Prevalence and Severity of Plaque-Induced Gingivitis in Three Latin American Cities: Mexico City-Mexico, Great Metropolitan Area-Costa Rica and Bogota-Colombia / Prevalencia y severidad de gingivitis inducida por placa en tres ciudades de Latinoamérica: Ciudad de México-México, Gran Área Metropolitana-Costa Rica y Bogotá- Colombia

Abstract Plaque-induced gingivitis is the most common form of periodontal disease and can affect 100% of the population. Gingivitis prevalence in Latin American population is not well documented, therefore the aim of this study was to determine the prevalence and severity of plaque-induced gingivitis in adult populations of three Latin American cities. Methods: This cross sectional multicenter study included 1650 participants, 550 from the Great Metropolitan Area of Costa Rica (GAM), 550 from Mexico City, Mexico (CDMX) and 550 from Bogota City, Colombia (BC). Subjects completed a questionnaire about their medical history and oral hygiene. Clinical assessment included recording of missing teeth, visible plaque index, calculus recording and gingival index (GI, Loe-Silness index). Results: Average GI was 1.36. No statistical difference was found between GAM (1.45) and BC (1.48); however, GI in CDMX was significantly lower (1.16). Average gingival bleeding on probing was 43%. Total plaque index was 0.76 showing the highest accumulation at interproximal sites (p=0.0001). A positive correlation was found between plaque and gingivitis (r=0.59). Dental calculus was present in at least one of the 18 evaluated sites per subject with no statistical difference between cities. There was no statistical difference in GI between smokers, former smokers and non- smokers. Conclusion: Gingivitis prevalence was 99.6%. Moderate Gingivitis was the predominant form, with no statistically significant difference between cities or gender. Dental plaque accumulation was the most important risk factor associated with the establishment of the disease.

Resumen La gingivitis inducida por placa es la forma más común de enfermedad periodontal y puede afectar al 100% de la población. La prevalencia de gingivitis en Latinoamerica no está bien documentada, por lo tanto, el objetivo de este estudio fue determinar la prevalencia y severidad de la gingivitis inducida por placa en poblaciones adultas de tres ciudades latinamericanas. Metodología: Este estudio transversal multicéntrico incluyó 1650 sujetos, 550 del Gran Área Metropolitana de Costa Rica (GAM), 550 de la Ciudad de México, México (CDMX) y 550 de la Ciudad de Bogotá, Colombia (BC). Los sujetos completaron un cuestionario sobre su historia médica y hábitos de higiene oral. El examen clínico incluyó el registro de piezas dentales ausentes, el índice de placa visible, el registro de cálculo y el índice gingival (GI, Índice de Silness y Loe). Resultados: El GI promedio fue de 1.36. No se encontró diferencia estadísticamente significativa entre GAM (1.45) y BC (1.48); sin embargo, el índice gingival en CDMX fue menor (1.16). El promedio de sangrado al sondaje fue de 43%. El índice de placa total fue 0.76, mostrando la mayor acumulación en sitios interproximales (p=0.0001). Se encontró una correlación positiva entre placa y gingivitis (r=0.59). Hubo presencia de cálculo dental en al menos uno de los 18 sitios evaluados por cada sujeto sin diferencia estadística entre ciudades. No se encontró diferencia estadísticamente significativa en cuanto al índice gingival entre fumadores, ex fumadores y no fumadores. Conclusión: La prevalencia de Gingivitis fue del 99.6%. La Gingivitis Moderada fue la forma predominante, sin diferencia estadísticamente significativa por ciudad o sexo. La acumulación de placa fue el principal factor de riesgo asociado con el establecimiento de la enfermedad.

Association between poor oral health and gastric cancer: A prospective cohort study.

