Interobserver reliability of methods for paleopathological diagnosis of dental caries

There is disagreement as to whether clinical methods of caries diagnosis will produce reliable results in skeletal material, and studies vary greatly in the extent to which such methods are employed. The purpose of this study is, therefore, to evaluate the interobserver reliability of visual, tactile, and radiographic methods of scoring dental caries in ancient populations. Thirty-three individuals from a Mogollon skeletal sample were scored on three occasions by pairs of examiners. The first exam employed visual criteria alone. In the second exam, visual methods were supplemented with the dental explorer. For the third exam, mesial and distal surfaces were scored from “intraoral” radiographs. Examiners worked independently, but did calibrate on material from clinical populations prior to the second and third exams. Exams were conducted on a “blind” basis, and analysis was delayed until all exams were completed. Caries scores were expressed as a percentage of total surfaces present per individual. Repeat-measures ANOVA and intraclass correlation coefficients (ICC) were used to estimate interobserver reliabilities. For visual scores, ICC = 0.97, and there is no significant difference between examiners (P = 0.897). For visual plus explorer scores, ICC drops to 0.90, and there is a significant difference between examiners (P = 0.003). For the radiographs, ICC = 0.86, and there is no significant difference between observers (P = 0.117). These results suggest that clinical methods are less reliable in skeletal populations. Probable sources of error include postmortem dehydration of carious dentin, confusing radiolucencies engendered by worn or fractured enamel, and inadequate radiologic standards for root caries. These problems can be avoided through reliance on visual criteria.     

Secretor status and dental caries in Iceland

Abstract The proportion of non-secretors of ABH blood-group substances among Icelanders is one of the highest recorded for European countries. Dental caries prevalence is also very high. In this study of dental caries in young adults mean number of decayed, missing and filled teeth for secretors were 17.4 and for non-secretors 19.9 ( P < 0.05). A majority of patients seeking free dental treatment in the Dental School were non-secretors (62.7%) significantly more than the proportion of non-secretors in the general population (36%; P < 0.01). It is postulated that blood group substances may interfere with the adherence of Streptococcus mutants to teeth.     

Association of genetic variants in enamel-formation genes with dental caries: A meta- and gene-cluster analysis

Previous studies have reported the association between multiple genetic variants in the enamel-formation genes and the risk of dental caries with inconsistent results. We performed a systematic literature search of the PubMed, Cochrane Library, HuGE and Google Scholar databases for studies published before March 21, 2020 and conducted meta-, gene-based and gene-cluster analysis on the association between genetic variants in the enamel-formation genes and the risk of dental caries. We identified 21 relevant publications including a total of 24 studies for analysis. The genetic variant rs17878486 in AMELX was significantly associated with dental caries risk (OR = 1.40, 95% CI: 1.02–1.93, P = 0.037). We found no significant association between the risk of dental caries with rs12640848 in ENAM (OR = 1.15, 95% CI: 0.88–1.52, P = 0.310), rs1784418 in MMP20 (OR = 1.07, 95% CI: 0.76–1.49, P = 0.702) and rs3796704 in ENAM (OR = 1.06, 95% CI: 0.96–1.17, P = 0.228). Gene-based analysis indicated that multiple genetic variants in AMELX showed joint association with the risk of dental caries (6 variants; P < 10⁻⁵), so did genetic variants in MMP13 (3 variants; P = 0.004), MMP2 (3 variants; P < 10⁻⁵), MMP20 (2 variants; P < 10⁻⁵) and MMP3 (2 variants; P < 10⁻⁵). The gene-cluster analysis indicated a significant association between the genetic variants in this enamel-formation gene cluster and the risk of dental caries (P < 10⁻⁵). The present meta-analysis revealed that genetic variant rs17878486 in AMELX was associated with dental caries, and multiple genetic variants in the enamel-formation genes jointly contributed to the risk of dental caries, supporting the role of genetic variants in the enamel-formation genes in the etiology of dental caries.     

细菌生物膜与龋齿相关性的研究进展

牙菌斑是由多种微生物在牙面上沉积,有机基质互相集聚、交联而形成的生物膜结构,生物膜中微生物相互依存、相互竞争,构成了复杂的微生态关系。牙菌斑生物膜的形成是导致龋齿重要过程。本文综述了细菌生物膜与龋齿发生的关系,以期为龋齿的预防与治疗提供新的思路。     

