Effects of treatments for drooling on caries risk in children and adolescents with cerebral palsy.

BACKGROUND: Neuromuscular impairment makes individuals with cerebral palsy (CP) more prone to drooling. Among the treatment options, there are procedures that interfere with saliva production. It is imperative to evaluate the effect of the different modalities since the reduction in salivary flow rate/production may exacerbate the risk of dental caries. MATERIAL AND METHODS: The aim of this study was to compare the effects of different treatments for drooling on caries risk and salivary parameters in children and adolescents with CP. STUDY DESIGN: A total of 142 children and adolescents with CP, aged 6 to 18 years, were assigned to groups based on the different treatments they had received for drooling: G1-anticholinergic drugs (n = 18), G2-botulinum toxin injection (n = 16), G3-salivary glands surgery (n = 16), G4-no treatment (n = 42), and G5-non-drooling subjects (n = 50). All participants were evaluated on the Simplified Oral Hygiene Index, and for the prevalence of dental caries (decayed, missing, and filled teeth index and white spot lesions). Unstimulated whole saliva was collected, and salivary flow rate and osmolality were measured. Chi-square, ANOVA and Poisson regression were calculated. Prevalence ratios and their respective 95 % confidence intervals were obtained. The significance level was fixed at 5%. RESULTS: No differences were found in the decayed, missing, and filled teeth index (p = 0.128) and Simplified Oral Hygiene Index (p = 0.674) among the different groups. G3 presented significantly higher percentages of WSL (p < 0.001), lower values of salivary flow rate (p < 0.001), and higher values of osmolality (p < 0.001). The white spot lesion prevalence ratio was higher only for G3 (Prevalence ratio = 14.36; IC 95% = 4.64-44.40; p < 0.001). CONCLUSIONS: Children and adolescents with CP who had received surgical treatment for drooling exhibited higher number of white spot lesions because of the reduced salivary flow rate and higher salivary osmolality.

Desmoplastic Fibroma Recurrence Associated with Tuberous Sclerosis in a Young Patient.

Case Report. A nine-year-old patient with a diagnosis of tuberous sclerosis (with no pathological record) that showed calcifications at the brain level. Besides, the case showed the Vogt triad (epilepsy, mental retardation, and sebaceous adenoma). The patient clinically showed a volume increase of hard consistency, without suppuration and no sessile that included the following teeth 73, 74, and 75. Cone beam computed tomography (CBCT) was obtained, and it displayed a delimited unilocular lesion. After surgical excision, the histopathological report was desmoplastic fibroma (DF). It was observed that the patient had an aggressive recurrence of DF at four months after surgery treatment. Due to these clinical findings, resective osseous surgery and curettage were carried out. It is uncommon to find these two pathologies together (DF and tuberous sclerosis). Since DF is a benign pathology but very invasive and destructive, it is necessary a constant follow-up examination due to a high recurrence frequency.

Frequency of dental caries in active and inactive systemic lupus erythematous patients: salivary and bacterial factors.

OBJECTIVE: The objective of this study was to determine dental caries frequency and to analyze salivary and bacterial factors associated with active and inactive systemic lupus erythematous (SLE) patients. Also, a proposal to identify dental caries by a surface, teeth, and the patient was developed. MATERIAL AND METHODS: A cross-sectional, blinded study that included 60 SLE patients divided into two groups of 30 subjects each, according to the Activity Index for Diagnosis of Systemic Lupus Erythematous (SLEDAI). The decayed, missing, and filled teeth (DMFT) index and Integrative Dental Caries Index (IDCI) were used for analyzing dental caries. The saliva variables recorded were: flow, pH, and buffer capacity. The DNA copies of Streptococcus mutans and Streptococcus sobrinus were estimated by real-time PCR. RESULTS: The caries frequency was 85% for SLE subjects (73.3% for inactive systemic lupus erythematous (ISLE) and 100% for active systemic lupus erythematous (ASLE)); DMFT for the SLE group was 12.6 ± 5.7 and the IDCI was (9.8 ± 5.9). The ASLE group showed a salivary flow of 0.65 compared with 0.97 ml/1 min from the ISLE group; all variables mentioned above showed a statistical difference (p < 0.05). The salivary pH was 4.6 (6.06 for ISLE and 3.9 for ASLE). The DNA copies of S. mutans and S. sobrinus were high; all variables mentioned above show a significant statistical difference (p < 0.05) between groups. CONCLUSION: SLE patients had high DMFT and IDCI scores that were associated with a decrease in salivary flow, pH, and buffer capacity. There were high counts of S. sobrinus and S. mutans species, and IDCI is a useful tool to provide more detail about dental caries in epidemiological studies.

