High levels of periodontal disease among the older adult population in San Juan, Puerto Rico.

UNLABELLED: The Puerto Rican Elderly Dental Health Study is the first to evaluate the periodontal status of a representative sample in Puerto Rico. OBJECTIVE: To assess the periodontal status among the elderly population in San Juan. BASIC RESEARCH DESIGN: Three dentists were trained and standardised by the US National Health and Nutrition Examination Survey (NHANES) reference examiner. They examined elders aged 70-97 in the San Juan area from participants in a representative cohort of the Puerto Rican elderly. Probing depth (PD), attachment loss (AL), and tooth mobility were assessed among the dentate participants on 4 sites on all teeth excluding third molars. We used the CDC-AAP definitions for moderate periodontitis (> or = 2 teeth with AL > or = 4mm at interproximal sites or > or = 2 teeth with PD > or = 5mm at interproximal sites) and severe periodontitis (> or = 2 teeth with AL > or = 6mm at interproximal sites and > or = 1 teeth with PD > or = 5mm at interproximal sites). RESULTS: The participation rate was 47%, 183 individuals, mean age 77.9 (sd 5.9), and 67% were females. Mean number of teeth was 15.8 (sd 6.8), and tooth mobility was present in 18% of participants. Mean PD was 1.5 (sd 0.6) and mean AL was 2.8 mm (sd1.5). The prevalence of moderate and severe periodontitis (CDC-AAP) was 44.5% compared to 20.7% in the NHANES 1999-2004 survey among 75 years and older. CONCLUSIONS: Our study showed high levels of severe and moderate periodontal disease among Puerto Rican older adults. Further research is needed to understand the reasons for the high prevalence.

Urease activity as a risk factor for caries development in children during a three-year study period: a survival analysis approach.

UNLABELLED: Recent cross-sectional studies suggest that reduced ability to generate alkali via the urease pathway in dental plaque may be an important caries risk factor, but it has not been assessed prospectively. OBJECTIVE: To evaluate the effect of plaque and saliva urease activity on the risk for developing new caries over a three-year period in children. METHODS: A panel of 80 children, three to six years of age at recruitment, was followed prospectively for three years. Plaque urease activity, saliva urease activity and dental caries were measured every six months. Survival analysis methodology was used to evaluate the effect of urease on caries development during the study period adjusted for gender, age, baseline caries levels, sugar consumption, amount of plaque, and mutans streptococci levels. RESULTS: The risk for developing new caries increased in a dose-responsive manner with increasing levels of urease activity in saliva (adjusted HR(Q4 vs. Q1): 4.98; 95% CI: 1.33, 18.69) and with decreasing urease activity in plaque (adjusted HR(Q4 vs. Q1): 0.29; 95% CI: 0.11, 0.76). Multiple measurements of urease activity were conducted to overcome the variability of urease activity in this study. Baseline caries and mutans streptococci in saliva were also important predictors of caries risk. CONCLUSIONS: Increased urease activity in saliva can be an indicator of increased caries risk in children, whilst increased urease activity in plaque may be associated with reduced caries risk. The reproducibility of urease measurements must be improved before these findings can be further tested and clinically applied.

Urease activity in dental plaque and saliva of children during a three-year study period and its relationship with other caries risk factors.

UNLABELLED: Bacterial urease activity in dental plaque and in saliva generates ammonia, which can increase the plaque pH and can protect acid-sensitive oral bacteria. Recent cross-sectional studies suggest that reduced ability to generate ammonia from urea in dental plaque can be an important caries risk factor. In spite of this proposed important clinical role, there is currently no information available regarding important clinical aspects of oral ureolysis in children. OBJECTIVE: The objective of this study was to evaluate the distribution and pattern of urease activity in the dental plaque and in the saliva of children during a three-year period, and to examine the relationship of urease with some important caries risk factors. METHODS: A longitudinal study was conducted with repeated measures over a three-year period on a panel of 80 children, aged 3-6 years at recruitment. The dynamics of change in urease activity were described and associated with clinical, biological, and behavioural caries risk factors. RESULTS: Urease activity in plaque showed a trend to remain stable during the study period and was negatively associated with sugar consumption (P<0.05). Urease activity in unstimulated saliva increased with age, and it was positively associated with the levels of mutans streptococci in saliva and with the educational level of the parents (P<0.05). CONCLUSIONS: The results of this study reveal interesting and complex interactions between oral urease activity and some important caries risk factors. Urease activity in saliva could be an indicator of mutans infection in children.

The effect of sucrose on plaque and saliva urease levels in vivo.

