Oral Health and Preventive Dentistry, 02/2017

Purpose: To determine the stage of caries in posterior permanent teeth at which dentists decide to intervene invasively. Materials and Methods: A search of the literature from January 1980 to November 2015 available in MEDLINE-PubMed, EMBASE, and the Cochrane Library was conducted. The main search terms used were decision-making, restorative treatment, dental caries lesion, occlusal surface, and approximal surface. The inclusion criterion was studies including dentists only. Three reviewers independently screened titles and abstracts to determine the eligibility of studies. Subsequently, the full texts of the papers deemed eligible were perused and included in the data extraction process. Results: The review encompassed 11 studies and the methodological quality was considered moderate. Most dentists would restore lesions confined to enamel and reaching the outer half of the dentin, irrespective of the surface involved. With regard to the occlusal surface, the percentage of dentists who restored enamel lesions ranged from 4.6% to 17.8%. Regarding dentin lesions (outer half), 50.2%-70.2% of the dentists opted for invasive treatment. For the approximal surface, the choice for invasive treatment of enamel lesions ranged from 5%-88%. In dentin lesions, 4.4%-94% of dentists restored lesions in the outer half of the dentin. Conclusion: Despite the progress achieved in the understanding of the development and management of caries, dentists still recommend restorative treatment in its early stages. Keywords: dental caries, decision making, permanent dentition, restorative treatment

Purpose: The present prospective, randomised, placebo-controlled, clinical trial was designed to evaluate the clinical effects of a commercially available dentifrice containing fluoride, xylitol or xylitol-probiotic on the decrease of plaque and gingival inflammation in children between 13 and 15 years of age. Materials and Methods: Forty-eight adolescents were randomly grouped into three groups of n = 16 each: study group A received xylitol (Xyliwhite) toothpaste; study group B received xylitol-probiotic (Periobiotic) toothpaste; and the control group C received fluoride (Colgate Max Fresh) toothpaste. The subjects were instructed to use the dentifrice determined and a modified Bass brushing technique twice a day for two minutes over a 6-week perioed. Clinical evaluation was performed using a gingival index and a plaque index at baseline and at the end of the 6-week period. Results: From day 0 to 42, reductions in the plaque index were statistically significant in all groups, Colgate Max Fresh, PerioBiotic and Xyliwhite (p-values 0.001, 0.001 and 0.035, respectively), but reductions in the gingival index were statistically significant only in the Colgate Max Fresh and PerioBiotic groups (both with p = 0.001), not in the Xyliwhite group (p = 0.116). PerioBiotic toothpaste was found to be better than Xyliwhite and Colgate Max Fresh toothpastes at reducing plaque and gingival scores. However, statistically significant differences with PerioBiotic and Colgate Max Fresh toothpaste were not observed. Conclusion: It was concluded that PerioBiotic was an all-round dentifrice that produced a significant reduction in both gingivitis and plaque. Keywords: dentifrices, gingival health, preventive dentistry, probiotic

Purpose: To assess the efficacy of motivational interviewing in conjuction with a caries risk assessment (MICRA) programme to improve the dental health status of preschool children. Materials and Methods: A randomised controlled trial was conducted among 214 parents or caregivers and their children at Health Centre 54, Bangkok, Thailand, from September 2015 to February 2016. The participants were randomised to the intervention and the control groups (107 participants per group). At baseline, the intervention group received a caries risk assessment, individual counseling by using motivational interviewing, and oral hygiene instruction. The intervention group received reinforcement education and individual counseling by motivational interviewing every 3 months. The control group received a routine programme. Participants were assessed at baseline, 3 months, and 6 months for plaque index and caries. The data were analysed by using descriptive statistics, the chi-squared test, Fisher's exact test, t-test, repeated-measures ANOVA, and negative binomial distribution. Results: After the 6-month follow-up, participants in the intervention group had a significantly lower plaque index, non-cavitated plus cavitated carious lesions, and cavitated carious lesions when compared to the control group. The intervention group had a lower caries incidence, non-cavitated plus cavitated carious lesions (1.81 times) and cavitated carious lesions (2.04 times) than the control group. Conclusion: The combination of motivational interviewing and caries risk assessment in one programme decreased early childhood caries in preschool children. It is not known whether the effects are due to the motivational interviewing, the caries risk assessment, or the combination of both. Keywords: caries risk assessment, dental health status, motivational interviewing, preschool children

