Caries clinical trial of a remineralising toothpaste in radiation patients

Objectives: The purpose of this study was to determine the efficacy and safety of a specially formulated remineralising toothpaste in controlling caries in a high‐risk population: head and neck radiation patients. Design: The study compared the performance of the remineralising toothpaste with a conventional fluoride dentifrice using double‐blind randomisation. Materials and methods: Test products: The products compared contained equivalent quantities of fluoride (1100 p.p.m.). The dual‐phase remineralising toothpaste, Enamelon^®, also delivered soluble calcium and phosphate ions, essential components of teeth, from separate phases. Both groups had all caries restored at baseline and used a fluoride rinse daily. Subjects: Fifty‐seven subjects who received radiation to the head and neck causing saliva hypofunction, entered the study, while 44 completed the 10–12 month visit. Measurements: Examinations included coronal and root caries using the Pitts Diagnostic Criteria, salivary flow rate, plaque and gingival indices and microbiological counts over a 1‐year period. Results: The average net increment per year for root caries per subject was 0.04 (±.052) in subjects completing the study using the remineralising toothpaste and 1.65 (±0.51) for root caries in subjects completing the study using the conventional fluoride dentifrice. The difference was statistically significant (p = 0.03), suggesting lower net root surface increment/year for the remineralising toothpaste relative to the conventional toothpaste. No significant differences were noted on coronal surfaces. Conclusion: The results indicate that the remineralising toothpaste provides a significant benefit in preventing and remineralising root caries in high‐risk patients.     

Effect of a 0.05% Neutral NaF Mouthrinse on Coronal and Root Caries of Adults1

Three-year coronal and root caries increments were compared in adults rinsing with either a 0.05% neutral NaF mouthrinse or a placebo mouthrinse. 1006 subjects, initially 20–65 years old (mean age: 39.9 yrs). who resided in fluoride deficient communities used a fluoride or placebo mouthrinse daily in their homes and brushed with an A.D.A. accepted fluoride dentifrice provided by the study. After three years, 731 subjects remained. Compliance was good. There were no significant differences (t-test, p≤ 0.05) in coronal DMFT, coronal DMFS, root DFT and root DFS between the two groups. In subjects exhibiting root caries at the final examination, the DF root surface increment was 25.1% less in the fluoride mouthrinse users compared to those using the placebo rinse, but this difference was not statistically significant. The only significant difference in the caries increment between the two study groups was found for the mesio-distal root surfaces of 45–65 year old participants.     

Remineralisation study of artificial root caries lesions after fluoride treatment. An in vitro study using electric caries monitor and transversal micro-radiography

Aims: To evaluate and compare remineralisation of root caries lesions after in vitro treatment with various fluoride (F) agents using an Electric Caries Monitor (ECM) and Transversal Micro‐Radiography (TMR). Materials: Permanent human teeth were extracted and root surface specimens were sectioned, prepared (n = 35), and randomly allocated into seven different experimental groups (groups 1–7). Methods: Root surfaces were demineralised in an acidified gel (pH = 5.0) for 3 weeks followed by various F treatments and stored in a standardised remineralising solution at 37°C for 6 weeks. The root surfaces were treated twice daily with different dentifrice slurries for 2 min, either with a neutral placebo dentifrice without F (group 5); or a neutral sodium fluoride (NaF) 1400 p.p.m. F dentifrice (group 1); or a neutral 1250 p.p.m. F dentifrice (group 6); or an acid dentifrice (pH 4.7) with 1400 p.p.m. F containing amine fluoride (AmF) (groups 3 and 4) or a 1250 p.p.m. (pH 4.7) AmF dentifrice (group 6). In groups 1, 2, 5, 6, and 7, the root surfaces were additionally rinsed for 2 min with a neutral non‐F placebo solution. In groups 3 and 4, rinsing were performed for 2 min with an acid (pH 4.7) 250 p.p.m. F solution, containing 125 p.p.m. F as AmF and 125 p.p.m. F as potassium fluoride (KF), once or twice per day respectively. ECM was used to measure electrical resistance on root surfaces at baseline and after 3 and 6 weeks respectively. TMR technique was used to measure and compare root surface lesion depths and mineral loss. Results: Six weeks daily treatment with a dentifrice slurry containing AmF followed by rinsing with a combination of equal amounts of AmF and KF solution twice a day showed a statistical significant higher ECM values compared with the other groups. TMR data measuring lesion depths and mineral loss reduction supported the results of the ECM findings. Conclusions: Daily application of a dentifrice slurry containing 1400 p.p.m. F as AmF combined with twice daily rinsing with a 250 p.p.m. F solution containing equal amount of AmF and KF significantly remineralise primary root caries lesions in vitro. ECM and TMR are valuable complementary methods in order to analyse the remineralisation processes.     

