Arginine: A New Paradigm in Preventive Oral Care.

Dental caries is ubiquitous and one of the most prevalent oral diseases and the foremost cause of dental pain and poor quality of life (QoL). Fluoride is an effective caries preventive agent; however, despite its use, there remain some gaps in prevention of dental caries. Arginine, an amino acid, helps to maintain a noncariogenic plaque. It shows synergistic effects with fluoride in dental caries and can help nourish the tooth by enhancing the remineralization effect of fluoride. Supplementing fluoride dentifrices with arginine can bridge the gap in caries prevention. Several clinical studies with 1.5% arginine + fluoride provide evidence for its use in prevention of dental caries. This report throws light on the benefits of arginine in dental caries and guides on its use with fluoride. Recommendations given in the report will help in effective prevention of dental caries. How to cite this article: Goyal V, Damle S, Puranik MP, et al. Arginine: A New Paradigm in Preventive Oral Care. Int J Clin Pediatr Dent 2023;16(5):698-706.

A study on genetic and mutans streptococcal transmissibility of dental caries.

Background: Dental caries is characterized by an interplay between environmental and genetic factors. Aim: The aim of this study was to analyse the transmissibilities of high caries risk chromosomal loci at 5q 12.1-13.3 and low caries risk chromosomal loci at 13q31.1 and Streptococcus mutans (S. mutans) in family units. Materials: This prospective cohort study was performed on 56 families grouped into four: (a) Group I: 18 families of children with caries affected primary teeth; (b) Group II: 21 families of children with caries in permanent teeth; (c) Group III: 6 families of children with no caries in primary teeth and (d) Group IV: 12 families of children with no caries in permanent teeth. Blood, saliva and plaque samples were collected from consenting study participants. Isolated DNAs were subjected to polymerase chain reactions using suitable primers. Data collected was analysed with ANOVA and Chi-squared test. Results: Wide expression of chromosome loci 5q12.1-13.3 was obtained in both blood and saliva samples. For chromosome loci 13q31.1, no expression was found in saliva samples, hence indicating its local absence. For the GtfB expression, transmissibility was common for a single band expressing S. mutans. Conclusion: This study reflects upon newer findings in the field of genetic research on dental caries.

Evaluation of the association between tuftelin gene polymorphism, Streptococcus mutans, and dental caries susceptibility.

CONTEXT: Dental caries can be conceptualized as an interaction between genetic and environmental factors. AIMS: The purpose of this study was to identify any polymorphism in tuftelin gene and its association with dental caries susceptibility, either singly or in combination with the microbial causing agent: Streptococcus mutans. SETTINGS AND DESIGN: The presented study included a total of 30 children of age group 12-16 years categorized into two groups: 15 children with no detectable caries in Group I and 15 children with high caries (DMFS ≥10) in group II. MATERIALS AND METHODS: The stimulated salivary samples were inoculated in mitis salivarius bacitracin agar plates and growth of S. mutans was estimated. DNA extraction was done from whole blood and amplification was done with the help of real-time polymerase chain reaction technique. Oligonucleotide primers were designed to flank single nucleotide polymorphism in the gene. STATISTICAL ANALYSIS USED: The collected data was statistically analyzed by unpaired t-test, paired t-test, Chi-square test, Pearson correlation, and regression analysis. RESULTS: The difference in mean salivary S. mutans counts between the two groups was highly significant. Correlation between tuftelin gene polymorphism and dental caries susceptibility was not significant in both Group I and Group II. Only 4.1% of the variability in dental caries risk can be explained by interaction between tuftelin gene and S. mutans. CONCLUSIONS: Future research studies including parents and siblings should be carried out to focus on further investigation into the mechanism of this gene-environment interaction.

Effect of dentifrices on their remineralizing potential in artificial carious lesions: An in situ study.