Molecular identification and antibiotic resistant bacteria isolated from primary dentition infections.

BACKGROUND: Bacterial resistance to antibiotics is a health problem in many parts of the world. The aim of this study was to identify bacteria from dental infections and determine bacterial resistance to antibiotics used in dental care in the primary dentition. METHODS: This cross-sectional study comprised 60 children who presented for dental treatment for active dental infections in the primary dentition. Samples from dental infections were collected and bacteria were identified by polymerase chain reaction (PCR) assay. Bacterial resistance to antibiotics was determined by colony forming units on agar plates containing amoxicillin, clindamycin and amoxillicin-clavulanic acid (A-CA) tested at 8 µg/ml or 16 µg/ml. RESULTS: Clindamycin in both concentrations tested (8 µg/ml and 16 µg/ml) showed the highest bacterial resistance (85.9%), followed by amoxicillin (43.7%) and A-CA (12.0%). All comparisons among the three antibiotics used in the study exhibited statistical significance (p = <0.05) in both concentrations tested (8 µg/ml and 16 µg/ml), and under aerobic and anaerobic conditions. The most prevalent resistant species identified by PCR in primary dentition infections were: Streptococcus oralis and Prevotella intermedia (75.0%); Treponema denticola and Porphyromonas gingivalis (48.3%); Streptococcus mutans (45.0%); Campylobacter rectus; and Streptococcus salivarius (40%). CONCLUSIONS: This study demonstrated that A-CA exhibited the lowest bacterial resistance for clinical isolates in primary dentition infections.

Characterization of periodontal biofilm in Down syndrome patients: a comparative study.

UNLABELLED: The aim of this study was to characterize the main periodontal bacterial species in Down syndrome (DS) patients with and without periodontitis. METHOD: This cross-sectional study involved 75 DS patients, 45 with and 30 without periodontitis. Informed consent, health and dental questionnaires and periodontitis diagnosis were performed PCR and LAMP assays were performed on subgingival dental plaque sample. RESULTS: Tannerella forsythia was the most frequent bacteria detected in the group with and without periodontitis (95.5 and 63.3%) followed by Treponema denticola (88.8 and 50%) and Porphyromonas gingivalis (53.3 and 25% respectively). There were statistical differences between groups (p < 0.05). Pg fimA type I was the most frequent Porphyromonas gingivalis genotype. Two different sets of primers (Aa-F/Aa-R and ltx3/ltx4) were used to detect Aggregatibacter actinomycetemcomitans and different frequencies were obtained, (68% and 14.6% respectively), they had a weak correlation (Cohen Kappa = 0.16). After sequencing of PCR products, ltx3/ltx4 showed more specificity. JP2 clone of A. actinomycetemcomitans was not detected in any sample. CONCLUSIONS: The composition of oral biofilm is fundamental for the development of periodontal disease independently of immunological alterations associated with DS. The frequency of detection of A. actinomycetemcomitans reported in the literature has a wide range, because the primers and probes applied

Adherence inhibition of Streptococcus mutans on dental enamel surface using silver nanoparticles.

