Some young adults can maintain good oral health despite socioeconomic challenges

The association between dental caries experience and socioeconomic status, as reflected in income and educational level, is well known. However, some individuals maintain good health despite socioeconomic disadvantage. The aim of this qualitative study was to explore salutogenic (health-promoting) factors among healthy caries-free young adults of low socioeconomic status. Seventeen participants (11 women), 19-23 years of age, who were caries-free and of low socioeconomic status were interviewed in-depth. The interviews were transcribed verbatim and analysed using qualitative content analysis with an inductive approach. The theme revealed was 'Building trust and shifting responsibility from parent to child throughout children's development lays the salutogenic foundation for oral health', comprising three categories: (i) a basis for health; (ii) creating one's own path by testing wings; and (iii) developing resources for health. A feeling of trust was expressed, participants were confident in the unconditional support of their caregivers, and caregivers were trusting participants to be able to take control over their own oral health. Health-promotive factors were established not only by instilling healthy habits during childhood, but also by parental guidance through adolescence, enabling young adults to develop resources and assets to take control over their own health independently.

[Dental caries - the most common noncommunicable disease and its impact on general health and disease]

More than 2.8 billion individuals worldwide suffer from untreated caries. Over ninety-five percent of all 50-year-olds in Sweden have caries experience. Caries is the most common cause of dental restorations and tooth loss. Tooth loss is associated with cardiovascular diseases, dementia, and death. Periapical tooth infections caused by caries can spread and cause severe infection, however rarely with lethal outcome. Sugars are a common risk factor for caries and other noncommunicable diseases such as cardiovascular diseases, diabetes, and obesity.  Caries is a consequence of sugar-provoked acid production and dysbiosis in the tooth biofilm (dental plaque). There are several conditions which may increase the risk for dental caries, such as different medical conditions and medications which may cause dry mouth. Treatment costs for caries are high.

Effect of a single application of silver diamine fluoride on root caries after 12 months in institutionalised older adults-A randomised clinical trial

OBJECTIVE

Silver diamine fluoride (SDF) has been shown to be highly effective against caries, in particular for arresting root surface caries and for dentine caries in primary teeth. SDF may complement fluoride varnish routines for treatment of root caries in nursing home residents. The aim of this randomised, single-blinded, placebo-controlled trial was to evaluate the additive effect of a single annual application of SDF for prevention and treatment of incipient root caries in older adult nursing home residents.

METHOD

Four hundred older adult nursing home residents (≥70 years old) with at least one exposed root surface (on teeth 15, 14, 13, 23, 24, or 25) were identified during routine dental examination visits in the domiciliary dental care setting. Eligible patients, who were able to understand the implication of consenting to the study, were invited to participate. Their cleaned root surfaces were randomly allocated to treatment with SDF (Advantage Arrest Silver Diamine Fluoride 38%, Advantage Arrest, LLC, Redmond, OR 97756, USA, Lot 16 152) or with placebo (tap water), each for 1 minute.

RESULTS

Of the 400 eligible individuals, 42 declined to participate and two forms were destroyed. The remaining 356 participants (89.0%; mean age 87.7 years) were randomly allocated, with 174 going to the SDF group and 182 to the placebo group. At 1 year, 273 participants (76.7%) were available for assessment: 135 in the SDF group and 138 in the placebo group. By that time, 109 individuals (39.9%) demonstrated root caries progression or regression. Among those 118 (16.7%) of the 708 included root surfaces had developed caries There were no statistically significant differences in the primary outcome related to treatment with SDF or placebo, at either patient or root surface level.

CONCLUSION

Based on the finding of this clinical trial, it is concluded that a single SDF application to complement a risk-based preventive programme including fluoride varnish applications did not have a statistically significant additional preventive effect on root caries development in a group of older adult nursing home residents with limited caries activity and cognitive capacity to cooperate in oral care activities.

Streptococcus Species Abundance in the Gut Is Linked to Subclinical Coronary Atherosclerosis in 8973 Participants From the SCAPIS Cohort

BACKGROUND

Gut microbiota have been implicated in atherosclerotic disease, but their relation with subclinical coronary atherosclerosis is unclear. This study aimed to identify associations between the gut microbiome and computed tomography-based measures of coronary atherosclerosis and to explore relevant clinical correlates.

METHODS

We conducted a cross-sectional study of 8973 participants (50 to 65 years of age) without overt atherosclerotic disease from the population-based SCAPIS (Swedish Cardiopulmonary Bioimage Study). Coronary atherosclerosis was measured using coronary artery calcium score and coronary computed tomography angiography. Gut microbiota species abundance and functional potential were assessed with shotgun metagenomics sequencing of fecal samples, and associations with coronary atherosclerosis were evaluated with multivariable regression models adjusted for cardiovascular risk factors. Associated species were evaluated for association with inflammatory markers, metabolites, and corresponding species in saliva.

RESULTS

The mean age of the study sample was 57.4 years, and 53.7% were female. Coronary artery calcification was detected in 40.3%, and 5.4% had at least 1 stenosis with >50% occlusion. Sixty-four species were associated with coronary artery calcium score independent of cardiovascular risk factors, with the strongest associations observed for Streptococcus anginosus and Streptococcus oralis subsp oralis (P<1×10-5). Associations were largely similar across coronary computed tomography angiography-based measurements. Out of the 64 species, 19 species, including streptococci and other species commonly found in the oral cavity, were associated with high-sensitivity C-reactive protein plasma concentrations, and 16 with neutrophil counts. Gut microbial species that are commonly found in the oral cavity were negatively associated with plasma indole propionate and positively associated with plasma secondary bile acids and imidazole propionate. Five species, including 3 streptococci, correlated with the same species in saliva and were associated with worse dental health in the Malmö Offspring Dental Study. Microbial functional potential of dissimilatory nitrate reduction, anaerobic fatty acid β-oxidation, and amino acid degradation were associated with coronary artery calcium score.

CONCLUSIONS

This study provides evidence of an association of a gut microbiota composition characterized by increased abundance of Streptococcus spp and other species commonly found in the oral cavity with coronary atherosclerosis and systemic inflammation markers. Further longitudinal and experimental studies are warranted to explore the potential implications of a bacterial component in atherogenesis.

Common resilience factors among healthy individuals exposed to chronic adversity: a systematic review

OBJECTIVE

To identify common resilience factors against non-communicable diseases (dental caries, diabetes type II, obesity and cardiovascular disease) among healthy individuals exposed to chronic adversity.

MATERIALS AND METHODS

The databases MEDLINE (via PubMed), Scopus and CINAHL were searched. Observational studies in English assessing resilience factors among populations living in chronic adversity were included. Intervention studies, systematic reviews, non-original articles and qualitative studies were excluded. There were no restrictions regarding publication year or age. No meta-analysis could be done. Quality assessments were made with the Newcastle-Ottawa scale (NOS).

RESULTS

A final total of 41 studies were included in this systematic review. The investigated health resilience factors were divided into the following domains: environmental (community and family) and individual (behavioural and psychosocial). A narrative synthesis of the results was made according to the domains.

CONCLUSIONS

Individual psychosocial, family and environmental factors play a role as health resilience factors in populations living in chronic adversity. However, the inconclusive results suggest that these factors do not act in isolation but interplay in a complex manner and that their interaction may vary during the life course, in different contexts, and over time.

Dental professionals' perception of their role in the practice of oral health promotion: a qualitative interview study

OBJECTIVE

To explore dental professionals' perceptions of their role in the practice of oral health promotion.

MATERIAL AND METHOD

In-depth interviews were conducted with three dentists, one specialist dentist and seven dental hygienists. All were employed in the public dental service in Kalmar County, Sweden and had at least 2 years' work experience. The interview questions addressed the experience and views of dental professionals with reference to their role in the practice of health promotion. The interview data were subjected to qualitative content analysis.