BACKGROUND: The eventual sequel of dental caries is determined by the dynamic equilibrium between pathological factors which lead to demineralization and protective elements, which in turn leads to remineralization. Remineralization is the natural process for noncavitated demineralized lesions and relies on calcium and phosphate ions assisted by fluoride to rebuild a new surface on existing crystal remnants in subsurface lesions remaining after demineralization. Hence, the present study was designed to evaluate the efficacy of fluoride dentifrices in remineralizing artificial caries-like lesions in situ. MATERIALS AND METHODS: A double-blind, randomized study with an initial washout period of 7 days was carried out for 3 weeks. Twenty volunteers were enrolled, who wore the intraoral cariogenicity test appliance having enamel slabs incorporated into them, for 3 weeks. 10 participants were instructed to use Group A dentifrice (fluoride) and the other 10 Group B dentifrice (nonfluoride) for brushing their teeth. The enamel slabs were analyzed by surface microhardness testing and scanning electron microscopy (SEM) at 3 intervals. RESULTS: No significant differences was seen in the microhardness values recorded for Group A and Group B at baseline and after demineralization (P > 0.05); however Group B exhibited lesser microhardness compared to Group A, after intra-oral exposure (P < 0.05). In the SEM analysis, the Group A enamel surfaces had more regular and longer crystallites to those of the Group B. CONCLUSION: Fluoride dentifrices avert the decrease in enamel hardness and loss of minerals from the enamel surface to a large extent as compared to the nonfluoride dentifrices.

A study of sports related occurrence of traumatic orodental injuries and associated risk factors in high school students in north India.

BACKGROUND: Oral and dental injuries contribute to a major part of sports related injuries in children. Trauma occurring in developing years disrupts normal social functioning and brings about a major impact on quality of life due to their cumulative effect. OBJECTIVES: To assess the prevalence and causes of various sports related traumatic orodental injuries among 8 to 16 year school students along with identifying the associated risk factors in North India. PATIENTS AND METHODS: A cross sectional study consisting of high school students of different organized sports teams aged 8-16 years was carried out in geographical area of north India. The students were selected by multistage cluster sampling methodology. 1105 students from 19 school teams (sports teams) and sports academies participated in study through structured interview and clinical examination in different sports situations. RESULTS: 30.3% (n = 335) of students suffered from orodental injuries. A higher number of girls had injury (32%) than boys (29%), though the difference was not significant. Most of the students suffered from soft tissue injuries (48%) followed by tooth fractures (43%). Maximum numbers of injuries were reported in high velocity (44.1%) and medium intensity sports (46.6%) (P < 0.001) Maximum injuries occurred in basketball (50%) and lowest in the field of badminton (6.1%) (P < 0.05). Amateurs (52%) suffered the most from injuries as per level of coaching. Only 6% of boys and 2% of girls used mouthguards. CONCLUSIONS: The result of the present study confirmed that students participating in different organized sports at high school level are at a very high risk of getting orodental injury. Hence knowledge and education regarding prevention of traumatic injuries is of paramount importance.

Effectiveness of supervised toothbrushing and oral health education in improving oral hygiene status and practices of urban and rural school children: A comparative study.

OBJECTIVE: To evaluate and compare the oral health status and the impact of supervised toothbrushing and oral health education among school children of urban and rural areas of Maharashtra, India. MATERIALS AND METHODS: A total of 200 school children in the age group 12-15 years were selected by stratified random sampling technique from two schools and were further divided into two groups: Group A (urban school) and Group B (rural school). Both the groups were again subdivided into control group and study group. Supervised toothbrushing was recommended for both the groups. The toothbrushing teaching program included session on oral health education, individual toothbrushing instructions, and supervised toothbrushing. Dental caries increment, plaque scores, and gingival status were assessed as per the World Health Organization (WHO) criteria (1997), Turesky-Gilmore-Glickman modification of the Quigley Hein Plaque Index, and Loe-Silness Gingival Index (1963), respectively. Cronbach's alpha, Chi-square test, paired t-test, and unpaired t-test were utilized for data analysis. RESULTS: The mean plaque and gingival score reduction was significantly higher in the study groups as compared to the control groups. An increase in the mean of Decayed, missing, filled teeth (DMFT) and Decayed, missing, filled teeth and surfaces (DMFS) scores throughout the study period was seen in children who participated in study. CONCLUSION: Oral health education was effective in establishing good oral health habits among school children and also in enhancing the knowledge of their parents about good oral health.

Mechanisms of resistance against cancer therapeutic drugs.

Cancer is the manifestation of multiple dysregulated cellular pathways. Treatment protocols engaged in treating these diseases involve mainly the cell cycle regulating genes/proteins, DNA synthesis and repair, protein synthetic machinery, apoptotic and proliferation activity and cytoskeletal framework. Some of the traditional therapeutic strategies have over the years developed resistance making cure difficult to achieve. This paper analyzes the mechanisms employed by various cancers that render them resistant against therapeutic drugs.