The aim of this ex vivo study was to evaluate the adherence capacity of Streptococcus mutans after being exposed to three different sizes of silver nanoparticles on healthy human dental enamel. Three different sizes of silver nanoparticles (9.3, 21.3 and 98 nm) were prepared, characterized and an adherence testing was performed to evaluate their anti-adherence activity on a reference strain of S. mutans on healthy dental enamel surfaces. Colony-Forming Unit count was made for adherence test and light microscopy, atomic force microscopy and scanning electron microscopy were used to compare qualitative characteristics of S. mutans. 9.3 nm and 21.3 nm groups did not show differences between them but statistical differences were found when 9.3 nm and 21.3 nm groups were compared with 98 nm and negative control groups (p<0.05). Microscopy analysis shows a better inhibition of S. mutans adherence in 9.3 nm and 21.3 nm groups than the 98 nm group when compared with control group. Silver nanoparticles showed an adherence inhibition on S. mutans and the anti-adherence capacity was better when silver nanoparticles were smaller.

Association between developmental enamel defects in the primary and permanent dentitions.

AIM: To determine if the presence of developmental enamel defects (DED) in the primary dentition is a risk indicator for the presence of DED in the permanent dentition in children with mixed dentition, as well as others factors. MATERIALS AND METHODS: A cross-sectional study was undertaken in 1296 school children ages six to 72 years. The DED [FDI; 1982] in both dentitions were identified by means of an oral exam scoring enamel opacities [classified as demarcated or diffused], and enamel hypoplasia. Sociodemographic and socioeconomic variables were collected through a questionnaire. Socioeconomic status (SES) was determined based on the occupation and maximum level of education of parents. Statistical analysis included logistic regression. RESULTS: Mean age of participants was 8.40 +/- 1.68; 51.6% were boys. DED prevalence was 7.5% in the permanent dentition and 10.0% in the primary dentition. The logistic regression model, adjusting for sociodemographic and socioeconomic variables, showed that for each primary tooth with DED, the odds of observing DED in the permanent dentition increased 7.38 times [95% CI = 1.17-1.64; p < 0.001]. CONCLUSION: An association between DED presence in both permanent and primary dentitions was observed. Further studies are necessary to fully characterise such relationship.

Fluoride content in bottled waters, juices and carbonated soft drinks in Mexico City, Mexico.

OBJECTIVE: The objective of this study was to analyse 283 samples of soft drinks available in the metropolitan market of Mexico City, Mexico: 105 juices, 101 nectars, 57 carbonated drinks and 20 bottled waters. MATERIALS AND METHODS: Samples of the beverages were analysed using an Orion 720A potentiometer and an Orion 9609BN F ion-specific electrode. RESULTS: Fluoride concentration in the above-mentioned products ranged from 0.07 to 1.42 p.p.m. It was found that fluoride concentrations varied according to the brand, flavour and presentation of the product. The highest mean concentration of fluoride was found in the juices and cola drinks (0.67 +/- 0.38 and 0.49 +/- 0.41 p.p.m., respectively). The mean fluoride concentration for carbonated drinks was 0.43 +/- 0.36 p.p.m. Bottled waters had a fluoride concentration of 0.21 +/- 0.08 p.p.m. CONCLUSIONS: The findings suggest that fluoride ingested through bottled drinks represents an important part of the total fluoride ingested by the population. In view of the wide variation of fluoride concentration in the tested products, it is necessary to implement regulatory guidelines for controlling its concentration in order to prevent dental fluorosis.

[Use of and verification with biological indicators in sterilizers belonging to dentistry surgeons from San Luis Potosi, Mexico]. / Uso y verificación con indicadores biológicos en esterilizadores de cirujanos dentistas de San Luis Potosí, México.