RESULTS

Analysis revealed two themes which capture the essence of the dental professionals' perception of their role in the practice of oral health promotion. One theme, having person-focused approach, comprised four categories: 'considering the patient's life situation', 'establishing a trusting relationship with patients', 'strengthening patients' commitment to oral health' and 'health education'. The other theme, perceiving social responsibility for oral health, comprised three categories: 'dissemination of oral health knowledge', 'interprofessional collaboration' and 'equality in oral health care'.

CONCLUSION

Dental professionals perceived promotion of oral health to be an important aspect of their professional role. They aspired to patient participation in the decision-making process and educational activities, as well as practising and evaluating skills development. Although the dental professionals perceived that they undertook health promotion activities, they did not clearly distinguish between oral health promotion and disease prevention. There was intra- and inter-professional agreement among the dentists and dental hygienists with respect to expected outcomes for health promotion activities.

Self-perceived oral health-related salutogenic factors in orally healthy older Swedes. A qualitative interview study

OBJECTIVE

This study aimed to explore oral health-related salutogenic factors in orally healthy older Swedish people, applying the three components of Antonovsky's Sense of Coherence (SOC) concept: comprehensibility, manageability and meaningfulness.

MATERIAL AND METHOD

Interviews were conducted with 12 orally healthy patients, aged 75 years and older, enrolled at public dental clinics. The interviews were subjected to qualitative content analysis, applying the SOC concept as the theoretical framework.

RESULTS

Three themes were formulated under the predefined SOC components, describing the central meaning of the informants' perception of factors favourable to their good oral health. The theme 'comprehension of cause and effect' consisted of three categories, for example importance of oral hygiene, and reflected the component comprehensibility. The theme 'living in confidence and trust in supporting society' consisted of five categories, for example self-esteem, and reflected the component manageability. The theme 'good oral health as a basis for satisfaction and social confidence' consisted of two categories, for example social norms, and reflected the component meaningfulness.

CONCLUSION

This study discloses how orally healthy elderly Swedish people perceive the lifelong impact of salutogenic factors in response to lifelong stressors on their oral health and highlights the important roles of their internal resources, dental professionals, family and society in supporting and reinforcing lifelong oral health.

Exploring salutogenic factors supporting oral health in the elderly

AIM

To explore associations between salutogenic factors and selected clinical outcome variables of oral health in the elderly, combining Antonovsky's salutogenic theory and the Lalonde Health Field concept.

METHODS

The subjects comprised 146 individuals, aged 60 years and older, who had participated in a population-based epidemiological study in Sweden, 2011-2012, using questionnaire and oral examination data. A cross-sectional analysis used the selected outcome variables, such as number of remaining teeth, DMFT-index and risk assessment, and salutogenic factors from the questionnaire, clustered into domains and health fields, as artifactual-material, cognitive-emotional and valuative-attitudinal. This selection was based on findings from our previous analysis using a framework cross-tabulating two health models. The purpose was to facilitate analysis of associations not previously addressed in the literature on oral health. Bivariate and Multiple Linear Regression analyses were used.

RESULTS

Numerous salutogenic factors were identified. Significant associations between outcome variables and salutogenic factors previously unreported could be added. Regression analysis identified three contributing independent factors for 'low DMFT'.

CONCLUSIONS

This study supports the usefulness of a salutogenic approach for analysing oral health outcomes, identifying university education, the importance of dental health organization recall system and close social network, as important salutogenic factors. The large number of salutogenic factors found supporting oral health among the elderly indicates the complexity of salutogenesis and the need for robust analysing tools. Combining two current health models was considered useful for exploring these covariations. These findings have implications for future investigations, identifying important research questions to be explored in qualitative analyses.

Risk Factors for Dental Erosion After Bariatric Surgery: A Patient Survey

Introduction

Treatment of obesity by bariatric surgery has increased in recent years. Reported side effects that may predispose to dental erosion include reflux, vomiting, and an increased frequency of intake of food and drink.

Objective

The aim was to investigate long-term dietary behaviour and experiences related to symptoms of dental erosion at least 5 years after bariatric surgery.

Methods

An online questionnaire study was conducted amongst 250 patients who had undergone bariatric surgery at King Saud Medical City in Saudi Arabia 5 years ago or more. It comprised 36 questions on demographic data, dietary habits, general health, dental health, and oral symptoms. The data were analysed using Chi-square and sign tests (significance level P < .05).

Results

A significant increase in acidic reflux and vomiting was found after bariatric surgery and appeared to increase with time after surgery. Also, a significant association between presence of acidic reflux and symptoms of dental erosion was found. However, 68.5% reported improved overall well-being after surgery. The response rate was 21.6% (most were female, aged 30-59 years). Respondents were generally not advised to visit a dentist in connection with bariatric surgery.

Conclusions

This long-term cross-sectional study suggests a time-dependent, increasing occurrence of vomiting and acidic reflux after bariatric surgery. Vomiting and reflux became even more common after 5 to 10 years. A significant relationship emerged between a high frequency of acidic reflux and a high frequency of oral symptoms related to dental erosion. Daily occurrence of general symptoms related to dumping syndrome were reported by the majority. However, in a 5- to 10-year perspective, general symptoms related to dumping syndrome and symptoms from dental erosion did not seem to detract from the respondents’ overall satisfaction with daily living. Oral health problems might be reduced if patients who had bariatric surgery were referred to a dentist for prevention and monitoring.

Salutogenic factors for oral health among older people: an integrative review connecting the theoretical frameworks of Antonovsky and Lalonde

OBJECTIVE

The aim of this integrative review was to describe salutogenic factors associated with oral health outcomes in older people, from the theoretical perspectives of Antonovsky and Lalonde.

MATERIAL AND METHODS

This study was based on a primary selection of 10,016 articles. To organize reported salutogenic factors, the Lalonde health field concept and Antonovsky's salutogenic theory were cross tabulated.

RESULTS

The final analysis was based on 58 studies. The following oral health outcome variables were reported: remaining teeth, caries, periodontal disease, oral function and oral health related quality of life (OHRQoL). We could identify 77 salutogenic factors for oral health and OHRQoL. Salutogenic factors were identified primarily within the fields of Human Biology (such as 'higher saliva flow', 'BMI < 30 kg/m²' and 'higher cognitive ability at age 11'), Lifestyle (such as 'higher education level', 'social network diversity' and 'optimal oral health behaviour') and Environment (such as 'lower income inequality', 'public water fluoridation' and 'higher neighbourhood education level'). In the age group 60 years and over, there was a lack of studies with specific reference to salutogenic factors.

CONCLUSIONS

The results provide an overview of salutogenic factors for oral health from two theoretical perspectives. The method allowed concomitant disclosure of both theoretical perspectives and examination of their congruence. Further hypothesis-driven research is needed to understand how elderly people can best maintain good oral health.

Salivary fluoride concentration and retention after rinsing with 0.05 and 0.2% sodium fluoride (NaF) compared with a new high F rinse containing 0.32% NaF

OBJECTIVE

To compare salivary fluoride (F) concentration and F retention after rinsing with a new 0.32% sodium fluoride (NaF) rinse and conventional 0.05 and 0.2% NaF rinses.

METHODS

Seventeen subjects (aged 22-26 years), with normal salivary secretion rates, participated in a double blind, cross-over study. In three separate sessions with a minimum washout period of 48 h, they rinsed for 1 min with 10 ml of 0.05, 0.2 or 0.32% NaF mouthrinse. Unstimulated whole saliva was collected before (baseline: 0 min) and after 1, 3, 5, 10, 20, 30, 45 and 60 min. The F concentration was plotted against time, and the area under the curve (AUC) calculated. Salivary F concentration and F retention for the three mouthrinses were compared by a randomized block test, followed by Tukey's test and a paired 2-tailed test.

RESULTS

There was a clear dose-response for AUC 3-60 min; 0.32% > 0.2% > 0.05% (p < .05). The mean F retention was 0.25 mg for 0.05% NaF, 0.86 mg F for 0.2% Na and 1.31 mg F for 0.32% NaF, (p < .05).

CONCLUSIONS

The higher salivary F concentration over time and the higher F retention after rinsing with an 0.32% NaF solution suggests a potential application in prevention of caries and dental erosion.

