1
|
García-Manríquez N, Lozano C, Muñoz A, Morales MF, Giacaman RA. Anticaries properties of natural berries: systematic literature review. Nutr Rev 2024; 82:302-317. [PMID: 37352393 DOI: 10.1093/nutrit/nuad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Abstract
CONTEXT Anticariogenic properties have been ascribed to polyphenolic compounds present in high concentrations in numerous fruits. Berries, in particular, have been reported as potentially having an inhibitory effect on the dental biofilm and subsequently on caries, but the evidence is unclear. OBJECTIVE The objective of this review was to explore the literature and summarize the evidence for berries having an inhibitory effect on the dental biofilm and an anticariogenic effect. DATA SOURCES Following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, the PubMed, Web of Science, and SCOPUS databases were scanned using predefined and accessible terms, with a search strategy based on a structured PICO question. DATA EXTRACTION After article selection, 23 studies met the inclusion criteria, most of them being in vitro studies. A risk assessment was performed, and data were extracted and presented in a table for qualitative analysis. DATA ANALYSIS Meta-analyses were conducted using standardized mean differences (SMDs) with a 95% confidence interval (CI) by Review manager 5.4. RESULTS Only 3 types of berries were found to have a reported anticaries effect: grape seed extract (GSE), cranberry, and sour cherry. Nine studies that fulfilled the eligibility criteria were subjected to quantitative analysis. Meta-analyses showed GSE was associated with enhanced remineralization of dental enamel (SMD = .96 95% CI [.45, 1.46], P < .0002) and of dentin (SMD = .65 95% CI [.13, 1.17], P = .01). Cranberry extracts positively influenced the cariogenic dental biofilm by decreasing the biofilm biomass (SMD = -2.23 95% CI [-4.40, -.05], P = .04), and biovolume (SMD = -2.86 95% CI [-4.34, -1.37], P = .0002), and increasing the biofilm pH (SMD = 7.9 95% CI [3.49, 12.31], P < .0004). CONCLUSION Within the limitations of this systematic review and metaanalysis, GSE and cranberries or their active compounds could represent an alternative for caries management. Further clinical trials are needed to verify this effect in a clinical setting. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42020223579.
Collapse
Affiliation(s)
- Natalia García-Manríquez
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
| | - Carla Lozano
- Biochemistry and Oral Biology Laboratory, Research Institute for Dental Sciences, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Ana Muñoz
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
| | - María Fernanda Morales
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
| | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
- Biochemistry and Oral Biology Laboratory, Research Institute for Dental Sciences, Faculty of Dentistry, University of Chile, Santiago, Chile
- In teruniversity Center for Healthy Aging, Chilean State Universities, Chile
| |
Collapse
|
2
|
Carletto-Kórber FPM, Sorazabal A, Medici S, Ali S, Barrionuevo A, Cardozo J, Cucchi A, D'Eramo L, Escandriolo J, Fontanetti P, García S, Lombardo A, Mardenlli A, Masoli C, Mulbany P, Pereira L, Pérez S, Preliasco M, Rossi G, Squassi A, Ulloque J, Vaculik P, Ventrera V, Bordoni N, Giacaman RA. Core curriculum in cariology for dentistry degrees in the Republic of Argentina. Acta Odontol Latinoam 2023; 36:183-190. [PMID: 38345281 PMCID: PMC10867854 DOI: 10.54589/aol.36/3/183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/01/2023] [Indexed: 02/15/2024]
Abstract
Aim To prepare a consensus document of the cariology contents and competences included in the curriculum for the dentistry degree at Argentine dental faculties/schools. Materials and Method Planning the process in stages: Stage 1- Diagnosis of the situation (Google Form) and invitation to participate extended to the 20 academic units (AU) that offer dentistry degrees. Stage 2- Assessment process of Content (C) and Competences (I) agreements in the five domains: D1 Basic Sciences, D2 Risk and diagnosis of dental caries, D3 Decision-making for non-invasive treatments, D4 Decision-making for invasive treatment, and D5 Evidence-based cariology at community level. Stage 3- Consensus. Stages 2 and 3 were held in Workshop format in virtual mode (W). Results Stage 1- Of the total 20 Google forms sent to the AU, 13 responses were received: 7 from National Universities and 6 from Private Universities. All participants agreed to be part of the consensus. Stage 2- W: 20 representatives from 10 AU participated. It began with a contextualizing conference, after which the representatives were divided into 5 groups to assess the agreements of each D. Stage 3- The Cariology Curriculum document was organized into 5 Domains, and 23 C and 31 I of clinical application were defined for teaching cariology. The contents and competences for each domain were agreed upon. The final document was sent to all W participants for their approval and dissemination in each AU involved. Conclusion Cariology contents were defined for dentistry students at Universities in the Argentine Republic.
Collapse
Affiliation(s)
- Fabiana PM Carletto-Kórber
- Universidad Nacional de Córdoba. Facultad de Odontología. Departamento de Odontología Preventiva y Comunitaria. Córdoba-Argentina.
| | - Ana Sorazabal
- Universidad de Buenos Aires. Facultad de Odontología. Buenos Aires-Argentina
| | - Silvia Medici
- Universidad de Buenos Aires. Facultad de Odontología. Buenos Aires-Argentina
| | - Sofía Ali
- Universidad Nacional del Nordeste. Facultad de Odontología. Corrientes-Argentina
| | | | - Juana Cardozo
- Universidad Nacional del Nordeste. Facultad de Odontología. Corrientes-Argentina
| | - Analía Cucchi
- Universidad Maimonides. Facultad de Odontología. Buenos Aires-Argentina
| | - Luciana D'Eramo
- Universidad de Buenos Aires. Facultad de Odontología. Buenos Aires-Argentina
| | - Jorge Escandriolo
- Universidad Adventista del Plata. Facultad de Odontología. Entre Ríos-Argentina
| | - Pablo Fontanetti
- Universidad Nacional de Córdoba. Facultad de Odontología. Departamento de Odontología Preventiva y Comunitaria. Córdoba-Argentina
| | - Shirley García
- Universidad Abierta Interamericana. Facultad de Odontología. Buenos Aires-Argentina
| | - Adriana Lombardo
- Universidad del Salvador. Facultad de Odontología. Buenos Aires-Argentina
| | - Alejandra Mardenlli
- Universidad Nacional de Rosario. Facultad de Odontología. Santa Fé-Argentina
| | - Carla Masoli
- Universidad de Buenos Aires. Facultad de Odontología. Buenos Aires-Argentina
- Universidad del Salvador. Facultad de Odontología. Buenos Aires-Argentina
| | - Patricia Mulbany
- Universidad Nacional de Río Negro. Facultad de Odontología. Río Negro-Argentina
| | - Lía Pereira
- Universidad Abierta Interamericana. Facultad de Odontología. Buenos Aires-Argentina
| | - Silvia Pérez
- Universidad Nacional del Nordeste. Facultad de Odontología. Corrientes-Argentina
| | - Mariana Preliasco
- Universidad Nacional de Río Negro. Facultad de Odontología. Río Negro-Argentina
| | - Glenda Rossi
- Universidad de Buenos Aires. Facultad de Odontología. Buenos Aires-Argentina
| | - Aldo Squassi
- Universidad de Buenos Aires. Facultad de Odontología. Buenos Aires-Argentina
| | - Jorgelina Ulloque
- Universidad Católica de Córdoba. Facultad de Ciencias de la Salud. Córdoba-Argentina
| | - Patricia Vaculik
- Universidad Nacional del Nordeste. Facultad de Odontología. Corrientes-Argentina
| | - Verónica Ventrera
- Universidad Nacional de Cuyo. Facultad de Odontología. Mendoza-Argentina
| | - Noemí Bordoni
- Universidad de Buenos Aires. Facultad de Odontología. Buenos Aires-Argentina
| | - Rodrigo A Giacaman
- Universidad de Talca, Facultad de Odontología, Unidad de Cariología, Departamento de Rehabilitación Buco Maxilofacial. Talca-Chile
| |
Collapse
|
3
|
Campus G, Jenni MML, Betancourt MD, Cagetti MG, Giacaman RA, Manton DJ, Douglas GVA, Carvalho JC, Wolf TG. The COVID-19 Pandemic and Dental Professionals' Infection Risk Perception: An International Survey. J Clin Med 2023; 12:6762. [PMID: 37959228 PMCID: PMC10650638 DOI: 10.3390/jcm12216762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
A global survey among dentists was used to identify the various impacts of the COVID-19 pandemic on this professional group. Special attention was given to perception and assessment of infection risk. From May to August 2020, the questionnaire was delivered in 36 countries by respective research groups and was completed by 52,491 dental professionals. The survey was designed as a cross-sectional survey based on a previously standardized questionnaire. This study focuses on the part of the questionnaire that deals with the perception of the infection risk of COVID-19 by dentists and their patients. A logistic regression model was used, which consisted of four Likert items as response options and the additional self-reported routine or emergency treatment as the dependent variable. Analysis by continent found that European and Asian dentists were particularly likely to be infected at work (OR = 1.45 95%CI = 1.02/1.84 and OR = 2.68, 95%CI = 1.45/3.22, respectively), while it was likely that Australian dentists did not feel particularly at risk due to low infection rates. Three quarters of Americans treated only emergencies during this survey period, while Europeans (64.71%) and Asians (66.67%) provided mostly routine care. This could affect the Europeans' confidence that they would not be able to protect themselves from infections in the long-term. The COVID-19 pandemic and its impact on dental professionals' infection risk perception is determined by the geographical origin of dentists. This study shows that, especially in high-incidence countries, infection risk perception was higher when dentists tried to provide routine dental procedures to their patients. Dental professionals can offer themselves and their patients good protection by maintaining high standards of hygiene. However, their concerns should be taken seriously and the dental professionals' group that is of great importance for oral health care and prevention, should not be neglected in the future, even in the event of emerging pandemics.
Collapse
Affiliation(s)
- Guglielmo Campus
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Viale San Pietro, 07100 Sassari, Italy
| | - Magdalena Marie-Luise Jenni
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland
| | - Marcela Diaz Betancourt
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland
| | - Maria Grazia Cagetti
- Department of Biomedical, Surgical and Dental Science, University of Milan, 20142 Milan, Italy
| | - Rodrigo A. Giacaman
- Cariology and Gerodontology Units, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca 3460000, Chile
| | - David J. Manton
- Cariology, Centrum voor Tandheelkunde en Mondzorgkunde, Universitair Medisch Centrum Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
| | - Gail V. A. Douglas
- Department of Dental Public Health, School of Dentistry, University of Leeds, Leeds LS2 9JT, UK
| | - Joana C. Carvalho
- Faculty of Medicine and Dentistry, UCLouvain, 1200 Brussels, Belgium
| | - Thomas Gerhard Wolf
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland
- Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| |
Collapse
|
4
|
León S, Giacaman RA, Araya-Bustos F, Venegas S, Saavedra N, Hugo FN, De Marchi RJ, Muñoz MF, Salazar C, Castrejón-Pérez RC, Bustillos L, Fortanete A, de López AC, Aredes JE, Marín-Zuluaga D, Elias-Boneta A. Current status of geriatric dentistry education in selected dental schools in Latin America and the Caribbean. Gerodontology 2023. [PMID: 37792411 DOI: 10.1111/ger.12714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Latin American and Carribean (LAC) are currently experiencing a rapid aging of their population, coupled with a significant burden of oral diseases. Despites this, there is a scarcity of evidence regarding the manner in wich geriatric dentistry is being taught in dental schools across LAC. So, the objective of this study is to investigate the current status of geriatric dentistry education at undergraduate and postgraduate levels in selected LAC dental schools. METHODS An electronic questionnaire was developed and emailed to all 539 dental schools in 19 LAC countries. The questionnaire recorded activity levels, contents and methodology of geriatric dentistry education as part of dental degree programmes. Reminders by email and telephone calls were used to encourage non-responders to complete the questionnaire. RESULTS In total, 317 schools from 17 countries responded to the questionnaire (response rate: 58.8%). Geriatric dentistry was taught in 54.6% of the schools at the undergraduate level and in 6.9% at the postgraduate level. Thirty two percent of the schools had a programme director trained in geriatric dentistry. Geriatric dentistry was taught as an independent course in 14.5% of the schools. Dry mouth, periodontal disease, denture-related conditions and prosthodontic management, oral mucosal disease and age-related changes of the orofacial complex were the most frequently covered topics. Clinical teaching of geriatric dentistry was reported by 26.5% of the schools, with 38.0% providing clinical training in outreach facilities. CONCLUSIONS Geriatric dentistry education remains incipient in LAC, with only one in every four dental school offering it as a standalone course. There is an urgent need to further develop geriatric dentistry education in the continent, including further research to develop a minimum geriatric dentistry curriculum.