Purpose: To assess the caries experience and periodontal health status among children with haemophilia in New Delhi. Materials and Methods: This case control study was conducted in New Delhi over a 14-month period. Data were collected from 110 children, of which 55 children had haemophilia and 55 were healthy. Caries was assessed in terms of decayed, missing and filled teeth, according to WHO criteria, while periodontal health status was assessed regarding plaque present, and recorded by utilising the Silness and Löe plaque index. Results: In children with haemophilia, overall caries experience was low in the primary dentition as compared to healthy children, with mean dmft of 2.02 ± 2.4 and mean dmfs of 4.71 ± 7.3, as well as in the permanent dentition with a mean DMFT of 0.47 ± 0.87 and mean DMFS of 0.56 ± 1.167. Thus, caries experience was lower in the permanent than in the primary dentition. There was no significant difference between the two groups regarding the periodontal health. The overall dental health in children with haemophilia was better than in healthy children, as there was a significant influence of parental toothbrushing habits on children with haemophilia. Conclusion: Caries experience was significantly lower in children with haemophilia as compared to healthy children. The periodontal health status of children with haemophilia was found to be comparable to that of the healthy children. Keywords: dental caries, haemophilia, periodontal health

Purpose: To analyse risk factors for tooth loss in women and men seeking treatment at the University of Basel, Switzerland. Materials and Methods: Records of patients from the pool of patients at the department were consecutively screened between January 2009 and October 2011. Gender, smoking habits, education, profession, general health status and dental variables were recorded. Tooth loss was assessed on full-mouth periapical radiographs. Gender-nested logistic regression models were applied for statistical analysis. Results: The sample consisted of 161 participants (4012 teeth in total, 3988 after exclusion of third molars), 80 women and 81 men, with a mean age of 48.0 ± 14.6 in women and 47.7 ± 12.5 in men. There were no significant differences in smoking status between men and women. Oral clinical data revealed similar gingival inflammation (BI) and number of sites with a periodontal probing depth (PPD) ? 5 mm among men and women. However, oral hygiene (PI) differed between men and women, with women having better oral hygiene (p 0.01). Tooth loss increased from the front to the molar regions. A significant risk for tooth loss was associated with decreasing educational level. Compared to advanced education, individuals with 'no school graduation' showed a significantly higher risk for tooth loss in women (OR = 3.2, p = 0.02) and men (OR = 3.6, p = 0.03). Age ? 50 years significantly predicted tooth loss in men only (OR 2.2, p = 0.01). Conclusion: The results from the present study demonstrate lower educational level as a strong risk factor for tooth loss in this Swiss cohort. The educational level may need to be considered for diagnosis and treatment planning, and particularly for patient information practices to increase the patients' understanding of the development of oral diseases leading to tooth loss. Keywords: educational level, gender, KREBS Project, socioeconomic, tooth loss

Purpose: To test the remineralisation potential of a single application of self-assembling peptides or acidic fluoride solution using quantitative light-induced fluorescence (QLF) in vitro. Materials and Methods: Bovine enamel disks were prepared, and white spot lesions were created on one half of the disk with an acidic buffer solution. After demineralisation, disks were allocated into three groups of 11 specimens each. Group A served as a control group and received no treatment. Group B had a single application of fluoride, and group C was treated once with self-assembling peptides. All disks were embedded in a plastic mold (diameter 15 mm, height 9 mm) with an a-silicone, and remineralisation was initiated using a pH-cycling protocol for five days. Four experimental regions on each disk were measured prior to the start of the study (T0), after demineralisation (T1) and after the remineralisation process (T2) using QLF. Results: After demineralisation, all areas showed a distinct loss of fluorescence, with no statistically significant difference between the groups (ΔF from -69.3 to -10.2). After remineralisation, samples of group B (treated with fluoride) showed a statistically significant fluorescence increase (ΔF from T1 to T2 15.2 ± 7.3) indicating remineralisation, whereas the samples of control group A and group C (treated with self-assembling peptides) showed no significant changes in ΔF of 1.1 ± 1.9 and 2.5 ± 1.9, respectively. Conclusions: Application of self-assembling peptides on demineralised bovine enamel did not lead to increased fluorescence using QLF, indicating either lack of remineralisation or irregular crystals. Increased fluorescence using QLF indicated mineral gain following a single application of a highly concentrated fluoride. Keywords: peptides, quantitative light-induced fluorescence, self-assembly, white spot lesions