Esthetic management of developmental enamel opacities in young permanent maxillary incisors with two microabrasion techniques--a split mouth study.

PURPOSE: This study evaluated the effectiveness of two microabrasion materials for the removal of developmental enamel opacities in young permanent maxillary incisors. MATERIALS AND METHODS: Using a split-mouth study design, 37% phosphoric acid and 18% hydrochloric acid were used for removal of visually unesthetic developmental enamel opacities of young permanent maxillary anterior teeth from 25 subjects (11-13 years old) by two microabrasion techniques for 10 and 5 seconds respectively. This procedure was repeated four to six times during each clinical appointment. The subjects were evaluated about their satisfaction with the treatment. Two blinded evaluators appraised both sides of the mouth using visual analog scale. The records were analyzed using Wilcoxon test. RESULTS: The majority of the subjects (approximately 97%) reported satisfaction at the end of the treatment (p = 0.001**). Statistical significant reduction in enamel opacities was observed by evaluators immediately after microabrasion technique in group 1 (81.75%) and in group 2 (81.4%) (p < 0.002). Reduction was increased to 97.2% in group 1 and 96.7% in group 2 after 1 month. CONCLUSIONS: Both microabrasion techniques showed comparative highly significant successful results in esthetic management of enamel opacities clinically and in terms of subject's satisfaction. CLINICAL SIGNIFICANCE: Developmental enamel defects like diffuse opacities due to high-fluoride content in water and demarcated opacities associated with positive dental history and are commonly seen in young permanent maxillary incisors of both boys and girls in their developing years. They are aware of unesthetic appearance of these newly erupted permanent anterior teeth and become highly motivated when informed about minimally invasive, patient friendly, cost-effective, and safe treatment like microabrasion for esthetic improvement. Both noninvasive microabrasion techniques using 37% phosphoric acid (group 1) and 18% hydrochloric acid (group 2) show comparatively high success results in treating enamel defects successfully to the subject's satisfaction along with their parents.

An investigation of the effects of a hand washing intervention on health outcomes and school absence using a randomised trial in Indian urban communities.

OBJECTIVES: To evaluate how an intervention, which combined hand washing promotion aimed at 5-year-olds with provision of free soap, affected illnesses among the children and their families and children's school absenteeism. METHODS: We monitored illnesses, including diarrhoea and acute respiratory infections (ARIs), school absences and soap consumption for 41 weeks in 70 low-income communities in Mumbai, India (35 communities per arm). RESULTS: Outcomes from 847 intervention households (containing 847 5-year-olds and 4863 subjects in total) and 833 control households (containing 833 5-year-olds and 4812 subjects) were modelled using negative binomial regression. Intervention group 5-year-olds had fewer episodes of diarrhoea (-25%, 95% confidence intervals [CI] = -37%, -2%), ARIs (-15%, 95% CI = -30%, -8%), school absences due to illnesses (-27%, 95% CI = -41%, -18%) and eye infections (-46%, 95% CI = -58%, -31%). Further, there were fewer episodes of diarrhoea and ARIs in the intervention group for 'whole families' (-31%, 95% CI = -37%, -5%; and -14%, 95% CI = -23%, -6%, respectively), 6- to 15-year-olds (-30%, 95% CI = -39%, -7%; and -15%, 95% CI = -24%, -6%) and under 5 s (-32%, 95% CI = -41%, -4%; and -20%, 95% CI = -29%, -8%). CONCLUSIONS: Direct-contact hand washing interventions aimed at younger school-aged children can affect the health of the whole family. These may be scalable through public-private partnerships and classroom-based campaigns. Further work is required to understand the conditions under which health benefits are transferred and the mechanisms for transference.

Isocitrate lyase: a potential target for anti-tubercular drugs.

Current TB regimen involves a combination of first and second line drugs which target only a small number of core metabolic processes such as deoxyribonucleic acid (DNA)/ ribonucleic acid (RNA) synthesis, cell wall synthesis, and energy metabolism pathways. New classes of drugs with additional drug targets that are resistant to mutation are an urgent necessity. Novel targets involved in vital aspects of bacterial growth, metabolism and viability and whose inactivation would lead to bacterial death or an inability to persist need to be investigated. Isocitrate lyase (ICL), which catalyses the first step in the glyoxylate cycle is found to play a pivotal role in persistence of Mycobacterium tuberculosis in mice, can be a potential target for anti-tubercular drug. The current review provides a detailed overview of the therapeutic potential, patents and recent advancements in the investigative studies done on isocitrate lyase (ICL) as an antitubercular drug target. Salicylanilide, benzanilide, 3-nitropropionamide and pthalazinyl derivatives, Pyruvate-isoniazid analogs and its copper complexes are among the synthesized compounds showing a great potential to inhibit mycobacterial ICL and a significant antimycobacterial effect. Some of the relevant patents in the ICL research have been further reviewed and discussed.