Collapse
Affiliation(s)
- Soraya León
- Gerodontology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca and Interuniversity Center for Healthy Aging, Talca, Chile
| | - Rodrigo A Giacaman
- Gerodontology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca and Interuniversity Center for Healthy Aging, Talca, Chile
| | - Francisca Araya-Bustos
- Gerodontology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca and Interuniversity Center for Healthy Aging, Talca, Chile
| | - Sardi Venegas
- Gerodontology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca and Interuniversity Center for Healthy Aging, Talca, Chile
| | - Nicole Saavedra
- Gerodontology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca and Interuniversity Center for Healthy Aging, Talca, Chile
| | - Fernando Neves Hugo
- Departamento de Odontologia Preventiva e Social, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Renato J De Marchi
- Departamento de Odontologia Preventiva e Social, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | | | | | | | | | | | | | | | | | - Augusto Elias-Boneta
- Recinto de Ciencias Médicas, Escuela de Medicina Dental, Universidad de Puerto Rico, San Juan, Puerto Rico
| |
Collapse
|
5
|
Campus G, Giacaman RA, Carvalho JC. Chapter 2: Epidemiology of Coronal Caries. Monogr Oral Sci 2023; 31:4-18. [PMID: 37364553 DOI: 10.1159/000530560] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/12/2023] [Indexed: 06/28/2023]
Abstract
This chapter summarizes the clinical data on coronal caries distribution and sociodemographic drivers in children, adults, and older people, at a global level. Mapping global caries prevalence showed an extreme variation on the prevalence, revealing still high rates in several countries. The disease is presented in each group as prevalence by age and mean number of affected teeth. Differences in the prevalence of dental caries in developed and developing countries may be due to not only wide variations in the age groups studied but also ethnic, cultural, geographic, and developmental differences, as well as access to dental services, healthcare availability, oral healthcare behaviors, nutritional habits, and lifestyles. The prevalence of caries in children and adults showed a decreasing trend in Western countries, notwithstanding the distribution of the disease is highly skewed linked to individual and community determinants. In older persons, a high caries prevalence up to 98% has been reported, with a very heterogeneous distribution among and within countries. Although still highly prevalent, a declining trend for tooth loss was observed. The patterns of the association between sociodemographic indicators and caries data indicate the need of a reform of the global oral healthcare system considering all the life course and caries inequalities. Further needs are related to the production of primary data on oral health to provide support to policymakers to create the national oral healthcare policies guided by epidemiology-based models of care.
Collapse
Affiliation(s)
- Guglielmo Campus
- Faculty of Medicine and Dentistry, University of Bern, Bern, Switzerland
- School of Dentistry, University of Sassari, Sassari, Italy
| | | | | |
Collapse
|
6
|
Castro RJ, Gambetta-Tessini K, Clavijo I, Arthur RA, Maltz M, Giacaman RA. Caries Experience in Elderly People Consuming a Milk-Based Drink Nutritional Supplement: A Cross-Sectional Study. Caries Res 2023; 57:211-219. [PMID: 37315548 DOI: 10.1159/000531546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 06/08/2023] [Indexed: 06/16/2023] Open
Abstract
Nutritional supplements have been recommended to cope with malnutrition in elderly persons. In Chile, the Supplementary Nutrition Program for the Elderly (PACAM, for its Spanish acronym) consists in a monthly distribution of a low-fat-milk-based drink that contains 8% sucrose. The aim of this study was to determine whether older persons consuming the milk-based drink have a higher caries experience when compared to those not receiving the supplement. A cross-sectional study was conducted in the Maule Region in Chile. The representative sample comprised two groups: (a) PACAM consumers (CS) (n = 60) and (b) nonconsumers (NCS) (n = 60). Participants received intraoral examination and coronal (DMFT/DMFS) and root caries (RCI index) experience were recorded. Additionally, questionnaires regarding acceptability and consumption habits of PACAM and a 24-h diet recall were applied. The influence of predictors was calculated using binary logistic regression for a dichotomized DMFS and Poisson Regression for root caries lesions. A p value <0.05 was considered significant. No differences were detected in food consumption patterns between study groups (p > 0.05). CS participants had increased dairy product consumption. Higher DMFS mean value was observed in the CS (85.35 ± 39.0) compared with NCS (77.28 ± 28.9) (p = 0.043). The multivariate analysis showed nonconsumers of the milk-based product (β = -0.41, p = 0.02) are less likely to have root surfaces affected by caries. Additionally, CS show higher RCI, compared to nonconsumers (β = -0.17, p = 0.02). Daily consumption of a PACAM's milk-based drink supplement seems to increase coronal and root caries risk. Based on these results, composition modification of milk-based drinks with added sucrose appears mandatory.
Collapse
Affiliation(s)
- Ramiro J Castro
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
- Interuniversity Center on Healthy Aging, Talca, Chile
| | - Karla Gambetta-Tessini
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
| | - Ignacio Clavijo
- Master's Program in Geriatric Dentistry, Faculty of Dentistry, University of Talca, Talca, Chile
| | - Rodrigo A Arthur
- Preventive and Community Dentistry Department, Dental School, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Marisa Maltz
- Preventive and Community Dentistry Department, Dental School, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
- Interuniversity Center on Healthy Aging, Talca, Chile
| |
Collapse
|
7
|
Giacaman RA, Umaña R, Nuñez MJ, Díaz-Garrido N, Echeverría C, García-Manríquez N, Mira A, Fernández CE, Gambetta-Tessini K, Lozano CP. Saliva Decreases Sucrose-Induced Cariogenicity in an Experimental Biological Caries Model. Microorganisms 2023; 11:1426. [PMID: 37374928 DOI: 10.3390/microorganisms11061426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE Whether a minimum quantity of saliva inhibit the caries process remains uncertain. This study aimed to investigate the impact of saliva dilutions on an in vitro caries model using Streptococcus mutans (S. mutans) biofilms. METHODS S. mutans biofilms were cultivated on enamel and root dentin slabs, in culture media containing different proportions of saliva (v/v): 0%, 5%, 10%, 25%, 50%, 75%, and 100% saliva, and exposed to a 10% sucrose solution (5 min, 3x/day), with appropriate controls. After 5 (enamel) and 4 (dentin) days, demineralization, biomass, viable bacteria, and polysaccharide formation were analyzed. The acidogenicity of the spent media was monitored overtime. Each assay was performed in triplicate across two independent experiments (n = 6). RESULTS In both enamel and dentin, an inverse relationship was observed between acidogenicity, demineralization, and the proportion of saliva. Even small quantities of saliva incorporated into the media led to a noticeable reduction in enamel and dentin demineralization. Saliva presence resulted in significant reductions in biomass, viable S. mutans cells, and polysaccharides, with the effects being concentration-dependent for both tissues. CONCLUSIONS High quantities of saliva can almost completely inhibit sucrose-induced cariogenicity, while even small amounts exhibit a dose-dependent caries-protective effect.
Collapse
Affiliation(s)
- Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca 3462227, Chile
- Interuniversity Center for Healthy Aging, Consortium of Chilean State Universities, Chilecito 03825, Chile
| | - Rodrigo Umaña
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca 3462227, Chile
| | - María José Nuñez
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca 3462227, Chile
| | - Natalia Díaz-Garrido
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca 3462227, Chile
| | - Constanza Echeverría
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca 3462227, Chile
| | - Natalia García-Manríquez
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca 3462227, Chile
| | - Alex Mira
- Genomics and Health Department, Foundation for the Promotion of Health and Biomedical Research (FISABIO), 46020 Valencia, Spain
| | - Constanza E Fernández
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca 3462227, Chile
| | - Karla Gambetta-Tessini
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca 3462227, Chile
| | - Carla P Lozano
- Laboratory of Biochemistry and Oral Biology, Institute for Research in Dental Sciences, Faculty of Dentistry, University of Chile, Santiago 8330111, Chile
| |
Collapse
|
8
|
Treerat P, Anderson D, Giacaman RA, Merritt J, Kreth J. Glycerol metabolism supports oral commensal interactions. ISME J 2023:10.1038/s41396-023-01426-9. [PMID: 37169870 DOI: 10.1038/s41396-023-01426-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/19/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023]
Abstract
During oral biofilm development, interspecies interactions drive species distribution and biofilm architecture. To understand what molecular mechanisms determine these interactions, we used information gained from recent biogeographical investigations demonstrating an association of corynebacteria with streptococci. We previously reported that Streptococcus sanguinis and Corynebacterium durum have a close relationship through the production of membrane vesicle and fatty acids leading to S. sanguinis chain elongation and overall increased fitness supporting their commensal state. Here we present the molecular mechanisms of this interspecies interaction. Coculture experiments for transcriptomic analysis identified several differentially expressed genes in S. sanguinis. Due to its connection to fatty acid synthesis, we focused on the glycerol-operon. We further explored the differentially expressed type IV pili genes due to their connection to motility and biofilm adhesion. Gene inactivation of the glycerol kinase glpK had a profound impact on the ability of S. sanguinis to metabolize C. durum secreted glycerol and impaired chain elongation important for their interaction. Investigations on the effect of type IV pili revealed a reduction of S. sanguinis twitching motility in the presence of C. durum, which was caused by a decrease in type IV pili abundance on the surface of S. sanguinis as determined by SEM. In conclusion, we identified that the ability to metabolize C. durum produced glycerol is crucial for the interaction of C. durum and S. sanguinis. Reduced twitching motility could lead to a closer interaction of both species, supporting niche development in the oral cavity and potentially shaping symbiotic health-associated biofilm communities.
Collapse
Affiliation(s)
- Puthayalai Treerat
- Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA.
| | - David Anderson
- Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA
| | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
| | - Justin Merritt
- Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA
- Department of Molecular Microbiology and Immunology, School of Medicine, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA
| | - Jens Kreth
- Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA.
- Department of Molecular Microbiology and Immunology, School of Medicine, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA.
| |
Collapse
|
9
|
Giacaman RA, Maturana CA, Molina J, Volgenant CMC, Fernández CE. Effect of Casein Phosphopeptide-Amorphous Calcium Phosphate Added to Milk, Chewing Gum, and Candy on Dental Caries: A Systematic Review. Caries Res 2023; 57:106-118. [PMID: 37054690 DOI: 10.1159/000530638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/04/2023] [Indexed: 04/15/2023] Open
Abstract
Casein is one of the most studied proteins with activity against dental caries. In particular, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) has shown promising remineralizing properties. In vivo evidence on the anticaries potential of CPP-ACP added to foodstuffs is elusive, nonetheless. Hence, this systematic review aimed at determining whether the use of CPP-ACP added to foodstuffs has a remineralizing or inhibitory action on dental demineralization either in vivo or in situ. The review protocol followed the PRISMA-P criteria and was registered in PROSPERO. PubMed, Scopus, and Web of Science databases were searched using predefined criteria, based on the PICO question: Is there an effect on dental caries upon adding CPP-ACP to milk, chewing gums, or candies? No year or language limits were applied. Article selection and data extraction were carried out independently by 2 investigators. Two hundred ten titles were examined, 23 were selected for full-text review, and 16 studies were included (2 in vivo and 14 in situ). CPP-ACP was added to candy in 2 studies, to milk in 2 studies, and to chewing gum in 12 studies. The main outcomes included enamel remineralization and activity against dental biofilm. The overall quality of the evidence was classified as moderate. The available evidence suggests that CPP-ACP added to milk, chewing gum, or candy has a potential remineralizing activity on tooth enamel, with some additional antibacterial activity on the dental biofilm. Further clinical studies are needed to verify if this effect is clinically significant in reducing the caries lesion incidence or to revert the demineralizing process.