Purpose: To assess the inhibitory effects of nitrite on plaque acidogenicity and its relationship with caries experience. Materials and Methods: Plaque (2 μl) was collected from 76 children (age 5.8 ± 2.6 years, dmft 2.9 ± 3.5, DMTF 0.6 ± 1.4) and mixed with nitrite solution (final concentration = 0.63 mM) or distilled water (control). The initial pH (pH-0) of each sample was measured using a portable pH meter. The samples were incubated for 10 min, then their pH (pH-1) was measured again. Next, glucose (final concentration = 0.67%) was added to the samples, which were then incubated for a further 10 min before their pH was assessed for a third time (pH-2). Results: The pH-0, pH-1, and pH-2 values of the control samples were 7.25 ± 0.16, 6.07 ± 0.44, and 5.11 ± 0.48, respectively, and those of the nitrite-treated samples were 7.26 ± 0.16, 6.37 ± 0.45, and 5.34 ± 0.48, respectively. The pH-1 and pH-2 values of the nitrite-treated samples were higher than those of the control samples (p 0.005). Greater plaque acid production was associated with stronger inhibition of plaque acid production by nitrite (p 0.005). No relationship was detected between the inhibition by nitrite and caries experience. Conclusions: Nitrite inhibited both endogenous and exogenous plaque acid production. Nitrite inhibited acid production more markedly in plaque that exhibited greater acid production, suggesting that nitrite might be effective at preventing caries, as it contributes to pH homeostasis in plaque by countering excess acidification. Keywords: acid production, dental plaque, nitrate, nitrite, pH

Purpose: To evaluate the efficacy of conventional acid etching alone (acid etching) and Er:YAG laser combined with acid etching (laser + acid etching) on fissure sealant (FS) retention of first permanent molars (FPMs) after 18 months. Materials and Methods: Using a split-mouth design in 51 children, a total of 204 FPMs were sealed with acid etching alone or laser plus acid etching (laser+acid). The retention of sealants and occurrence of caries were evaluated at 3, 6, 12, and 18 months. Statistical analysis was performed using Pearson's chi-squared tests. Results: The retention rate for FS in the laser+acid group was significantly higher than that of the acid-etch group at 12 (p = 0.0161) and 18 (p = 0.0227) months. Six FSs in the acid group and five FSs in the laser+acid group were completely lost after 18 months. The incidence of caries in the acid-etch group was 22% (n = 18) vs 10% (n = 8) in the laser+acid group at 18 months. The difference in caries development between the groups was not significant (p > 0.05). Conclusions: As enamel pretreatment, Er:YAG laser combined with acid etching significantly improves FS retention over conventional acid etching alone. Keywords: dental acid etching, lasers, pit and fissure sealants

Purpose: To evaluate the effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP) application on noncarious MIH (molar-incisor hypomineralisation) lesions using a DIAGNOdent device (KaVo), which measures laser fluorescence within the mineral structure of the tooth. Materials and Methods: A total of 461 subjects age 7-12 (mean ± SD was 9.9 ± 1.6) years were examined. Fifty- four children were diagnosed with MIH and divided into 2 groups. A total of 38 teeth met the inclusion criteria and were included in the study. Group 1 subjects (n = 15) used a paste containing 10% CPP-ACP, and group 2 subjects (n = 23) used a paste containing 10% CPP-ACP with 0.2% NaF (CPP-ACFP) for one month. Results: After the application of the pastes for one month, significant decreases were found in the mean DIAGNOdent readings for both groups (CPP-ACP p = 0.0015 and CPP-ACFP p = 0.0001). However, the percentage decreases in both groups were not significantly different from each other (60.4% and 45.5% in CPP-ACP and CPP-ACFP groups, respectively). Conclusion: This pilot study shows that using CPP-ACP and CPP-ACFP had a positive effect in reducing hypomineralisation on enamel surfaces of MIH-diagnosed teeth for a one month period. It is important to diagnose molar-incisor hypomineralisation at an early stage to prevent excessive caries develeopment. Therefore, further clinical studies are necessary on the long-term application of these kinds of nanocomplexes. Keywords: CPP-ACP, CPP-ACFP, DIAGNOdent, fluoride, molar-incisor hypomineralisation