Comparative efficacy of dentifrice containing sodium monofluorophosphate + calcium glycerophosphate and non-fluoridated dentifrice: A randomized, double-blind, prospective study.

BACKGROUND: The efficacy of fluoridated dentifrices in caries prevention has been well documented and research into various formulations continues for a more effective dentifrice. This study evaluated the anti-caries and anti-plaque efficacy of a dentifrice containing sodium monofluorophosphate (1000 ppm) and calcium glycerophosphate, and compared it with a non-fluoridated dentifrice. MATERIALS AND METHODS: A total of 595 school children (12-15 years) were divided into test (302 children) and control (293 children) groups. The test group used the dentifrice containing sodium monofluorophosphate (1000 ppm) and calcium glycerophosphate, whereas the control group was given a placebo dentifrice. Oral examination for dental caries and plaque assessment was carried out at the start of the study and the children were followed up semiannually up to 18 months. Data were analyzed using repeated-measure analysis of variance (ANOVA) followed by one-way ANOVA. RESULTS: The values for decayed missing filled teeth (DMFT) increased from baseline to 18 month examination from 4.43±2.03 and 4.67±2.25 (P=0.175) to 5.84±2.29 and 5.13±2.30 (P=0.001) for control and test groups, respectively. Similarly, the increase in decayed missing filled surface (DMFS) values were from 6.42±4.10 and 7.06±4.77 (P=0.082) to 8.64±4.51 and 7.92±5.07 (P=0.095) for test and control groups, respectively. The mean DMFT and DMFS values increased for both the groups; however, the increase was less in test group as compared to control group. The baseline plaque score reduced from 2.94±0.72 and 2.91±0.72 (P=0.679), respectively, for control and test groups to 1.33±0.46 and 0.91±0.38 (P<0.001), respectively, at 18 month examination. CONCLUSION: Results revealed that the test dentifrice was effective in inhibiting the progression of plaque and control of dental caries as compared to the placebo dentifrice.

The effect of consumption of carbonated beverages on the oral health of children: a study in real life situation / Efeito do consumo de refrigerantes na saúde bucal de crianças: estudo em uma situação real

Objetivo: Avaliar a saúde bucal de crianças que consomem refrigerantes e também conhecer as razões para o consumo excessivo dessas bebidas. Método: Um estudo de natureza transversal CAP (conhecimento, atitude e prática) com uma amostra de 200 crianças na faixa etária de 12-13 anos de idade foi realizado em Maharishi Markandeshwar International School, Mullana, Ambala, na Índia. Um questionário foi elaborado e distribuído para verificar as razões para o alto consumo de refrigerantes e os seus efeitos sobre a saúde bucal. Os dados coletados foram analisados estatisticamente. Resultados: Em média, as crianças na faixa etária de 12-13 anos consumiam entre 7 e 8 refrigerantes (latas - 250ml) por semana, ou seja, de 1500mL a 2000mL. Verificou-se que a gravidade da cárie dentária foi elevada quando os resultados foram comparados a crianças que não consumiram bebidas carbonatadas na mesma escola. Os resultados também confirmam que as crianças não estão conscientes dos efeitos nocivos dos refrigerantes sobre a saúde bucal. Conclusão: As crianças que consomem refrigerantes regularmente são mais propensas a cárie dentária.

Objective: To assess the oral health of children consuming carbonated beverages and also to ascertain the reasons for excess consumption of these beverages. Methods: A cross-sectional KAP (knowledge, attitude and practice) survey of 200 children in the age group of 12 - 13 years was carried out in Maharishi Markandeshwar International School, Mullana, Ambala, India. A questionnaire was designed and distributed to ascertain the reasons for high consumption of carbonated beverages and its effects if any on oral health. The data collected was analysed statistically. Results: The results of the study revealed that on an average, children in the age group of 12-13 years consumed 7-8 drinks (cans - 250ml) per week, i.e. 1500 - 2000 ml consumption. The severity of tooth decay was seen to be high, when the results were compared to those children who did not consume carbonated drinks in the same school. The findings also confirm that children are not aware of the detrimental effects of carbonated beverages on oral health. Conclusion: The children who consume carbonated drinks regularly are more prone to tooth decay.