Why Do Adolescents Use Fluoride Toothpaste? A Qualitative Interview Investigation

PURPOSE

Fluoride toothpastes are effective in caries prevention. In legislation, regular fluoride toothpaste is a cosmetic product; adolescents use it for aesthetic purposes. In dentistry, fluoride toothpaste is considered a caries preventive drug recommended to patients for that reason. Knowledge is lacking concerning what motivates adolescents to use fluoride toothpaste. Dental professionals need to understand how to motivate a risk-group for caries development to use fluoride toothpaste frequently in order to effectively motivate patients to prevent tooth decay. The purpose of this study was to investigate what motivates adolescents to use fluoride toothpaste.

MATERIALS AND METHODS

The study was conducted at a high school in southern Sweden. The final sample consisted of 16 adolescents age 16 to 19. This study employed a qualitative design using semi-structured interviews. The data were analysed using manifest content analysis with an occasional inductive approach.

RESULTS

Reasons for why adolescents use fluoride toothpaste were found in four different categories: oral health, economy, upbringing and habit, social influences.

CONCLUSION

There are reasons to believe that dental professionals might have missed important arguments for why adolescents use fluoride toothpaste. The participants mentioned oral health and aesthetics as important reasons for using fluoride toothpaste, as well as other more surprising factors such as financial reasons and social environment. There are thus more arguments for using fluoride toothpaste that adolescents value than the ones we believe dental professionals use.

Odontoblast-like MDPC-23 cells produce pro-inflammatory IL-6 in response to lipoteichoic acid and express the antimicrobial peptide CRAMP

Objective: Odontoblasts are thought to be involved in innate immunity but their precise role in this process is not fully understood. Here, we assess effects of lipopolysaccharide (LPS) and lipoteichoic acid (LTA), produced by Gram-negative and Gram-positive bacteria, respectively, on matrix metalloproteinase-8 (MMP-8), interleukin-6 (IL-6) and cathelin-related antimicrobial peptide (CRAMP) expression in odontoblast-like MDPC-23 cells.Material and methods: Gene activity and protein production was determined by quantitative real-time RT-PCR and ELISA, respectively. Cellular expression of CRAMP was determined by immunocytochemistry.Results: Stimulation with LTA (5 and 25 µg/ml) but not LPS (1 and 5 µg/ml) for 24 h enhanced IL-6 mRNA expression. The LTA-induced up-regulation of IL-6 mRNA levels was associated with increased IL-6 protein levels. Stimulation with either LPS or LTA for 24 h lacked effect on both MMP-8 transcript and protein expression. Immunocytochemistry disclosed that MDPC-23 cells expressed immunoreactivity for CRAMP. MDPC-23 cells showed mRNA expression for CRAMP, but stimulation with either LPS or LTA did not modulate CRAMP transcript expression.Conclusions: We show that MDPC-23 cells possess immune-like cell properties such as LTA-induced IL-6 production and expression of the antimicrobial peptide CRAMP, suggesting that odontoblasts may modulate innate immunity via these mechanisms.

Swedish Quality Registry for Caries and Periodontal Diseases - a framework for quality development in dentistry

ObjectivesL There is a need for monitoring dental health and healthcare, as support for quality development, allocation of resources and long-term planning of dental care. The aim of this paper is to describe the concept and implementation of the Swedish Quality Registry for Caries and Periodontal Diseases (SKaPa). Materials and methods: The SKaPa receives information by automatic transfer of data daily from electronic patient dental records via secure connections from affiliated dental care organisations (DCOs). The registry stores information about DCOs, dental professionals and patients. Information on a patient level includes personal identifier, gender, age, living area, dental status, risk assessments for caries and periodontitis, and dental care provided. In addition, data generated from a global question on patient-perceived oral health are uploaded. In total, more than 400 variables are transferred to the registry and updated daily. Results: In 2018, all of the 21 public DCOs and the largest private DCO in Sweden were affiliated to SKaPa, representing a total of 1,089 public and 234 private dental clinics. The accumulated amount of information on dental healthcare covers 6.9 million individuals out of the total Swedish population of 10 million. SKaPa produces reports on de-identified data, both cross-sectional and longitudinal. Conclusion: As a nationwide registry based on automatic retrieval of data directly from patient records, SKaPa offers the basis for a new era of systematic evaluation of oral health and quality of dental care. The registry supports clinical and epidemiological research, data mining and external validation of results from randomised controlled trials

The host defense peptide LL-37 is detected in human parotid and submandibular/sublingual saliva and expressed in glandular neutrophils

The human host defense peptide, LL-37, is an important player in the first line of defense against invading microorganisms. LL-37 and its precursor, hCAP18, have been detected in unstimulated whole saliva but no reports showing hCAP18/LL-37 in isolated, parotid, and/or submandibular/sublingual saliva have been presented. Here, we measured the levels of hCAP18/LL-37 in human parotid and submandibular/sublingual saliva and investigated the expression of hCAP18/LL-37 in parotid and submandibular gland tissue. Parotid and submandibular/sublingual saliva was collected from healthy volunteers, and the levels of hCAP18/LL-37 in saliva were analyzed by dot blot, ELISA, and western blotting. Cellular expression of hCAP18/LL-37 in human parotid and submandibular glands was investigated by immunohistochemistry. Immunoreactivity for hCAP18/LL-37 was detected in both parotid and submandibular/sublingual saliva of all individuals. The concentration of hCAP18/LL-37 was similar in parotid and submandibular/sublingual saliva, and was determined by densitometric scanning of each dot and normalization to the total protein concentration of each sample, and by ELISA. Double immunohistochemistry revealed that intravascular neutrophils of both parotid and submandibular glands express hCAP18/LL-37. For the first time, we demonstrate hCAP18/LL-37 in isolated human parotid and submandibular/sublingual saliva and expression of hCAP18/LL-37 in glandular intravascular neutrophils, indicating that neutrophils of the major salivary glands contribute to the LL-37 content of whole saliva.

Evaluation of an outreach education model over five years: Perception of dental students and their outreach clinical mentors

INTRODUCTION

The objective was to investigate changes in students' and clinical mentors' perceptions of a model for outreach education over a 5-year period, 2006-2010.

MATERIAL AND METHOD

Two cohorts of last-year students of a dental problem-based curriculum and their clinical mentors in the Public Dental Service (PDS) were invited to respond to a questionnaire. In 2006, 85% of 54 students and 72% of their 54 mentors responded; 98% of 40 students and 88% of 41 of the mentors did so in 2010. Participants scored their level of agreement with different statements on a numeric rating scale and gave comments.

RESULTS

Dental students and their clinical mentors reported that they shared a consistent and favourable perception of this outreach education model over 5 years. The students reported increased professional confidence and self-reliance. Clinical mentors expressed a transfer of knowledge to their clinics. Differences in scoring were seen between students and mentors for two statements in 2006 and two statements in 2010 (P < 0.05).

CONCLUSIONS

The current model for outreach education received favourable and stable ratings over the 5-year period. This model resulted in that students perceived that they became self-reliant, which may facilitate their transition from being a student to becoming a professional. The current model supports exchange and professional development for students, faculty and outreach clinics. This leads us to look at outreach education as an opportunity to form a mutual learning community comprised of the outreach clinics and the dental school.

Oral Pilocarpine for Treatment of Opioid-induced Oral Dryness in Healthy Adults

Pilocarpine induces a profuse flow of saliva when administered orally, but effects on drug-induced oral dryness have not been examined. The aim of this trial was to investigate if pilocarpine increases production of saliva in individuals suffering from dry mouth due to treatment with opioids. Sixty-five individuals were enrolled in a randomized, double-blind, placebo-controlled trial. The subjects received tramadol (50 mg t.d.s.) to induce oral dryness, and were thereafter assigned to one of three groups. Secretion rate of saliva was measured before and after tramadol, and after the oral administration of pilocarpine (5 mg), placebo, or no treatment. Baseline characteristics did not differ among the groups (mean ± SEM: 0.37 ± 0.06 mL/min), and tramadol lowered the secretion at the same level in all groups (0.15 ± 0.02 mL/min). Pilocarpine increased the flow above that observed with placebo (0.66 ± 0.19 vs. 0.15 ± 0.02 mL/min). Thus, pilocarpine re-establishes the flow of saliva in the state of tramadol-induced oral dryness.

