Oral Health and Preventive Dentistry, 03/2016

Purpose: To evaluate the efficacy of minimally invasive methods for the treatment of white-spot lesions involving fluorides, CPP-ACP (casein phosphopeptide-stabilised amorphous calcium phosphate) and resin infiltration vs a placebo or control. Materials and Methods: According to predetermined criteria, four databases were searched for eligible studies. References of the selected articles and relevant reviews were searched for any missed publications. Results: Eight randomised controlled trials were selected as eligible studies, and only qualitative analyses were performed because of the diversity of the interventions and outcome measures. Three studies showed significant effects of three different fluoride preparations and used DIAGNOdent and ICDAS to assess the white spot lesions. Both studies comparing resin infiltration to a placebo showed significant effects in treating white spot lesions. One study using CPP-ACP showed a significant improvement in the lesions post treatment. Conclusion: Evidence suggests minimally invasive treatment modalities of white spot lesions produced significant improvement in the appearance and regression of white spot lesions following treatment when compared to a control or placebo. Keywords: CPP-ACP, dental caries, fluorides, resin infiltration, white spot lesions

Purpose: Heat-killed Lactobacillus plantarum L-137 (HK L-137) has been shown to activate innate and acquired immunity in humans. The aim of this randomised, double-blind, placebo-controlled clinical trial was to examine the effects of the oral administration of HK L-137 on the outcome of periodontal therapy. Materials and Methods: Thirty-nine patients undergoing supportive periodontal therapy (SPT) were randomly assigned to receive a capsule containing 10 mg of HK L-137 or a placebo capsule daily for 12 weeks. Nineteen patients in the experimental group and 17 patients in the control group were followed-up. Clinical parameters, including plaque index (PI), gingival index (GI), bleeding on probing (BOP), and probing depth (PD) were scored at baseline and weeks 4, 8 and 12 prior to prophylaxis in conjunction with regular SPT visits. Results: BOP and the number of teeth or sites with PD ≥ 4 mm were significantly reduced in both groups by a successive SPT programme, while there was significantly greater PD reduction (p 0.05) at teeth with site(s) with PD ≥ 4 mm at baseline in the experimental group than in the control group at week 12. Conclusion: These clinical findings suggest that daily HK L-137 intake can decrease the depth of periodontal pockets in patients undergoing supportive periodontal therapy. Keywords: dental plaque, gingivitis, Lactobacillus plantarum, probing depth, randomised clinical trial

Purpose: To determine the pattern of dental care utilisation of people living with HIV (PLHIV). Materials and Methods: A cross-sectional questionnaire survey of 239 PLHIV patients in three care centres was done. Information on sociodemographics, dental visit, risk groups, living arrangement, medical insurance and need of dental care was recorded. The EC Clearinghouse and WHO clinical staging was used to determine the stage of HIV/AIDS infection following routine oral examinations under natural daylight. Multivariate logistic regression models were created after adjusting for all the covariates that were statistically significant at univariate/bivariate levels. Results: The majority of subjects were younger than 50 years, about 93% had not seen a dentist before being diagnosed HIV positive and 92% reported no dental visit after contracting HIV. Among nonusers of dental care, 14.3% reported that they wanted care but were afraid to seek it. Other reasons included poor awareness, lack of money and stigmatisation. Multivariate analysis showed that lack of dental care was associated with employment status, living arrangements, educational status, income per annum and presenting with oral symptoms. The area under the receiver operating curve was 84% for multivariate logistic regression model 1, 70% for model 2, 67% for model 3 and 71% for model 4, which means that the predictive power of the models were good. Conclusion: Contrary to our expectations, dental utilisation among PLHIV was generally poor among this group of patients. There is serious and immediate need to improve the awareness of PLHIVs in African settings and barriers to dental care utilisation should also be removed or reduced. Keywords: dental health care utilisation, HIV, Nigeria

Purpose: Dental disease is associated with methamphetamine (MA) use and partly attributed to excessive consumption of sugared sodas. Hence, the purpose of this study was to verify patterns of sugared soda intake and their relationship to oral health. Materials and Methods: Detailed assessments with 541 MA users at two dental clinics were conducted. Assessment included a lifetime history of methamphetamine use, sugared soda consumption and a dental exam. Results: Subjects were predominantly male (80.8%; mean age 44.4 years), on average had used MA for 11.6 years and drank an average of 35.3 sodas per month. Number of days of MA use over the past 30 days was significantly associated with soda consumption. Increased years of MA use was associated with the likelihood of users reporting less overall satisfaction with life because of their teeth, specifically difficulty eating, and dry mouth. This is the first study to show a statistically significant association between MA use and sugared soda consumption. Conclusions: MA users' consumption of sugared sodas is higher than in the adult general population, and this is the first study to show a statistically significant association between MA use and sugared soda consumption. In addition, increased soda consumption was associated with more dental problems among MA users. Keywords: carbonated beverages, dental clinics, dental health surveys, dental research, drug users, methamphetamine