Collapse
Affiliation(s)
- Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
- Interuniversity Center for Healthy Aging, Chilean State Universities, Santiago, Chile
- Academic Centre for Dentistry Amsterdam (ACTA), Department of Cariology, Vrije Universiteit Amsterdam and Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - Catalina A Maturana
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
| | - José Molina
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
| | - Catherine M C Volgenant
- Academic Centre for Dentistry Amsterdam (ACTA), Department of Cariology, Vrije Universiteit Amsterdam and Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - Constanza E Fernández
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
| |
Collapse
|
10
|
Rösing CK, Randall C, Giacaman RA. Editorial: Dental caries and periodontal diseases as non-communicable chronic diseases. Front Oral Health 2023; 3:1113029. [PMID: 36686600 PMCID: PMC9852967 DOI: 10.3389/froh.2022.1113029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/06/2022] [Indexed: 01/07/2023] Open
Affiliation(s)
- Cassiano Kuchenbecker Rösing
- School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil,Correspondence: Cassiano Kuchenbecker Rösing
| | - Cameron Randall
- University of Washington School of Dentistry, University of Washington, Seattle, WA, United States
| | | |
Collapse
|
11
|
Giacaman RA, Fernández CE, Muñoz-Sandoval C, León S, García-Manríquez N, Echeverría C, Valdés S, Castro RJ, Gambetta-Tessini K. Understanding dental caries as a non-communicable and behavioral disease: Management implications. Front Oral Health 2022; 3:764479. [PMID: 36092137 PMCID: PMC9448953 DOI: 10.3389/froh.2022.764479] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
New paradigms in caries conceptualization have emerged during the last decades, leading to intense debate and discussion on how to approach the disease, both from a preventive and a therapeutic perspective. Among many new ideas, research discoveries and technologies, one major concept can be highlighted that created a deep frontier between the old and the new paradigm in caries conceptualization; the non-communicable nature of the disease, firmly associated with behaviors and lifestyles. This article synthetizes the conceptual construction of dental caries as a non-communicable disease (NCD) based on the current evidence and discusses the appropriate management of the disease in this context. Dental caries has shifted from being considered transmissible and infectious to an ecological and non-communicable disease. Environmental factors such as frequent sugars intake, disrupt the symbiosis of the dental biofilm leading to a dysbiosis, which favors caries lesion initiation and progression. As an NCD, dental caries shares characteristics with other NCDs such as cardiovascular and chronic respiratory diseases, cancer and diabetes, including long duration and slow progression, not being transmissible from person-to-person, being strongly related to modifiable behavioral risk factors, and affecting preferentially disadvantaged populations with a strong inequality gradient. Given the high prevalence of dental caries, and its consequences on people's health and quality of life, a recognizable conceptual view of caries as a NCD is required to target an effective management. Current understanding of dental caries supports prevention through acting on the modifiable risk factors (behaviors) and involves management based on an interdisciplinary approach. Communicating these modern concepts among researchers, clinicians and policymakers is needed to decrease the global high burden of the disease.
Collapse
Affiliation(s)
- Rodrigo A. Giacaman
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
- Gerodontology Research Group, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
- Interuniversity Center on Healthy Aging, Punta Arenas, Chile
- Centro de Epidemiología y Vigilancia de las Enfermedades Orales, University of Chile and University of Talca, Santiago, Chile
- *Correspondence: Rodrigo A. Giacaman
| | - Constanza E. Fernández
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
- Gerodontology Research Group, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
| | - Cecilia Muñoz-Sandoval
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
| | - Soraya León
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
- Gerodontology Research Group, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
- Interuniversity Center on Healthy Aging, Punta Arenas, Chile
- Centro de Epidemiología y Vigilancia de las Enfermedades Orales, University of Chile and University of Talca, Santiago, Chile
| | - Natalia García-Manríquez
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
| | - Constanza Echeverría
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
| | - Sebastián Valdés
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
| | - Ramiro J. Castro
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
- Gerodontology Research Group, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
- Interuniversity Center on Healthy Aging, Punta Arenas, Chile
| | - Karla Gambetta-Tessini
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
- Gerodontology Research Group, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
- Centro de Epidemiología y Vigilancia de las Enfermedades Orales, University of Chile and University of Talca, Santiago, Chile
| |
Collapse
|
12
|
Muñoz-Sandoval C, Gambetta-Tessini K, Rodriguez-Jaque C, Bravo-Cavicchioli D, Giacaman RA. Effect of Liners on Composite Resin Microleakage after Selective Carious Lesion Removal. An experimental Study. J Oral Res 2022. [DOI: 10.17126/joralres.2022.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Objetive: To evaluate microleakage of composite resins (CR) placed over different cavitary liners after managing deep caries lesions through selective removal of soft carious tissue to soft dentin (SRCT-S). Material and Methods: Fifty four human teeth were collected for microleakage testing. Each assay comprised ICDAS 5 or ICDAS 6 carious lesions and sound teeth for controls. Sound teeth were prepared with cavities that mirrored the carious teeth cavities, which were prepared with SRCT-S. Sound and carious teeth were further randomly assigned to one of the three experimental groups: Group A: universal adhesive (UA) + CR, Group B: glass ionomer cement liner + UA + CR, and Group C: calcium hydroxide + UA+ CR. Occlusal microleakage (OM) and cervical microleakage (CM) was classified within one of 5 depth categories. ANOVA and Chi-square tests were computed (p<0.05). Results: OM and CM were similarly distributed across subgroups (p>0.05). All Group C samples with carious lesions presented some degree of microleakage. However, no statistically significant differences were observed between groups and within each group (p>0.05). Conclusion: Teeth restored with CR after SRCT-S using calcium hydroxide as a liner material seem to exhibit higher microleakage than those restored using glass ionomer or UA alone. Further clinical research is needed to deepen these findings. Clinical significance: The application of calcium hydroxide as a liner under a composite resin may reduce the longevity of a restoration after performing selective or partial removal of carious tissues. Clinicians should rethink the need of using calcium hydroxide for this application, albeit the lack of clinical evidence.
Collapse
|
13
|
Muñoz-Sandoval C, Gambetta-Tessini K, Botelho JN, Giacaman RA. Detection of cavitated proximal carious lesions in permanent teeth, a visual and radiographic assessment. Caries Res 2022; 56:171-178. [PMID: 35605576 DOI: 10.1159/000525193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/01/2022] [Indexed: 11/19/2022] Open
Abstract
Detection of proximal carious lesion involves the combination of clinical and radiographic methods, both with inherent difficulties. The present cross-sectional study aimed at estimating the prevalence of cavitation in proximal carious lesions, based on a direct clinical assessment of previously detected radiographic lesions, in permanent molars and premolars. Proximal dental surfaces were radiographically evaluated using the ADA coding system and cavitation was determined through clinical visual examination of the surfaces after separation with elastomeric bands. One-hundred and twenty-six patients attending the dental clinics at the University of Talca were examined comprising 508 proximal surfaces with radiographic codes ranging from E1 to D3. Two examiners were trained and calibrated for radiographic and clinical detection of proximal lesions. Most participants were females (61.9%). The age mean of participants was 28.7 (0.8) years old. A total of 22.2% of the examined surfaces were cavitated. Only few lesions coded as E1 (n=4; 2.1%) and E2 (n=9; 9.8%) were cavitated. Fifty D1 (35.5%) and 22 D2 (41.5%) lesions were cavitated after separation. Most lesions coded as D3 (n=28; 84.8%) were cavitated. The multilevel binary regression model (p=0.003) demonstrated that sex, age, jaw, tooth type, surface and side were not associated with the likelihood of having proximal cavitation. Challenging conventional wisdom, most D1 and D2 lesions were not cavitated. Combining detection methods seems desirable to increase the accuracy in assessing approximal posterior lesions. The low proportion of cavitated lesions reinforces the idea of cautiously indicating invasive approaches for managing proximal carious lesions.
Collapse
Affiliation(s)
- Cecilia Muñoz-Sandoval
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
| | - Karla Gambetta-Tessini
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
| | - Juliana N Botelho
- Department of Pediatric Stomatology, Faculty of Dentistry, University of Talca, Talca, Chile
| | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
- Interuniversity Center on Healthy Aging, Curico, Chile
| |
Collapse
|
14
|
Abstract
Demographic changes with an increasingly higher proportion of older adults worldwide and an epidemiologic transition resulting in more teeth retained and higher demand and expectations set up new scenarios for the oral health of the older population. Thus, geriatric dentistry must be reconfigured, transitioning from the traditional focus on prosthesis to a more holistic discipline, actively incorporating geriatric and gerontologic aspects. We describe some situations that provide the rationale for a new conceptual framework for the advancement of geriatric dentistry as a clinical specialty. On the basis of scientific evidence and our academic experience, we propose 4 concepts that should steer the discipline during the following years and become its structural pillars: minimal intervention dentistry, oral functionality, patient-centered care, and interdisciplinary teamwork. Since data and evidence are limited, a special focus on poor and developing countries is incorporated. Adjusting clinical guidelines and public health policies around these concepts will increase access to oral care for older people, including those with physical or social barriers, and will ensure better oral health-related quality of life and well-being. These concepts have deep consequences in the education and training of new dentists and specialists, at the public and private levels.
Collapse
Affiliation(s)
- S León
- Gerodontology and Cariology Units, Department of Oral Rehabilitation, Faculty of Health Sciences, University of Talca, Talca, Chile.,Chilean Society for Geriatric Dentistry, Talca, Chile.,Interuniversity Center on Healthy Aging, Chile
| | - R A Giacaman
- Gerodontology and Cariology Units, Department of Oral Rehabilitation, Faculty of Health Sciences, University of Talca, Talca, Chile.,Chilean Society for Geriatric Dentistry, Talca, Chile.,Interuniversity Center on Healthy Aging, Chile
| |
Collapse
|
15
|
Fernández CE, Maturana CA, Coloma SI, Carrasco-Labra A, Giacaman RA. Teledentistry and mHealth for Promotion and Prevention of Oral Health: A Systematic Review and Meta-analysis. J Dent Res 2021; 100:914-927. [PMID: 33769123 DOI: 10.1177/00220345211003828] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The dental profession has experienced a dramatic acceleration in the use of communication systems and information-based technologies over recent years, originating new paradigms for the prevention and promotion of oral health. The purpose of this systematic review was to determine the effect of teledentistry-based (telematic) strategies, reported in randomized controlled trials and quasi-randomized trials, with a focus on oral health prevention and promotion-related outcomes in patients of all ages. We searched Medline via PubMed, SCOPUS, and Web of Science from inception until August 2020, regardless of the language of publication. We selected studies for inclusion and conducted data extraction, assessed risk of bias (Cochrane tool), and evaluated the certainty of the evidence (GRADE approach) in duplicate and independently. Out of 898 potentially eligible references, we selected 43 for full-text screening, of which 19 studies proved eligible: 18 randomized controlled trials and 1 quasi-randomized study. Virtual interventions were mostly asynchronous via apps (n = 9), text messages (n = 9), or computer-aided learning (n = 1). The use of teledentistry as compared with conventional strategies may result in a large reduction in the plaque index (standardized mean difference, -1.18; 95% CI, -1.54 to -0.82; I2 = 92%; low certainty) and will likely result in a large reduction in the gingival index (standardized mean difference, -2.17; 95% CI, -3.15 to -1.19; I2 = 97%; moderate certainty) and in the incidence of white spot lesions (risk ratio, 0.48; 95% CI, 0.35 to 0.66; I2 = 0%; moderate certainty), with an increased effect over time. Evidence suggests that teledentistry, particularly mHealth (messages and apps), is a promising clinical tool for preventing and promoting oral health, especially under the accelerated virtualization of dentistry. Future studies should include a broader spectrum of the population, including adults and elders, to better inform policy and implementation of teledentistry (PROSPERO: CRD42020192685).