Presence of Lactobacillus reuteri in saliva coincide with higher salivary IgA in young adults after intake of probiotic lozenges

The aim of this study was to compare the concentration of salivary immunoglobulin A (IgA) and the selected interleukins (IL)-1β, IL-6, IL-8 and IL-10 in young individuals with presence and non-presence of Lactobacillus reuteri in saliva after a three-week intervention with probiotic lozenges. The study group consisted of 47 healthy individuals aged 18-32 years with no clinical signs of oral inflammation. In a randomised, double-blind, placebo-controlled, cross-over trial participants ingested two lozenges per day containing two strains of the probiotic bacterium L. reuteri or placebo lozenges. The intervention and wash-out periods were three weeks. Stimulated and unstimulated whole saliva was collected at baseline and immediately after termination of the intervention periods. The samples were analysed for total protein, salivary IgA and selected cytokines. In this extended analysis, data were collected by analysing baseline and follow-up saliva samples related to ingestion of the probiotic lozenges for the presence of L. reuteri through DNA-extraction, PCR-amplification and gel-electrophoresis. At baseline, 27% of the individuals displayed presence of L. reuteri and 42% were positive immediately after the three-week probiotic intervention. Individuals with presence of L. reuteri in saliva had significantly higher (P<0.05) concentrations of salivary IgA and %IgA/protein at the termination of the probiotic intake compared with non-presence. No differences in the cytokine levels were observed. In conclusion, detectable levels of L. reuteri in saliva coincided with higher concentrations of salivary IgA and %IgA/protein in stimulated whole saliva after the three-week daily intake of probiotic lozenges. Our findings suggest that monitoring the presence of probiotic candidates in the oral environment is important to interpret and understand their possible immune-modulating role in maintaining oral health.

Comparison of risk assessment based on clinical judgement and Cariogram in addition to patient perceived treatment need

Background

Predicting future risk for oral diseases, treatment need and prognosis are tasks performed daily in clinical practice. A large variety of methods have been reported, ranging from clinical judgement or “gut feeling” or even patient interviewing, to complex assessments of combinations of known risk factors. In clinical practice, there is an ongoing continuous search for less complicated and more valid tools for risk assessment. There is also a lack of knowledge how different common methods relates to one another. The aim of this study was to investigate if caries risk assessment (CRA) based on clinical judgement and the Cariogram model give similar results. In addition, to assess which factors from clinical status and history agree best with the CRA based on clinical judgement and how the patient’s own perception of future oral treatment need correspond with the sum of examiners risk score.

Methods

Clinical examinations were performed on randomly selected individuals 20–89 years old living in Skåne, Sweden. In total, 451 individuals were examined, 51 % women. The clinical examination included caries detection, saliva samples and radiographic examination together with history and a questionnaire. The examiners made a risk classification and the authors made a second risk calculation according to the Cariogram.

Results

For those assessed as low risk using the Cariogram 69 % also were assessed as low risk based on clinical judgement. For the other risk groups the agreement was lower. Clinical variables that significantly related to CRA based on clinical judgement were DS (decayed surfaces) and combining DS and incipient lesions, DMFT (decayed, missed, filled teeth), plaque amount, history and soft drink intake. Patients’ perception of future oral treatment need correlated to some extent with the sum of examiners risk score.

Conclusions

The main finding was that CRA based on clinical judgement and the Cariogram model gave similar results for the groups that were predicted at low level of future disease, but not so well for the other groups. CRA based on clinical judgement agreed best with the number of DS plus incipient lesions.

Lactobacillus reuteri supplements do not affect salivary IgA or cytokine levels in healthy subjects: A randomized, double-blind, placebo-controlled, cross-over trial

OBJECTIVES

To evaluate the effect of daily ingestion of probiotic lactobacilli on the levels of secretory IgA (sIgA) and selected cytokines in whole saliva of healthy young adults.

MATERIALS AND METHODS

The study group consisted of 47 healthy adults (18-32 years) who volunteered for a randomized, double-blind, placebo-controlled, cross-over trial after informed consent. During intervention, the subjects ingested two lozenges per day containing two strains of the probiotic bacterium Lactobacillus reuteri (DSM 17938 and ATCC PTA 5289) or placebo lozenges. The intervention and wash-out periods were 3 weeks. Saliva samples were collected at baseline, immediately after each intervention period and 3 weeks post-intervention. ELISA was used to measure sIgA and luminex technology was used to measure the interleukins (IL)-1β, IL-6, IL-8 and IL-10. For statistical analyses a mixed ANOVA model was employed to calculate changes in the salivary outcome variables.

RESULTS

Forty-one subjects completed the study and reported a good compliance. No significant differences in the concentrations of salivary sIgA or cytokines were recorded between the L. reuteri and placebo interventions or between baseline and 3 weeks post-intervention levels. No side- or adverse effects were reported.

CONCLUSIONS

Supplementation with two strains of the probiotic L. reuteri did not affect sIgA or cytokine levels in whole saliva in healthy young adults. The results thereby indicate that daily oral supplementation with L. reuteri do not seem to modulate the salivary oral immune response in healthy young subjects (ClinicalTrials.gov NCT02017886).

Streptococcus mutans biofilm inhibition using antisense oligonucleotide to glucosyltransferases B and C

Background. Biofilm formation by Streptococcus mutans bacteria on teeth leads to dental caries, which still remains one of the most prevalent human diseases strongly related to increase of dietary sucrose consumption in modern society. In the biofilm, sucrose is metabolized by S. mutans to acids causing tooth decay. S. mutans also produces glucosyltransferases (Gtfs) for synthesis of sticky glucan polymers from sucrose that provides matrix for biofilm formation on teeth. For reducing biofilm build-up, one preventive measure could be blocking of Gtf synthesis. The aim of this study was to test antisense phosphorothioate oligodeoxyribonucleotide (PS-ODN) targeting simultaneously S. mutans gtfB and gtfC mRNAs in order to inhibit biofilm formation in vitro. Materials and methods. S. mutans bacteria were grown anaerobically on glass slides inserted vertically in 24-well cell culture plates containing Todd Hewitt broth with sucrose under exposure to antisense or missense PS-ODNs at the final concentration of 10 μM. Untreated bacteria served as controls. After 24 h of incubation, glass slides were removed, air-dried and further used for the quantitative evaluation of the streptococci biofilm applying an optical profilometry technique. Results. It was revealed that antisense PS-ODN considerably reduced the most critical biofilm surface roughness parameter Sa (average difference between the peak hight and valleys) inhibiting the biofilm development by 46% and 77% in comparison to untreated (p = 0.06) and missense PS-ODN-treated bacteria (p < 0.05), respectively. Conclusions. The results demonstrate that antisense PS-ODN considerably decreases streptococci-induced biofilm development on glass slides, and might therefore significantly suppress dental biofilm formation through simultaneous inactivation of S. mutans gtfB and gtfC mRNAs.

