Efficacy of chlorhexidine varnish for the prevention of adult caries: a randomized trial.

The Prevention of Adult Caries Study, an NIDCR-funded multicenter, double-blind, randomized clinical trial, enrolled 983 adults (aged 18-80 yrs) at high risk for developing caries (20 or more intact teeth and 2 or more lesions at screening) to test the efficacy of a chlorhexidine diacetate 10% weight per volume (w/v) dental coating (CHX). We excluded participants for whom the study treatment was contraindicated or whose health might affect outcomes or ability to complete the study. Participants were randomly assigned to receive either the CHX coating (n = 490) or a placebo control (n = 493). Coatings were applied weekly for 4 weeks and a fifth time 6 months later. The primary outcome (total net D(1-2)FS increment) was the sum of weighted counts of changes in tooth surface status over 13 months. We observed no significant difference between the two treatment arms in either the intention-to-treat or per-protocol analyses. Analysis of 3 protocol-specified secondary outcomes produced similar findings. This trial failed to find that 10% (w/v) chlorhexidine diacetate coating was superior to placebo coating for the prevention of new caries (Clinicaltrials.gov registration number NCT00357877).

The oral mucosa as a therapeutic target for xerostomia.

Autoimmune disorders, medical interventions, and aging are all known to be associated with salivary gland hypofunction, which results in the uncomfortable feeling of dry mouth (xerostomia) and significantly diminished oral health. The current therapeutic regimen includes increasing oral hydration using over-the-counter oral comfort agents and the use of systemic cholinergic drugs to stimulate salivary output. However, these approaches produce very transient relief or are associated with uncomfortable side-effects. Thus, new treatments that provide long-lasting relief from discomfort and improve oral health with minimal side-effects would benefit the therapy of this disease. The processes that mediate fluid loss from the oral cavity, such as the absorption of fluid from the oral mucosa, represent novel therapeutic targets for xerostomia. Preventing fluid absorption from the oral cavity is predicted to improve oral hydration and alleviate the clinical symptoms and discomfort associated with dry mouth. Furthermore, therapeutic strategies that prevent fluid absorption should complement current approaches that increase salivary output. This review discusses the current understanding of oral fluid balance and how these processes may be manipulated to provide relief for those suffering from dry mouth.

A prospective, randomized trial for the prevention of mucositis in patients undergoing hematopoietic stem cell transplantation.

Oral mucositis is a complication common to many cancer therapies and produces considerable pain and morbidity. The present study reports a double-blind, prospective, randomized clinical trial testing the efficacy of a calcium phosphate mouth rinse (Caphosol) with fluoride treatments vs a standard regimen of fluoride rinsing and placebo tray treatments in 95 patients undergoing hematopoietic stem cell transplantation (HSCT). The days and severity of mucositis were prospectively evaluated. There were statistically significant decreases in days of mucositis (3.72 vs 7.22 P=0.001), duration of pain (2.86 vs 7.67, P=0.0001), dose of morphine (34.54 mg vs 122.78 mg), days of morphine (1.26 vs 4.02, P=0.0001) and days to the onset of engraftment ANC (absolute neurotrophil count)>200 mm(3) (11.12 vs 12.56) in the Caphosol and fluoride treatment group vs fluoride-rinse group, respectively. Caphosol, a neutral, supersaturated, Ca(2+)/PO(4)(3-) mouth rinse, used in combination with topical fluoride treatments, is superior to fluoride rinse alone in reducing the frequency, intensity and duration of oral mucositis in patients undergoing HSCT.

Nutrient intake in women with primary and secondary Sjögren's syndrome.