Poor oral health may be involved in the pathogenesis of gastric cancer, however, some aspects have not been explored. Further, for previously studied aspects, for example, tooth-loss, the findings are inconsistent. We conducted a prospective cohort study of 19,831 participants from Uppsala, Sweden, cancer-free at baseline in 1973-1974 and followed until 2012 through linkage to national registers. We found that individuals with fewest teeth at baseline had an increased risk of gastric cancer relative to subjects with all examined teeth present (p = 1.75e-2). Presence of denture-associated lesions was also associated with an increased risk of gastric cancer (p = 1.00e-4). However, these excess risks significantly varied with attained age; estimated hazard ratio (HR) at attained age 50 for tooth loss was 4.24 [95% confidence interval (CI) 1.83-9.80] and 5.91 (95% CI 2.76-12.63) for denture-associated lesions, decreasing at an estimated 4% and 6% per year respectively, resulting in HR of 1.54 (95% CI 0.90-2.64) for tooth loss and HR 1.29 (95% CI 0.90-1.85) for denture-associated lesions at attained age 75. No increased risk of gastric cancer was found for individuals with higher levels of dental plaque, or with Candida-related or tongue lesions. In conclusion, tooth-loss and denture-associated lesions are associated with increased risks of gastric cancer. Previous conflicting findings of tooth-loss and gastric cancer risk may partly be explained by the age-varying relative risk of gastric cancer.

The Effects of Tooth Brushing on Whole Salivary Flow Rate in Older Adults.

OBJECTIVES: (1) To determine whether manual (MTB), or electric, tooth brushing (ETB) modulates whole salivary flow rate in older adults who are free of systemic disease. (2) To determine the duration of the brushing-related modulation of salivary flow rate. (3) To compare salivary flow rate modulation associated with MTB and ETB. METHOD: Twenty-one adults aged 60 years and older participated in two experimental sessions during which they used a manual, or electric, toothbrush to brush their teeth, tongue, and palate. Whole salivary flow rates were determined using the draining method before, during, and after brushing. Differences in salivary flow rates across time periods, and between conditions, were examined using paired samples t-tests applying a Holm-Bonferroni sequential procedure (pcorr < 0.0045). The relationship between tooth brushing and age with respect to maximum salivary flow rate increase was examined using Pearson's correlation coefficient (p < 0.05). RESULTS/CONCLUSION: Whole salivary flow rates increased during, and for up to 5 minutes following, tooth brushing in adults aged 60 years and older who were free of systemic disease. The salivary effects of MTB and ETB were not significantly different. A moderate, positive correlation was observed between tooth-brushing-related maximum salivary flow rate increase and age.

Periodontal diseases.

Periodontal diseases comprise a wide range of inflammatory conditions that affect the supporting structures of the teeth (the gingiva, bone and periodontal ligament), which could lead to tooth loss and contribute to systemic inflammation. Chronic periodontitis predominantly affects adults, but aggressive periodontitis may occasionally occur in children. Periodontal disease initiation and propagation is through a dysbiosis of the commensal oral microbiota (dental plaque), which then interacts with the immune defences of the host, leading to inflammation and disease. This pathophysiological situation persists through bouts of activity and quiescence, until the affected tooth is extracted or the microbial biofilm is therapeutically removed and the inflammation subsides. The severity of the periodontal disease depends on environmental and host risk factors, both modifiable (for example, smoking) and non-modifiable (for example, genetic susceptibility). Prevention is achieved with daily self-performed oral hygiene and professional removal of the microbial biofilm on a quarterly or bi-annual basis. New treatment modalities that are actively explored include antimicrobial therapy, host modulation therapy, laser therapy and tissue engineering for tissue repair and regeneration.

Prevalencia y algunos factores de riesgo de caries dental en el primer molar permanente en una población escolar de 6 a 12 años de edad / Incidence and risk factors of tooth decay on the first permanent molar in a schoolchildren population aged 6 to 12 years old