A comparison of four home-care fluoride programs on the caries incidence in the elderly

Objective : To estimate the caries preventive effect of 4 fluoride programs over 2 years in the elderly. Setting : The Public Dental Clinics of Balsta and Knivsta and the Faculty of Odontology in Göteborg, Sweden Subjects : One hundred and sixty-four individuals, aged 60 years and older (mean age 71.5 years) who were considered to be at risk from caries. Design : The participants were randomly assigned either to: 1) rinse twice a day with a 0.05% NaF solution (n=49; rinsing group), 2) suck twice a day on a 1.66 mg NaF tablet (n=51; tablet group). 3) brush their teeth three times a day using a toothpaste slurry rinsing technique (n=32; slurry group), or 4) brush their teeth in their usual manner (n=32; control group). The participants in all 4 groups used a fluoride toothpaste (containing 0.32% NaF) at least twice daily. Results : No new carious lesions were found in 67% of the participants in the rinsing, 43% in the tablet, 25% in the slurry and 16% in the control group over the 2 years. The mean (± SD) 2-year caries increment was 0.8±1.4, 1.4±1.7, 1.9±1.9 and 2.3±2.1 DFS in the rinsing, tablet, slurry and control groups, respectively; it was significantly lower in the rinsing than in the control group (p<0.01). A lower incidence of DFS was also found in the tablet group than in the slurry group, but only for the lingual surfaces (p<0.05). Conclusion : The type of fluoride program may be of importance in the reduction of new caries lesions in an older population.     

Oral health status of the elderly in a residential home in Turkey

Objectives: To determine the oral health status and treatment needs of elderly residents of a residential home in Ankara, Turkey. Background: Little is known about oral health problems of elderly living in the institutions. Methods: Among 216 elderly, 193 of them were interviewed and were clinically examined according to WHO criteria. Age, gender, educational and occupational status, oral hygiene practices, dental insurance, access to dental care and systemic diseases were recorded using a structured questionnaire. Coronal and root caries, periodontal disease, dental status and related treatment needs were assessed by two calibrated dentists. Results: The mean age of the subjects were 75.2 ± 8.3 in males, 79.1 ± 7.9 in females; 32.6% of subjects were dentate and the mean number of teeth was 3.7 ± 7.0 (median = 0). A functional dentition was present in 7.3% of subjects (≥20). The mean decayed, missing and filled teeth (DMFT) was 29.3 ± 5.8 (median = 32) and mean root caries was 2.2 ± 3.1 (median = 1.0). The major reason for tooth extraction was dental caries. Of the subjects, 20.7% had at least one untreated coronal caries and 18.1% root caries. The assessment of periodontal status according to CPI revealed that only four persons had nine healthy sextants with the score of ‘0’. Edentulousness was 67.4% while 11.9% of them lacked denture in both jaws. Conclusion: The results illustrated poor dental health and showed extremely high demand for the dental health services programmes for the elderly living in these institutions.     

The effectiveness of 10% chlorhexidine varnish treatment on dental caries incidence in adults with dry mouth

Objectives: This study compared a 10% chlorhexidine varnish treatment with placebo and sham treatments for preventing dental caries in adult patients with xerostomia (dry mouth). Design: The study was a multicentred, randomized, parallel group, double blind, placebo‐controlled clinical trial. Setting: All examinations and procedures were performed at Tuft's University, Boston, MA, the University of British Columbia, Vancouver, BC or the University of Western Ontario, London, ON. Subjects: Subjects were adults with recent or current dental caries experience, high salivary levels of cariogenic microorganisms and low salivary flow rates. Results: 236 subjects completed at least one post‐treatment examination. There were 697 new carious lesions diagnosed, 446 (64%) located on coronal surfaces and 251 (36%) located on root surfaces. The mean attack rate was 0.23 surfaces/100 surfaces at risk. A treatment difference observed between the Active and Placebo groups was statistically significant for root caries increment (p=.02) and total caries increment (p=.03). A treatment difference observed between the Active and Sham groups was not statistically significant for coronal, root or total caries increment. Analysis of variance of treatment group differences was performed using mutans streptococci counts, salivary flow rates, age, sex, caries prevalence, medications, time to first event and early withdrawal as co‐variables. These factors did not meaningfully alter the findings. Conclusions: The difference between the 10% chlorhexidine varnish and placebo treatments is considered to be highly clinically significant for root caries increment (41% reduction) and for total caries increment (25% reduction) but only for coronal caries increment (14%).     