Caries correlates strongly to salivary levels of matrix metalloproteinase-8

The caries process in dentin involves the degradation of both mineral and organic matrix. The demineralization has been demonstrated to be caused by bacterial acids. However, the collagen degradation is considered to be initiated by endogenous proteolytic enzymes, mainly collagenolytic matrix metalloproteinases (MMPs). This paper aims to relate salivary MMP-8 (or salivary collagenase-2) and tissue inhibitor of MMP (TIMP-1) levels to manifest caries in a large number of subjects. A random sample of 451 adults (aged 18-87 years) living in the south of Sweden was included in this study. Standard clinical examinations were performed, and stimulated saliva was collected and analyzed for concentrations of MMP-8, TIMP-1 and total protein, using an immunofluorometric assay, an enzyme-linked immunosorbent assay and the Bradford assay, respectively. Salivary numbers of mutans streptococci and lactobacilli were determined using a chair-side kit. Subjects with manifest caries lesions presented with elevated levels of MMP-8 (p < 0.001) as well as total protein, MMP-8/TIMP-1 ratio, bleeding on probing and plaque index (p = 0.05) compared with subjects without manifest caries. Multiple linear regression analysis with caries as the dependent variable revealed MMP-8 as the only significant explanatory variable (p < 0.001). TIMP-1 was not significant in any case. Using MMP-8 as the dependent variable revealed total protein concentration, caries lesions (p ≤ 0.001) and salivary secretion rate (p = 0.05) as explanatory variables. In conclusion, our data reveal that subjects with manifest caries lesions have elevated levels of salivary MMP-8 relative to subjects with no caries lesions.

Reducing dental plaque formation and caries development. A review of current methods and implications for novel pharmaceuticals

Dental caries is an oral disease, which has a high worldwide prevalence despite the availability of various prophylactic means, including the daily use of fluoride toothpastes, water fluoridation, dental sealants, oral health educational programs and various antiseptic mouth-rinses. One important reason for this is uncontrolled increase in consumption of foods containing considerable sucrose concentration, especially among children. Sucrose is easily metabolized by oral bacteria (mostly streptococci) to acids and, subsequently, causing tooth decay or dental caries. In the oral ecosystem, streptococci principally reside on tooth surfaces forming biofilm. Important structural and binding materials of biofilm are glucan polymers synthesized by several isoforms of glucosyltransferase enzyme present in certain species of oral bacteria, including mutans group streptococci - Streptococcus mutans and Streptococcus sobrinus, which preferably colonize humans. Thus, there is a constant need to develop the methods and chemotherapeutics for improving oral health care and decreasing teeth decay through the suppression of cariogenic biofilm formation in the oral cavity. The aim of this paper was to review literature related to the pathogenesis of dental caries as well as currently existing and experimental pharmaceutical substances used for prevention of this process.

Salivary IgA response to probiotic bacteria and mutans streptococci after the use of chewing gum containing Lactobacillus reuteri

We investigated whether ingestion of probiotic bacteria could influence salivary IgA levels, specific anti-mutans streptococci IgA levels and specific antibodies towards the ingested probiotic bacterium. The study was a randomised, double-blind, placebo-controlled trial, where the test group (n = 11) received twice daily chewing of gum containing Lactobacillus reuteri (2 × 10(8)  CFU per dose) and the control group (n = 12) received placebo. Resting saliva was collected before and after 12 weeks of treatment and 4 weeks after end of treatment. Total salivary IgA concentrations were measured by ELISA. Specific IgA reactivity was determined using a whole-cell ELISA. Results were expressed as % IgA per protein in saliva. The level of total IgA% per protein increased significantly between pretreatment levels (13.5%) and follow-up treatment levels (14.4%) within the test group only (P < 0.05). No changes were seen in the control group during the trial. The level of probiotic-reactive antibodies decreased significantly between pre- and post-treatment samples (from 12.2% to 9.0%, P < 0.05) in the test group. Similarly, the level of specific mutans streptococci antibodies decreased significantly between pre- and post-treatment samples (P < 0.05) in the test group only (for Streptococcus mutans from 20.1% to 15.0%; for Streptococcus sobrinus from 7.4% to 5.3%). Ingestion of probiotic bacteria might influence the adaptive immune response of the host.

Aciduric bacterial communities at three levels in dentin caries

PURPOSE

Dentin caries constitute a complex ecosystem with a diverse microbiota adapted to fluctuations in nutrient concentration and acidity. However, knowledge about the acid tolerant microbiota at different levels in the lesion is rather poor. Hence, the purpose of this study was to investigate the acid tolerant microflora at different levels in established dentin caries lesions using solid pH-selective media.

MATERIALS AND METHODS

Primary dentin caries lesions were sampled with a bur at three levels (superficial, centre and the clinically caries-free floor of the lesion) in 10 patients. Samples were incubated on pH-neutral and pH-selective (pH 4.0, 4.5, 5.0, 5.5) agars. Numbers of colony-forming units (cfu) were determined and colonies were subsequently characterised morphologically and isolated.

RESULTS

The total number of bacteria in the carious lesions, recovered using blood agar (BA), ranged from 5.88 x 103 to 5.85 x 105 (median 2.64 x 105; range 5.80 x 105) and numbers of recovered bacteria decreased with decreasing agar pH. Fewer bacteria were found in the clinically caries-free dentin (P = 0.042), but the mean number of cfu (BA) was still 5.88 x 103 in those samples.

CONCLUSION

Each of the 10 investigated dentin caries lesions harboured a unique microbial flora, indicating that various combinations of aciduric bacteria can colonise, survive in and probably propagate dentin caries. Solid pH-selective agars can be used successfully to select acid-tolerant microorganisms in dentin caries lesions. This could be used to describe this subset of the total microbiome from a phenotypic point of view, an objective that cannot be accomplished using molecular methods.

The Legacy of Cariologist Douglas Bratthall, an Inspired Scientist

Douglas Bratthall was an inspirational cariologist known for his playful curiosity, thoughtful inquisitiveness, incisive scholarship, and energetic leadership. He became a time, mind, and global traveler who viewed his career path as an exotic safari. This ‘Discovery!’ report identifies where his era’s burning issues have led and how they were shaped by his contributions.

Proceedings for the 5th Asia-Pacific Conference on Disaster Medicine: Creating an Agenda for Action

Disaster medicine has come to the forefront and has become the focus of interest not only in the medical community, but also in the eyes of the public. The 5th APCDM was convened in Vancouver, Canada, 27–30 September 2000. It brought together over 300 delegates from 32 countries to share their experiences and thoughts regarding disaster events and how to effectively manage them.

The conference was devoted to the task of establishing priorities and creating an Agenda for Action. From the discussions, key actions required were defined:

Communications: (1) Identify existing regional telehealth groups and gather lessons to be learned from them; (2) Form a telehealth advisory group to work with regional groups to compile telehealth initiatives, identify international protocols in telehealth already in existence, and solicit feedback before setting international standards; and (3) Increase corporate partnerships in the fields of telehealth and telecommunications, and invite corporations to send delegates to future APCDM meetings. This should be an initiative of the APCDM, the World Association of Disaster and Emergency Medicine (WADEM), or the European Society of Emergency Medicine.

Education and research: (1) Formalize education in disaster medicine and management. The World Health Organization and WADEM should take a leadership role; (2) WADEM is requested to hold a conference with a focus on qualitative research; (3) WHO is requested to continue the provision of international research teams, but to advocate for the development of national disaster research infrastructure; (4) Make research findings and reports available on web sites of such organizations as WHO and PAHO; (5) Develop the translation of research for community utilization. The WHO and PAHO are organizations that are requested to consider this action; and (6) WADEM/APCDM are requested to focus future conferences on applied research.

Information and data: (1) Create an “Information and Data Clearinghouse on Disaster Management” to collect, collate, and disseminate information; (2) Collect data using standardized tools, such as CAR or Hazmat indices; (3) Analyze incentives and disincentives for disaster readiness and establish mechanisms for addressing the obstacles to preparedness; and (4) WADEM is requested to develop a web site providing a resource list of interdisciplinary institutions and response activities, organized by country, topic, and research interests. Links to other pertinent web sites should be provided.

Interdisciplinary development: (1) Focus on the interdisciplinary nature of disaster response through more conferences encompassing grassroots efforts and through WADEM publications; (2)Develop and apply a standardized template of Needs Assessment for use by multidisciplinary teams. Team Needs Assessment is essential to determine the following: (a) Local response and international assistance required; (b) Appropriate command system; and (c) Psychosocial impact and support necessary.

Psychosocial aspects: (1) Incorporate relief for caregivers into action plans. This should include prime family members who also are caregivers; and (2) Implement measures that give survivors control over the recovery process.

