The Impact of Carbohydrate Quality on Dental Plaque pH: Does the Glycemic Index of Starchy Foods Matter for Dental Health?

The Oral-Gut Microbiome-Brain Axis in Cognition

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline and neuronal loss, affecting millions worldwide. Emerging evidence highlights the oral microbiome-a complex ecosystem of bacteria, fungi, viruses, and protozoa as a significant factor in cognitive health. Dysbiosis of the oral microbiome contributes to systemic inflammation, disrupts the blood-brain barrier, and promotes neuroinflammation, processes increasingly implicated in the pathogenesis of AD. This review examines the mechanisms linking oral microbiome dysbiosis to cognitive decline through the oral-brain and oral-gut-brain axis. These interconnected pathways enable bidirectional communication between the oral cavity, gut, and brain via neural, immune, and endocrine signaling. Oral pathogens, such as Porphyromonas gingivalis, along with virulence factors, including lipopolysaccharides (LPS) and gingipains, contribute to neuroinflammation, while metabolic byproducts, such as short-chain fatty acids (SCFAs) and peptidoglycans, further exacerbate systemic immune activation. Additionally, this review explores the influence of external factors, including diet, pH balance, medication use, smoking, alcohol consumption, and oral hygiene, on oral microbial diversity and stability, highlighting their role in shaping cognitive outcomes. The dynamic interplay between the oral and gut microbiomes reinforces the importance of microbial homeostasis in preserving systemic and neurological health. The interventions, including probiotics, prebiotics, and dietary modifications, offer promising strategies to support cognitive function and reduce the risk of neurodegenerative diseases, such as AD, by maintaining a diverse microbiome. Future longitudinal research is needed to identify the long-term impact of oral microbiome dysbiosis on cognition.

Addressing disparities in oral health access and outcomes for aging adults in the United States

Oral health is essential for the overall well-being of aging adults, yet significant disparities persist in the United States, contributing to malnutrition, reduced quality of life, and social isolation. Despite advancements in preventive dentistry, older adults continue to face substantial oral health challenges. This study reviewed the current state of oral health among aging adults in the United States, analyzing national health surveys and existing preventive dentistry protocols to assess their effectiveness. National data indicated that a high percentage of older adults experience tooth loss, periodontal disease, and root caries. Results indicated that almost 40% of adults aged 65 and older have lost a significant number of teeth, and a large proportion of the aging adult population has suffered from high rates of caries and periodontal disease. Socioeconomic factors were found to significantly influence access to dental care. Key barriers included low income, inadequate insurance, and low oral health literacy exacerbating disparities. The study proposes a multifaceted approach to improve oral health equity, including policy changes, community-based preventive programs, enhanced geriatric dentistry education, and the integration of oral health into primary care. Addressing these disparities is needed to improve both oral and overall health outcomes for the growing elderly population in the United States.

Starch intake and changes in dental caries among adults: A longitudinal study in Finland

OBJECTIVE

To evaluate the association between starch intake (amount and type) and changes in dental caries among adults over 11 years.

METHODS

Data from 1679 adults, aged 30 years and over, who participated in three consecutive surveys in Finland were pooled for analysis. Participants completed a validated semi-structured 128-item food frequency questionnaire at baseline, from which total starch intake (g/day and % energy intake) and the intake (g/day) of seven food groups high in starch (potatoes, potato products, roots and tubers, refined grains, pasta, wholegrains, and legumes) were estimated. Dental caries was determined during clinical examinations and summarized using the DMFT score, which was treated as a repeated outcome. The association between baseline starch intake and 11-year-change in DMFT score was tested in linear mixed-effects models adjusted for sociodemographic factors, behaviors, sugar intake, and health status.

RESULTS

The mean DMFT score was 21.9 (95%CI: 21.6, 22.2) in 2000 (baseline), increasing by 0.47 (95% CI: 0.38, 0.56) in 2004/05, and additionally by 0.33 (95%CI: 0.20, 0.45) in 2011. Total starch intake was not associated with change in DMFT. This finding was similar irrespective of how starch intake was expressed (g/day or %EI). Of the seven food groups evaluated, only the intake of pasta was inversely associated with the DMFT score at baseline, but not with the change in DMFT over time.