The effect of geochemical factors on prevalences of dental diseases for prehistoric inhabitants of the state of Missouri

In previous epidemiological studies, it has been suggested that geochemical factors besides fluoride may affect the prevalences of dental diseases. Our objective in this study was to determine whether the prevalences of periodontal diseases, coronal caries, and root caries for prehistoric inhabitants vary between geochemical regions of the state of Missouri. Burial sites were located on unique maps that depict geochemical variation among regions of the state. Data on dental caries and alveolar bone loss were gathered from 179 of the best preserved skeletal remains of the Late Woodland (A.D. 400-900) and Mississippian (A.D. 900-1700) periods. Mean caries scores and proportions of individuals with caries were calculated for these geochemical regions. Average alveolar bone loss was regressed on age for the individuals of these regions. Significant differences in caries and bone loss were found between several regions. These differences cannot be adequately explained by fluoride concentrations or by diet. It is suggested that geochemical factors, in addition to fluoride, may have affected the prevalences of dental diseases.     

Caries incidence in patients with dementia

One in ten persons over the age of 65 and as many as half the population aged 85 and over have Alzbeimer's disease. Review of the literature reveals substantial decrements in oral health in persons with dementia as measured by denture hygiene, coronal decayed, missing and filled teeth, filled teeth (cervical), percentage of the population with caries. Oral Hygiene Index-simplified, and of sites with plaque, gingival bleeding and calculus. A study of caries incidence is described in 23 male veterans with moderate and advanced dementia of the Alzheimer's type, using a comparison group of male veterans from the Department of Veterans Affairs Dental Longitudinal Study, matching 2 :1 for age, number of teeth and education. Baseline findings indicate significant differences in the numbers of coronal surfaces with decay, root decayed and/or filled teeth and root decayed and/or filled surfaces. Mean annual increments of coronal caries in the dementia group were 2.29±4.29 per 100 surfaces at risk, over twice that in the comparison group (0.88±1.14). For root caries, mean annual increments in the dementia group were 2.38±5.57 per 100 available surfaces, versus 0.31± 0.69 in the comparison group. Despite these large mean differences, the marked variability in these small samples statistical significance in caries increments between the two groups. The article concludes by suggesting some potential modifications to clinical trials of caries preventive agents and some overall research issues in populations with dementia.     

Development and evaluation of two root caries controlling programmes for home-based frail people older than 75 years

Objectives: (i) Initially, to devise and examine the validity of a system for determining lesion activity on root surfaces, and (ii) compare the effectiveness of two preventive programmes in controlling root caries in elderly people using the devised system. Materials and methods: (i) Four clinical variables: texture, contour, location and colour of root caries lesions were selected to evaluate lesion activity. The intraexaminer reproducibility of the scoring system was assessed on 28 elderly patients. The accuracy was assessed on 10 of these persons using an impression material (Clinpro, 3M ESPE). (ii) Of total, 215 homebound 75+ year olds were randomly assigned to one of three groups: group 1, once a month a dental hygienist brushed the teeth of the participants and applied Duraphat vanish to active root caries lesions. The participants in groups 2 and 3 received 5000 and 1450 ppm F‐toothpaste, respectively, to use twice a day. This study included an interview, a baseline examination and a final follow‐up examination after 8 months. Results: (i) Intraexaminer reproducibility of the root caries scoring system was 0.86 (Kappa). The sensitivity and specificity was 0.86 and 0.81. (ii) Data from those 189 (88%) who completed the study disclosed that there were no inter‐group differences at the baseline examination concerning relevant conditions. At the end of the study, the root caries status of participants in groups 1 and 2 had improved significantly when compared with group 3 (p < 0.02). No significant difference was observed between groups 1 and 2 (p = 0.14). Conclusion: The data suggest that the root caries scoring system is reliable. Both the intervention programmes controlled root caries development; the hygienist in eight of 10 persons, the 5000 ppm F‐toothpaste in seven of 10. In contrast, five of 10 participants who only brushed with 1450 ppm F‐toothpaste had root caries progression.     

