineral and bone disorder (CKD-MBD). CKD-MBD affects all aspects of bone physiology: bone volume, bone turnover and bone mineralization. Jaw bones affected with CKD-MBD can have important clinical implications for the survival and osseointegration of dental implants, success of bone regeneration therapy, and increased risk of bone loss in patients with periodontitis or risk of bone fracture. Assessment of bone turnover is the most important diagnostic tool to monitor progression of CKD-MBD. Bone biomarkers and radiographical examination of bone density may be particularly useful to both, diagnosis and monitoring of bone turnover. Cone beam computed tomography (CBCT) as a reliable method with many advantages over other radiographic methods can be used for analysis of jaw bone micro-architectural changes and may be of a great help in bone quality determination in CKD-MBD. Keywords: biomarkers, bone turnover, chronic kidney disease, jaw bone metabolism

Purpose: To evaluate the prevalence of early childhood caries (ECC) and severe ECC (S-ECC) among Italian preschool children and its predictors regarding children's lifestyle. Materials and Methods: A cross-sectional study was carried out involving 563 preschool children. A questionnaire for children's parents and clinical examinations were conducted by calibrated, blinded examiners. The odds ratios (OR) for ECC or S-ECC and co-presence of risk factors were calculated using univariate and multivariate models. Statistical significance was set at p < 0.05 in all analyses. Results: The prevalence of ECC and S-ECC was 14.4% and 5.9%, respectively. According to the multivariate analysis, the predictors for caries were (p < 0.05): age (OR = 2.5; 95% CI = 1.36 - 4.52), non-Italian ethnic origin (OR = 4.3; 95% CI = 2.83 - 7.37), consumption of sugary beverages more than once per day (OR = 2.1; 95% CI = 1.21 - 5.26) and having inadequate oral hygiene status (OR = 3.6; 95% CI = 2.01 - 5.83). Conclusions: Dietary habits and dental care are important environmental contributing factors in the development of caries in preschool children. Oral health promotion should include an oral hygiene instruction programme and dietary guidelines focused on daily sugar intake for the preschool children themselves as well as for their parents. Keywords: children, early childhood caries, feeding habits, prevention, public health

Purpose: Dental caries is the primary pathological cause of early tooth loss in children, which may lead to malnutrition and other health problems. Identification of patients with active carious lesions and at high risk for caries can help to dramatically decrease the disease prevalence. Thus, recognising the importance of early diagnosis of caries, the present study was carried out to correlate caries with oral microflora using Oratest among 12- to 15-year-old schoolchildren. Materials and Methods: A total of 100 children were divided into control and test groups (n = 50) according to their DMFT scores. The test group was further divided into subgroup 1 (DMFT = 1-3) and subgroup 2 (DMFT > 3). Oratest, a caries activity test, was performed on all the children. Comparison among the variables was done using ANOVA and the independent sample t-test. Results: Boys had lower DMFT values (1.35 ± 0.2) than did girls (1.67 ± 0.2) (p = 0.38), and the Oratest time was higher among boys (132.8 ± 0.5 min) than girls (126.4 ± 0.5 min) (p = 0.53). The control group had the highest mean Oratest time (172.7 ± 0.3 min), followed by subgroup 1 (97.8 ± 0.2 min), and subgroup 2 had the lowest Oratest time (68.5 ± 14.8 min). A statistically significant negative correlation (r = -0.893) was found between the mean DMFT and the Oratest time (p < 0.001), ie, they were inversely related to each other. Conclusion: An inverse relationship exists between Oratest and DMFT score. Keywords: caries activity test, children, dental caries, Oratest