Accuracy of a chair-side test for predicting caries risk compared with established methods. A pilot study.

PURPOSE: The aim of this study was to determine the prognostic accuracy of a new chair-side test, determination of lactic-acid production on the tongue, for caries-risk assessment according to caries increment within two years. METHODS: 35 children (6-8 years old) participated in the study. The past caries experience (df-t1, DF-T1), caries at second deciduous molars (df-2.mol), approximal plaque index (API) were the clinical, and salivary counts of mutans streptococci (MS)/lactobacilli (LB) and lactic-acid production on the tongue (LAP) the subclinical predictors recorded at baseline. Two years later, the dental examination was repeated (df-t2/DF-T2). According to the increase in DF-T (delta DF-T), caries-risk groups (delta DF-T = 0 versus delta DF-T > or = 0) were built. To assess the prognostic accuracy sensitivity and specificity were calculated. Statistical analysis was performed using Spearman's test for nonparametric correlations. RESULTS: The DF-T increased from 0.3 +/- 0.8 to 1.2 +/- 1.6. 20 children were in the no-caries-risk and 15 in the caries-risk group. The p-value for the correlation of delta DF-T to API was 0.007 and to LB counts 0.069. The highest sensitivity and specificity levels were found for LB (65%/70%), LAP reached a maximum sensitivity of 33% with a specificity of 55%. CONCLUSION: According to the results, because of its insufficient prognostic accuracy the LAP test is not suitable as a sole screening-tool for an accurate caries-risk assessment.

In vitro evaluation of enamel remineralisation by a casein phosphopeptide-amorphous calcium phosphate paste.

PURPOSE: The aim of this preliminary in vitro study was to evaluate the effect of a casein phosphopeptide and amorphous calcium phosphate (CPP-ACP) paste on untreated enamel surfaces that had previously been exposed to an erosive challenge. MATERIALS AND METHODS: Over a period of 6 h, enamel samples from five fully erupted, caries-free molars were incubated with apple juice and later covered with CPP-ACP paste for 15 min. Enamel samples incubated with physiological sodium chloride solution or with apple juice alone served as controls. The quantitative elementary analysis for calcium and phosphorus in various depths ranging from 5 to 50 microm was performed using an electron-probe microanalyser. RESULTS: Exposure to apple juice resulted in a loss of minerals down to a depth of 30 microm with a mean loss of 13% at 5 microm and 6% at 10 microm. After treatment with CPP-ACP paste, the mineral loss decreased to a mean of 9% at 5 microm and remained at 5% at a depth of 10 microm (not a statistically significant difference). At a depth of 20 microm, no further mineral loss was recorded. CONCLUSIONS: This study demonstrated that there is a slight gain in the mineral contents after the application of a CPP-ACP paste, mainly in the upper enamel layer. Within the limitations of this in vitro study, the application of CPP-ACP paste may enhance the remineralisation after an erosive challenge and thus offer some protection for patients who are at risk for erosion.

Comparison of a new chairside test for caries risk assessment with established methods in children.

PURPOSE: The aim of this study was to compare the results of a new method, measurement of lactic-acid production on the tongue (LAP), with established methods of caries risk assessment in children. METHODS: One hundred nineteen children (6-10 years old) participated in the study. Data collection included number of carious lesions (D-T) and filled teeth (F-T), approximal plaque index (API), LAP, buffering capacity (BC), counts of mutans streptococci (MS) and lactobacilli (LB) in stimulated saliva. According to caries presence, the children were divided into low risk (LR group; D-T = 0) and high risk (HR group; D-T > or = 1) groups. Statistical analysis was performed using Chi-square test, Spearman's test for nonparametric correlations, uni- and multivariate regression analysis. RESULTS: Seventy-two children (F-T = 0.4 +/- 1.4) were in the LR and 47 (D-T = 2.5 +/- 2.7; F-T = 1.5 +/- 1.9) in the HR group. The correlation analysis verified statistically significant correlations between D-T and the salivary counts of MS/LB and between D-T and F-T. API correlated with F-T and LB, while F-T and LB also correlated with each other significantly. The counts of MS and LB showed also a significant correlation. The LAP showed a significant correlation only to F-T. Significances in univariate regression analysis were found for F-T, counts of LB and MS in saliva, and for LAP. The multivariate regression analysis indicated significances only for F-T and LB in saliva, but not for LAP. CONCLUSION: LAP might be useful only as a supplementary screening tool for caries risk assessment, but not as a sole predictor.

Usefulness of combining clinical and radiological dental findings for a more accurate noninvasive age estimation.

The aim of this study was to establish correlations of clinical and radiological dental findings, alone or in combination, with chronological age in adults. Dental findings and orthopantomograms of 984 patients (aged 20-60 years; 524 females/460 males) were analyzed. DMF-T index and distance (alveolar bone level, ABL) between cemento-enamel junction and alveolar bone margin were recorded. Additionally, clinical and radiological findings at each tooth crown and root were collected according to the actual status of destruction and restoration, and a total score for each dentition (TSD) was calculated. After univariate correlation analysis, correlation coefficients for ABL and TSD were improved by using square root (sqrt). However, the determination accuracy was still not satisfactory; 90% of the residuals were in the range of about +/-10. The present study showed that clinical and radiological dental findings could not be used, not even in combination, for accurate age estimation as a single method, but that they could support other methods.

Local gingival blood flow at healthy and inflamed sites measured by laser Doppler flowmetry.