Prosthetic crowns and other clinical risk indicators of caries among old-old Swedish adults: findings from the KEOHS Project. Kungsholmen Elders Oral Health Study

Objectives: The Kungsholmen Elders Oral Health Study (KEOHS) evaluated the oral health status of generally healthy, community‐dwelling persons over the age of 80 living in Kungsholmen, Sweden. This paper explored possible clinical risk indicators of coronal and root caries among the KEOHS subjects. Design: In this cross‐sectional study, dentate KEOHS subjects received a caries assessment using defined visual, tactile criteria. Setting: Examinations were carried out in two local clinics by standardized examiners. Subjects: One hundred twenty‐nine dentate persons were examined. Main Outcome Measures: The examination identified decayed and filled surfaces, prosthetic crowns, and missing teeth. Results: More root than coronal surfaces had untreated decay, and secondary root caries contributed the greatest number of decayed surfaces. Ninety percent of the examined dentate subjects had at least one prosthetic crown. Root surfaces exposed to crown margins were more likely to have caries than root surfaces not so exposed, particularly among women. The presence of untreated coronal caries (yes/no) was positively associated with having untreated root caries and an intermediate number (14–20) of teeth, but inversely associated with having 4+ prosthetic crowns. Active root caries (yes/no) was positively associated with having untreated coronal caries, 14–20 teeth, and 4+ prosthetic crowns. Nearly 20% of identified root lesions were present at or below the gingival margin, and most (88%) were secondary caries associated with crown margins (65%) or other restorations (23%). Conclusions: Our findings suggest that some dental characteristics, including the presence of prosthetic crowns, are risk indicators for the presence of untreated coronal and root caries.     

南京市栖霞区3～5岁儿童乳牙患龋现状调查及其影响因素分析

目的:调查南京市栖霞区3~5岁儿童乳牙患龋现状,并分析患龋的影响因素。方法:于2020年1月到2020年12月,采用整群随机抽样法,抽取南京市栖霞区8所幼儿园中符合3~5周岁年龄段的儿童。观察入选对象的乳牙患龋现状,对入选对象的照顾者进行问卷调查,采用单因素及多因素Logistic回归分析南京市栖霞区3~5岁儿童乳牙患龋的影响因素。结果:每所幼儿园抽取3、4、5岁儿童各42人,合计1008人。实际完成调查1000人,响应率99.21%,1000人中有573人乳牙患龋,患龋率为57.30%。不同性别、年龄的儿童其患龋率对比差异有统计学意义(P<0.05)。单因素分析结果显示,南京市栖霞区3~5岁儿童乳牙患龋与糖摄入频率、照顾者学历、家庭人均月收入、使用含氟牙膏情况、睡前进食、大人帮助下刷牙、每天刷牙次数、开始刷牙年龄、近半年有无口腔检查有关(P<0.05)。多因素Logistic回归分析结果显示,年龄>4岁、糖摄入频率≥2次/d、睡前进食、家庭人均月收入<2000元、照顾者学历初中及以下是南京市栖霞区3~5岁儿童乳牙患龋的危险因素,而开始刷牙年龄≤2岁、每天刷牙次数≥2次、使用含氟牙膏是南京市栖霞区3~5岁儿童乳牙患龋的保护因素(P<0.05)。结论:南京市栖霞区3~5岁儿童乳牙患龋率较高,且受到年龄、糖摄入频率、睡前进食等多种因素影响,可考虑针对相关因素加强口腔健康教育和龋病预防控制工作。     