Purpose: To assess and compare the oral health related quality of life in patients suffering from chronic periodontitis using the short questionnaire of oral health impact profile (OHIP-14) in rural and urban populations of Punjab state, India. Materials and Methods: One hundred patients suffering from chronic periodontitis were screened and divided into two groups, rural and urban (50 participants in each group). The clinical parameters plaque index (PI), gingival index (GI), pocket probing depth (PPD) and OHIP-14 were assessed in all patients. Results: The mean PI (2.11 ± 0.635), GI (1.61 ± 0.45), PPD (3.12 ± 0.692) and OHIP-14 (11.49 ± 9.733) scores were significantly higher in the rural than in the urban population (1.69 ± 0.45, 1.56 ± 0.355, 3.30 ± 0.973, 5.88 ± 5.588, respectively) suffering from chronic periodontitis. The most affected domain in the rural population was functional limitation, whereas psychological disability was the most affected in the urban population. A statistically significant positive correlation was observed between the periodontal parameters and OHIP-14 (p 0.001) in both groups. Conclusion: Within the limitations of the study, periodontal status and oral health related quality of life are significantly correlated with each other in both rural and urban populations. Keywords: chronic periodontitis, quality of life, rural, urban

Purpose: To assess the prevalence of apical periodontitis (AP), as determined by orthopantomograms (OPGs), and its correlation with the quality of root fillings and coronal restorations. Materials and Methods: This cross-sectional study evaluated a random sample of 193 patients - 112 (58%) females and 81 (42%) males - who presented as new patients at the Division of Endodontics. Digital OPGs were independently examined by two reliability-calibrated endodontists. The total number of teeth present, the location of the root canalfilled teeth, and the presence or absence of AP were recorded for each radiograph. The results were statistically analysed using the chi-square test followed by model building using multiple logistic regression. Results: A total of 324 endodontically treated teeth from the 193 selected radiographs were analysed. The mean number of teeth per patient was 25.5 ± 4.6, with an average of 1.64 root canal treatments per subject. Radiographically detected AP was associated with 190 (58.6%) root canal-treated teeth. The logistic model shows that the quality of endodontic treatment (adjusted odds ratio [ORa] = 1.82; 95% confidence interval [CI]: 1.40-3.17), status of coronal restoration (ORa = 1.77; 95% CI: 1.20-2.61) and the type of material used for coronal restorations (ORa = 1.39; 95% CI: 1.03-1.87) were significantly related to the periapical health of the teeth. Conclusions: The quality of endodontic treatment, status of coronal restoration and the type of coronal restorative material were found to be the most important factors influencing the health of periradicular tissue. Keywords: apical periodontitis, coronal restoration, coronal status, root canal filing

Purpose: Racial and ethnic disparities in periodontal disease exist in the United States. This study examined the prevalence of self-reported periodontal disease, and the extent to which racial/ethnic disparities in the reported disease were reduced or eliminated after controlling for various risk factors in a multi-ethnic study population of older adults. Materials and Methods: Information from the baseline examination (July 2000-August 2002) of the Multi-Ethnic Study of Atherosclerosis (MESA) was used. Study participants (N = 6256) were age 45-84 years and identified themselves as either: white, black, Hispanic or Chinese. Periodontal disease was assessed by self-report; demographic and socioeconomic status (SES) indicators, biomedical risk factors and psychosocial stress factors were used as predictors of self-reported periodontal disease. Results: Chinese displayed the highest prevalence of self-reported periodontal disease (39.8%), followed by blacks (32.0%) and whites (26.0%), with Hispanics displaying the lowest prevalence (17.4%). Chinese and black participants had a significantly higher prevalence of disease compared to whites that persisted after adjusting for demographic and SES indicators, biomedical risk factors and psychosocial stress factors. After such adjustment, Hispanics did not differ significantly from whites in their reporting of disease. Conclusion: Racial/ethnic disparities in self-reported periodontal disease persisted after adjusting for all study covariates. This study highlights the need for continued research into the determinants of racial/ethnic disparities in periodontal disease in order to better target interventions aimed at reducing the burden of disease in all segments of the U.S. population. Keywords: ethnicity, healthcare disparities, minority health, periodontal diseases, race