CONCLUSION

Neither the amount nor the type of starch intake was associated with changes in dental caries over 11 years among Finnish adults.

Is Starch Intake Associated With Periodontal Status? An 11-Year Longitudinal Analysis Among Finnish Adults

AIM

To evaluate the association between baseline starch intake (amount and sources) and changes in periodontal status over 11 years in adults.

METHODS

Adults aged 30-82 years, who participated in the Finnish Health 2000 survey and were re-examined in 2004/2005 and/or 2011 were included in the study. The consumption of total starch and six relevant food groups (potatoes, fried potatoes, roots and tubers, pasta, wholegrains and legumes) over the past year was determined at baseline with a validated food frequency questionnaire. The number of teeth with periodontal pocketing ≥ 4 mm (NTPP) was recorded during clinical examinations in 2000, 2004/2005 and 2011. The association between baseline starch intake and the 11-year change in the NTPP was tested in mixed-effects negative binomial regression models, adjusting for covariates.

RESULTS

A total of 1369 adults were included in the analysis. The mean NTPP was 4.1 ± 5.6, 6.3 ± 5.6, and 4.8 ± 5.9 in waves 1, 2 and 3, respectively. Baseline starch intake (in g/day or % energy intake) was not associated with changes in the NTPP after adjustment for covariates. In analysis by food groups, the baseline intake of wholegrains was negatively associated with the NTPP at baseline.

CONCLUSION

This study found no evidence of an association between baseline starch intake and changes in periodontal status. Baseline intake of wholegrains was associated with better periodontal status at baseline.

Dietary patterns and their associations with the occurrence and severity of early childhood caries among 1-5-year-olds in Iran: A multicenter cluster randomized survey

AIM

A health-promoting and tooth-friendly diet can reduce the risk factors associated with early childhood caries (ECC) and promote overall health in children. This study aimed to identify dietary habits and feeding practices and their associations with ECC among 1-5-year-olds in Iran.

METHODS

This analytical cross-sectional study utilized data from a survey conducted from August 1, 2020, to January 20, 2021. A three-stage stratified cluster sampling method was employed to recruit participants. Parents provided written informed consent in Persian before enrollment and were then interviewed via a valid and reliable questionnaire inquiring about background information, feeding practices, and dietary habits. Each child underwent a dental examination by one of four trained and calibrated dentists to assess dental plaque and ECC. After appropriate weightings were applied, associations between key covariates and outcome measures were analyzed using multivariable logistic regression modeling and multivariate generalized negative binomial regression modeling. Statistical analysis was performed using SPSS V25 and Stata V14.2 software.

RESULTS

The mean age of the study population was 45.0 (±0.5) months, and 53% (±5%) had ECC. Visible dental plaque was present on the tooth surfaces of 39% ( ± 3%) of the toddlers and 66% ( ± 4%) of the preschoolers. The majority of the children had been breastfed for over 18 months (65%). Most children consumed sugar between meals once a day or less (66%) and fruits once (39%) or twice (37%) a day. ECC experience increased with age and poor oral hygiene across all age groups. Toddlers with a higher frequency of sugar intake between meals had higher dmft and ECC prevalence. The consumption of four to five servings of grain products per day was associated with a five-fold reduction in ECC occurrence (p = 0.047, OR = 0.2). In contrast, the consumption of two servings of fruits per day was associated with a doubling of the dmft score in toddlers (p = 0.015, IRR = 2.0).

CONCLUSIONS

This study identified possible dietary risk factors for ECC in Iranian children, such as increased sugar intake and fruit consumption, while balancing diet with grain consumption played a protective role. Considering the role of oral hygiene and the multifactorial nature of the disease may highlight a route toward developing future targeted and effective preventive strategies.