Introducción: La Organización Mundial de la Salud reporta que la caries en México afecta a 48 por ciento de los menores de 5 años y que 93 por ciento de los niños de 15 años la padecen. En conjunto se estima que 99 por ciento de la población ha tenido caries y que esta enfermedad es la causa más importante de la pérdida de dientes antes de los 35 años de edad. La pérdida principal la constituyen los primeros molares permanentes, estos órganos dentales acompañan a la dentición primaria en la boca de un niño transformando la oclusión de la primera dentición a la dentición mixta. El propósito de este trabajo fue identifi car la prevalencia y algunos factores de riesgo de caries en el primer molar permanente en una comunidad escolar del municipio de Tultitlán, Estado de México. Métodos: Estudio observacional, prolectivo, transversal y descriptivo en una población de 560 escolares con una media de edad de 9.0 (± 2.0), mediana de 9.0 (6-12 años). Se valoró la presencia de placa dentobacteriana con el índice O’Leary y la experiencia de caries con los índices CPOD y CPOS. Resultados: La prevalencia de caries en el primer molar permanente en la población de estudio fue de 25.6 por ciento, el valordel índice CPOS fue de 1.6 ± 2.7; CPOD de 1.0 ± 1.4; los más afectados son los molares inferiores en 30.6 por ciento (n = 343) con un CPOS 1.0 (± 1.7) vs. los superiores 20.5 por ciento (n = 226) con un CPOS de 0.6 (± 1.4). De los riesgos analizados, el factor tiempo de exposición a la PDB medido a través de la edad mostró que los escolares ≥ 8 años tienen 7.1 veces más riesgo de presentar caries en el PMP que los menores de esa edad, siendo esta diferencia clínica estadísticamente significativa (RM = 8.1; IC95 por ciento 4.4-14.7, p < 0.0001). Conclusiones: Nuestra población de estudio muestra una similitud en los índices de caries en la dentición permanente con la literatura científica.

Introduction: The World Health Organization reports that tooth decay inMexico aff ects 48% of children under 5 years of age and 93% of childrenunder 15. Overall it is estimated that 99% of the population has hadtooth decay and that this disease is the most important cause of tooth lossbefore age 35. The greatest loss is of the fi rst permanent molars, thesedental organs represent the primary dentition in the mouth of a child,transforming with its presence the primary occlusion in mixed. Therefore,the purpose of this study was to identify the prevalence and some risk factorsfor tooth decay in the fi rst permanent molar in a school community in themunicipality of Tultitlan, State of Mexico. Methods: An observational,prolective, transverse and descriptive study in a population of 560 studentswith a mean age of 9.0 (± 2.0), median of 9.0 (6-12 years), the presenceof dental plaque (biofi lm) was assessed with the O’Leary index and theexperience of tooth decay with the DMFT and DMF indexes. Results:The prevalence of tooth decay in the fi rst permanent molar in the studypopulation was 25.6%, the value of the DMF index was 1.6 ± 2.7; DMFTof 1.0 ± 1.4; the most aff ected were the lower molars with 30.6% (n = 343)with a DMF 1.0 (± 1.7) vs. the upper ones with 20.5% (n = 226) with aDMF of 0.6 (± 1.4). Of the risks analyzed, the factor «time of exposure toPDB¼ measured through age showed that, schoolchildren ≥ 8 years of ageare 7.1 times more likely to have tooth decay in the fi rst molar than childrenunder that age, this diff erence is clinically and statistically signifi cant (RM= 8.1, IC95% 4.4-14.7, p < 0.0001). Conclusions: Our study populationshows a similarity in the tooth decay indexes in permanent dentitionwith the one indicated in the scientifi c literature; of the risks analyzed,the exposure time to dental plaque (biofi lm) was the one that showed astatistically signifi cant diff erence.

Avaliação de lesões cariosas e biofilme dentário por fluorescência em pacientes portadores da síndrome metabólica submetidos à cirurgia bariátrica: um estudo de coorte prospectivo / Evaluation of caries lesions and dental biofilm by fluorescence, in patients with metabolic syndrome submitted to bariatric surgery: a prospective cohort study