Collapse
Affiliation(s)
- C E Fernández
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - C A Maturana
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - S I Coloma
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - A Carrasco-Labra
- Department of Evidence Synthesis and Translation Research, Science and Research Institute, American Dental Association, Chicago, IL, USA
- Department of Oral and Craniofacial Health Science, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - R A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Health Sciences, University of Talca, Talca, Chile
| |
Collapse
|
16
|
Paris S, Banerjee A, Bottenberg P, Breschi L, Campus G, Doméjean S, Ekstrand K, Giacaman RA, Haak R, Hannig M, Hickel R, Juric H, Lussi A, Machiulskiene V, Manton D, Jablonski-Momeni A, Santamaria R, Schwendicke F, Splieth CH, Tassery H, Zandona A, Zero D, Zimmer S, Opdam N. How to Intervene in the Caries Process in Older Adults: A Joint ORCA and EFCD Expert Delphi Consensus Statement. Caries Res 2020; 54:1-7. [PMID: 33291110 DOI: 10.1159/000510843] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 11/19/2022] Open
Abstract
AIM To provide recommendations for dental clinicians for the management of dental caries in older adults with special emphasis on root caries lesions. METHODS A consensus workshop followed by a Delphi consensus process were conducted with an expert panel nominated by ORCA, EFCD, and DGZ boards. Based on a systematic review of the literature, as well as non-systematic literature search, recommendations for clinicians were developed and consented in a two-stage Delphi process. RESULTS Demographic and epidemiologic changes will significantly increase the need of management of older adults and root caries in the future. Ageing is associated with a decline of intrinsic capacities and an increased risk of general diseases. As oral and systemic health are linked, bidirectional consequences of diseases and interventions need to be considered. Caries prevention and treatment in older adults must respond to the patient's individual abilities for self-care and cooperation and often involves the support of caregivers. Systemic interventions may involve dietary counselling, oral hygiene instruction, the use of fluoridated toothpastes, and the stimulation of salivary flow. Local interventions to manage root lesions may comprise local biofilm control, application of highly fluoridated toothpastes or varnishes as well as antimicrobial agents. Restorative treatment is often compromised by the accessibility of such root caries lesions as well as the ability of the senior patient to cooperate. If optimum restorative treatment is impossible or inappropriate, long-term stabilization, e.g., by using glass-ionomer cements, and palliative treatments that aim to maintain oral function as long and as well as possible may be the treatment of choice for the individual.
Collapse
Affiliation(s)
- Sebastian Paris
- Department of Operative and Preventive Dentistry, Center for Dental and Craniofacial Sciences, Charité - Universitätsmedizin Berlin, Berlin, Germany,
| | - Avijit Banerjee
- Conservative & MI Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom
| | - Peter Bottenberg
- Oral Health Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lorenzo Breschi
- Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna - Alma Mater Studiorum, Bologna, Italy
| | - Guglielmo Campus
- Department of Restorative, Preventive and Paediatric Dentistry, Zahnmedizinische Kliniken (ZMK), University of Bern, Bern, Switzerland
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Sassari, Italy
| | - Sophie Doméjean
- Département d'Odontologie Conservatrice, Université Clermont Auvergne, UFR d'Odontologie, Centre de Recherche en Odontologie Clinique Clermont-Ferrand, Clermont-Ferrand, France
| | - Kim Ekstrand
- Cariology and Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University Leipzig, Leipzig, Germany
| | - Matthias Hannig
- Clinic of Operative Dentistry and Periodontology, Saarland University, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Munich, Germany
| | - Hrvoje Juric
- Department of Paediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Adrian Lussi
- School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Operative Dentistry and Periodontology, Faculty of Dentistry, University Medical Centre, Freiburg, Germany
| | - Vita Machiulskiene
- Clinic of Dental and Oral Pathology, Faculty of Odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - David Manton
- Centrum van Tandheelkunde en Mondzorgkunde, Universitair Medisch Centrum Groningen, University of Groningen, Groningen, The Netherlands
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Ruth Santamaria
- Preventive and Pediatric Dentistry, Center for Oral Health, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Falk Schwendicke
- Department of Oral Diagnosis, Digital Health and Health Services Research, Center for Dental and Craniofacial Sciences, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian H Splieth
- Preventive and Pediatric Dentistry, Center for Oral Health, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Hervé Tassery
- Faculté d'Odontologie Marseille, Preventive and Restorative Department, Aix-Marseille-Université, Marseille, France
- EA 4203 Laboratory, Université de Montpellier, Montpellier, France
| | - Andrea Zandona
- Department of Comprehensive Care, School of Dental Medicine, Tufts University, Boston, Massachusetts, USA
| | - Domenick Zero
- Department of Cariology, Operative Dentistry and Dental Public Health, Oral Health Research Institute, School of Dentistry, Indiana University, Indianapolis, Indiana, USA
| | - Stefan Zimmer
- Department of Operative and Preventive Dentistry, Dental School, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Niek Opdam
- Radboud University Medical Centre, Department of Dentistry, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| |
Collapse
|
17
|
Schwendicke F, Splieth CH, Bottenberg P, Breschi L, Campus G, Doméjean S, Ekstrand K, Giacaman RA, Haak R, Hannig M, Hickel R, Juric H, Lussi A, Machiulskiene V, Manton D, Jablonski-Momeni A, Opdam N, Paris S, Santamaria R, Tassery H, Zandona A, Zero D, Zimmer S, Banerjee A. How to intervene in the caries process in adults: proximal and secondary caries? An EFCD-ORCA-DGZ expert Delphi consensus statement. Clin Oral Investig 2020; 24:3315-3321. [PMID: 32643090 DOI: 10.1007/s00784-020-03431-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/23/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To provide consensus recommendations on how to intervene in the caries process in adults, specifically proximal and secondary carious lesions. METHODS Based on two systematic reviews, a consensus conference and followed by an e-Delphi consensus process were held with EFCD/ORCA/DGZ delegates. RESULTS Managing an individual's caries risk using non-invasive means (oral hygiene measures including flossing/interdental brushes, fluoride application) is recommended, as both proximal and secondary carious lesions may be prevented or their activity reduced. For proximal lesions, only cavitated lesions (confirmed by visual-tactile, or radiographically extending into the middle/inner dentine third) should be treated invasively/restoratively. Non-cavitated lesions may be successfully arrested using non-invasive measures in low-risk individuals or if radiographically confined to the enamel. In high-risk individuals or if radiographically extended into dentine, for these lesions, additional micro-invasive (lesion sealing and infiltration) treatment should be considered. For restoring proximal lesions, adhesive direct restorations allow minimally invasive, tooth-preserving preparations. Amalgams come with a lower risk of secondary lesions and may be preferable in more clinically complex scenarios, dependent on specific national guidelines. In structurally compromised (especially endodontically treated) teeth, indirect cuspal coverage restorations may be indicated. Detection methods for secondary lesions should be tailored according to the individual's caries risk. Avoiding false positive detection and over-treatment is a priority. Bitewing radiographs should be combined with visual-tactile assessment to confirm secondary caries detections. Review/refurbishing/resealing/repairing instead of replacing partially defective restorations should be considered for managing secondary caries, if possible. CONCLUSIONS An individualized and lesion-specific approach is recommended for intervening in the caries process in adults. CLINICAL SIGNIFICANCE Dental clinicians have an increasing number of interventions available for the management of dental caries. Many of them are grounded in the growing understanding of the disease. The best evidence, patients' expectations, clinicians' expertise, and the individual clinical scenario all need to be considered during the decision-making process.
Collapse
Affiliation(s)
- Falk Schwendicke
- Department of Operative Dentistry, Charité - Universitätsmedizin, Berlin, Germany.
| | - Christian H Splieth
- Preventive and Pediatric Dentistry, Center for Oral Health, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Peter Bottenberg
- Oral Health Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Lorenzo Breschi
- Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna - Alma Mater Studiorum, Bologna, Italy
| | - Guglielmo Campus
- Department of Restorative, Preventive and Paediatric Dentistry, Zahnmedizinische Kliniken (ZMK), University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Sassari, Italy
| | - Sophie Doméjean
- Département d'Odontologie Conservatrice, Univ Clermont Auvergne, UFR d'Odontologie; Centre de Recherche en Odontologie Clinique EA 4847, F-63100, Clermont-Ferrand, France
- CHU Estaing Clermont-Ferrand, Service d'Odontologie, F-63001, Clermont-Ferrand, France
| | - Kim Ekstrand
- Cariology and Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University Leipzig, Leipzig, Germany
| | - Matthias Hannig
- Clinic of Operative Dentistry and Periodontology, Saarland University, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Munich, Germany
| | - Hrvoje Juric
- Department of Paediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Adrian Lussi
- School of Dental Medicine, University of Bern, Bern, Switzerland and Department of Operative Dentistry and Periodontology, Faculty of Dentistry, University Medical Centre, Freiburg, Germany
| | - Vita Machiulskiene
- Clinic of Dental and Oral Pathology, Faculty of odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - David Manton
- Centrum van Tandheelkunde en Mondzorgkunde, UMCG, Groningen, Netherlands
| | | | - Niek Opdam
- Radboud University Medical Centre, Department of Dentistry, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Sebastian Paris
- Department of Operative Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ruth Santamaria
- Preventive and Pediatric Dentistry, Center for Oral Health, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Hervé Tassery
- Faculté d'Odontologie Marseille, Preventive and Restorative Department, Marseille cedex, Aix-Marseille-Université, Marseille, France
- EA 4203 Laboratory, Université de Montpellier, Montpellier, France
| | - Andrea Zandona
- Department of Comprehensive Care, School of Dental Medicine, Tufts University, Boston, Massachusetts, USA
| | - Domenick Zero
- Department of Cariology, Operative Dentistry and Dental Public Health, Oral Health Research Institute, School of Dentistry Indiana University, Indianapolis, IN, USA
| | - Stefan Zimmer
- Department of Operative and Preventive Dentistry, Faculty of Health, Dental School, Witten/Herdecke University, Witten, Germany
| | - Avijit Banerjee
- Conservative & MI Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| |
Collapse
|
18
|
Splieth CH, Banerjee A, Bottenberg P, Breschi L, Campus G, Ekstrand KR, Giacaman RA, Haak R, Hannig M, Hickel R, Juric H, Lussi A, Machiulskiene V, Manton DJ, Jablonski-Momeni A, Opdam NJM, Paris S, Santamaría RM, Schwendicke F, Tassery H, Ferreira Zandona A, Zero DT, Zimmer S, Doméjean S. How to Intervene in the Caries Process in Children: A Joint ORCA and EFCD Expert Delphi Consensus Statement. Caries Res 2020; 54:297-305. [PMID: 32610317 DOI: 10.1159/000507692] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/29/2020] [Indexed: 11/19/2022] Open
Abstract
This paper provides recommendations for dentists for the treatment of dental caries in children, with an emphasis on early childhood caries (ECC), primary teeth, and occlusal surfaces in permanent teeth. A consensus workshop followed by an e-Delphi consensus process was conducted with an expert panel nominated by the European Organization for Caries Research (ORCA) and European Federation of Conservative Dentistry (EFCD)/German Association of Conservative Dentistry (DGZ) boards. Based on 3 systematic reviews and a nonsystematic literature search, recommendations were developed. The caries decline has led to a more polarized disease distribution in children and adolescents along social gradients which should be taken into account when managing the caries process at all levels, such as the individual, the group, or a population. The control or reduction of caries activity is the basis for successful caries management. In children, caries management requires adequate daily oral hygiene and fluoride application via toothpaste, ensured by caregivers, and especially for ECC prevention an emphasis on sugar intake reduction is needed. These noninvasive interventions are also suitable to arrest or control initial or even cavitated dentine caries lesions in the absence of irreversible pulpitis. Fluoride varnish or silver diammine fluoride can be added as supplementary agents. In pits and fissures, composite resin materials can be used as preventive sealants and for defect-oriented minimally invasive restorations. In primary molars, preformed metal crowns are more successful than multisurface fillings, especially in caries-active patients. With persisting high caries activity, multiple lesions, and limited cooperation, caries control should consist of robust measures with high success rates, even including extraction in selected cases. This applies especially to treatments performed under general anesthesia.