BACKGROUND: This investigation aimed to: 1) develop a method to obtain reproducible laser Doppler flow readings (LDFRs) at the gingiva of the maxillary front teeth; 2) evaluate regional gingival blood flow (GBF) in healthy gingiva by laser Doppler flowmetry; 3) compare hand-held LDFR (H-LDFR) with splint LDFR (S-LDFR); and 4) monitor changes in GBF in experimental gingivitis (EG) and chronic gingivitis (CG). METHODS: The LDFR, gingival index (GI), and plaque index (PI) were measured at 13 gingival sites (teeth #6 to #11) in 10 healthy volunteers (five males and five females), 23 to 34 years of age, over a period of 12.5 +/- 3.27 days employing a partial-mouth EG model and in 11 patients (three males and eight females), 20 to 63 years or age, with CG. LDFRs were obtained by S-LDFR or H-LDFR. RESULTS: H-LDFRs were significantly higher than S-LDFRs (P <0.05). All EG subjects developed gingivitis (PI: 2.77 +/- 0.23; GI: 1.5 +/- 0.53). EG-LDFRs at diseased sites increased slightly but not significantly over the study period. All CG-patients had high plaque and inflammation scores (PI: 2.8 +/- 0.2; GI: 1.63 +/- 0.78). CG-LDFRs at sites with GI >1 were significantly higher than LDFRs at healthy sites (P <0.05). CG-LDFRs were significantly higher than EG-LDFRs at sites with a comparable GI (P <0.05). CONCLUSIONS: LDFRs are positively correlated with the degree of gingival inflammation. GBF demonstrated significant differences in EG and CG. Modifications of the probe are needed to enhance its clinical applicability in clinical research of periodontal diseases.

Dystrophic epidermolysis bullosa: oral findings and problems.

Dystrophic epidermolysis bullosa (DEB) is one of the three major types of epidermolysis bullosa (EB), an inherited cutaneous disease with blister formation following minor trauma. A subtype of DEB is recessive dystrophic epidermolysis bullosa, Hallopeau-Siemens type (RDEB-HS), where marked scarring leads to deformities of extremities. In RDEB-HS the mucous membranes may also be involved and form adhesions with ankyloglossia and microstomia. Oral hygiene is difficult. A 7-year-old boy with RDEB-HS was brought to the Johannes Gutenberg University dental clinic with dental pain. He had multiple carious lesions, poor oral hygiene and gingivitis. Because he was noncompliant and had microstomia, he required dental therapy under general anesthesia. The recall visits over the past two years had demonstrated that the dental health of this patient with RDEB-HS could be maintained by means of improved oral home care, using antibacterial agents.

Effect of periodontal therapy on sulcular sulphide level a longitudinal study.

PURPOSE: The identification of active disease sites is a leading goal in basic periodontal research. Of toxic bacterial metabolites detectable in gingival crevicular fluid, volatile sulphur compounds (VSC) have been implicated in periodontal tissue destruction. Several bacteria associated with active destructive disease are capable of producing VSC, this fact supporting the idea of sulcular VSC being a possible marker of disease activity. A new portable sulphide monitor providing chairside information on sulcular sulphide level (SU) has been developed. The aim of this study was 1) to monitor the effect of mechanical therapy on SU and clinical parameters and 2) to clarify whether SU-measurements might have the potential to detect disease activity. METHODS: 34 patients (22 M, 12 F) with generalized or localized chronic periodontitis received periodontal treatment in a private practice consisting of an oral hygiene phase (HP) lasting several weeks, scaling and root planing (SRP), and flap surgery at sites >5 mm or with furcation involvement. Subjects were examined three times (1 week after the diagnosis was made, at the end of HP and at the 1st maintenance session 3 months after SRP) recording clinical parameters (clinical attachment loss CAL, probing depth PD, bleeding on probing intensity BI, plaque index PI) and sulcular sulphide level (SU) measured by the portable monitor as as digital score ranging from 0.0 (<10 superset 6 M of S superset 2-) to 5.0 (10 superset 2 M of S superset 2-) in increments of 0.5. RESULTS: 23 patients (15 M, 8 F, 47.5 +/- 9 years) were included in the data analysis. Periodontal therapy resulted in a significant reduction of mean BI by 0.69 +/- 0.45, of mean PD by 1.39 +/- 0.33 mm and in a mean gain of attachment of 1.07 +/- 0.38 mm (p = 0.0001). The clinical improvement was accompanied by a reduction of mean SU by 0.20 +/- 0.13 and of the mean percentage of SU-positive sites per patient (SUp) by 20.09 +/- 13. SU-positive sites were located at all types of teeth. 67.9 % of SU-positive sites and 83.8 % of sites with a SU > 1 were found at the molars. 16.1 % of initially 579 SU-positive sites remained SU-positive. For these sites, BI reduction by treatment was significantly lower compared with SU-negative sites (p < 0.01). SU was significantly correlated with PD, CAL, BI and PI (p = 0.0001). Sensitivity and specificity of SU related to BOP (BI > 0) was 29.3 % and 96.8 %, respectively. CONCLUSIONS: Sulcular VSC as measured by the portable sulphide monitor may be an indicator of therapeutical success and periodontal stability. The sensor system offers chairside information on sulcular sulphide production at specific sites and is a valuable supplementation of traditional clinical methods in periodontal examination. More controlled longitudinal studies are needed to clarify the role of sulcular VSC at sites undergoing periodontal destruction.