A obesidade e a síndrome metabólica têm aumentado em proporções preocupantes em nível mundial. Além das consequências sistêmicas, a obesidade e suas comorbidades também têm sido relacionadas com a condição bucal. O objetivo deste estudo foi identificar a progressão de lesões cariosas, presença de biofilme dentário, fluxo salivar e presença de saburra lingual em indivíduos eutróficos, sendo avaliados em dois momentos e portadores de síndrome metabólica antes e após a cirurgia bariátrica. A amostra foi constituída por 150 indivíduos, divididos em dois grupos: grupo controle (GC: 75) e grupo obeso (GO: 75), ambos avaliados em T0 e T1, sendo GC 6 meses após a primeira avaliação e GO 6 meses após a cirurgia bariátrica. A avaliação antropométrica dos indivíduos foi realizada por meio do IMC e circunferência da cintura. Os índices ICDAS II e CPOD foram utilizados para avaliar a progressão da cárie dentária. O método de fluorescência verde (QLF- Quantitative Light-induced Fluorescence) avaliou a perda mineral nas superfícies lisas dos dentes e presença de biofilme dentário. O fluxo salivar estimulado foi avaliado em mL/min. O Índice de Saburra Lingual foi utilizado para a avaliação da presença de saburra na língua. Para análise estatística, utilizou-se os testes Qui Quadrado, Exato de Fisher, Mann-Whitney, Kruskal-Wallis e Regressão Logística Múltipla, adotando nível de significância de 5%. Os resultados mostraram que houve diferença significativas entre os grupos, GC apresentou maior número de dentes hígidos (p=0,038) e dentes sem alteração no esmalte (p=0,005) quando comparado ao GO. Ao comparar GC e GO no T1, verificou-se que houve diferença significativa em relação ao CPOD (p<0,0001), dentes restaurados (p<0,0001) e área da lesão (Ws) (p=0,045), sendo as piores condições encontradas encontradas em GO. Observou-se que houve diferença significativa entre a perda mineral e quantidade de biofilme dentário por fluorescência entre os grupos, mas não entre T0 e T1. Diante dos resultados, podese concluir que indivíduos portadores de síndrome metabólica, comparado com os eutróficos, apresentam maior número de lesões cariosas antes e após a cirurgia bariátrica. No presente estudo a cirurgia bariátrica não interferiu na progressão das lesões cariosas, todavia, destaca-se a necessidade de abordagem multiprofissional e contínua, atuando na prevenção de doenças e atenção odontológica.(AU)

Obesity and the metabolic syndrome have increased in alarming proportions at world level. Apart from systemic consequences, obesity and its comorbidities have also been related to the oral condition. The aim of this study was to identify the caries lesion progression, presence of dental biofilm, the salivary flow and tongue coating in eutrophic individuals, being evaluated in two moments and individuals with metabolic syndrome before and after undergoing bariatric surgery. The sample consisted of 150 individuals divided into two groups: Control Group (CG: 75) and Obese Group (OG): 75, both evaluated in T0 and T1; CG being evaluated six months after T0, and EG, 6 months after bariatric surgery. Anthropometric assessment of individuals was made by means of BMI and waist circumference measurement. The ICDAS II and DMFT indices were used for evaluating the progression of dental caries. The Quantitative Light-induced Fluorescence (QLF) method, for evaluating mineral loss on the smooth tooth surfaces and the presence for dental biofilm. The stimulated salivary flow was evaluated in mL/min. The Winkel tongue coating index (WTCI) was used to evaluate the presence of tongue coating. For statistical analysis, the Chi- Square, Fishers Exact, Kruskal-Wallis and Multiple Logistic Regression tests were used, adopting a significance level of 5%. The results showed statistical difference between the groups: CG presented a higher; number of healthy teeth (p=0.038) and teeth without changes in enamel (p=0.005) when compared to OG. When comparing CG and EG after the second evaluation (T1), statistically significant difference was verified in relation to DMFT (p<0.0001), restored teeth (p<0.0001) and lesion area (Ws) (p=0.045), being the worst conditions found in OG. It was observed that there was a significant difference between mineral loss and the quantity dental biofilm by fluorescence between groups, but not between T0 and T1. In view of the results, the authors concluded that patients with metabolic syndrome, compared to eutrophic, have a higher number of caries lesions before and after bariatric surgery. In the present study, bariatric surgery did not influence in caries lesion progression, however, highlights the necessity to a continuous multi professional approach to acting in the prevention of diseases and dental care.(AU)

Clinical Assessment of a New Caries Activity Test Using Dental Plaque Acidogenicity in Children under Three Years of Age.

OBJECTIVES: The aim of this study was to assess the validity of a new caries activity test that uses dental plaque acidogenicity in children with deciduous dentition. STUDY DESIGN: Ninety-two children under the age of three years old underwent clinical examination using the dft index and examinations with two caries activity tests. Plaque samples for the new Cariview(®) test and the saliva sample for the conventional Dentocult SM(®) test were collected, incubated, and scored according to each manufacturers' instruction. The data were analysed using ANOVA and Spearman correlation analyses to evaluate the relationships between the test results and the caries experience. RESULTS: The mean dft index of all of the subjects was 4.73, and 17.4% of the subjects were caries-free. The levels of caries risk based on the new Cariview test score significantly increased with the caries experience (p < 0.01). The test results revealed a stronger correlation with caries indices (dft and dt index) than the conventional SM colony counting method (r = 0.43, r = 0.39, p < 0.01). CONCLUSIONS: The new caries activity test to analyse the acidogenic potential of whole microorganisms from dental plaques can be used to evaluate caries risk in children with deciduous teeth.