OBJECTIVE: To assess the utilization of sterilizing equipment used by dentists, and verification of sterilization using biological indicators. MATERIAL AND METHODS: A cross-sectional study was conducted in 1999-2000, among 130 (65%) dentists having sterilizing equipment, at Facultad de Estomatología, Universidad Autónoma de San Luis Potosí and Colegio Dental Potosino. Biological indicators for sterilization containing Bacillus subtilis and Bacillus stearothermophilus were used. RESULTS: Thirty autoclaves and 100 dry-heat sterilizers were evaluated: 23 (17.7%) of them showed bacterial growth. Twenty-one (16.1%) dentists already were using biological indicators to verify their sterilizing equipment. Both sterilization methods were found to allow bacterial growth with similar frequencies (p = > 0.66). CONCLUSIONS: Few dentists verify the quality of sterilization process through biological indicators; bacterial growth and failure of sterilization were evidenced.

[Fluorosis in primary dentition in a region with endemic water fluoride]. / Fluorosis en dentición temporal en un área con hidrofluorosis endémica.

OBJECTIVE: The aim of the present study was to estimate the prevalence of dental fluorosis in primary dentition of a San Luis Potosi children population, and its association to fluoride concentration in drinking water and urine. An additional objective was, to develop, validate, and test a specific index for dental fluorosis in primary dentition. MATERIAL AND METHODS: From May 1997, to January 1999, we conducted a cross-sectional study to assess the prevalence of dental fluorosis in primary dentition. Study subjects were 100 children aged 3-6 years, selected at random from three kindergartens in three risk areas of San Luis Potosi. The specific index of dental fluorosis for primary dentition (Dental Fluorosis for Primary Dentition Index--DFPDI) was validated by estimating fluoride concentrations in enamel of teeth with and without dental fluorosis. The Kruskal-Wallis test was used to assess the association between fluoride concentrations in drinking water and urine, with dental fluorosis; the association between risk area and dental fluorosis was assessed with the Mantel-Haenszel chi 2 test. RESULTS: The prevalence of dental fluorosis in primary dentition was 78%; primary molars were most affected in both maxillae and the predominant color was a non-glossy white appearance. We found a strong direct correlation (r = 0.93) between fluoride concentrations in primary teeth and the DFPDI. Associations were found between fluoride concentrations of drinking water and urine, with dental fluorosis (Kruskal-Wallis p = 0.00001), and between risk area and dental fluorosis (Mantel-Haenszel chi 2 p = 0.00001). CONCLUSIONS: DFPDI allowed adequate identification and grading of dental fluorosis in primary dentition. It is important to detect the initial toxic effects of fluoride exposure to predict dental fluorosis in permanent dentition and skeletal fluorosis.

[Bottled beverages as additional sources of exposure to fluoride]. / Bebidas embotelladas como fuentes adicionales de exposición a flúor.

OBJECTIVE: To evaluate and to report the concentration of floride in soft drinks and juices consumed in San Luis Potosi, S.L.P., Mexico, and its implications as a risk factor for developing dental fluorosis. MATERIAL AND METHODS: The contents of some products from 2 main national companies and 2 other local companies were studied. The samples were collected from 10 different batches in the case of the soft drinks, and from 5 batches in the case of the juices, with 3 samples per batch, during 3 months. The ion selective electrode method was used to determine the concentration of fluoride. RESULTS: Soft drinks from 2 main national companies showed high fluoride concentrations that were statistically significant between groups (p < 0.05). Fluoride levels of products from local and national companies also showed differences that were statistically significant between groups (p < 0.05). All natural juices tested showed high fluoride concentrations. CONCLUSIONS: Most soft drinks and juices consumed in SLP had high fluoride levels above Mexican regulations (0.7 ppm) and could be a substantial risk factor for developing dental fluorosis.

Antibacterial activity of fluoride release sealants on mutans streptococci.

This study was conducted to study the antibacterial activity of sealants on mutans streptococci. The antibacterial effect of fluoride release sealants was estimated by using agar plates infected with several strains of S. mutans and S. sobrinus. Both bacterial groups were sensitive to sealant antibacterial activity, there was not statistical difference in the inhibition between both groups. The Teethmate-F was the only active material in this study and showed more than four times fluoride release than FluoroShield. The inhibition activity was associated with sealant fluoride release after the setting of this material.