Purpose: To evaluate the effectiveness of an educational intervention in improving the level of knowledge of tooth avulsion among non-dental healthcare professionals of an emergency medical service in Brazil and the maintenance of this knowledge after a 6-month period. Materials and Methods: An intervention study was carried out involving the administration of a questionnaire and presentation of a lecture to 73 healthcare professionals (11 physicians, 41 nurses and 21 paramedics) of an emergency medical service in Brazil. The questionnaire was administered before (T0), immediately after (T1) and 6 months after the lecture (T2). McNemar's test was used to compare the responses, with the significance level set at 5% (p 0.05). Results: A general improvement was found regarding the concept of tooth avulsion, replantation, conduct in cases of avulsion, ideal time for replantation, ability to perform replantation and storage medium prior to replantation between baseline (T0) and the post-lecture evaluations (p 0.05). However, an increase in insecurity regarding replantation was found between T1 and T2 (p 0.001). Conclusion: The educational intervention led to a significant increase in the number of correct answers regarding the measures to be taken in cases of tooth avulsion. The professionals' knowledge level remained high 6 months after the lecture. However, a certain degree of insecurity was found regarding the ability to perform replantation. Keywords: dental education, health personnel, interventional studies, tooth avulsion

Purpose: To determine the prevalence and potential risk factors of ECC in 3- to 6-year-old preschool children. Materials and Methods: A sample of 477 preschool children aged 3 to 6 years was randomly selected from the schools in the area of study. Caries was recorded according to the WHO criteria from 1997. Information regarding demographic data, socioeconomic status, feeding habits, oral hygiene practices, birthweight and the children's visits to the dentist was obtained through a structured questionnaire. The data were analysed using Student's t-test, the chisquare test and Pearson's correlation analysis. Results: The prevalence of early childhood caries in 3- to 6-year-old preschool children was found to be 27.3% with a mean dmft of 2.36. ECC increased significantly with age and is more predominant in girls. The maxillary arch was more affected than mandibular arch and children belonging to the low socioeconomic group showed higher caries prevalence. ECC is more prevalent in children accustomed to on-demand breast feeding, bottle feeding at night, betweenmeal snacking and sweetened pacifier use. Factors such as increased frequency of toothbrushing, use of toothbrush and fluoridated dentifrice were found to be the protective factors against the risk of ECC. Conclusion: A strong correlation between the risk factors studied and ECC was found. Health education, proper guidelines on feeding and oral hygiene practices and access to early oral health care can substantially reduce the risk and prevalence of ECC. Keywords: early childhood caries, feeding practices, oral hygiene practices, preschool children, socioeconomic status

Errata for the following articles: OHPD 2015;13(1):4 Comparative Evaluation of Terminalia chebula Extract Mouthwash and Chlorhexidine Mouthwash on Plaque and Gingival Inflammation - 4-week Randomised Control Trial Devanand Gupta/Rajendra Kumar Gupta/Dara John Bhaskar/Vipul Gupta OHPD 2015;13(4):309-315 Comparative Efficacy of Aloe vera and Benzydamine Mouthwashes on Radiation-induced Oral Mucositis: A Triple-blind, Randomised, Controlled Clinical Trial Sahebjamee, Mahnaz / Mansourian, Arash / Mohammad, Haji Mirza Mohammad / Zadeh, Mohsen Taghi / Bekhradi, Reza / Kazemian, Ali / Manifar, Soheila / Ashnagar, Sajjad / Doroudgar, Kiavash

Purpose: To compare the level of agreement between carious lesion assessments according to the visual clinical examination and the colour photograph methods. Materials and Methods: Data on the presence of enamel/dentin carious lesions in previously sealed occlusal surfaces in first molars were obtained by two trained and calibrated examiners through visual clinical examination and from colour photographs 4 years after sealing. Kappa statistics were applied to calculate agreement between assessment methods. Data analysis was performed using sign, Bowker symmetry and McNemar's tests. Results: The prevalence of dentin carious lesions was very low. The kappa coefficients for detecting enamel/dentin carious lesions using the two assessment methods were 0.65 (CI: 0.56-0.74) for examiner 1 and 0.70 (CI: 0.62-0.78) for examiner 2. Examiner 2 observed more enamel/dentin carious lesions on colour photographs than did examiner 1 (p = 0.008). Sensitivity analyses did not confirm this outcome. Conclusions: There was no difference in the detection of enamel/dentin carious lesions in previously sealed occlusal surfaces using colour photographs vs visual clinical examination. The colour photograph method is therefore equivalent to the visual clinical examination in detecting enamel/dentin carious lesions. More studies are required. Keywords: carious lesion detection, dental caries, intraoral photography, oral examination, sealants