Xylitol Chewing Gums on the Market: Do They Prevent Caries?

PURPOSE: To measure the xylitol content in sugar-free chewing gums available on the market in Gulf Cooperation Council (GCC) countries in the Middle East, in order to identify those products that can provide the recommended daily dose of xylitol for caries prevention (6-7 g). Acid production from chewing gums was also measured in vitro and in vivo. MATERIALS AND METHODS: Twenty-one chewing gums containing xylitol were identified and collected from the GCC market (Kuwait, Bahrain, Qatar, Saudi Arabia, UAE and Oman). Xylitol was extracted and its concentration was analysed using a special enzymatic kit. The pH of extracts was measured during 30-min incubation with Streptococcus mutans. Changes in saliva and plaque pH were noted in four subjects after the consumption of highly concentrated xylitol gums. RESULTS: The xylitol content in grams was clearly mentioned only on one product's label. Twelve products stated the percentage of xylitol (3.5% to 35%). The rest did not specify the amount. The mean measured weight of one piece of gum was 1.67 ± 0.38 g. The mean measured xylitol content/piece was 0.33 ± 0.21 g. Xylitol content was < 0.3 g/ piece in 9 products, 0.3-0.5 g in 7 and > 0.5 g in 5 products. None of the highly concentrated xylitol gums showed a pH drop in vitro or in vivo. One chewing gum, containing xylitol and glucose, resulted in a low pH level (< 5.5) when tested in vitro. CONCLUSION: The majority of xylitol chewing gums sold on the GCC market do not provide the consumers with the recommended daily dose of xylitol for caries prevention. Clear, accurate labeling is recommended.

Dental plaque assessment lifelogging system using commercial camera for oral healthcare.

We present a system for estimating the dental plaque adhesion area using a commercial camera image for oral healthcare via management of the intraoral environment. In recent years, several studies have reported on the relationship between a general disease and a periodontal disease. Such studies mention that normalization of the intraoral environment by tooth brushing is the most important treatment in preventive dentistry. However, evaluation of individual tooth brushing skill is difficult. Some devices for automatically measuring the quantity of dental plaque have already been proposed for the teaching tool of tooth brushing. However, these devices have certain limitations, such as large size, requirement to fix the head position, and limited applicability in daily life. In this study, we propose a method for calculating the dental plaque adhesion area using a commercial camera and an intraoral camera. We also propose an evaluation method for the quantity of adhered dental plaque for replacing the Plaque Control Record (PCR). The relationship between PCR of the front teeth and that of all teeth was investigated by using the proposed method. The experimental results show that the proposed method can estimate the PCR of all teeth from the information of the front tooth. This method is not dependent on a particular camera system, and is applicable with many types of cameras, including smartphones. Therefore, it will be a useful tool in daily use for routine and sustainable management of the intraoral environment.

Anthropometric measurements and periodontal diseases in children and adolescents: a systematic review and meta-analysis.

The aim of this systematic review was to identify and summarize evidence of the association between anthropometric measurements and periodontal status in children and adolescents. We searched PubMed, Institute for Scientific Information Web of Knowledge, Cochrane Library, and 7 additional databases, following the guidance of Preferred Reporting Items for Systematic Reviews and Meta-Analyses, up to December 2014. Observational studies reporting data on the association between anthropometric measurements and periodontal diseases in 2-18-y-old participants were included. An initial search identified 4191 papers; 278 potentially effective studies (k = 0.82) and 16 effective studies (k = 0.83) were included after screening. The mean quality of evidence among the studies was 20.3, according to the Strengthening the Reporting of Observational studies in Epidemiology checklist (k = 0.79). Meta-analyses showed that obesity (measured by body mass index) was significantly associated with visible plaque index (OR: 4.75; 95% CI: 2.42, 9.34), bleeding on probing (OR: 5.41; 95% CI: 2.75, 10.63), subgingival calculus (OR: 3.07; 95% CI: 1.10, 8.62), probing depth (OR: 14.15; 95% CI: 5.10, 39.25) and flow rate of salivary secretion (standardized mean difference: -0.89; 95% CI: -1.18, -0.61). However, various results were reported in the effective studies that were not included in meta-analyses. In conclusion, obesity is associated with some signs of periodontal disease in children and adolescents. Further studies with a comprehensive prospective cohort design and more potential variables are recommended.