Comparison between amine fluoride and chlorhexidine with institutionalized elders: a pilot study

doi: 10.1111/j.1741‐2358.2012.00650.x Comparison between amine fluoride and chlorhexidine with institutionalized elders: a pilot study Objective: Compare the efficacy of amine fluoride toothpaste and gel with chlorhexidine spray in an institutionalised population. Background: People who live in nursing homes have poorer oral hygiene because of their dependency for the basic activities of daily living as they rely on caregivers. Methods: Twenty‐six people over 65 years old who had at least four teeth and living in a nursing home. They were assigned to three groups: A: amine fluoride toothpaste and once a week amine fluoride gel (Elmex^®), B: 0.12% spray‐chlorhexidine once a day (Perio‐Aid^®) and C: brush teeth without toothpaste. The plaque and gingival index of Silness and Löe, General Oral Health Assessment Index, McLeran and Pfeiffer index were recorded, and the number of colonies of Streptoccocus mutans and Lactobacillus and the remineralisation of caries were evaluated using Diagnodent^®. Measurements were taken at the beginning of the study and after 6 months. Results: Twenty‐two people finished the study. No group showed a statistical difference in the plaque or gingival index, but there was a tendency to show improvement in the amine fluoride group. There was also no difference between the number of colonies of either S. mutans or lactobacillus. There was a significant difference between the plaque and gingival index and the cognitive status (p = 0.0054), along with their requirement for assistance to perform good oral hygiene (p = 0.0001). Both products remineralised the carious lesions in this period compared with the control group (p = 0.0151). Conclusion: The plaque and gingival indices did not improve during the study, but both products remineralised the previous caries lesions.     

妊娠期妇女产次与龋病及牙周病发生关系的探究

目的探究妊娠期妇女龋病及牙周病发生情况和不同产次对妊娠期妇女龋病及牙周病发生的差异。方法以228名妊娠期妇女(其中初产妇140名,经产妇88名)和85名同龄未妊娠妇女(对照)为研究对象,检查其龋病及牙周病发生状况,并记录菌斑指数(PLI)、探诊深度(PD)、临床附着丧失(CAL)、牙石指数(CI)和龈沟出血指数(SBI),进行组间统计分析。结果 (1)初产组(47.86%)、经产组(67.05%)的患龋率均高于对照组(29.41%)(P0.05),且经产组的患龋率高于初产组(P0.05)。初产组、经产组和对照组的龋均分别为1.57、2.18和0.90。(2)PLI、CI、PD、CAL和SBI在初产组(0.60±0.06,1.92±0.54,4.38±1.20,0.21±0.05,2.51±1.14)和经产组(0.71±0.59,2.06±0.97,4.77±1.35,0.22±0.08,3.05±1.40)均高于对照组(0.52±0.28,1.26±0.39,2.80±0.78,0.18±0.11,2.06±1.17)(P0.05),且经产组的PD、SBI高于初产组(P0.05),而初产组和经产组间PLI、CI、CAL的差异无统计学意义(P0.05)。结论妊娠可能导致妇女患龋率、PLI、CI、PD、CAL和SBI的增加,且产次增加可能导致妇女患龋率、PD和SBI的增加。     

Predominance of non-Streptococcus mutans bacteria in dental biofilm and its relation to caries progression

This study aims to assess differences in biofilm bacterial composition between patients with low and high caries. Patients without a medical problem and with no history of antibiotic use, mouth wash or fluoride application in the previous 3 months were recruited. Caries was recorded at cavitation level; score was calculated by a national mean (dmft of 4.8 and DMFT of 2.7). Pooled biofilm samples were collected from mesial, distal, buccal, lingual, and occlusal surfaces. Based on caries experience, individuals were classified into low and high caries and both groups were compared regarding bacteria identified using 16S rRNA gene sequencing, and molecular phylogenetic analysis of the isolates was performed. A total of twenty seven randomly selected samples with low (n = 13) and high (n = 14) caries. Identification of oral bacteria was performed using 16S rRNA sequence, Rothia mucilaginosa and R. aeria were identified in low caries individuals, while R. dentocariosa was detected in high caries individuals. Two Streptococcus spp. were identified only in low caries S. salivarius and S. gordonii whereas S. sanguinis, S. mitis, S. sinensis, S. rubneri, S. vestibularis, S. cristatus and S. massiliensis were identified only in individuals with high caries. This study revealed the absence of R. mucilaginosa in the high caries subjects and its coexistence with the low caries subjects. Streptococcus mutans was insignificant contributor of caries among samples, while, Streptococcus sanguinis was the main constituent of high caries Saudi patients.     