Response management. (1) Define relationships and roles between governments, military and security personnel, non-governmental organizations (NGOs), and civic groups. Use an international legal framework and liability to reinforce accountability of disaster responders; (2) Establish a more sophisticated use of the media during disasters; (3) Establish standards in key areas. WADEM is requested to write “White Papers” on standards for the following areas: (a) management, (b) health/public health, (c) education/training, (d) psychosocial, and (e) disaster plans; (4) Establish task forces to anticipate and resolve issues around evolving and emerging disasters (e.g., chemical and biological terrorism, landmines, emerging infectious diseases). WADEM was again identified as the vehicle for promoting this action.

The responsibility of the next meeting of the Asia-Pacific Conference on Disaster Medicine will be to measure progress made in these areas by assessing how well these collective decisions have been implemented.

Attitudes of some European dental undergraduate students to the placement of direct restorative materials in posterior teeth

The aim of this article was to report on the attitudes, opinions and confidences of final year dental students in three European schools towards the restoration of posterior teeth and in particular towards the use of amalgam and resin composite. One hundred and twenty-eight pre-piloted questionnaires were distributed to final year dental students in Cardiff, Dublin and Malmö. The questionnaire sought information relating to various opinions and attitudes towards the use of amalgam and resin composite in posterior teeth. Information was returned anonymously. Ninety-one completed questionnaires were returned (response rate=71%; Cardiff: n =40, Dublin: n=24, Malmö: n=27). Ninety-three per cent of Malmö students (n=24), 67% of Dublin students (n=16) and 60% of Cardiff students (n=24) reported that they feel confident when placing posterior resin composites. One hundred per cent of Malmö students (n=27), 75% of Cardiff students (n=30) and 33% of Dublin students (n=8) would prefer to have a resin composite rather than amalgam, placed in one of their own posterior teeth. Eighty-five per cent of Malmö students (n=23), 30% of Cardiff students (n=12) and 25% of Dublin students (n=6) perceive amalgam as being harmful to the environment. For the restoration of a posterior tooth in a pregnant female, 44% of students (n=40) would place a resin composite restoration, and 7% (n=6) would place an amalgam restoration, while 32% (n=29) would place a temporary restoration. Students at Malmö report that they place more posterior resin composites and have greater confidence at placing posterior resin composites than students at Cardiff or Dublin. There was confusion relating to the choice of restorative materials for pregnant females. Large variations in restorative strategies among graduates must be considered as dental professionals can practice in all countries within the European Union.

Tramadol-induced oral dryness and pilocarpine treatment: effects on total protein and IgA

Pilocarpine induces a profuse flow of saliva, and it may re-establish saliva production in cases of drug-induced oral dryness. The aim of the study (a sub-study to the previous trial investigating the pilocarpine fluid effects in individuals suffering from drug-induced dry mouth) was to search for saliva quality changes induced by the treatments. Sixty-five individuals were enrolled in a randomized, double-blind, placebo-controlled trial. The subjects received tramadol to induce oral dryness. Secretion rate was measured before and after tramadol, and then after pilocarpine, placebo, or no treatment. All saliva was analyzed for its protein and IgA content in the pilocarpine (n=15) and placebo groups (n=12). At baseline, the flow of saliva was 0.47±0.05ml/min, the protein output 0.17±0.2mg/min and the IgA output 0.022±0.002mg/min. After tramadol treatment (50mg 3×/day over two days), the flow was reduced by 64%, protein output by 52% and the IgA output by 38%. While placebo treatment did not affect any of the variables, the flow was 120%, the protein output 193% and the IgA output 83% of the baseline characteristics after pilocarpine treatment (5mg). Thus, the pilocarpine-induced increase in the flow rate in the state of tramadol-induced oral dryness results in saliva with a well preserved protein concentration but with a decrease in IgA concentration. However, compared to baseline, there was neither a decrease in output nor in concentration of IgA.

Attitudes of final-year dental students to bleaching of vital and non-vital teeth in Cardiff, Cork, and Malmö

The aim of this study was to determine attitudes of final-year dental students in Cardiff, Cork and Malmö towards tooth whitening. Following receipt of ethical approval, pre-piloted questionnaires were distributed to final-year dental students in Cork, Cardiff, and Malmö as close as possible to graduation. The questionnaire sought information relating to various opinions and attitudes towards the use of bleaching techniques including safety of bleaching, confidence in the provision of bleaching, recommendations to patients, teaching received, awareness of restrictions on the use of bleaching products and management of simulated clinical scenarios. Eighty three per cent (n = 116) of questionnaires were returned. Cork dental students had the most didactic teaching (2-h vital, 1-h non-vital bleaching) compared to Cardiff or Malmö students (0 h each). More Cork students regarded bleaching as safe (76%, n = 28) than Cardiff (70%, n = 32) or Malmö (36%, n = 12) students. More than 50% of Cork students feel they know enough about bleaching to provide it in practice, significantly more than Cardiff (< 25%) or Malmö (< 25%) students. The majority of students would provide vital bleaching after qualification (100% (n = 37) Cork; 82% (n = 27) Malmö; 76% (n = 35) Cardiff). In simulated clinical scenarios, more Cork students would propose bleaching treatments (89%n = 33) than Malmö (64%n = 21) or Cardiff (48%n= 22) students. Variations exist in the attitudes and approaches of three European dental schools towards bleaching. Dental students need to be best prepared to meet the needs of their future patients.

Comparison of two minimally invasive methods on the longevity of glass ionomer cement restorations: short-term results of a pilot study

The purpose of this study was to evaluate the clinical performance of glass ionomer cement (GIC) restorations comparing two minimally invasive methods in permanent teeth after 12 months. Fifty pregnant women (second trimester of pregnancy), mean age 22 +/- 5.30 years, were treated by two previously trained operators. The treatment approaches tested were: chemomechanical method (Carisolv; MediTeam) and atraumatic restorative treatment (ART). A split-mouth study design was used in which the two treatments were randomly placed in 50 matched pairs of permanent teeth. The chemomechanical method (CM) was the test group and the ART was the control group. The treatments were performed in Public Health Centers. The tested restorative material was a high-strength GIC (Ketac Molar; 3M/ESPE). The restorations were placed according to the ART guidelines. Two calibrated independent examiners evaluated the restorations in accordance with ART criteria. The inter-examiner kappa was 0.97. Data were analyzed using 95% confidence interval on the binomial distribution and Fisher's exact test at 5% significance level. In a 12-month follow-up, 86% of the restorations were evaluated. In the test group (CM), 100% (CI=93.3-100%) of the restorations were considered successful. In the control group (ART) 97.6% (CI=87.4-99.9%) of the restorations were considered successful and 2.4% unsuccessful (marginal defect >0.5 mm). There was no statistically significant difference between the 12-month success rate for both groups (Fisher's exact test: P=0.49) and between the two operators (Fisher's exact test: P=1.00). Both minimally invasive methods, chemomechanical method and ART, showed a similar clinical performance after 12 months of follow up.

In Vitro Fluoride Release and the Antibacterial Effect of Glass Ionomers Containing Chlorhexidine Gluconate

Modification of inherent fluoride-containing materials with chlorhexidine provides an antibacterial and remineralizing varnish with potential anti-cariogenic properties.

The concept of minimally invasive dentistry

This paper reviews Minimally Invasive Dentistry (MID) from a day-to-day dentistry perspective, focusing mostly on cariology and restorative dentistry, even though it embraces many aspects of dentistry. The concept of MID supports a systematic respect for the original tissue, including diagnosis, risk assessment, preventive treatment, and minimal tissue removal upon restoration. The motivation for MID emerges from the fact that fillings are not permanent and that the main reasons for failure are secondary caries and filling fracture. To address these flaws, there is a need for economical re-routing so that practices can survive on maintaining dental health and not only by operative procedures.

