Oral Health and Preventive Dentistry, 04/2003

This review describes various forms of fluoride applications for reducing dental erosive lesions induced by acidic substances. Fluoride admixtures to acidic solutions in a concentration excluding toxicologically side-effects seem unable to arrest erosive lesions. By contrast, topical fluoride applications of toothpastes, oral rinses, gels or varnishes appear to be an effective agent for reducing demineralization by erosion. In particular, high-concentrated fluoride applications are able to increase abrasion resistance and decrease the development of erosions in enamel and dentin. Keywords: fluoride, erosion, abrasion

To assess the associations between social and physical school environments and the prevalence of traumatic dental injuries (TDI) in 12-year-old children in Thailand. A cross-sectional study in 52 urban schools in Thailand was carried out from a sample of 2,725 12-year-old children that were clinically examined for TDI and interviewed. Cluster analyses were performed to classify the schools into supportive and non-supportive schools by social and physical environmental characteristics. Analyses of the associations were performed using multilevel analyses, accounting for school variations and controlling for confounding factors at the child level. 35.0% of children had TDI. Prevalence was twice as high amongst boys than girls. The prevalence of TDI was significantly lower in the schools with a supportive social environment (Crude OR = 0.6 (95% CI = 0.4 to 0.8, p = 0.004)). The adjusted OR was 0.7 (95% CI = 0.5 to 0.9, p = 0.02). This statistically significant association existed in boys but there was only an insignificant tendency of association in girls. There was no statistically significant association between TDI and the physical environment of the schools. But there was an insignificant tendency of association with the physical environment in girls. TDI were much more common in boys than girls. TDI were significantly less prevalent in male children in schools with supportive, compared to less supportive social environments. In boys, there was a tendency for the more socially supportive environment to be more protective rather than the effect of any type of physical environment. In girls, this protective tendency was only apparent when school environments were both more socially supportive, and physically favourable. Keywords: dental, injuries, determinants, schools, sex

This investigation aimed at determining whether a collagenolytic matrix metalloproteinase (MMP-8) present in the oral fluids might attack demineralized dentin and thereby affect the potential for remineralization. Dentin specimens from freshly extracted third molars were demineralized for 14 days in vitro and then remineralized for 7 days in the presence or absence of activated MMP-8. Following treatment the mineral level of the specimens was assessed from the outer dentinal surface using Electron Probe Micro Analysis (EPMA). The findings suggested that the addition of activated MMP-8 to the remineralizing solution led to reduced remineralization in the surface of the dentin. There appeared to be no effect on the remineralization from any dentin bound MMP activity. It appears that MMP-8 may negatively influence the remineralization of demineralized dentin. Keywords: dentin, matrix metalloproteinase, remineralization

In Anguilla, dental nurses are responsible for providing oral healthcare for children until they reach 18 years of age. This study determined the diagnostic conformity and consistency in caries assessment among dental nurses trained to carry out an oral health survey of 6, 12 and 15-year-old schoolchildren. Following training in caries diagnosis using slides, extracted teeth and visual-tactile examination, three dental nurses were calibrated by a benchmark examiner (BE) using modified WHO criteria. Conformity and consistency were assessed on four different occasions - on extracted teeth (T0) and in three different groups of children (at C0, D1 and D2) for subject (SB), tooth (TH) and surface (SF) using Kappa statistics. Perfect agreement (kappa score of 1.0) was attained for all sound, decayed and filled lingual and buccal surfaces at D1 and D2 respectively. Levels of conformity (with and without BE) and consistency increased as the survey progressed. Accuracy level ranges for SB, TH and SF were .770-.935(T0), .895-.951(C0), .947-.989(D1) and .985-.993(D2) respectively. Kappa score of 1.0 was obtained by all three examiners for SB, TH and SF at D2. Identical accuracy levels were attained by all examiners for TH (.985) and SF (.993) at D2. Reliability levels for SB, TH and SF ranged from .972-.999(C0), .977-.996(D1) and was 1.0 at D2. Substantial and almost perfect inter and intraexaminer agreements were attained at calibration, and maintained throughout the survey. Dental nurses in Anguilla can conduct valid and reliable child oral health surveys when adequate and appropriate training is provided. Keywords: caries assessment, caries diagnosis, conformity, consistency, reliability

To verify the total (TF), soluble (SF) and ionic (IF) fluoride concentrations in the main Brazilian dentifrices for comparison and quality control according to the current Brazilian Ministry of Health Regulations, 2000. Nineteen brands, from 2 batches, fresh or aged at 45°C/48 h, had their F concentrations and pH analyzed with a specific electrode and pHmeter. To analyze the TF, 0.25 ml of 2M HCL was added to 0.25 ml of the suspension of each dentifrice. This was kept at 45°C/1 h and 0.50 ml of M NaOH and 1.0 ml of TISAB II was added. To assay SF and IF, after centrifugation, the supernatant was used and the same steps described above were followed for SF. The analysis of IF was made by adding 0.25 ml of the supernatant to 1.0 ml of TISAB II, 0.5 ml of M NaOH and 0.25 ml of 2M HCL. Paired t tests were used for statistical analysis. The concentration of TF, SF and IF ranged from 555.7 - 1835.1; 449.3 - 1619.3 and 96.9 - 1534.6 ppm respectively. After aging, a significant reduction in the SF concentration (p = 0.00002) was observed, which did not occur for TF and IF (p > 0.05). Only the brand Colgate Baby' presented pH 6.8. The other dentifrices had an alkaline pH, ranging from 7.1 - 9.9. Although the term 'soluble' was suppressed by the new regulation, the dentifrices analyzed were in accordance to the Brazilian Ministry of Health Regulations, 1989. Keywords: dentifrices, fluoride, pH, quality control, stability