Effect on oral pH changes and taste perception in 10-14-year-old children, after calcium fortification of a fruit juice.

AIM: The aim was to determine the effect of calcium fortification of a commercially available mixed-fruit juice on oral pH changes and taste perception in a group of 10 to 14 year-old Indian children. METHOD: A controlled, blinded, non-randomised clinical trial was adopted, consisting of a sample of 100 healthy children (DMFT <3; age 10-14 years), who were exposed to three test juices one by one [Group A: original fruit juice (control group); Group B: calcium-fortified fruit juice and Group C: calcium + vitamin D fortified fruit juice]. Oral pH, collection of saliva and plaque sampling was undertaken, before and after the juice exposure by each subject at 0, 1, 5, 15, 30 and 45 min. The respective pH was measured with a digital pH meter. For taste perception, a scoring system was used after exposure of the juices to the subjects in a blind manner. The statistical evaluation was done using one-way ANOVA for salivary and plaque pH and Kruskal-Wallis test for buffer capacity and taste perception. RESULTS: There was a smaller drop in salivary and plaque pH (p < 0.5) and a significant reduction in perceived taste (p < 0.001) by the subjects after calcium modification of fruit juice. CONCLUSION: The calcium-modified mixed fruit juices was less acidogenic compared with the unfortified juice, and hence will be less cariogenic and erosive towards teeth.

Validity and reliability of autofluorescence-based quantification method of dental plaque.

BACKGROUND: The aim of this study was to evaluate validity and reliability of autofluorescence-based plaque quantification (APQ) method. METHODS: The facial surfaces of 600 sound anterior teeth of 50 subjects were examined. The subjects received dental plaque examination using Turesky modified Quigley Hein plaque index (QHI) and Silness & Löe plaque index (SLI). The autofluorescence images were taken before the plaque examination with Quantitative Light-induced Fluorescence-Digital, and plaque percent index (PPI) was calculated. Correlation between two existing plaque indices and the PPI of the APQ method was evaluated to find which level of plaque redness on tooth (ΔR) by the APQ method shows the highest correlation. The area under the ROC curve (AUC) analysis and intra- and inter-examiner reliability tests were performed. RESULTS: The PPIΔR20 of the APQ method showed a moderate correlation with two existing plaque indices (rho of QHI=0.48, SLI=0.51). This methodology fell in the fair category and it had an excellent reliability. The APQ method also showed possibility to detect heavy plaque with fair validity. CONCLUSIONS: The APQ method demonstrated excellent reliability, and fair validity, compared with 2 conventional indices. The plaque quantification described has the potential to be used in clinical evaluation of oral hygiene procedures.

Detection and quantification of dental plaque based on laser-induced autofluorescence intensity ratio values.

The aim of this study was to evaluate the applicability of laser-induced autofluorescence (LIAF) spectroscopy to detect and quantify dental plaque. LIAF spectra were recorded in situ from dental plaque (0­3 grades of plaque index) in 300 patients with 404 nm diode laser excitation. The fluorescence intensity ratio of the emission peaks was calculated from the LIAF spectral data following which their scatter plots were drawn and the area under the receiver operating characteristics were calculated. The LIAF spectrum of clinically invisible grade-1 plaque showed a prominent emission peak at 510 nm with a satellite peak around 630 nm in contrast to grade 0 that has a single peak around 500 nm. The fluorescence intensity ratio (F510/F630) has a decreasing trend with increase in plaque grade and the ratio values show statistically significant differences (p<0.01) between different grades. An overall sensitivity and specificity of 100% each was achieved for discrimination between grade-0 and grade-1 plaque. The clinical significance of this study is that the diagnostic algorithm developed based on fluorescence spectral intensity ratio (F510/F630) would be useful to precisely identify minute amounts of plaque without the need for disclosing solutions and to convince patients of the need for proper oral hygiene and homecare practices.