Collapse
Affiliation(s)
- Christian H Splieth
- Preventive and Pediatric Dentistry, Center for Oral Health, Universitätsmedizin Greifswald, Greifswald, Germany,
| | - Avijit Banerjee
- Conservative & MI Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Peter Bottenberg
- Oral Health Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Lorenzo Breschi
- Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna - Alma Mater Studiorum, Bologna, Italy
| | - Guglielmo Campus
- Department of Restorative, Preventive and Pediatric Dentistry, Zahnmedizinische Kliniken (ZMK), University of Bern, Bern, Switzerland
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Sassari, Italy
| | - Kim Rud Ekstrand
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University Leipzig, Leipzig, Germany
| | - Matthias Hannig
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Homburg, Germany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Munich, Germany
| | - Hrvoje Juric
- Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Adrian Lussi
- School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Operative Dentistry and Periodontology, Faculty of Dentistry, University Medical Centre Freiburg, Freiburg, Germany
| | - Vita Machiulskiene
- Clinic of Dental and Oral Pathology, Faculty of Odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - David J Manton
- Centrum voor Tandheelkunde en Mondzorgkunde, Universitair Medisch Centrum Groningen, University of Groningen, Groningen, The Netherlands
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Niek J M Opdam
- Department of Dentistry, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ruth M Santamaría
- Preventive and Pediatric Dentistry, Center for Oral Health, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Falk Schwendicke
- Department of Oral Diagnosis, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Herve Tassery
- EA 4203 Laboratory, Faculté d'Odontologie, Université de Montpellier, Montpellier, France
- Faculté d'Odontologie Marseille, Preventive and Restorative Department, Aix-Marseille-Université, Marseille, France
| | - Andrea Ferreira Zandona
- Department of Comprehensive Care, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Domenick T Zero
- Oral Health Research Institute, Indiana University School of Dentistry, Indianapolis, Indiana, USA
| | - Stefan Zimmer
- Faculty of Health, School of Dentistry, Department of Operative and Preventive Dentistry, Witten/Herdecke University, Witten, Germany
| | - Sophie Doméjean
- Centre de Recherche en Odontologie Clinique EA 4847, UFR d'Odontologie, Département d'Odontologie Conservatrice, Université Clermont Auvergne, Clermont-Ferrand, France
- Service d'Odontologie, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
| |
Collapse
|
19
|
Abstract
KNOWLEDGE TRANSFER STATEMENT This article provides an overview of the oral health situation imposed by COVID-19 and the minimal intervention alternatives to provide care to older people who are at risk and have reduced access to care.
Collapse
Affiliation(s)
- S León
- Gerodontology and Cariology Unit, Department of Oral Rehabilitation, Faculty of Health Sciences, University of Talca, Talca, Maule, Chile.,Chilean Society for Geriatric Dentistry, Chile
| | - R A Giacaman
- Gerodontology and Cariology Unit, Department of Oral Rehabilitation, Faculty of Health Sciences, University of Talca, Talca, Maule, Chile.,Chilean Society for Geriatric Dentistry, Chile
| |
Collapse
|
20
|
Treerat P, Redanz U, Redanz S, Giacaman RA, Merritt J, Kreth J. Synergism between Corynebacterium and Streptococcus sanguinis reveals new interactions between oral commensals. ISME J 2020; 14:1154-1169. [PMID: 32020052 PMCID: PMC7174362 DOI: 10.1038/s41396-020-0598-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 01/15/2020] [Accepted: 01/23/2020] [Indexed: 01/28/2023]
Abstract
The oral microbiome engages in a diverse array of highly sophisticated ecological interactions that are crucial for maintaining symbiosis with the host. Streptococci and corynebacteria are among the most abundant oral commensals and their interactions are critical for normal biofilm development. In this study, we discovered that Streptococcus sanguinis specifically responds to the presence of Corynebacterium durum by dramatically altering its chain morphology and improving its overall fitness. By employing gas chromatography-mass spectrometry (GC-MS) analysis, specific fatty acids were identified in C. durum supernatants that are responsible for the observed effect. Membrane vesicles (MVs) containing these fatty acids were isolated from C. durum supernatants and were able to replicate the chain morphology phenotype in S. sanguinis, suggesting MV as a mediator of interspecies interactions. Furthermore, S. sanguinis responds to C. durum lipids by decreasing the expression of key FASII genes involved in fatty acid synthesis. Several of these genes are also essential for the chain elongation phenotype, which implicates a regulatory connection between lipid metabolism and chain elongation. In addition, C. durum was found to affect the growth, cell aggregation, and phagocytosis of S. sanguinis, revealing a complex association of these species that likely supports oral commensal colonization and survival.
Collapse
Affiliation(s)
- Puthayalai Treerat
- Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA
| | - Ulrike Redanz
- Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA
| | - Sylvio Redanz
- Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Schillingallee 70, 18057, Rostock, Germany
| | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Justin Merritt
- Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA
- Department of Molecular Microbiology and Immunology, School of Medicine, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA
| | - Jens Kreth
- Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA.
- Department of Molecular Microbiology and Immunology, School of Medicine, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA.
| |
Collapse
|
21
|
Frencken JE, Giacaman RA, Leal SC. An assessment of three contemporary dental caries epidemiological instruments: a critical review. Br Dent J 2020; 228:25-31. [DOI: 10.1038/s41415-019-1081-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
22
|
Abstract
Objectives Frequent consumption of sugars-containing carbonated beverages has been associated with caries, but the consequences on the dental biofilm remain unclear. The aim was to evaluate the effect of commercial carbonated beverages and their sugar-free version on enamel and dentine demineralization and on the cariogenic properties of Streptococcus mutans biofilms. Materials and Methods Biofilms of S. mutans UA159 were grown on enamel and dentin slabs and exposed 3 times/day for 5 min, to a commercial cola or orange-flavored carbonated beverage or to their sugar-free version. Biofilms/slabs were recovered to assess biomass, viable microorganisms, protein content and polysaccharides. Demineralization was estimated by the variation of Knoop surface microhardness. Results Exposures to the biofilm with sugars-containing carbonated beverages resulted in similar biomass, viable microorganisms, proteins, and polysaccharides than sucrose (P < 0.05). The sugar-free cola and orange-flavored drink showed lower effect on the biofilm, as compared with sucrose or their sugared version (P < 0.05). All of the products tested, included the sugar-free, showed higher demineralization than the negative control (P < 0.05). Conclusions Sugars-containing carbonated beverages enhance cariogenic activity of S. mutans biofilms, comparable with sucrose. Sugar-free carbonated beverages also have a high demineralizing potential, without affecting biofilm properties.
Collapse
Affiliation(s)
- Rodrigo A Giacaman
- Department of Oral Rehabilitation, Cariology Unit, University of Talca, Talca, Chile.,Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), University of Talca, Talca, Chile
| | - Vanesa Pailahual
- Department of Oral Rehabilitation, Cariology Unit, University of Talca, Talca, Chile
| | - Natalia Díaz-Garrido
- Department of Oral Rehabilitation, Cariology Unit, University of Talca, Talca, Chile
| |
Collapse
|
23
|
Meyer-Lueckel H, Machiulskiene V, Giacaman RA. How to Intervene in the Root Caries Process? Systematic Review and Meta-Analyses. Caries Res 2019; 53:599-608. [PMID: 31412343 DOI: 10.1159/000501588] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/12/2019] [Indexed: 11/19/2022] Open
Abstract
The aim of this review as part of the preparation for a workshop organized by the European Federation of Conservative Dentistry (EFCD) in conjunction with the European Organisation for Caries Research (ORCA) was to systematically analyze available evidence of non-, micro- as well as invasive interventions for root caries lesions (RCLs). For each treatment strategy, a separate systematic review was either performed (micro-invasive and choice of restorative material) or updated (non-invasive and excavation technique) each of them following PRISMA guidelines, and if possible meta-analyses were performed. Besides the general advice to improve tooth brushing with fluoride toothpaste main findings for non-invasive interventions in RCLs, the use of dentifrices containing 5,000 ppm F- as well as professionally applied chlorhexidine varnish or silver diamine fluoride seemed to be more efficacious to arrest root caries compared to conventional fluoride toothpaste or placebo respectively. However, this conclusion is based only on a few randomized clinical trials. For micro-invasive treatments, only 2 studies focusing on sealants were available without clear conclusions. A recent review on the comparison of atraumatic restorative treatment compared with conventional treatment concluded that there is insufficient data to clearly rule out if any difference with regard to restoration longevity between both techniques exists. When restoring coventionally, composites performed better than resin-modified and glass ionomer cements. However, all materials showed rather high annual failure rates in the majority of the studies and evidence is based on a low number of prospective studies with a rather high risk of bias.
Collapse
Affiliation(s)
- Hendrik Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland,
| | - Vita Machiulskiene
- Clinic of Dental and Oral Pathology, Faculty of Odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, University of Talca, Talca, Chile
| |
Collapse
|
24
|
Muñoz-Sandoval C, Gambetta-Tessini K, Giacaman RA. Microcavitated (ICDAS 3) carious lesion arrest with resin or glass ionomer sealants in first permanent molars: A randomized controlled trial. J Dent 2019; 88:103163. [PMID: 31276747 DOI: 10.1016/j.jdent.2019.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 06/28/2019] [Accepted: 07/01/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Although there is some consensus that carious lesions in early stages (non-cavitated) could be treated using sealants, neither the type of materials nor their use in lesions with localized enamel breakdown (microcavitated) has been reported To compare the efficacy of resin or glass ionomer (GI) sealants in arresting microcavitated carious lesions (ICDAS 3) in first permanent molars. MATERIALS AND METHODS A double-blinded randomized controlled clinical trial was conducted in 41 healthy 6 to 11-year-old children. At the baseline examination, each subject had at least one carious lesion classified as ICDAS 3 on the first permanent molar. One hundred fifty-one lesions were randomized into: Group 1: resin sealants (76 lesions) and Group 2: GI sealant (75 lesions). Carious lesion progression was assessed clinically and radiographically. Progression and retention failure were the outcomes used for group comparisons at p-value<0.05. RESULTS After a two-year follow-up, only one lesion progressed to ICDAS 5, without statistically significant differences between the groups (χ2(1) = 0.90, p = 0.53). Radiographically, 100 lesions (98%) were arrested and 2 (2%) showed radiographic progression, without differences between groups (χ2(1) = 0.93, p = 0.93). At 2 years, complete retention was observed in 77% of the resin-based and in 83% of the GI sealants, without statistical differences between type of sealant (χ2(1) = 0.71, p = 0.48). The multilevel mixed model demonstrated that location and type of sealant did not affect retention rates (χ2(1) = 24,98, p < 0.001). CONCLUSION Sealing ICDAS 3 carious lesions in permanent molars appears to be effective in arresting lesions after a two-year follow-up. Clinicaltrials.gov: RCTICDAS3/2015. CLINICAL SIGNIFICANCE Minimally invasive approaches for carious lesion management have been promoted. Using sealants for the treatment of microcavitated lesions (ICDAS 3) appears predictable in the routine practice, without predilection for resin or glass ionomer materials. In addition to preserving tooth structure, this strategy reduces chair-time, dental fear and costs, and increases coverage to dental care.