The Impact of Human Salivary Amylase Gene Copy Number and Starch on Oral Biofilms

The copy number (CN) variant AMY1 encodes the salivary amylase enzyme which promotes starch digestion. Although this gene has been associated with dental caries and periodontal disease susceptibility, the impact of the interaction between AMY1 CN and starch on oral biofilms is unclear. We explored how oral microbiota communities shaped by AMY1 CN respond to starch by employing an in vitro model of biofilm formation. We cultured biofilms using saliva samples from 31 donors with a range of AMY1 CNs (between 2 and 20 copies) and self-reported gum disease states; we used media with and without starch. Many of the most prevalent genera in saliva were also prevalent in the derived biofilms. The presence of starch in the media was associated with lower biofilm alpha diversity. We found a significant interaction between AMY1 CN and the media carbohydrate content that influenced the proportions of Atopobium and Veillonella. Members of these genera have been associated with dental caries and periodontitis. These findings suggest that the effects of carbohydrates on oral microbiome composition depend on AMY1 CN and that human oral bacteria evolved in response to expansion of this host gene locus.

Starch intake and caries increment: A longitudinal study in Finnish adults

OBJECTIVE

To evaluate whether changes in starch intake (in terms of amount and food sources) were associated with increments in dental caries among adults.

DESIGN

This is an 11-year longitudinal study (2000-2011) with duplicate assessments for all variables. A 128-item FFQ was used to estimate intake of starch (g/d) and six starch-rich food groups (potatoes, potato products, roots and tubers, pasta, wholegrains and legumes). Dental caries was assessed through clinical examinations and summarised using the number of decayed, missing and filled teeth (DMFT score). The relationship between quintiles of starch intake and DMFT score was tested in linear hybrid models adjusting for confounders.

SETTING

Northern and Southern regions of Finland.

PARTICIPANTS

922 adults, aged 30-88 years.

RESULTS

Mean starch intake was 127·6 (sd: 47·8) g/d at baseline and 120·7 (55·8) g/d at follow-up. Mean DMFT score was 21·7 (6·4) and 22·4 (6·2) at baseline and follow-up. Starch intake was inversely associated with DMFT score cross-sectionally (rate ratio for highest v. lowest quintile of intake: -2·73, 95 % CI -4·64, -0·82) but not longitudinally (0·32, 95 % CI -0·12, 0·76). By food sources, the intakes of pasta (-2·77, 95 % CI -4·21, -1·32) and wholegrains (-1·91, 95 % CI -3·38, -0·45) were negatively associated with DMFT score cross-sectionally but not longitudinally (0·03, 95 % CI -0·33, 0·39 and -0·10, 95 % CI -0·44, 0·24, respectively).

CONCLUSION

Changes in the amount and sources of starch intake were not associated with changes in dental caries. Further studies should be conducted in different settings and age groups while focusing on starch digestibility and specific sources of starch.

Evaluation of frequency of consumption of cariogenic snacks by freshmen versus the senior dental students in Tehran and the related factors: a cross-sectional study

BACKGROUND

Senior dental students are more aware of the harmful effects of cariogenic snacks and are expected to better watch their diet compared with freshmen dental students. This study aimed to compare the frequency of consumption of cariogenic snacks by senior and freshmen dental students of Tehran city and the related factors.

METHODS

This cross-sectional study evaluated the senior and freshmen dental students attending dental schools in Tehran in 2018, who were selected by census sampling. A cariogenic snack record form was used to collect information regarding the frequency of consumption of cariogenic snacks both prospectively (within the upcoming week) and retrospectively (previous 24 hours). We also collected information on the demographic characteristics of the participants. The plaque-producing and decay-producing potential of the diet (PAP) index was calculated for each dental student. Data were analysed by the backward regression model using SPSS.