OBJECTIVE: Recently, it has been proposed that dietary factors may contribute to the etiology and progression of Sjögren's syndrome, and that nutritional intervention may modify the severity of pathological abnormalities. The objective of this study was to determine whether the nutrient intake of women with primary (1 degrees SS) or secondary (2 degrees SS; ie with systemic lupus erythematosus (2 degrees SS/SLE) or rheumatoid arthritis (2 degrees SS/RA) Sjögren's syndrome is significantly different than that of age- and gender-matched controls. DESIGN: Women with Sjögren's syndrome were asked to complete the 97 General Purpose Semi-Quantitative Food Frequency Questionnaire, which consists of a list of 147 separate food items that represent the major sources of multiple nutrients. Nutritional data were evaluated in terms of absolute and energy-adjusted nutrient amounts and analyzed by ANOVA. RESULTS: Our results showed: (a) greater intake of energy, glutamate, carbohydrates, lactose, phosphorus, caffeine and unsupplemental thiamin and riboflavin in 1 degrees SS, as well as supplemental calcium in 2 degrees SS/SLE, compared with controls; (b) greater nutrient intake of energy, protein, glutamate, methionine, tryptophan, carbohydrates, lactose, supplemental calcium and phosphorus, sodium, caffeine and unsupplemental calcium, riboflavin and thiamin in 2 degrees SS/RA, relative to 1 degrees SS and/or 2 degrees SS/SLE; (c) higher energy-adjusted values for supplemental calcium in 2 degrees SS/SLE, and for vitamin A and supplemental iron and zinc in 2 degrees SS/RA, compared with other groups; and (d) higher energy-adjusted intake of supplemental calcium, and a lower energy-adjusted intake of unsupplemental vitamin C, polyunsaturated fat, linoleic acid, omega-3 fatty acid, and specific other unsaturated fatty acids, in the Sjögren's syndrome group as a whole, relative to controls. CONCLUSIONS: Our findings demonstrate that nutrient intake is altered in Sjögren's syndrome.

The effects of denture status on nutrition.

In Part I of this study, the Human Nutrition Research Center of the United States Department of Agriculture's Nutritional Status Study (NSS) of 691 independently living elderly people aged 60-98 found that poor dietary quality was associated with low educational attainment, low median family income, and self-report of partial or full dentures. In Part II, further analysis was conducted on a random subsample of 181 subjects who were examined and divided into four groups according to dentate status: two dentures, one denture, partial dentures, and teeth. In this subgroup, significant correlations were found between the quality of nutrient intake and the degree of edentulousness. Analysis of 53 nutrients plus calories from three-day food records showed a significantly higher nutritional quality of the diet in dentate volunteers than in the other groups. This difference was approximately 20% for 19 nutrients, bringing some nutrients (such as calcium) below the RDA for this age group. Although direct correlations cannot be made with actual nutritional status, the introduction of dentures could further compromise the precarious nutritional intake of the elderly population. With this in mind, dentists need to consider carefully the importance of their elderly patients maintaining at least some natural dentition and should provide adequate information on nutritional adaptations to dentures.

Relationships among education, dentate status, and diet in adults.

The Nutrition and Oral Health Study (NOHS) was established to study the interrelationship of oral health status, dietary intake, and education, and to define their relative impact on the middle aged and elderly. Two hundred forty-seven partially or fully dentate (at least 6 teeth) subjects returned two food diaries over a 16-month period. Despite the investigators' efforts to enroll from a socio-economically diverse Boston population, the volunteers were health-conscious, with 85% having been to the dentist within the last year; 95% brushed, and 60% flossed daily. More than half the volunteers had attended college. With the exception of cholesterol intake, which was high in both the higher- and lower-educated males, most individuals, despite their dentate status, sought good nutrition. People who wore dentures consumed more refined carbohydrates and sucrose. As the number of teeth declined, Vitamin A, crude fiber, and calcium declined, while cholesterol rose. These factors may have a significant implication for general health.

Dietary models for root caries.

A stepwise multiple logistic regression was computed to assess which of the nutritional variables differentiate the healthy and diseased group of participants in the Forsyth Specialized Caries Center (n = 275). Variables considered as candidates for the model included the consumption per week of sugars, starch, cheese, fruits and fruit juices, noncariogenic foods, and dairy products. Two variables--sugars and cheese--were statistically significant by the stepwise procedure. Increased intake of sugar was associated with being in the root caries group, whereas high intake of cheese was negatively associated with root caries. Thus, cheese seems to have a protective effect after sugar intake is controlled for. Odds ratios were computed to quantify the influence of the variables. An increase of two exposures of sugar per day corresponded with an odds ratio of 1.26. The odds ratio continues to increase with sugar intake so that an increase to five exposures per day gives an odds ratio of 1.79. This model is consistent with past in vitro studies suggesting that cheese protects against caries formation when sugar intake is controlled for and that increasing frequency of sugar intake increases the odds of root caries.