The primary aim was to investigate the oral health; oral care habits and the ability of the participants to afford dental care in an adult Swedish population. A secondary aim was to study whether there is a relationship between dental care habits, self-reported oral health status and cardiovascular disease (CVD). The participants answered a questionnaire about the frequencies of diseases, the need for treatment and the effects of socio-economic factors on oral care habits. A questionnaire was mailed to 893 persons in 3 age groups (20-29, 50-59, and 75-84 years of age) of whom 723 replied (81.0%). The answers indicated that 16% had experienced dental problems without seeking help and more then 10% reported problems with chewing. In the group as a whole, 31.5% had sought no dental treatment, partly for financial reasons. When using a logistic regression model, as regards bleeding gums as a risk indicator of CVD, correcting for diabetes, education, gender, age and tobacco use, the estimated odds ratio (OR) was 1.70 (p = 0.05). The OR for those 50 years old or more was 1.79 (p = 0.05). For the oldest group alone, the OR was 2.69 (p = 0.05). The model showed an increased risk of CVD among those who had problems with their teeth without seeking help, OR 2.45 (p = 0.05). The study indicates that a large proportion of those answering the questionnaire had experienced dental problems without seeking help, partly for financial reasons. This group is more likely to have CVD and bleeding gums. It shows a relationship between the presence of bleeding gums and CVD, especially amongst the oldest participants. Keywords: cardiovascular disease, epidemiology, oral health, periodontitis, questionnaire

The aim of the study was to compare the effect of the chewing stick (miswak), and toothbrushing on plaque removal and gingival health. The participants comprised 15 healthy Saudi Arabian male volunteers aged 21 to 36 years, attending the Dental Center at Al-Noor Specialist Hospital in Makkah City in Saudi Arabia. The study was designed as a single, blind, randomized crossover study. The Turesky modified Quigley-Hein plaque and Löe-Silness gingival indices and digital photographs of plaque distribution were recorded at baseline, one week after professional tooth cleaning, and again following three weeks use of either the miswak or toothbrush. Professional tooth cleaning was repeated, and after a further three weeks use of either the miswak or toothbrush (using the alternative method to that used in the first experimental period), plaque and gingival indices, and digital photographs of plaque distribution were recorded anew. Compared to toothbrushing, the use of the miswak resulted in significant reductions in plaque (p 0.001) and gingival (p 0.01) indices. Image analysis of the plaque distribution showed a significant difference in reduction of plaque between the miswak and toothbrush periods (p 0.05). It is concluded that the miswak is more effective than toothbrushing for reducing plaque and gingivitis, when preceded by professional instruction in its correct application. The miswak appeared to be more effective than toothbrushing for removing plaque from the embrasures, thus enhancing interproximal health. Keywords: chewing stick, miswak, oral hygiene, plaque, salvadora persica

In addition to several other chronic diseases, tobacco use is a primary cause of many oral diseases and adverse oral conditions. For example, tobacco is a risk factor for oral cancer, periodontal disease, and congenital defects in children whose mothers smoke during pregnancy. The epidemic of tobacco use is one of the greatest threats to global health; sadly the future appears worse because of the globalization of marketing. The World Health Organization (WHO) has strengthened the work for effective control of tobacco use. At the World Health Assembly in May 2003 the Member States agreed on a groundbreaking public health treaty to control tobacco supply and consumption. The treaty covers tobacco taxation, smoking prevention and treatment, illicit trade, advertising, sponsorship and promotion, and product regulation. Oral health professionals and dental associations worldwide should consider this platform for their future work for tobacco prevention since in several countries they play an important role in communication with patients and communities. The WHO Oral Health Programme gives priority to tobacco control in many ways through the development of national and community programmes which incorporates oral health and tobacco issues, tobacco prevention through schools, tobacco risk assessment in countries, and design of modern surveillance systems on risk factors and oral health. Systematic evaluation of coordinated efforts should be carried out at country and inter-country levels.

To assess place, activities and human intention related to Traumatic Dental Injuries (TDI) events in 11 to 13-year-old schoolchildren in Biguaçu, Brazil. Also, to test the association between socio-economic status and TDI. A cross-sectional survey (n = 2,260) was carried out. A trained and calibrated dentist collected the data through clinical examinations and interviews. Clinical examination included the type of TDI, the treatment required and provided, the size of incisal overjet and the type of lip coverage. The response rate was 90.6%. The prevalence of TDI was 10.7%. Boys experienced more TDI than girls, 13.6% and 7.6% respectively (P 0.001). Fathers' and mothers' levels of education were not statistically associated with TDI (P > 0.05). Children who had an incisal overjet greater than 5 mm had more dental injuries than those whose incisal overjet was less than 5 mm (P = 0.003). There was no association between inadequate lip coverage and TDI (P > 0.05). Multiple logistic regression analysis showed that maleness and incisal overjet remained statistically associated with dental injuries, after adjusting for other risk factors. The main activities associated with TDI were physical leisure activities (28.9%), playing with other people (18.2%), collisions (9.1%), and falls (8.3%). Common places where the TDI event occurred were at home (42.6%), in the street (21.5%) and at school (9.5%). 29.2% of TDI were the result of the actions of another person. The most common TDI events were physical leisure activities, most TDI occurred at home, and the actions of another person were an important factor in relation to the occurrence of TDI. Keywords: causes, child abuse, dental injury, etiology, gender, sex, trauma