RESULTS

A total of 294 dental students with a mean age of 22±2.85 years participated in this study. The mean PAP score was 76.48±49.91 for the freshmen and 89.87±49.41 for the senior dental students with a significant difference between them (p=0.023). Older dental students (p=0.008) and those not living with their parents (p=0.001) acquired a higher PAP score.

CONCLUSION

The mean PAP score of freshmen and senior dental students in Tehran was slightly higher than the optimal level. So the instructional techniques of dental curricula are better to be revised to improve the performance of dental students to cut down the consumption of cariogenic snacks.

Prevalence of dental caries among children in Indonesia: A systematic review and meta-analysis of observational studies

Objective

The prevalence of dental caries among children in Indonesia remains unclear. Therefore, we aimed to provide an updated assessment of this prevalence while also investigating the influence of patient characteristics and methodological factors.

Design

We performed a systematic review and meta-analysis, including searches of PubMed, Cochrane Library, and Embase from inception to August 24, 2023. We included 8840 participants in 27 studies reporting the prevalence of dental caries among Indonesian children.

Results

The overall prevalence of dental caries was 76 % (95 % confidence interval: 71%-81 %). Studies in which decay-missing-filled teeth (DMFT) criteria were used to diagnose dental caries were significantly more prevalent than studies using non-DMFT criteria (78 % vs. 64 %, P < 0.05). No significant moderators were identified for the study subgroup based on study origin (Jakarta vs. non-Jakarta) or comorbidity status (comorbidity vs. no comorbidity). Owing to incomplete reporting of variables, metaregression analysis could not be conducted for continuous variables, such as age and male percentage.

Conclusions

The prevalence of dental caries among Indonesian children remains notably high, showing consistency across Jakarta-based studies and non-Jakarta studies. Initiating dental caries prevention and health promotion campaigns is imperative, focusing on the critical importance of early detection.

Human milk microbiome: associations with maternal diet and infant growth

Introduction

Ingestion of human milk (HM) is identified as a significant factor associated with early infant gut microbial colonization, which has been associated with infant health and development. Maternal diet has been associated with the HM microbiome (HMM). However, a few studies have explored the associations among maternal diet, HMM, and infant growth during the first 6 months of lactation.

Methods

For this cross-sectional study, Mam-Mayan mother-infant dyads (n = 64) were recruited from 8 rural communities in the Western Highlands of Guatemala at two stages of lactation: early (6-46 days postpartum, n = 29) or late (109-184 days postpartum, n = 35). Recruited mothers had vaginally delivered singleton births, had no subclinical mastitis or antibiotic treatments, and breastfed their infants. Data collected at both stages of lactation included two 24-h recalls, milk samples, and infant growth status indicators: head-circumference-for-age-z-score (HCAZ), length-for-age-z-score (LAZ), and weight-for-age-z-score (WAZ). Infants were divided into subgroups: normal weight (WAZ ≥ -1SD) and mildly underweight (WAZ < -1SD), non-stunted (LAZ ≥ -1.5SD) and mildly stunted (LAZ < -1.5SD), and normal head-circumference (HCAZ ≥ -1SD) and smaller head-circumference (HCAZ < -1SD). HMM was identified using 16S rRNA gene sequencing; amplicon analysis was performed with the high-resolution ANCHOR pipeline, and DESeq2 identified the differentially abundant (DA) HMM at the species-level between infant growth groups (FDR < 0.05) in both early and late lactation.

Results

Using both cluster and univariate analyses, we identified (a) positive correlations between infant growth clusters and maternal dietary clusters, (b) both positive and negative associations among maternal macronutrient and micronutrient intakes with the HMM at the species level and (c) distinct correlations between HMM DA taxa with maternal nutrient intakes and infant z-scores that differed between breast-fed infants experiencing growth faltering and normal growth in early and late lactation.

Conclusion

Collectively, these findings provide important evidence of the potential influence of maternal diet on the early-life growth of breastfed infants via modulation of the HMM.