Assessing risk factors for dental caries: a statistical modeling approach.

The problem of identifying potential determinants and predictors of dental caries is of key importance in caries research and it has received considerable attention in the scientific literature. From the methodological side, a broad range of statistical models is currently available to analyze dental caries indices (DMFT, dmfs, etc.). These models have been applied in several studies to investigate the impact of different risk factors on the cumulative severity of dental caries experience. However, in most of the cases (i) these studies focus on a very specific subset of risk factors; and (ii) in the statistical modeling only few candidate models are considered and model selection is at best only marginally addressed. As a result, our understanding of the robustness of the statistical inferences with respect to the choice of the model is very limited; the richness of the set of statistical models available for analysis in only marginally exploited; and inferences could be biased due the omission of potentially important confounding variables in the model's specification. In this paper we argue that these limitations can be overcome considering a general class of candidate models and carefully exploring the model space using standard model selection criteria and measures of global fit and predictive performance of the candidate models. Strengths and limitations of the proposed approach are illustrated with a real data set. In our illustration the model space contains more than 2.6 million models, which require inferences to be adjusted for 'optimism'.

Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) May Be an Alternative Preventive Therapy in Children with Cerebral Palsy.

PURPOSE: To evaluate the effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on the buffering capacity of saliva and plaque pH in individuals with cerebral palsy (CP). MATERIALS AND METHODS: A total of 15 3- to 8-year-old subjects with CP living in a governmental institution were included in this study. Dental plaque pH and the buffering capacity of saliva were measured at the first visit (baseline) and accepted as control values. CPP-ACP complex (GC Tooth Mousse) was applied to the children twice a day. Measurements were repeated after the 1st, 2nd, 3rd, 4th, 6th and 8th weeks. RESULTS: Plaque indicator data show decreased acidogenicity in the 8-week period. Although there were no significant differences between the baseline and the 1st, 2nd and 3rd weeks' pH scores, a statistically significant difference was observed between the initial and 4th, 6th and 8th weeks' plaque pH scores. Saliva buffer scores were found to statistically significant increase between baseline and the 3rd, 4th, 6th and 8th weeks. CONCLUSION: Daily application of 10% w/v CPP-ACP paste is effectively changes saliva buffering capacity and plaque pH, thus promoting caries prevention in the primary and mixed dentition of CP children.

Plaque pH in caries-free and caries-active young individuals before and after frequent rinses with sucrose and urea solution.

OBJECTIVE: To examine pH in the approximal dental biofilm after acid and alkali formation from sucrose and urea, after an adaptation period to these substances, in caries-free (CF) and caries-active (CA) individuals. Saliva flow and buffer capacity, and aciduric bacteria in saliva and plaque were also examined. MATERIAL AND METHODS: Twenty adolescents and young adults (15-21 years) with no caries (n = 10, D(m + i)MFS = 0) or ≥1 new manifest lesions/year (n = 10, DmMFS = 3.4 ± 1.8) participated. After plaque sampling, interproximal plaque pH was measured using the strip method before (baseline) and up to 30 min (final pH) after random distribution of a 1-min rinse with 10 ml of 10% sucrose or 0.25% urea. This procedure was repeated after a 1-week adaptation period of rinsing 5 times/day with 10 ml of the selected solution. After a 2-week washout period the second solution was similarly tested. Mutans streptococci, lactobacilli and pH 5.2-tolerant bacteria were analyzed by culturing. RESULTS: In the CF group, acid adaptation resulted in lowering of baseline and final plaque pH values after a sugar challenge, and in increased numbers of bacteria growing at pH 5.2, which was increased also after alkali adaptation. In the CA group, the final pH was decreased after acid adaptation. No clear effects of alkali adaptation were seen in this group. CONCLUSION: One-week daily rinses with sucrose and urea had the most pronounced effect on the CF group, resulting in increased plaque acidogenicity from the sugar rinses and increased number of acid-tolerant plaque bacteria from both rinses.