Caries and periodontal disease of the elderly in Pomerania, Germany: results of the Study of Health in Pomerania

Objective: The aim of this study was to describe the oral health status of older adults living in north‐eastern Germany. Materials and Methods: Representative samples of adults aged 60 years or older were examined as part of Study of the Health in Pomerania, a cross‐sectional, population‐based study. Data on 1446 subjects aged 60–79 years were evaluated for coronal caries using the decayed/missing/filled teeth (DMFT) index, root caries using the root caries index (RCI), calculus, plaque, bleeding on probing, pocket depth and attachment loss. Results: The prevalence of edentulousness varied from 16% in the 60–65‐year‐old group to 30% in the 75–79‐year‐old group, whereas the median number of remaining natural teeth per subject varied from 14 in the youngest age group (60–65 years) to one in the oldest (75–79 years). Among subjects aged 60–69 years, a quarter (26%) of the teeth examined had coronal restoration against 17% in the oldest age group (70–79 years). Coronal caries was found in 2% of the teeth in both age groups. Among teeth with gingival recession, 6% had fillings on root surfaces and 2% had root caries, irrespective of age. In all, 11% of the subjects had at least one untreated coronal lesion and 27% had at least one untreated root caries lesion. Plaque score, calculus score and bleeding on probing were higher in the oldest age group (70–79 years). The prevalence of periodontal disease expressed as the presence of at least one periodontal pocket of 4 mm and more, was higher in men and among the younger subjects (men aged 60–69 years: 85% vs. 71% in 70–79‐year‐old men; women aged 60–69 years: 71% vs. 62% in 70–79‐year‐olds). The prevalence of attachment loss of 3 mm or more followed a similar pattern. Conclusions: It seems therefore that in this population, the major oral health concern is related to caries and the small number of teeth retained among the dentate subjects.     

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).     

Non-invasive management of superficial root caries lesions in disabled and infirm patients

In disabled and infirm patients with limited, if any, capacity for independent oral self‐care, it is difficult to control progression of root caries lesions. Objective: To evaluate the effect of non‐restorative cariostatic treatment on progression of active superficial root caries lesions (n =56). Design: Pilot study. Setting: Department of Cariology, Institute of Odontology, Karolinska Institutet, Huddinge. Subjects: 15 physically‐dependent patients. Intervention: The patients were allotted to one of the following groups. Group 1, professional tooth cleaning and application of tap water flavoured with eucalyptus oil; Group 2, professional tooth cleaning and application of Cervitec, (1% chlorhexidine in thymol‐containing varnish), Group 3, professional tooth cleaning and application of Cervitec and Fluor Protector (varnish containing 0.1% fluoride). Every three months for 18 months, each subject received the treatment twice within a 10‐day interval. Measurements: The status of the 56 root caries lesions was evaluated every six months using a root caries index based on visual and tactile criteria. The examiners were blind to which treatment group the patients belonged. Results: In most subjects (14 out of 15), progression of root caries lesions was arrested. No statistically significant differences could be demonstrated between the three treatment groups. However, regardless of treatment regimen, there was a statistically significant difference between the greater number of subjects exhibiting no progression of root caries lesions and those with lesion progression, at 6 (p=0.022), 12 (p=0.006) and 18 months (p<0.001). Conclusion: This pilot study suggests that in disabled and infirm patients regular professional tooth cleaning with a fluoride containing paste, with or without supplementary varnishing with chlorhexidine‐thymol and/or fluoride can prevent further progression of existing superficial root caries lesions.     

The influence of rinsing routines on fluoride retention after toothbrushing

Objective: An important determinant of the anticaries effect of brushing with a fluoride dentifrice is the retention of fluoride in the oral fluids. This study measured the influence of various post‐brushing rinsing routines on fluoride retention. Setting: The Faculty of Odontology, Göteborg University, Sweden. Subjects: Twenty‐one healthy dental students, aged 23±2 yr. Desing: A randomised, cross‐over protocol, comparing various post‐brushing rinsing procedures, with the following variables: volume of rinsing water (5 mL vs. 10×3mL) and duration of rinsing (10 vs. 60 s). Samples of whole saliva, interdental fluid and interdental plaque were analysed for fluoride content. Results: The duration of rinsing did not influence fluoride retention in whole saliva, interdental fluid or interdental plaque. Rinsing with a higher volume of water substantially decreased fluoride retention in all samples. Conclusion: Brushing with a fluoride dentifrice should be followed by rinsing procedures which enhance the retention of fluoride. Rinsing with large volumes of water decreases fluoride retention in the oral fluids, and should be discouraged.     