Association between dental caries and adherence to the Mediterranean diet, dietary intake, and body mass index in children

BACKGROUND

Children with healthier nutritional status are less likely to develop severe caries than those with a high-sugar content diet. Studies evaluating dental caries and nutritional status in school-age children have generally focused on dietary intake, diet quality, or anthropometric measures, and the number of studies evaluating them together is limited.

OBJECTIVE

It was aimed to evaluate the relationship between dental caries adherence to the Mediterranean Diet (MD), dietary intake, and Body Mass Index (BMI) in school-age children.

MATERIALS AND METHODS

This study was conducted with 300 healthy children (52.0% boys, 48.0% girls) aged between 6 and 12 years. The data collection forms included sociodemographic characteristics, oral health practices of children, Mediterranean Diet Quality Index for children and adolescents (KIDMED), and food consumption records. Anthropometric measurements (body weight and height) of the children were taken. Dental examinations were performed by a pediatric dentist.

RESULTS

While the DMFT mean score of the children was 1.7 ± 2.09, the mean dft score was 2.9 ± 3.29. The mean of KIDMED scores was 5.9 ± 3.32. DMFT and dft scores decreased statistically as maternal education increased (p < 0.05). DMFT and dft scores were not statistically different between BMI groups according to gender and age (p > 0.05). DMFT scores differed statistically between KIDMED groups (p < 0.05). This difference was between low-optimal and low-improvement-needed groups. While there was a low negative correlation (r=-0.169) between calcium intake and DMFT score, a low positive correlation was found between glucose (r = 0.172) and fructose (r = 0.149) intake and dft score (p < 0.05). In regression analysis, while the children's age related DMFT scores positively, maternal education and KIDMED scores related DMFT scores negatively. Also, children's age and maternal education related dft scores negatively.

CONCLUSION

In this study, adherence to the MD rather than nutrients was found to be important in dental caries. Also maternal education level was also found to be a determinant factor in dental caries in children. DMFT and dft did not differ between BMI groups.Further studies should be conducted to assess the impact of the MD on dental caries in children to develop dietary interventions for preventative purposes.

Efficient clearance of periodontitis pathogens by S. gordonii membrane-coated H2O2 self-supplied nanocomposites in a "Jenga" style

As a key pathogen of periodontitis, P. gingivalis requires support of the initial colonizing bacterium (S. gordonii preferably) to form symbiotic biofilms on gingival tissues with enhanced antibiotic resistance. Here, we report a new strategy to treat periodontitis biofilms with S. gordonii membrane-coated H2O2 self-supplied nanocomposites (ZnO2/Fe3O4@MV NPs) in a "Jenga" style. Integration of our special MV coatings enables selectively enhanced internalization of the cargos in S. gordonii, thus inducing severe damage to the foundational bacterial layer and collapse/clearance of symbiotic biofilms consequently. This strategy allows us to clear the symbiotic biofilms of S. gordonii and P. gingivalis with active hydroxyl radicals (˙OH) derived from ZnO2-Fe3O4@MV NPs in a H2O2 self-supplied, nanocatalyst-assisted manner. This "Jenga-style" treatment provides a cutting-edge proof of concept for the removal of otherwise robust symbiotic biofilms of periodontitis where the critical pathogens are difficult to target and have antibiotic resistance.

Knowledge, perceptions, and behavior regarding children's oral health among Syrian pediatricians: a cross-sectional study

BACKGROUND

Oral health has a direct impact on health-related quality of life (HRQoL). Hence, general health and oral health cannot be separated. Pediatricians play a pivotal role in providing primary care for infants and are the first to interact with them since birth. Therefore, the aim of this study was to evaluate the knowledge, perceptions, and behavior of Syrian pediatricians regarding children's oral health.

METHODS

This was a cross-sectional study. The questionnaire consisted of six main sections and required answers regarding demographic characteristics, knowledge, behavior, perceptions, and training received in oral health. The association between categorical variables was tested with Pearson's chi-square tests and Fishers exact tests using SPSS ver. 23.