Collapse
Affiliation(s)
| | | | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, University of Talca, Chile.
| |
Collapse
|
25
|
Palomo I, Giacaman RA, León S, Lobos G, Bustamante M, Wehinger S, Tapia JC, Fuentes M, Alarcón M, García F, Albala C, Fuentes E. Analysis of the characteristics and components for the frailty syndrome in older adults from central Chile. The PIEI-ES study. Arch Gerontol Geriatr 2019; 80:70-75. [DOI: 10.1016/j.archger.2018.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/04/2018] [Accepted: 10/11/2018] [Indexed: 01/19/2023]
|
26
|
Giacaman RA, Jobet-Vila P, Muñoz-Sandoval C. Anticaries activity of egg ovalbumin in an experimental caries biofilm model on enamel and dentin. Clin Oral Investig 2018; 23:3509-3516. [PMID: 30543026 DOI: 10.1007/s00784-018-2769-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Limited evidence suggests a putative inhibitory effect of dietary proteins on demineralization during the carious process. The aim was to explore a potential anticaries activity of the egg protein ovalbumin on a relevant in vitro approach. MATERIALS AND METHODS Biofilms of Streptococcus mutans UA159 were formed on saliva-coated enamel and dentin bovine slabs. Biofilms were challenged with 10% sucrose followed by either a 200 μg/mL solution of ovalbumin or 1:10, 1:100, and 1:1000 (v/v) serial dilutions of that ovalbumin solution, for the entire length of the experiment. Biofilms exposed to 10% sucrose followed only by 0.9% NaCl served as caries-positive control. Once completed the experimental phase, biofilms were analyzed for biomass, viable bacteria, and polysaccharide formation. Final surface hardness (SH) was obtained to calculate %SH loss (demineralization). Two independent experiments were conducted, in triplicate. Data were analyzed by ANOVA and a post hoc test at the 95% confidence level. RESULTS A reduction (p < 0.05) in biomass and extracellular polysaccharide formation, but not in the number of viable cells, was observed for both dental substrates. All ovalbumin concentrations tested showed lower demineralization than the positive control (p < 0.05), in a dose-dependent manner. The highest concentration showed a reduction in the %SH loss of about 30% for both enamel and dentin. CONCLUSION Egg ovalbumin presented to sucrose-challenged biofilms of Streptococcus mutans seems to reduce cariogenicity of a biofilm-caries model. CLINICAL RELEVANCE Ovalbumin may counteract the cariogenic effect of sugars. If these findings are clinically confirmed, novel preventive approaches for caries are warranted.
Collapse
Affiliation(s)
- Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, University of Talca, 1 poniente 1141, Escuela de Odontología, Talca, Chile.
| | - Pascale Jobet-Vila
- Cariology Unit, Department of Oral Rehabilitation, University of Talca, 1 poniente 1141, Escuela de Odontología, Talca, Chile
| | - Cecilia Muñoz-Sandoval
- Cariology Unit, Department of Oral Rehabilitation, University of Talca, 1 poniente 1141, Escuela de Odontología, Talca, Chile
| |
Collapse
|
27
|
Sanz M, Beighton D, Curtis MA, Cury JA, Dige I, Dommisch H, Ellwood R, Giacaman RA, Herrera D, Herzberg MC, Könönen E, Marsh PD, Meyle J, Mira A, Molina A, Mombelli A, Quirynen M, Reynolds EC, Shapira L, Zaura E. Role of microbial biofilms in the maintenance of oral health and in the development of dental caries and periodontal diseases. Consensus report of group 1 of the Joint EFP/ORCA workshop on the boundaries between caries and periodontal disease. J Clin Periodontol 2018; 44 Suppl 18:S5-S11. [PMID: 28266109 DOI: 10.1111/jcpe.12682] [Citation(s) in RCA: 204] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS The scope of this working group was to review (1) ecological interactions at the dental biofilm in health and disease, (2) the role of microbial communities in the pathogenesis of periodontitis and caries, and (3) the innate host response in caries and periodontal diseases. RESULTS AND CONCLUSIONS A health-associated biofilm includes genera such as Neisseria, Streptococcus, Actinomyces, Veillonella and Granulicatella. Microorganisms associated with both caries and periodontal diseases are metabolically highly specialized and organized as multispecies microbial biofilms. Progression of these diseases involves multiple microbial interactions driven by different stressors. In caries, the exposure of dental biofilms to dietary sugars and their fermentation to organic acids results in increasing proportions of acidogenic and aciduric species. In gingivitis, plaque accumulation at the gingival margin leads to inflammation and increasing proportions of proteolytic and often obligately anaerobic species. The natural mucosal barriers and saliva are the main innate defence mechanisms against soft tissue bacterial invasion. Similarly, enamel and dentin are important hard tissue barriers to the caries process. Given that the present state of knowledge suggests that the aetiologies of caries and periodontal diseases are mutually independent, the elements of innate immunity that appear to contribute to resistance to both are somewhat coincidental.
Collapse
Affiliation(s)
- Mariano Sanz
- ETEP (Etiolgy and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - David Beighton
- King's College London School of Medical Education, London, UK
| | - Michael A Curtis
- Microbiology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jaime A Cury
- Piracicaba Dental School, UNICAM, Piracicaba, SP, Brazil
| | - Irene Dige
- Department of Dentistry and Oral Health, Faculty of Health, Aarhus Universitet, Aarhus C, Denmark
| | | | | | | | - David Herrera
- ETEP (Etiolgy and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Mark C Herzberg
- University of Minnesota School of Dentistry, Minneapolis, MN, USA
| | - Eija Könönen
- Periodontology, University of Turku, Turku, Finland
| | - Philip D Marsh
- Department of Oral Biology, School of Dentistry, University of Leeds, Leeds, UK
| | - Joerg Meyle
- Periodontology, University of Giessen, Giessen, Germany
| | - Alex Mira
- Centre for Advanced Research in Public Health, FISABIO Foundation, Valencia, Spain
| | - Ana Molina
- ETEP (Etiolgy and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | | | | | - Eric C Reynolds
- Oral Health Cooperative Research Centre, Melbourne Dental School, The University of Melbourne, Melbourne, Australia
| | - Lior Shapira
- Periodontology, Hebrew University and Hadassah Medical Center, Jerusalem, Israel
| | - Egija Zaura
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| |
Collapse
|
28
|
Lozano CP, Díaz-Garrido N, Kreth J, Giacaman RA. Streptococcus mutans and Streptococcus sanguinis Expression of Competition-Related Genes, Under Sucrose. Caries Res 2018; 53:194-203. [PMID: 30107374 DOI: 10.1159/000490950] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/12/2018] [Indexed: 11/19/2022] Open
Abstract
Streptococcus mutans synthesizes 3 glucosyltransferases (Gtfs) associated with cariogenic biofilms, while commensal Streptococcus sanguinis produces only one; gtfP and hydrogen peroxide (H2O2) by SpxB. The aim was to test the hypothesis that under a sucrose-induced cariogenic challenge, the expression of competition-related genes is differentially regulated depending on whether S. sanguinis or S. mutans primarily colonize enamel. Dual-species biofilms of S. sanguinis and S. mutans were formed under different colonization sequences on enamel slabs and exposed to 10% sucrose for 5 min, 3×/day for 5 days. Biofilms were analyzed for the transcriptional response of competition-related genes encoding gtfB, gtfC, and gtfD for S. mutans and gtfP and spxB for S. sanguinis. In addition, acidogenicity (pH) and viable cells in each of the conditions were determined. For all the genes, a downregulation was observed during simultaneous colonization by both bacterial species. In contrast, gtfB was upregulated when S. sanguinis was the first colonizer (p < 0.05). Both gtfC and gtfD were upregulated during sequential inoculation with S. sanguinis as the first colonizer. An eleven-fold upregulation of gtfP was observed in biofilms with S. mutans as initial colonizer (p < 0.05), with a moderate increase in spxB expression. The lowest pH values and viable cells of S. sanguinis were observed when S. mutans first colonized the enamel slabs, compared to the other conditions (p < 0.05). Demanding sucrose-challenged oral environment requires increased expression of virulence traits to effectively compete and thrive in the dental biofilm, especially when the competitor has already colonized the ecological niche.
Collapse
Affiliation(s)
- Carla P Lozano
- Oral Biology and Biochemistry Laboratory, Institute for Research in Dental Sciences, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Natalia Díaz-Garrido
- Cariology Unit, Department of Oral Rehabilitation, University of Talca, Talca, Chile
| | - Jens Kreth
- Department of Restorative Dentistry, Oregon Health and Science University, Portland, Oregon, USA
| | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, University of Talca, Talca, .,Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), University of Talca, Talca,
| |
Collapse
|
29
|
|
30
|
León S, Rivera M, Payero S, Correa-Beltrán G, Hugo FN, Giacaman RA. Assessment of oral health-related quality of life as a function of non-invasive treatment with high-fluoride toothpastes for root caries lesions in community-dwelling elderly. Int Dent J 2018; 69:58-66. [PMID: 30028021 DOI: 10.1111/idj.12415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Non-invasive treatment of root caries lesions (RCLs) may impact oral health-related quality of life (OHRQoL), but no evidence is available. The purpose of the study was to assess changes in OHRQoL among patients exposed to non-invasive treatment of RCLs with conventional or high-fluoride dentifrices. METHODS To be eligible, subjects had to be ≥60 years of age, independently living, with at least five teeth and one RCL. The 14-item Oral Health Impact Profile for adults in Spanish (OHIP-14Sp), oral examination and sociodemographic data were documented at the beginning of the study (T0). The presence and activity of RCLs were detected and diagnosed. Subjects were randomly assigned to either the control (1,450 ppm fluoride) or the experimental (5,000 ppm fluoride) treatment group. A new set of measurements was obtained at 12 months (T1). Mean comparisons were carried out using the Student's t-test for total OHIP-14Sp scores. To determine whether T1 OHRQoL scores were different regarding sex, age, educational level and socio-economic status, mean OHIP-14Sp scores were obtained and compared with those variables at 12 months. RESULTS An overall improvement in OHRQoL after the non-invasive treatment of RCLs was verified when T1 was compared with T0 (P < 0.0001). Regarding treatment type, no significant differences were detected between groups (P = 0.114). Subjects with higher income and more years of formal education had better OHRQoL than those with a lower salary (P < 0.0001) and with fewer years of education (P = 0.0006). CONCLUSIONS Non-invasive treatment for RCLs in community-dwelling elders appears to cause a positive impact on OHRQoL. Better OHRQoL was associated with higher socio-economic status and educational level. No significant differences were detected regarding the fluoride concentration in the dentifrices.
Collapse
Affiliation(s)
- Soraya León
- Gerodontology Research Group (GIOG), Department of Oral Rehabilitation, University of Talca, Talca, Chile.,Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), University of Talca, Talca, Chile
| | - Miguel Rivera
- Gerodontology Research Group (GIOG), Department of Oral Rehabilitation, University of Talca, Talca, Chile
| | - Sebastián Payero
- Gerodontology Research Group (GIOG), Department of Oral Rehabilitation, University of Talca, Talca, Chile
| | - Gloria Correa-Beltrán
- Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), University of Talca, Talca, Chile.,Institute of Mathematics and Physics, University of Talca, Talca, Chile
| | - Fernando N Hugo
- Department of Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rodrigo A Giacaman
- Gerodontology Research Group (GIOG), Department of Oral Rehabilitation, University of Talca, Talca, Chile.,Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), University of Talca, Talca, Chile
| |
Collapse
|
31
|
Redanz S, Cheng X, Giacaman RA, Pfeifer CS, Merritt J, Kreth J. Live and let die: Hydrogen peroxide production by the commensal flora and its role in maintaining a symbiotic microbiome. Mol Oral Microbiol 2018; 33:337-352. [PMID: 29897662 DOI: 10.1111/omi.12231] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2018] [Indexed: 02/05/2023]
Abstract
The majority of commensal oral streptococci are able to generate hydrogen peroxide (H2 O2 ) during aerobic growth, which can diffuse through the cell membrane and inhibit competing species in close proximity. Competing H2 O2 production is mainly dependent upon the pyruvate oxidase SpxB, and to a lesser extent the lactate oxidase LctO, both of which are important for energy generation in aerobic environments. Several studies point to a broad impact of H2 O2 production in the oral environment, including a potential role in biofilm homeostasis, signaling, and interspecies interactions. Here, we summarize the current research regarding oral streptococcal H2 O2 generation, resistance mechanisms, and the ecological impact of H2 O2 production. We also discuss the potential therapeutic utility of H2 O2 for the prevention/treatment of dysbiotic diseases as well as its potential role as a biomarker of oral health.