OBJECTIVE: Dietary sugar exposures induce an immediate drop of the plaque pH. Based on in vitro observations, it was hypothesized that oral bacteria may rapidly respond to this environmental change by increasing the activity or expression of alkali-generating pathways, such as the urease pathway. The objective of this exploratory in vivo study was to determine the short-term effect of a brief sucrose exposure on plaque and saliva urease activity and expression, and to relate this effect to caries experience. METHODS: Urease activity levels were measured in plaque and saliva samples collected from 20 children during fasting conditions and 30 min after rinsing with a sucrose solution. Streptococcus salivarius ureC-specific mRNA in saliva was quantified using real-time RT-PCR. The impact of host-related factors, such as age, gender, sugar consumption, salivary mutans streptococci levels and caries status on urease activity was evaluated. RESULTS: Plaque urease activity under fasting conditions was higher in subjects with low caries and mutans streptococci levels. This difference was not observed after the sucrose exposure. The response of urease to sucrose in vivo did not depend on caries experience or salivary mutans levels. Significant increase in urease activity of plaque and saliva after exposure to sucrose was observed only in the subjects who had low urease levels at baseline. CONCLUSIONS: The findings of this exploratory study suggest that plaque urease activity may have an important long-term influence in caries development but not during a cariogenic challenge.

Relationship between dental caries experience (DMFS) and dental fluorosis in 12-year-old Puerto Ricans.

OBJECTIVES: Examine the relationship between (1) DMFS and community fluorosis index (CFI) scores, and (2) between individual DMFS and NIDR/Dean Index fluorosis scores. DESIGN: Population-based, cross-sectional study. SETTING: Public and private schools of Puerto Rico. SUBJECTS: 1435, 12-year old students. METHOD: A probabilistic stratified sample was selected from 11 regions of Puerto Rico, according to type of school (public and private), and setting (urban and rural). Children were examined using NIDR criteria for DMFS and fluorosis. Regressions examined the relationship between DMFS means and CFI scores. Individual level DMFS was regressed on NIDR/Dean Index scores to test for linear and deviation from linear trends. RESULTS: (1) There was no statistically significant relationship between regional DMFS and CFI scores, and (2) individual level fluorosis scores when dichotomized as 0-2 as the referent level to level 3-4 demonstrated a statistical significant higher DMFS with the higher fluorosis level. Gender and school setting were statistically significant in all models: females and public school attendance were associated with increased DMFS. CONCLUSION: No ecological relationship between CFI and DMFS scores was found in 12-year-old children in Puerto Rico. Moderate and severe fluorosis were associated with higher DMFS levels relative to lower fluorosis scores, though this finding may be associated with restorations placed for cosmetic reasons. While controlling severe fluorosis is desirable, this will have little impact on overall high caries in Puerto Rican children. These findings suggest caution when interpreting caries experience using the DMFS index in populations with differing fluorosis levels.

The prevalence of pit and fissure sealants among twelve year olds living in Puerto Rico during 1997

OBJECTIVE: to estimate the prevalence of pit and fissure sealants on first permanent molars in twelve year olds living in Puerto Rico and to further evaluate dental sealant prevalence by (1) urban/rural and public/private school status as well as (2) gender; DESIGN: population-based, cross-sectional study. SETTING: public and private schools encompassing the 11 health regions of Puerto Rico. Subjects: a probabilistic sample of 12-year old school attendees in Puerto Rico representing a population of approximately 70,000. METHOD: during April through December 1997, the first permanent molars of 1435 subjects were evaluated by visual and tactile methods for the presence of dental sealants. RESULTS: the data collected revealed that 4.3of 12 years olds presented at least one permanent first molar sealed. A statistically significant difference (p = 0.01) between urban-public (2.5), rural-public (3.39) and urban-private (11.0) schools was observed. The prevalence of sealants was higher in males (5.5) than females (2.9); (p = 0.02). CONCLUSIONS: the prevalence of dental sealants in the first permanent molars of 12-year olds living in Puerto Rico during 1997 (4.3) is lower than that reported in the United States (18.5). Sealant prevalence was higher in males and students attending (urban) private schools.

An in vitro comparison of the ability of fibre-optic transillumination, visual inspection and radiographs to detect occlusal caries and evaluate lesion depth.

The aim of this study was to compare the performance of fibre-optic transillumination (FOTI), visual inspection and bite-wing radiographs to detect occlusal caries and estimate the lesion depth. Fifty-nine extracted molars were assessed using FOTI and visual examination by 4 trained examiners and 1 examiner evaluated the bite-wing radiographs. Histological validation was performed using 250-microm sections examined with a stereomicroscope. For the three methods, the correlation between the lesion depth and the histological scores varied from 0.65 to 0.73. For dentinal caries detection, the areas under ROC curves ranged from 0.83 to 0.87. The radiographic method was poor at detecting lesions confined to enamel. FOTI, visual inspection and radiographs showed a good correlation with the histology but had difficulty in distinguishing lesions located deep in enamel or in the outer third of dentine. FOTI was shown to be as accurate as a detailed visual inspection in detecting occlusal caries.