RESULTS

The response rate was 43.12% (229/531). Most of the participants (64.02%) got a poor level of knowledge and no significant association was found between knowledge level and years of experience (p = 0.270). The majority of the participants (99.13%) perceived that diet, bacteria, and sugar exposure time are the etiological factors of dental caries. The overwhelming majority of the participants (98.25%) acknowledged the need for further oral health training during residency.

CONCLUSIONS

Most pediatricians reported a poor level of knowledge. It is recommended to update the postgraduate and residency curriculum to equip pediatricians with adequate knowledge regarding children's oral health.

Effectiveness of a Combined Toothbrushing Technique on Cariogenic Dental Biofilm in Relation to Stainless Steel and Elastomeric Ligatures in Orthodontic Patients: A Randomized Clinical Trial

Increased dental biofilm commonly occurs during orthodontic treatment. The aim of this study was to evaluate the effect of a combined toothbrushing method on dental biofilm cariogenicity in patients with stainless steel (SSL) and elastomeric (EL) ligatures. At baseline (T1), 70 participants were randomized (1:1 ratio) to the SSL or EL group. Dental biofilm maturity was evaluated using a three-color-disclosing dye. The participants were instructed to brush their teeth using a combined horizontal-Charters-modified Bass technique. Dental biofilm maturity was reassessed at the 4-week follow-up (T2). We found that at T1, new dental biofilm was the highest, followed by mature and cariogenic dental biofilm in the SSL group (p < 0.05). In the EL group, cariogenic dental biofilm was highly observed, followed by mature and new dental biofilm (p < 0.05). After intervention, cariogenic dental biofilm significantly decreased in both groups (p < 0.05). Moreover, a marked decrease in cariogenic dental biofilm was observed in the EL group compared with the SSL group (p < 0.05). However, the change in mature dental biofilm in the groups was similar (p > 0.05). Our results demonstrated that the combined toothbrushing method reduced cariogenic dental biofilm in the SSL and EL groups.

Glycemic index and insulin index after a standard carbohydrate meal consumed with live kombucha: A randomised, placebo-controlled, crossover trial

Introduction

Kombucha is a complex probiotic beverage made from fermented tea, yet despite extensive historical, anecdotal, and in-vivo evidence for its health benefits, no controlled trials have been published on its effect on humans.

Methods

We conducted a randomised placebo-controlled, cross-over study that examined the Glycemic Index (GI) and Insulin Index (II) responses after a standardised high-GI meal consumed with three different test beverages (soda water, diet lemonade soft drink and an unpasteurised kombucha) in 11 healthy adults. The study was prospectively registered with the Australian New Zealand Clinical Trials Registry (anzctr.org.au: 12620000460909). Soda water was used as the control beverage. GI or II values were calculated by expressing the 2-h blood glucose or insulin response as a percentage of the response produced by 50 g of glucose dissolved in water.

Results

There was no statistically significant difference in GI or II between the standard meal consumed with soda water (GI: 86 and II: 85) or diet soft drink (GI: 84 and II: 81, (p = 0.929 for GI and p = 0.374 for II). In contrast, when kombucha was consumed there was a clinically significant reduction in GI and II (GI: 68, p = 0.041 and II: 70, p = 0.041) compared to the meal consumed with soda water.

Discussion

These results suggest live kombucha can produce reductions in acute postprandial hyperglycemia. Further studies examining the mechanisms and potential therapeutic benefits of kombucha are warranted.

Regulations on nutrition in Indonesia and its relation to early childhood caries

There is a close relationship between food and nutrition policies and oral health. The relationship between nutrition and dental problems has been widely discussed, including the major dental problem in children: early childhood caries (ECC). Health-oriented national policies are the main principles of public health welfare. This article is a policy brief that provide a review of the food and nutrition policies in Indonesia that may have a relationship with ECC. It is concluded that some policies support the efforts to prevent ECC however, other technical explanations are still needed for health workers and especially parents regarding its simple implementation in everyday life. Multisectoral approaches that includes health, nutrition and education are needed to address ECC.