Salivary mutans streptococci and lactobacilli modulations in young children on consumption of probiotic ice-cream containing Bifidobacterium lactis Bb12 and Lactobacillus acidophilus La5.

OBJECTIVES: To compare the levels of mutans streptococci and lactobacilli in saliva of school children, before and after consumption of probiotic and control ice-cream. MATERIALS AND METHODS: A double-blind, cross-over, placebo-controlled trial was carried out in forty, 12-14 year-old children, with no clinically detectable caries. The selected children were randomized equally into two groups I and II. Following an initial run-in period of 1 week, children in group I and II were given ice-creams 'A' and 'B', respectively, for 10 days. Being a cross-over study, the ice-creams were interchanged in the two groups after a 2-week wash-out period. Saliva samples at baseline and follow-up were assessed using Dentocult SM and Dentocult LB kits. RESULTS: On statistical evaluation, it was seen that probiotic ice-cream brought about a statistically significant reduction (p-value = 0.003) in salivary mutans streptococci levels with no significant effect on lactobacilli levels. CONCLUSION: In conclusion, probiotic ice-cream containing Bifidobacterium lactis Bb-12 ATCC27536 and Lactobacillus acidophilus La-5 can reduce the levels of certain caries-associated micro-organisms in saliva.

Evaluation of ability of dentifrices to remineralize artificial caries-like lesions.

BACKGROUND: Human endeavors to prevent dental caries have led to the use of different modalities and agents, the most commonly used of which is fluoridated dentifrice. An in situ study was carried out to evaluate the efficacy of fluoridated dentifrices in achieving remineralization of initial caries-like lesions using surface microhardness measurements and to study the qualitative changes by scan-ning electron microscopy. METHODS: Sixteen children 12-16 years of age wore a specially fabricated appliance with an artificially demineralized enamel slab for 24 hours a day, for four weeks. The children were divided into two groups, A and B. Following one week use of placebo dentifrice by both groups, group A used a fluoride dentifrice containing l000 ppm sodium monofluorophosphate, whereas group B used a placebo twice daily for 5 minutes for 21 days. Surface microhardness test carried out using a Knoop diamond indenter followed by scanning electron microscopy to evaluate the lesions. The results were statistically analyzed using the student t test. P value less than 0.05 was considered significant. RESULTS: The average hardness recovery for the experimental group was significantly higher than that in the control group (P < 0.001). Scanning electron microscopy revealed that fluoride significantly enhances remineralization of initial caries-like lesions. CONCLUSION: Regular use of fluoridated dentifrices significantly enhances remineralization of white spot lesions.

Apexogenesis of a symptomatic mandibular first permanent molar with calcium hydroxide pulpotomy.

Vital pulp therapy of immature, symptomatic permanent posterior teeth presents a challenge in pediatric endodontics. A case report is presented in which cervical pulpotomy with calcium hydroxide was performed on a cariously exposed mandibular first permanent molar. The patient was seen every 3 months for a total of 18 months for a clinical and radiographic follow up. During the follow-up period, root development, as evidenced by root lengthening, was observed. Apical closure was evident at the end of 19 months. As the root canals showed a tendency toward calcification, root canal treatment was carried out, followed by restoration of the tooth with a stainless-steel crown. The success of this single-visit apexogenesis procedure supports the contention that young pulp possesses remarkable reparative capacity, as well as resistance to bacterial infection due to greater vascularity, and that apexogenesis with calcium hydroxide apical closure pulpotomy can be attempted for continued root development of symptomatic, vital, permanent teeth.

Retrieval of a foreign object from the palatal root canal of a permanent maxillary first molar: A case report.

A 12-year-old boy presented with a fractured sewing needle within the palatal root canal of a nonvital permanent maxillary first molar. The patient admitted that he had often placed a sewing needle in the tooth to relieve discomfort associated with it. A minimal amount of tooth structure was removed around the foreign object to facilitate access for K-type files. Under copious irrigation, the files were worked around the object to loosen it. The fractured needle was removed with a tweezers that had long, narrow beaks. Use of this simple technique allowed the object to be removed from the root canal with minimal damage to internal tooth structure.