Low salivary IgA activity to cell-surface antigens of mutans streptococci related to HLA-DRB1*04

BACKGROUND/AIMS

Mutans streptococci are found in almost all individuals, though there are large differences in colonization levels between individuals. These differences are not readily explained, though several factors are believed to influence the colonization. One factor is the immune response to mutans streptococci, mainly provided by salivary immunoglobulin A (IgA). In a previous study, differences in salivary IgA reactions to oral streptococci were observed between human leukocyte antigen (HLA)-DR4-positive and DR4-negative individuals. A lower salivary IgA activity to Streptococcus mutans in particular was most pronounced for two DR4 subgroups, DRB1*0401 and *0404. The main purpose of this study was to further investigate, in a larger study group, the salivary IgA activity to antigens of three oral streptococci in relation to different HLA-DRB1*04 alleles.

METHODS

Stimulated saliva was collected from 58 HLA-DRB1*04-positive individuals. Whole cell antigen extracts from S. mutans, Streptococcus sobrinus and Streptococcus parasanguis and the streptococcal antigen (SA) I/II were separated in SDS-PAGE, transblotted and detected with diluted saliva (Western blot), and analyzed in a computer program. All distinct immunoblot bands over 100 kDa were recorded and compared in relation to DRB1*04.

RESULTS

The immunoblots revealed lower salivary IgA reactions to S. mutans, S. sobrinus and SA I/II, but not to S. parasanguis, for the DRB1*0401- and *0404-positive individuals compared to other DRB1*04 types. For the *0401 subgroup there was a significant association with a lower IgA response to S. mutans.

CONCLUSION

The results confirm earlier observations and may also support previous demonstrated association between colonization by mutans streptococci and the serologically defined HLA-DR4.

Protein profile of pepsin-digested carious and sound human dentine

The purpose of this study was to describe the protein profile of pepsin-digested carious and sound dentine using sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Carious and sound dentine powder was decalcified using 10% EDTA at pH 7.4 for 48 h. The decalcified pellet was digested using pepsin at pH 2 under sequenced conditions: at 4 degrees C for 24 h, a further 24 h at 23 degrees C, and finally for 24 h at 37 degrees C. After every step, the soluble fraction was separated by centrifugation and analyzed in 15% SDS-PAGE. Two bands at 56 and 62 kDa could be observed in carious dentine digests and were considered specific carious bands. Similar bands could be observed in sound dentine samples, but only after pepsin digestion at higher temperatures (23 degrees C and 37 degrees C). Pepsin digests non-helical collagen and the triple helix structure of collagen is lost when the temperature rises. The bands at 56 and 62 kDa in sound dentine specimens thus represent pepsin-cleaved collagen. There is a possibility that the specific carious bands in carious dentine represent collagen decomposed in a manner similar to the way pepsin digests native dentine collagen at 23 degrees C and 37 degrees C.

Chlorhexidine-containing glass ionomer cement. A clinical investigation on the fissure caries inhibiting effect in first permanent molars

Glass ionomer cement with addition of chlorhexidine used as a varnish on tooth surfaces has been shown to reduce the number of interproximal mutans streptococci (ms). The effect of a single application of such a varnish containing 2.5% chlorhexidine on occlusal caries development of the first permanent molars on 6-year-old children in a high caries incidence area was investigated. The children were examined according to WHO criteria and 262 children with 2 caries free contra-lateral molars were selected for treatment. Salivary ms samples were collected using the Strip-mutans (SM) method. After brushing the occlusal surfaces with a toothbrush and pumice in water slurry, rinsing and drying with a cotton roll, glass ionomer cement containing chlorhexidine (GI-CHX) and glass ionomer (GI) were applied randomly with a micro brush and the varnish was covered with occlusal wax. At baseline, the mean defs was 18.18 and DMFS was 0.25 and after one year 18.24 and 0.83 respectively. The salivary ms scores were high or very high (SM 2 and 3) in 85.6% at baseline. At the one-year follow up, the GI-CHX and GI materials could not be detected in the fissures. Also, a large number of fissure sealants had been placed in the molars outside the study protocol; thus 4% of the GI-CHX and GI, and 70% of the untreated were sealed at year one. Overall, there was no significant difference between the caries-reducing effect of GI-CHX and GI, but a trend towards a higher effect was seen for GI-CHX. Excluding the sealed molars the reduction was 74% in the GI-CHX-group, and 71% in the GI-group.

CONCLUSION

Addition of 2.5% chlorhexidine to glass ionomer did not seem to increase the caries-reducing effect of the varnish in this high caries incidence population.

Platelet storage solution improves the in vitro function of preserved platelet concentrate

BACKGROUND AND OBJECTIVES

Stored platelets develop biochemical lesions, manifest as depressed haemostatic function, clot retraction and wound healing. ViaCyte trade mark, a proprietary experimental preservative solution (comprising D-ribose, D-glucose, Hanks solution, Hepes solution, bovine serum albumin, tic anticoagulant peptide and sterile water), was tested in comparison with the presently accepted storage solution, citrate-dextrose-phosphate-plasma (CDP-P), to evaluate its ability to preserve platelet function during storage.

MATERIALS AND METHODS

Platelets stored in ViaCyte and platelets suspended in CDP-P were transferred to polypropylene tubes with PL732 covers and analysed for adenine nucleotide levels (ATP molecules), in vitro agonist-mediated P-selectin expression and aggregation.

RESULTS

After 5 days of storage at room temperature, 12.2% of platelets stored in ViaCyte exhibited P-selectin expression at rest, and 64.2% exhibited P-selectin expression upon activation with thrombin challenge, an increase of 52%. Platelets stored in CDP-P exhibited 44.4% P-selectin expression at rest, suggesting significant activation during storage, and thrombin stimulation resulted in P-selectin expression of 47.9%, an increase of only 2.5% (P< or =0.002, untreated vs. treated). ViaCyte also maintained ATP levels throughout the storage period, while these levels became depressed in platelets stored in CDP-P (P< or =0.02, untreated vs. treated). Storing platelets in the experimental preservative solution maintained their ability to aggregate, while control platelets lost their ability to aggregate in response to agonist.

CONCLUSIONS

ViaCyte appears to protect platelets during storage, reflected by a low level of induced lesions. Platelets stored in ViaCyte maintain energy levels at their resting state, which preserves their ability to aggregate and secrete granule contents, and ensures the availability of additional platelets for activation upon in vitro challenge.

Salivary IgA reactions to cell-surface antigens of oral streptococci

BACKGROUND

In the immunoblot technique, using whole bacteria cell extracts as antigens, both intra- and extracellular antigens are detected, which gives a large number of immunoglobulin A (IgA) reactions (immunoblot bands) when incubated with saliva. It is important to distinguish which immunoblot bands represent bacterial cell-surface antigens, since these antigens could be involved in adhesion mechanisms and be available for blocking in vivo.

METHODS

Bacterial extracts of Streptococcus mutans, Streptococcus sobrinus, Streptococcus parasanguis and the streptococcal antigen I/II were separated using SDS-PAGE. The antigens were detected with saliva in Western blot. Untreated saliva and saliva in which cell-surface reactive IgA had been absorbed with whole bacteria cells were analyzed.

RESULTS

Approximately half the number of the bands were absent for saliva absorbed with homologous cells, compared to untreated saliva. The absorption pattern was almost identical for S. mutans and S. sobrinus but not for S. parasanguis. Salivary IgA reactive against streptococcal antigen I/II was absorbed by S. mutans cells, to a lesser extent by S. sobrinus cells, and not at all by S. parasanguis cells.

CONCLUSION

It is likely that the bands that were absent after absorption represented cell-surface antigens. For S. mutans and S. sobrinus, these bands were probably the streptococcal antigen I/II.

What is minimally invasive dentistry?