Collapse
Affiliation(s)
- Sylvio Redanz
- Department of Restorative Dentistry, Oregon Health and Science University, Portland, Oregon
| | - Xingqun Cheng
- The State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,The Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation and Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), University of Talca, Talca, Chile
| | - Carmen S Pfeifer
- Department of Restorative Dentistry, Oregon Health and Science University, Portland, Oregon
| | - Justin Merritt
- Department of Restorative Dentistry, Oregon Health and Science University, Portland, Oregon
| | - Jens Kreth
- Department of Restorative Dentistry, Oregon Health and Science University, Portland, Oregon
| |
Collapse
|
32
|
Giacaman RA, Muñoz-Sandoval C, Neuhaus KW, Fontana M, Chałas R. Evidence-based strategies for the minimally invasive treatment of carious lesions: Review of the literature. ADV CLIN EXP MED 2018; 27:1009-1016. [PMID: 29962116 DOI: 10.17219/acem/77022] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Resulting in a high economic and biological cost, the traditional therapeutic approach to carious lesion management is still largely restorative. Minimally invasive (MI) treatment offers an attractive alternative to managing carious lesions in a more conservative and effective manner, resulting in enhanced preservation of tooth structure. The aim of this review was to summarize the evidence behind several MI alternatives for carious lesion management, including the use of sealants, infiltration, atraumatic restorative treatment (ART), and selective carious tissue removal (e.g., indirect pulp capping, stepwise removal, or selective removal to soft dentine). Relevant literature was screened, and articles reporting randomized controlled trials or systematic reviews of strategies to manage non-cavitated or cavitated carious lesions in adults and children were included. Fifty six articles met the inclusion criteria. For non-cavitated lesions, the use of sealants is supported by strong evidence, while the evidence for infiltration of proximal lesions is moderate. For deep cavitated lesions, selective removal to soft dentin and/or stepwise excavation is supported by strong evidence. The use of the ART technique to restore cavitated lesions is also supported by strong evidence as a suitable strategy that has been used extensively in the literature concerning non-dental settings. Preservation of tooth structure through the use of MI treatment for both non-cavitated and cavitated lesions is supported by moderatestrong evidence, which supports the paradigm shift towards routine use of more conservative strategies in the treatment of carious lesions.
Collapse
Affiliation(s)
- Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation and Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), University of Talca, Chile
| | - Cecilia Muñoz-Sandoval
- Cariology Unit, Department of Oral Rehabilitation and Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), University of Talca, Chile
| | - Klaus W Neuhaus
- Department of Preventive, Restorative and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland
| | - Margherita Fontana
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, USA
| | - Renata Chałas
- Department of Conservative Dentistry and Endodontics, Medical University of Lublin, Poland
| |
Collapse
|
33
|
|
34
|
Giacaman RA, Aranguiz V, Botelho J, Bustos IP, Cabello R, Candiales Y, Carrizo AM, Carvajal C, Castro R, Castro R, Díaz J, Díaz-Yokens M, Díaz-Dosque M, Diaz-Garrido N, Durán G, Faleiros S, Flores M, Fonseca J, Fontana M, Gajardo M, Gómez M, Gonzalez-Cabezas C, González S, Irribarra R, Jara G, León S, Marró ML, Mautz C, Mustakis A, Onetto JE, Ortiz ME, Pérez D, Pérez V, Ramírez V, Rodríguez G, Rojas V, Ruiz B, Silva A, Urzúa I, Valle CD, Zaror C, Moncada G. Creación de un Currículo de Competencias en Cariología para Estudiantes de Pregrado de Odontología en Chile. ACTA ACUST UNITED AC 2018. [DOI: 10.4067/s0719-01072018000100058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
35
|
León S, De Marchi RJ, Tôrres LH, Hugo FN, Espinoza I, Giacaman RA. Oral health of the Latin American elders: What we know and what we should do-Position paper of the Latin American Oral Geriatric Group of the International Association for Dental Research. Gerodontology 2018; 35:71-77. [DOI: 10.1111/ger.12318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Soraya León
- Gerodontology and Cariology Unit; Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES); University of Talca; Talca Chile
| | - Renato J. De Marchi
- Department of Preventive and Social Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul Porto Alegre; Porto Alegre Rio Grande do Sul Brazil
| | - Luisa H. Tôrres
- Department of Preventive and Social Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul Porto Alegre; Porto Alegre Rio Grande do Sul Brazil
| | - Fernando N. Hugo
- Department of Preventive and Social Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul Porto Alegre; Porto Alegre Rio Grande do Sul Brazil
| | - Iris Espinoza
- Faculty of Dentistry; University of Chile; Santiago Chile
| | - Rodrigo A. Giacaman
- Gerodontology and Cariology Unit; Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES); University of Talca; Talca Chile
| |
Collapse
|
36
|
Valdebenito B, Tullume-Vergara PO, González W, Kreth J, Giacaman RA. In silico analysis of the competition between Streptococcus sanguinis and Streptococcus mutans in the dental biofilm. Mol Oral Microbiol 2018; 33:168-180. [PMID: 29237244 DOI: 10.1111/omi.12209] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2017] [Indexed: 01/03/2023]
Abstract
During dental caries, the dental biofilm modifies the composition of the hundreds of involved bacterial species. Changing environmental conditions influence competition. A pertinent model to exemplify the complex interplay of the microorganisms in the human dental biofilm is the competition between Streptococcus sanguinis and Streptococcus mutans. It has been reported that children and adults harbor greater numbers of S. sanguinis in the oral cavity, associated with caries-free teeth. Conversely, S. mutans is predominant in individuals with a high number of carious lesions. Competition between both microorganisms stems from the production of H2 O2 by S. sanguinis and mutacins, a type of bacteriocins, by S. mutans. There is limited evidence on how S. sanguinis survives its own H2 O2 levels, or if it has other mechanisms that might aid in the competition against S. mutans, nonetheless. We performed a genomic and metabolic pathway comparison, coupled with a comprehensive literature review, to better understand the competition between these two species. Results indicated that S. sanguinis can outcompete S. mutans by the production of an enzyme capable of metabolizing H2 O2 . S. mutans, however, lacks the enzyme and is susceptible to the peroxide from S. sanguinis. In addition, S. sanguinis can generate energy through gluconeogenesis and seems to have evolved different communication mechanisms, indicating that novel proteins may be responsible for intra-species communication.
Collapse
Affiliation(s)
- B Valdebenito
- Centro de Bioinformática y Simulación Molecular (CBSM), University of Talca, Talca, Chile
| | - P O Tullume-Vergara
- Facultad de Ciencias Biológicas, Universidad Nacional Pedro Ruiz Gallo, Lambayeque, Peru
| | - W González
- Centro de Bioinformática y Simulación Molecular (CBSM), University of Talca, Talca, Chile.,Millennium Nucleus of Ion Channels-Associated Diseases (MiNICAD), Talca, Chile
| | - J Kreth
- Department of Restorative Dentistry, Oregon Health & Science University, Portland, OR, USA
| | - R A Giacaman
- Cariology Unit, Department of Oral Rehabilitation and Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), University of Talca, Talca, Chile
| |
Collapse
|
37
|
León S, Giacaman RA. Changes in the strategies for caries management in older adults; a non-invasive alternative. J Oral Res 2018. [DOI: 10.17126/joralres.2018.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
38
|
Abstract
BACKGROUND Storage time may reduce the amount of soluble fluoride (F) in toothpastes. Although we previously studied the type and concentration of F in fresh samples of commercial Chilean toothpastes, their stability was not determined. AIM To evaluate the stability of soluble F in Chilean toothpastes after 1 year of storage. DESIGN All the toothpastes (n = 30) previously used were re-analyzed after 1 year of storage time at room temperature (±22°C). Total F (TF = soluble F + insoluble F) and total soluble F (TSF = F ion + MFP ion) were assessed using an ion-specific electrode, through a validated methodology. Data were expressed in ppm of F (mg F/kg). RESULTS Mean (±SD; n = 30) TF and TSF concentrations after storage were 1049 ± 427 and 987 ± 411 ppm F, respectively. Five toothpastes showed between 30% and 50% of insoluble F, four of them formulated with MFP/calcium-based abrasive. In two products, there was a reduction in TSF below the evidence-based anticaries effectiveness threshold of 1000 ppm F. CONCLUSIONS Although most of the toothpastes tested kept their original TSF content after 1 year of storage, some products evidenced an important reduction, which may compromise their anticaries efficacy. Reductions in TSF may be explained by an incorrect F salt-abrasive formulation.
Collapse
Affiliation(s)
- Constanza E Fernández
- Piracicaba Dental School, UNICAMP, Piracicaba, SP, Brazil.,Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Jaime A Cury
- Piracicaba Dental School, UNICAMP, Piracicaba, SP, Brazil
| | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, University of Talca, Talca, Chile.,Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), University of Talca, Talca, Chile
| |
Collapse
|
39
|
Meyle J, Dommisch H, Groeger S, Giacaman RA, Costalonga M, Herzberg M. The innate host response in caries and periodontitis. J Clin Periodontol 2017; 44:1215-1225. [PMID: 28727164 DOI: 10.1111/jcpe.12781] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Innate immunity rapidly defends the host against infectious insults. These reactions are of limited specificity and exhaust without providing long-term protection. Functional fluids and effector molecules contribute to the defence against infectious agents, drive the immune response, and direct the cellular players. AIM To review the literature and present a summary of current knowledge about the function of tissues, cellular players and soluble mediators of innate immunity relevant to caries and periodontitis. METHODS Historical and recent literature was critically reviewed based on publications in peer-reviewed scientific journals. RESULTS The innate immune response is vital to resistance against caries and periodontitis and rapidly attempts to protect against infectious agents in the dental hard and soft tissues. Soluble mediators include specialized proteins and lipids. They function to signal to immune and inflammatory cells, provide antimicrobial resistance, and also induce mechanisms for potential repair of damaged tissues. CONCLUSIONS Far less investigated than adaptive immunity, innate immune responses are an emerging scientific and therapeutic frontier. Soluble mediators of the innate response provide a network of signals to organize the near immediate molecular and cellular response to infection, including direct and immediate antimicrobial activity. Further studies in human disease and animal models are generally needed.
Collapse
Affiliation(s)
- Joerg Meyle
- Department of Periodontology, University of Giessen, Giessen, Germany
| | - Henrik Dommisch
- Department of Periodontology and Synoptic Dentistry, Charité - Medical University Berlin, Berlin, Germany
| | - Sabine Groeger
- Department of Periodontology, University of Giessen, Giessen, Germany
| | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation and Interdisciplinary Excellence Research Program on Healthy Aging (PIEIES), University of Talca, Talca, Chile
| | - Massimo Costalonga
- Department of Developmental and Surgical Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Mark Herzberg
- Department of Diagnostic and Biological Sciences, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
40
|
Giacaman RA. Sugars and beyond. The role of sugars and the other nutrients and their potential impact on caries. Oral Dis 2017; 24:1185-1197. [PMID: 28898520 DOI: 10.1111/odi.12778] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/31/2017] [Accepted: 09/05/2017] [Indexed: 12/14/2022]
Abstract
The traditional concept of caries as a multifactorial transmittable and infectious disease has been challenged. Novel conceptual ideas have come to add to the complexity of this highly prevalent disease worldwide. Current etiological understanding of the disease has emphasized the pivotal role of sugars in caries. In fact, current definition points toward an ecological disease caused by the commensal microbiota that under ecological imbalances, mainly due to high and or frequent sugars consumption, creates a state of dysbiosis in the dental biofilm. This modern conceptual idea, however, tends to underrate a key issue. As humans are omnivore and consume a mix diet composed by a multitude of substances, the role of the diet in caries must not be restricted only to the presence of fermentable sugars. This review explores the contribution of other food components, ubiquitous to the diet, mostly as potentially protective factors. Anticaries nutrients might determine an environmental change, affecting the ecology of the oral microbiome and partially mitigating the effect of sugars. Understanding the function of the food usually consumed by the people will contribute new knowledge on the mechanisms associated with the onset of caries, on new caries risk variables and on potential novel strategies for the prevention and treatment of the disease.