Purpose: To evaluate the effect of three different fluoride treatments on the surface microhardness and morphology of human enamel exposed to two different bleaching agents. Materials and Methods: Twenty-three extracted human third molars were sectioned to obtain 90 enamel fragments, mounted on acrylic resin supports, polished and randomly divided into 9 groups (n = 10). The specimens were exposed to a combination of two bleaching agents (22% carbamide peroxide [CP] and 38% hydrogen peroxide [HP]) and three fluoride treatments (0.05% NaF daily, 0.2% NaF weekly and 5% NaF final topical fluoridation). The positive control group specimens were not exposed to bleaching agents or fluoride treatments. The negative control group specimens were exposed to the bleaching agents but none of the fluoride treatments. All specimens were stored in artificial saliva during the entire experiment, and enamel microhardness was evaluated. Surface microhardness data were statistically analysed using two-way ANOVA and Tukey's post-hoc test at a significance level of ? = 0.05. Additionally, three specimens of each experimental group were examined under SEM. Results: Two-way ANOVA revealed significant differences between the experimental groups (p 0.05). The bleached group specimens which did not receive fluoride treatment exhibited significantly lower microhardness than those treated with fluoride (p 0.05). Varying degrees of surface changes were observed among the experimental groups. Conclusion: Both bleaching agents significantly reduced enamel microhardness and the topical fluoride treatments after bleaching significantly enhanced the surface microhardness of the enamel. The surface morphology of the enamel was altered after bleaching and fluoride treatments. Keywords: enamel, fluoride treatments, surface microhardness, surface morphology, tooth bleaching

Pemphigus vulgaris, mucosal pemphigoid (mucous membrane pemphigoid), lichen planus, discoid lupus erythematosus and erythema multiforme are a group of immune-mediated mucocutaneous disorders characterised clinically by the formation of blisters, erosions or ulcers. The oral mucosa is often affected, and sometimes the disease is limited to the mouth. The target antigens, autoreactive immune responses, microscopic features, treatment and prognosis vary from one disease to the other. Treatment aims to eliminate exogenous risk factors, suppress the pathogenic immuno-inflammatory reactions, promote healing and prevent infection. The aim of this article is to provide the general dental practitioner with a succinct overview of the diagnostic, clinical, aetiopathogenic features and characteristics of, as well as treatment guidelines for oral pemphigus vulgaris and oral mucosal pemphigoid. Early diagnosis and treatment could prevent severe consequences of the disease in their full-blown forms. Keywords: autoreactive antibodies, blisters, desmosomes, desquamative gingivitis, hemidesmosomes, immune-mediated mucocutaneous disorders, immunofluorescence

Purpose: To evaluate marginal bone loss over a 10-year period in individuals and in tooth groups in relation to age and level of marginal bone. Materials and Methods: In 1997, 616 randomly selected individuals (mean age: 42 years, range: 21-63 years) underwent a full-mouth radiographic survey. In 2008, the survey was repeated in 362 of the same individuals (182 women and 180 men). The marginal bone level of each tooth was measured in mm from the cementoenamel junction to the marginal bone. These measurements were used to calculate marginal bone loss during the 10-year period for individuals and tooth groups in relation to age and to baseline marginal bone level, calculated as the average between measurements in 1997 and 2008 to circumvent regression towards the mean. Results: The average annual marginal bone loss was 0.09 mm (SD ± 0.04 mm) during the 10-year study period. The association between marginal bone loss and baseline marginal bone level was more pronounced in the youngest age group, compared to the other age groups. Molars displayed the most severe bone loss during the study period. Conclusion: Marginal bone loss over a 10-year period is associated with age and baseline marginal bone level. Younger individuals with a reduced marginal bone level were at higher risk for further bone loss. Molars lose marginal bone more rapidly than other tooth groups. Keywords: age group, alveolar bone loss, epidemiology, dental radiographs, longitudinal studies

Purpose: To record periodontal treatment needs in a randomised sample and evaluate the association between body mass index (BMI) and periodontal treatment needs, as well as the association between diabetes, smoking, BMI and periodontal treatment needs. Materials and Methods: The study sample comprised 633 patients aged 18 to 85 years visiting an outpatient clinic. Body mass index (BMI) and periodontal status were recorded. Demographic data including gender, year of birth, smoking habits and medical history were collected from each patient. Results: 216 subjects (36%) were overweight, while 188 subjects (31.3%) were obese. CPITN (Community Periodontal Index of Treatment Needs) scores of 2 and 3 (minimal to moderate periodontal treatment needs) were widespread among this population (68.2%). Using model-based clustering, the total sample of 600 subjects was divided into four clusters of 202, 241, 111 and 46 subjects. Conclusion: The periodontal treatment needs of the sample were generally minimal to moderate, with only a weak association between the BMI and treatment needs. However, diabetics, smokers and older subjects classified as overweight or obese needed moderate to complex periodontal treatments. Keywords: body weight, diabetes, periodontitis, risk factors, risk indicators