Caries incidence and increments in community-living older adults with and without dementia

Objectives: The Oral Health of Older Adults with Dementia was instigated in the late 1990s to quantify and compare coronal and root caries incidence and increments in community‐living older Australians with and without dementia. Methods: A longitudinal design was used to conduct dental inspections at baseline and one‐year, for two groups of randomly selected community‐living older adults ‐ one group of 116 people with dementia and a comparison group of 116 people without dementia. Results: At one‐year there were 103 dementia and 113(112 dentate) non‐dementia participants. Coronal and root surface caries incidence was higher for dementia participants (p<0.05). Dementia participants had higher coronal and root caries adjusted caries increments (ADJCI) (p<0.01). Both coronal and root ADJCI were evident in half of dementia participants, compared with one‐quarter of non‐dementia participants. Dementia participants with higher coronal ADJCI were those who had visited the dentist since baseline, who were taking neuroleptics with high anticholinergic adverse effects, and whose carer had high carer burden score (p<0.01). Dementia participants with higher root ADJCI were those needing assistance with oral hygiene care and whose carers had difficulties with oral hygiene care (p<0.05). Baseline characteristics predictive in linear regression for: (1) coronal caries increments among all participants were ‐ dementia participants, those with cognitive testing scores indicative of moderate‐severe dementia, those with private health insurance; (2) root caries increments among all participants were ‐ dementia participants, and those who had 1 decayed/filled root surface at baseline. Among dementia participants, being male was the baseline characteristic predictive in logistic regression for coronal caries increments, and having 1 decayed coronal surface was the baseline characteristic predictive for root caries increments. Conclusions: Coronal and root caries incidence and increments were significantly higher in the community‐living older adults with dementia over the one‐year follow‐up period. Dementia participants had high levels of coronal and root caries increments; characteristics related to high caries increments included sex (males), dementia severity (moderate‐severe), high carer burden, oral hygiene care difficulties, use of neuroleptic medication (with high anticholinergic adverse effects) and previous experience of caries.     

Caries activity and associated risk factors in elderly hospitalised population--15-months follow-up in French institutions

Only a few studies have been published concerning hospitalised elderly disabled people. Objectives: 1) to investigate the oral health status of elderly French patients hospitalised in the two main geriatric hospitals of Paris. 2) to describe the respective influences of general parameters (type of hospitalisation, pathologies and medication) on oral environment parameters. 3) to analyse the influences of these oral parameters on caries activity in Long-Term Care (LTCF) and in rehabilitation facilities (RF) patients and to study the incidence and the time-course of caries in these specific population. Subjects: 117 subjects (mean age=83.0 years, SD=7.8, range=64 to 102 years) were examined at baseline and 32 of the 50 LTCF subjects were reexamined 15-months later. Methods: The general parameters recorded were age, gender, type of hospitalisation, period of stay, removable prosthesis, general diseases, number of diagnoses, medications with hyposalivary side-effects. The oral environment parameters recorded were flow rate, buffer capacity, mutans streptococci and lactobacilli counts, measured at baseline by tests on stimulated saliva, and plaque index. Crown and root surfaces were recorded according to a modified caries activity index. Results: Among the polypathological subjects (85.5% of the population), the number of diseases ranged from 2 to 8. The LTCF patients had a significantly higher mean number of diagnoses (3.5; SD=1.5) than the RF patients (2.8; SD=1.4). 76.9% of patients were taking medications with hyposalivary side-effects. The stimulated flow rate ranged from 0.02 ml/min to 5 ml/min. Its mean was significantly lower for LTCF patients (0.67 ml/min; SD=0.51) than for RF patients (1.12 ml/min; SD=0.89). The plaque index was significantly higher in LTCF subjects and in patients with mental diseases. At baseline, 17,442 crown and root surfaces were examined. Flow rate was related to crown caries and buffer capacity to root caries. During the 15-months follow-up, the mean number of active root surfaces was significantly increased: from 0.148 (SD=0.116) at baseline vs. 0.250 (SD=0.174) at the second examination. Conclusions: The strongest relationship in the present study between oral parameters and caries activity was the negative relationship between buffer capacity and active root caries. This study confirms an association between the type of hospitalisation and both salivary parameters flow rate and plaque index. This investigation illustrates the critical need for hygiene and oral care, in this elderly disabled population.