Collapse
Affiliation(s)
- R A Giacaman
- Cariology Unit, Department of Oral Rehabilitation and Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), University of Talca, Talca, Chile
| |
Collapse
|
41
|
Giacaman RA. Prescribing health to unveil the enemy. Restricting sugars consumption for oral and systemic health. J Oral Res 2017. [DOI: 10.17126/joralres.2017.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
42
|
Kreth J, Giacaman RA, Raghavan R, Merritt J. The road less traveled - defining molecular commensalism with Streptococcus sanguinis. Mol Oral Microbiol 2017; 32:181-196. [PMID: 27476770 PMCID: PMC5288394 DOI: 10.1111/omi.12170] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2016] [Indexed: 12/15/2022]
Abstract
The commensal oral microbial flora has evolved with the human host to support colonization of the various intraoral sites without triggering a significant immune response. In exchange, the commensal microbes provide critical protection against invading pathogens. The intrinsic ability of the oral flora to create a symbiotic microbial community with the host can be disturbed, selecting for the overgrowth of a dysbiotic community that can result in dental diseases, such as caries and periodontitis. Although the mechanisms of molecular pathogenesis in oral diseases are well characterized, much less is known about the molecular mechanisms used by the commensal flora to maintain oral health. Here we focus on the commensal species Streptococcus sanguinis, which is found in abundance in the early oral biofilm and is strongly correlated with oral health. Streptococcus sanguinis exhibits a variety of features that make it ideally suited as a model organism to explore the molecular basis for commensalism. As such, this review will describe our current mechanistic understanding of S. sanguinis commensalism and speculate upon its molecular traits that may be exploitable to maintain or restore oral health under conditions that would otherwise lead to disease.
Collapse
Affiliation(s)
- Jens Kreth
- Department of Restorative Dentistry, Oregon Health and Science University, Portland, OR, USA
| | - Rodrigo A. Giacaman
- Cariology Unit, Department of Oral Rehabilitation and Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), University of Talca, Talca, Chile
| | - Rahul Raghavan
- Department of Biology and Center for Life in Extreme Environments, Portland State University, Portland, OR, USA
| | - Justin Merritt
- Department of Restorative Dentistry, Oregon Health and Science University, Portland, OR, USA
| |
Collapse
|
43
|
|
44
|
Mariño R, Giacaman RA. Patterns of use of oral health care services and barriers to dental care among ambulatory older Chilean. BMC Oral Health 2017; 17:38. [PMID: 28068973 PMCID: PMC5223417 DOI: 10.1186/s12903-016-0329-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper describes the patterns of use of oral health care services among ambulant 65-74 years or older adults, living in the Maule Region of Chile, factors associated with their use of oral health care services, and self-reported barriers to using oral health care services. METHODS Four hundred and thirty eight older adults, aged 65-74 years, living independently in the community were orally examined and underwent an oral health interview. Recency of visits was related to the use of oral health care services within the 12 months prior to the study. RESULTS 31.5% of respondents had used oral health services in the previous 12 months. In multivariate analyses, those living in rural areas (OR = 2.15; 95% CI:1.27-3.63), and those with secondary or higher education (OR = 1.65; 95% CI:1.03-2.64) visited the dentist in the last 12 months in a higher proportion. Those with more filled tooth-surfaces were more likely to have visited the dentist (OR = 4.02; 95% CI;3.58-4.51). Participants who self-reported dental fear, were less likely to have visited the dentist than those who did not (OR = 0.43; 95% CI;0.24-0.76). CONCLUSION Comparing with existing data in Chile, participants in this study appear to have a slightly lower attendance. Findings question assumptions regarding oral health services utilization by rural residents and highlight the need to identify factors that influence the use of oral health services by older Chileans.
Collapse
Affiliation(s)
- Rodrigo Mariño
- Oral Health Cooperative Research Centre Melbourne Dental School, University of Melbourne, Melbourne, VIC, 3010, Australia.
| | | |
Collapse
|
45
|
Giacaman RA. Healthy Aging? Pensions, Quality of Life and the Challenges of Oral Health for the Elderly. J Oral Res 2016. [DOI: 10.17126/joralres.2016.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
46
|
Castro RJ, Herrera R, Giacaman RA. Salivary protein characteristics from saliva of carious lesionfree and high caries adults. Acta Odontol Latinoam 2016; 29:178-185. [PMID: 27731488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
It has been argued that specific salivary proteins could have a protective effect against caries, but data from the many available studies are rather contradictory. The purpose of this study was to analyze whether there is a relationship between protein concentration, electrophoretic profile and concentration of salivary IgA and the presence or absence of caries in adults. Adults with high caries activity (HC) and without caries lesions (CF), assessed by ICDAS criteria, were asked to provide unstimulated saliva samples. Protein concentration (μg/mL) was determined using the Bradford method. Western blotting was used to detect IgA. Data were compared using Student's t test at p<0.05. Total protein concentration in CF was higher (50.65±7.5 μg/mL) than in HC individuals (26.80±2.5 μg/mL) (p=0.001). More protein bands were visualized in the gels from CF than the HC group (p=0.001). CF subjects showed higher salivary IgA concentration (11.27±0.5 μg) than HC individuals (1.71±0.2μg) (p=0.001).Salivary composition in high caries experience and cariesfree young adults seems to differ in terms of the type and amount of proteins. Further research is needed to expand these findings.
Collapse
Affiliation(s)
- Ramiro J Castro
- Cariology Unit, Department of Oral Rehabilitation and Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), University of Talca, Talca, Chile
| | - Raúl Herrera
- Biological Science Institute, University of Talca, Talca, Chile
| | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation and Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), University of Talca, Talca, Chile.
| |
Collapse
|
47
|
Abstract
OBJECTIVE Although sucrose is considered the most cariogenic carbohydrate in the human diet, the question of how many exposures are needed to induce damage on the hard dental tissues remains unclear. To approach this question, different frequencies of daily sucrose exposure were tested on a relevant biological caries model. MATERIALS AND METHODS Biofilms of the Streptococcus mutans were formed on enamel slabs and exposed to cariogenic challenges with 10% sucrose for 5 min at 0, 1, 3, 5, 8, or 10 times per day. After 5 days, biofilms were retrieved to analyze biomass, protein content, viable bacteria, and polysaccharide formation. Enamel demineralization was evaluated by percentage of microhardness loss (percentage surface hardness loss [%SHL]). RESULTS Biomass, protein content, polysaccharide production, acidogenicity of the biofilm, and %SHL proportionally increased with the number of daily exposures to sucrose (P < 0.05). One daily sucrose exposure was enough to induce 20% more demineralization than the negative unexposed control. Higher frequencies induced greater demineralization and more virulent biofilms, but eight and ten exposures were not different between them in most of the analyzed variables (P > 0.05). CONCLUSIONS Higher sucrose exposure seems to increase cariogenicity, in a frequency-dependent manner, by the modification of bacterial virulent properties.
Collapse
Affiliation(s)
- Natalia Díaz-Garrido
- Department of Oral Rehabilitation, Cariology Unit, University of Talca, Talca, Chile
| | - Carla Lozano
- Oral Biology and Biochemistry Laboratory, Institute for Research in Dental Sciences, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Rodrigo A Giacaman
- Department of Oral Rehabilitation, Cariology Unit, University of Talca, Talca, Chile.,Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), University of Talca, Talca, Chile
| |
Collapse
|
48
|
Giacaman RA, Valenzuela-Ramos R, Muñoz-Sandoval C. In situ anticariogenic activity of free fatty acids after sucrose exposure to oral biofilms formed on enamel. Am J Dent 2016; 29:81-86. [PMID: 27295865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To test whether the effect of sucrose on enamel is hampered by immediate free fatty acids exposure to the oral biofilm formed under a highly cariogenic environment, in situ. METHODS A split-mouth, cross-over and double-blind in situ experiment was carried out with 11 volunteers who wore palatal appliances containing bovine enamel slabs. In two 15-day phases, volunteers dripped 20% sucrose onto the slabs eight times per/day for 5 minutes followed by 5 additional minutes with suspensions of 10 mM oleic, linoleic or stearic acid or sucrose (caries-positive control), four times/day. Biofilms were analyzed for biomass, bacteria and polysaccharide formation and enamel demineralization was estimated by surface microhardness. RESULTS Biofilms exposed to oleic and linoleic acids showed significantly lower biomass than the control. S. mutans counts were reduced upon linoleic acid exposure (P< 0.05). All free fatty acids reduced polysaccharide formation (P < 0.05). Slabs exposed to 20% sucrose followed by free fatty acids had significantly lower demineralization than those exposed to sucrose alone, with reductions of 33%, 27% and 20% for linoleic, oleic and stearic acid, respectively. Data suggest that unsaturated free fatty acids exposed after sucrose might potentially reduce cariogenicity of the oral biofilm formed on enamel in situ, but further clinical confirmation is required.
Collapse
|
49
|
León S, Giacaman RA. Realidad y desafíos de la salud bucal de las personas mayores en Chile y el rol de una nueva disciplina: Odontogeriatría. Rev Med Chil 2016; 144:496-502. [DOI: 10.4067/s0034-98872016000400011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 12/01/2015] [Indexed: 11/17/2022]
|
50
|
León S, Correa-Beltrán G, De Marchi RJ, Giacaman RA. Ultra-short version of the oral health impact profile in elderly Chileans. Geriatr Gerontol Int 2016; 17:277-285. [PMID: 26800115 DOI: 10.1111/ggi.12710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2015] [Indexed: 11/29/2022]
Abstract
AIM The aim of the present study was to develop and validate an ultra-short Spanish version of the Oral Health Impact Profile (OHIP) in an elderly Chilean population. METHODS The OHIP-49Sp was applied to 490 older adults, and the seven questions with the higher impact on oral health-related quality of life were selected through linear regression. These items were applied to 85 older adults to test internal consistency (Cronbach's alpha). A discriminative validity analysis was carried out along with the assessment of sociodemographic and clinical variables. Data were analyzed using the Mann-Whitney U-test, Student's t-test and one-way anova tests with a 95% confidence level. RESULTS High internal consistency values were obtained for the OHIP-7Sp instrument (0.93). There was an association between the OHIP-7Sp scores and the presence of caries, need for complex periodontal treatment, prosthetic needs, and age younger than 70 years. CONCLUSION The OHIP-7Sp proved to be a consistent and valid tool to assess oral health-related quality of life in Chilean older adults, and can be incorporated in epidemiological studies that include several other targets. Geriatr Gerontol Int 2017; 17: 277-285.
Collapse
Affiliation(s)
- Soraya León
- Gerodontology Research Group (GIOG) and Caridology Unit, Department of Oral Rehabilitation, University of Talca, Talca, Chile.,Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), University of Talca, Talca, Chile
| | - Gloria Correa-Beltrán
- Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), University of Talca, Talca, Chile.,Institute of Mathematics and Physics, University of Talca, Talca, Chile
| | - Renato J De Marchi
- Department of Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rodrigo A Giacaman
- Gerodontology Research Group (GIOG) and Caridology Unit, Department of Oral Rehabilitation, University of Talca, Talca, Chile.,Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), University of Talca, Talca, Chile
| |
Collapse
|