Relationship of diet to root caries.

A Nutrition and Oral Health Study was conducted on 141 middle-aged and elderly adults (54% female and 46% male; aged 47-83 y, mean = 67; 51% college educated; and 89% white). This study reports on the relationship between root caries and diet. Nutritional composition was derived from two 3-d food diaries. Root caries was measured according to the 1985 Adult Survey Diagnostic Criteria of the National Institute of Dental Research. When the individuals were segregated by their root DFS (decayed and filled surfaces) status into highest (> or = 7) and lowest (< or = 1) quartiles, the sucrose consumption was significantly higher in the higher DFS group. Mean energy consumption and mean number of teeth were the same in both groups. When the individuals were segregated by sucrose consumption into highest (> or = 89 g) and lowest (< or = 31 g) quartiles, DFS root status was significantly higher (P < 0.01) in the highest quartile group (7 g) vs the lowest group (4 g). By using data from subjects with two food diaries, a stepwise-linear-regression model for root caries showed that 4.2% of the variance for root caries was explained by sucrose, 2.8% by plaque, 3.8% by total number of teeth, and 5.6% by gingival recession. These data suggest that root caries has a similar dietary etiology to coronal caries.

Root caries incidence and associated risk factors in middle-aged and older adults.

Data from population-based longitudinal studies required to assess the incidence of root caries and associated risk factors are sparse in the literature. To this end, a group of 130 middle-aged and older adults were examined for root caries at baseline and at a follow-up visit between nine and 24 months (median: 16 months). Dental examinations were conducted by one examiner at a Tufts dental clinic using NIDR defined diagnostic criteria. Fifty percent of subjects in this study population developed one or more new root caries lesions over the follow-up period. Also, an annualised increment of 0.60 (SD: 0.72) decayed and filled surfaces per person was observed for the 45-59 year old group while the 70+ group showed an annualised increment of 1.38 (SD: 1.97) DFS in this study. Multivariate logistic regression analysis identified past root caries experience, high plaque score, and high number of teeth (> = 22) to be positively associated with new root caries (p < 0.05).

Caries prevalence in xerostomic individuals.

Saliva, via its lubricating, cleansing, remineralizing, antibacterial, and buffering actions, is an important protective factor for both dentition and soft tissue. Xerostomia is commonly found in older individuals due to the use of medications or medical conditions, such as Sjögren's, which directly affect salivary gland function. A xerostomic subgroup (n = 60), mean age = 60, 66 per cent female) of the Nutrition and Oral Health Study (n = 370) was reexamined for caries. Unstimulated and two-per-cent citric-acid stimulated parotid and submandibular/sublingual salivary flow rates were determined. This group was matched for number of teeth, age, sex, and alcohol and smoking habits with a medication-free subgroup (n = 60). Active root and coronal caries were found to be significantly higher in the xerostomic subgroup than in a matched subgroup of medication-free individuals. The mean DFS for the xerostomic subgroup was 45.4 +/- 21.7 for coronal caries and 5.3 +/- 5.8 for root caries. The mean number of teeth was 21.8. The mean DFS in the medication-free subgroup was 36.5 +/- 22.1 for coronal caries and 3.2 +/- 3.2 for root caries. The mean DFS in the xerostomic subgroup for coronal and root caries was statistically significantly higher (p < 0.05). The odds ratio was 2.89 for coronal caries and 3.27 for root caries in the xerostomic versus the medication-free subgroup. Caries varied inversely with salivary flow rate. The difference in flow rates for those in the lowest and highest quartile for coronal caries experience (DFS) in the xerostomic subgroup was found to be statistically significant (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Nutrition and the oral health of the elderly.

The dental problems of the elderly, though they may seem slight, can have far-reaching effects on both health and quality of life. The complexity and variety of potential physical and psychosocial problems of older citizens require a multidisciplinary management approach. Dental team members need to target appropriate resources outside of the dental office, and nondental care providers need to attend to dental needs as well as other more evident problems. Only in this way can we help to optimize the health and longevity of this ever-increasing segment of the population.