Minimally Invasive Dentistry is the application of "a systematic respect for the original tissue." This implies that the dental profession recognizes that an artifact is of less biological value than the original healthy tissue. Minimally invasive dentistry is a concept that can embrace all aspects of the profession. The common delineator is tissue preservation, preferably by preventing disease from occurring and intercepting its progress, but also removing and replacing with as little tissue loss as possible. It does not suggest that we make small fillings to restore incipient lesions or surgically remove impacted third molars without symptoms as routine procedures. The introduction of predictable adhesive technologies has led to a giant leap in interest in minimally invasive dentistry. The concept bridges the traditional gap between prevention and surgical procedures, which is just what dentistry needs today. The evidence-base for survival of restorations clearly indicates that restoring teeth is a temporary palliative measure that is doomed to fail if the disease that caused the condition is not addressed properly. Today, the means, motives and opportunities for minimally invasive dentistry are at hand, but incentives are definitely lacking. Patients and third parties seem to be convinced that the only things that count are replacements. Namely, they are prepared to pay for a filling but not for a procedure that can help avoid having one.

Cultivatable bacteria in dentine after caries excavation using rose-bur or carisolv

To measure the amount of viable bacteria after excavation using conventional rose-bur or the chemo-mechanical Carisolv method, a total of 22 lesions were analyzed (one vital tooth per patient) in this open, controlled and randomized study. Two samples per lesion were taken under aseptic conditions using a rose-bur, one superficially in the caries lesion and one after completed excavation. In in vitro tests more material was collected from the hard caries free dentine as compared to the carious dentine. The samples were incubated on blood agar (aerobically and anaerobically), Rogosa (SL) agar and mitis salivarius (MS) agar. For blood agar (aerobic) both methods resulted in a significant decrease in CFU, for blood agar (anaerobic) and MS agar only the Carisolv method resulted in a significant decrease in CFU and for SL agar neither method resulted in a significant decrease in CFU. Comparing CFU before and after excavation, a considerable reduction of CFU was seen ranging from 10(1) to 10(4). Comparing the excavation methods, there were no significant differences, except in the case of blood agar (aerobic), which showed that Carisolv excavation was more effective in reducing CFU. This study indicated that bacterial sampling collected more material from hard dentine as compared from soft. Remaining bacteria after excavation were low in both groups. The Carisolv method seemed to remove bacteria at least up to and possibly beyond the extent of conventional drilling.

Minimally Invasive Dentistry--concepts and techniques in cariology

The concept 'Minimally Invasive Dentistry' can be defined as maximal preservation of healthy dental structures. Within cariology, this concept includes the use of all available information and techniques ranging from accurate diagnosis of caries, caries risk assessment and prevention, to technical procedures in repairing restorations. Dentists are currently spending more than half their time replacing old restorations. The main reasons for restoration failures are secondary caries and fractures, factors that are generally not addressed in the technical process of replacing a restoration. Prevailing concepts on minimally invasive dentistry seem to be 'product or technique-motivated', challenging one technique or product with another, rather than focusing on a general concept. New knowledge of caries progression rates has also led to substantial modification of restorative intervention thresholds and further handling of the disease. New diagnostic tools for caries lesion detection, caries risk assessment and focused preventive treatments have decreased the need for early restorative interventions. In parallel to this, new techniques for cutting teeth and removing decay have evolved. This paper focuses on describing minimally invasive dentistry in cariology from a conceptual perspective, relating to clinical caries diagnosis, restorative intervention thresholds and operative procedures, with special reference to survival of tunnel and slot restorations and to repair vs. replacement of defective restorations.

HLA-DR4 and salivary immunoglobulin A reactions to oral streptococci

The aim of this study was to describe and compare salivary immunoglobulin A (IgA) antibody reactions to extracts of strains of three oral streptococci in human leukocyte antigen (HLA)-DR4-positive and -DR4-negative subjects. Whole paraffin-stimulated saliva samples were collected from 27 apparently healthy subjects. Previous HLA typing showed that 20 subjects were DR4 positive and 7 were DR4 negative. HLA-DRB1*04 subtyping was performed among the DR4-positive subjects. Whole-cell antigen extracts from Streptococcus mutans (KPSK 2), Streptococcus sobrinus (OMZ 65) and Streptococcus parasanguis (Nt 62) were separated in SDS-PAGE. The antigens were immunoblotted with diluted saliva (Western blot), scanned and analyzed in a computer system. All immunoblot bands were recorded in DR4-positive and DR4-negative saliva pools, and bands with an optical density >or=0.1 were selected for analysis in individual salivas. The DR4-negative subjects in general had more immunoblot bands and more distinct bands than did the DR4-positive subjects. A higher concentration of total IgA in saliva was correlated with more bands, especially to antigens separated from S. mutans. When the number of bands was calculated per IgA unit, significant differences were observed between DR4-positive and DR4-negative salivas. This was particularly seen for S. mutans and S. parasanguis. As the number of bands was analyzed in relation to DR4 subgroups, DRB1*04, there was a lower salivary IgA activity to S. mutans in the DRB1*0401 and *0404. The variable level of correlation previously demonstrated for S. mutans colonisation and serologically defined DR4 positive subjects might be explained by the heterogeneity in this group, and the relation should be sought on a subgroup level.

The comparison of the efficacy and safety of intravenous versus subcutaneous immunoglobulin replacement therapy

To compare the efficacy of immunoglobulin replacement therapy given intravenously versus subcutaneously to prevent infections in patients with primary antibody deficiency syndromes, an international, multicenter, open label, crossover study was designed. Forty patients were randomized to receive either subcutaneous or intravenous immunoglobulin replacement therapy for 1 year. In the second year, patients were switched to the alternative treatment, enabling patients to act as their own controls. Equivalent doses were given by both routes. Ethical approval was obtained from the review boards of the hospitals in which the patients were seen and written consent obtained from each patient. Patients with a primary antibody deficiency syndrome, either common variable immunodeficiency or IgG subclass deficiency or specific antibody deficiency, who required immunoglobulin replacement therapy were included in the study. Patients were excluded if they had significant thrombocytopenia (defined as platelets less than 50 x 10(9)/liter), had high levels of anti-IgA antibodies (defined as greater than 1:8192), or had severe adverse reactions to a blood product within the last 2 years. The primary end point was the number of infections and their severity (moderate and major) during the two treatment periods. Secondary end points were adverse reactions, length of infections, days lost from school or work due to infections, and acceptability of treatment regimens to the patients. Based on the assumption that it was difficult to prove equivalence of therapies statistically in crossover studies, an arbitrary number of 40 patients was selected on the basis that this might be achievable in 2 years. There are no significant differences in efficacy or adverse reaction rates between immunoglobulin replacement therapy given subcutaneously or intravenously.

Transient reduction of mutans streptococci on tooth surfaces using a chlorhexidine-containing glass ionomer cement varnish

Chlorhexidine (CHX) has been incorporated in polymer-based varnishes to reduce mutans streptococci (ms) by the sustained release of CHX. Such varnishes often adhere well to teeth initially but are easily peeled off. To be effective, repeated application is necessary. Glass ionomer (GI) cements interacts with tooth minerals to form a stronger bond, and the inherent brittleness of the cement makes it difficult to remove in large fragments. The fluoride content may also reduce demineralisation. The aim of this study was to observe whether ms could be reduced interproximally and in saliva by a single application of a GI cement containing 3.3% CHX gluconate (CHX-GI). After professional tooth cleaning and a mouth rinse for 2 min with 0.2% CHX, the teeth of six subjects were coated with CHX-GI cement. An additional six subjects were treated with a GI cement that did not contain CHX, and seven subjects received professional tooth cleaning only. Ms samples were taken interproximally with the tooth pick method before and after treatment. Interproximal levels were classified according to the number of colony-forming units (c.f.u.) found: 0, 1-20, 21-100, and > 100. Saliva ms were sampled with the Strip Mutans method. After four weeks, the interproximal levels of ms had decreased only in the CHX-GI group (p < 0.05). In this group 9 of 14 highly colonised sites (> 100 c.f.u.) remained reduced throughout this period. In the GI and the untreated group a slight increase of ms interproximally was seen after one week. The interproximal ms scores in all groups approached baseline levels after 8 weeks. There were no significant differences in saliva ms levels between the groups during the test period. GI cement may be a possible vehicle for CHX in reducing ms interproximally.