The effect of recommending a CPP-ACPF product on salivary and plaque pH levels in orthodontic patients: a randomized cross-over clinical trial.

OBJECTIVE: Along with their re-mineralizing capacity, calcium phosphopeptide-amorphous calcium phosphate products combined with fluoride (CPP-ACPF) could also be beneficial by neutralizing acidic salivary and plaque pH. The purpose was to evaluate the effect of CPP-ACPF on salivary and plaque pH in orthodontic patients. MATERIALS AND METHODS: As a triple-blind, cross-over randomized trial, 30 orthodontic patients with fixed appliances (age range = 15.70 ± 4.08 years) were recruited and randomly assigned to two groups. A CPP-ACPF paste (MI Paste Plus, GC America, Alsip, IL) was used by group 1 (n = 15) and a placebo by group 2 (n = 15) for 1 month. After a 1 month washout period, patients used the alternative paste for another month. Plaque and salivary pH levels were measured at all before and after periods. RESULTS: By applying MI Paste Plus, the plaque pH increased from 5.81 ± 0.45 to 6.60 ± 0.38 (p < 0.05), whereas the before and after salivary pH recordings, which were 6.72 ± 0.43 and 6.71 ± 0.38, respectively, remained statistically unchanged (p > 0.05). CONCLUSION: MI Paste Plus can be clinically beneficial in increasing plaque pH levels, but has no effect on the salivary pH.

Effect of water rinsing after acidulated phosphate fluoride gel on dental plaque acidity: an in situ study.

PURPOSE: This study's purpose was to determine whether rinsing with water or cleansing teeth after topical fluoride therapy affected plaque acidity. METHODS: This randomized, controlled, crossover, in situ study was conducted on 25 dental students who wore an acrylic mandibular appliance containing one enamel block. The patients were subjected to four treatment protocols involving acidulated phosphate fluoride (APF) application followed by rinsing the mouth with water: (1) after 30 minutes (APF-30); (2) after 15 minutes (APF-15); (3) immediately (APF-0); after cleansing the teeth with a cotton roll immediately following APF (APF-cotton); or (4) no fluoride therapy (control). After 48 hours, plaque pH was measured before and five, 10, 15, 20, and 30 minutes after rinsing with 10 percent sucrose solution. RESULTS: The least pH changes, the lowest pH drop, and the fastest pH recovery were found in the APF-30 and APF-15 groups, followed by the APF-0 and APF-cotton groups. CONCLUSIONS: Rinsing with water or cleansing the teeth with a cotton roll immediately after acidulated phosphate fluoride application can reduce its effect on dental plaque acidity; however, the inclusion of a controlled water rinse 15 minutes after APF gel application did not seem to influence the inhibitory effect of fluoride on plaque acidity.

Relationship between plaque pH and different caries-associated variables in a group of adolescents with varying caries prevalence.

The pH response of the dental biofilm after a sugar challenge can be considered to mirror the acidogenic potential and thereby the caries risk of an individual. The aim of this cross-sectional study was to evaluate the relationship between plaque pH and different caries variables in adolescents with varying caries prevalence. One hundred individuals, aged 14-15 years, were examined regarding different caries-related variables: (i) caries score (DSm, DSi, DSm + i, DTm), (ii) salivary secretion rate and buffer capacity, (iii) oral microflora of plaque and saliva, (iv) plaque amount, (v) plaque pH and (vi) dietary intake, oral hygiene habits and fluoride use. Plaque pH was assessed using the microtouch method before and after a 1-min mouthrinse with 10 ml 10% sucrose. Depending on the minimum pH, the participants were divided into three groups: low pH (≤5.3), medium pH (>5.3-6.3) and high pH (>6.3). Statistically significant differences between the three groups (p < 0.01) were found for initial caries (DSi) and combined manifest and initial caries (DSm + i). A statistically significant difference was also found in the log values for salivary lactobacilli (p = 0.02) within the three groups, and for the total number of bacteria in plaque (p = 0.04); for both variables, the low-pH group had the highest values. The only covariate significantly associated was the Cariogram score in the medium-pH group (p < 0.01) and the number of meals per day in the high-pH group (p = 0.02). To conclude, plaque pH measured by the microtouch method is a method that can be used for discriminating between individuals with varying caries prevalence.