益生菌防治龋病的研究进展

随着人们生活水平日益提高,口腔健康越来越受到关注。近年来,益生菌对口腔菌群和宿主健康的调节作用已成为广泛研究的话题。已有证据表明,益生菌可以竞争性地抑制口腔中致病细菌的黏附和定植,分泌抗菌物质以减少病原菌。本文综述了相关益生菌对变形链球菌这一公认的龋齿病原菌的作用,包括:(1)生物表面活性剂、细菌素、胞外多糖等益生菌代谢产物对变形链球菌牙菌生物膜的抑制作用;(2)刺激宿主免疫反应,调节口腔菌群组成;(3)下调或阻断变形链球菌细胞中与黏附在牙齿表面形成生物膜相关的基因表达。     

Temporomandibular joint osteoarthritis in a British skeletal population

The potential role of dental function in TMJ osteoarthritis is examined in an ancient British population. Human skeletal remains from five archaeological sites in England (n = 369) were studied to assess the associations between the presence of osteoarthritis and dental function variables, in particular antemortem tooth loss and dental attrition. Individuals aged over 17 years with at least a portion of either the left or right TMJ were included in the study. Each individual was scored for the occurrence of arthritic lesions on the mandibular condyle and glenoid fossa, the level of dental attrition, and antemortem tooth loss. A loglinear analysis was performed with osteoarthritis as the dependent variable and tooth loss, attrition, sex, and age as the independent variables. Tooth loss and sex are not significantly associated with TMJ osteoarthritis when attrition and age are included in the analysis. Attrition is significantly associated with osteoarthritis even when the analysis corrects for age. The significant association of attrition with osteoarthritis suggests that dental functions may have an influence, separate from ageing, on the development of TMJ osteoarthritis.     

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 efficacy of three formulations of Lippia sidoides Cham. essential oil in the reduction of salivary Streptococcus mutans in children with caries: A randomized,double-blind,controlled study

Essential oils of many plants have been previously tested in the treatment of oral diseases and other infections. This study was a randomized, double-blind, in parallel with an active control study, which aimed to evaluate the efficacy of three formulations of the Lippia sidoides Cham. essential oil (LSO) in the reduction of salivary Streptococcus mutans in children with caries. 81 volunteers, aged 6–12 years, both genders, with caries, were recruited to participate in this study, and randomly assigned to either one of five different groups. Each group received topical treatment with either 1.4% LSO toothpaste, 1.4% LSO gel, 0.8% LSO mouthwash, 1% chlorhexidine gel, or 0.12% chlorhexidine mouthwash. A 5-ml volume of each gel was placed inside disposable trays, and applied for 1 min, every 24 h, for 5 consecutive days. The mouthwash groups used 5-ml volume of a mouthwash inside disposable syringes. In the toothpaste group, children brushed their teeth for 1 min, once a day for 5 days. Saliva was collected before and after treatment. MS colonies were counted, isolated and confirmed through biochemical tests. Differences in MS levels measured in different days within the same treatment group was only verified with LSO toothpaste, chlorhexidine gel and chlorhexidine mouthwash. Comparison between groups of LSO mouthwash, toothpaste and gel showed that the toothpaste group expressed significantly lower MS levels than the mouthwash and gel groups at day-30. Chlorhexidine significantly reduced MS levels after 5 days of treatment, but these levels returned to baseline in other periods of the study. LSO toothpaste reduced MS levels after 5 days of treatment, and MS levels remained low and did not return to baseline during subsequent analysis. Hence, LSO toothpaste demonstrated the most long-lasting MS reduction in saliva, whereas other LSO formulations did not effectively reduce MS levels in children with dental caries.     

Association between salivary s-IgA concentration and dental caries: an updated meta-analysis

Objective: To determine the levels of s-IgA in saliva of caries patients and healthy controls, and to evaluate whether there is a correlation between it and caries by meta-analysis. Methods: The PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Library, Scopus, Chinese National Knowledge Infrastructure, Wanfang Data, Chongqing VIP database for Chinese Technical Periodicals, and China BioMedical Literature Services System databases were searched initially in April 2020 and repeated in August 2020. Two independent evaluators screened the literature and extracted the data according to the inclusion and exclusion criteria. R 4.0.2 software was used for meta-analysis. I² test was commonly reflected the heterogeneity. Subgroup analysis and meta-regression analysis explore the sources of heterogeneity. Sensitivity analysis, funnel diagram, Begg’s rank correlation, and Egger’s linear regression were used to determine the possibility of publication bias. Results: The study was reviewed according to the project guidelines for optimal reporting (PRISMA) based on meta-analysis. A total of 30 case–control studies were included, with a total sample size of 1545 patients, including 918 caries patients and 627 healthy controls. Salivary s-IgA levels in caries patients were significantly lower than those in healthy controls (SMD = −0.49, 95%CI: [−0.94; −0.03], P=0.03). In addition, the results of subgroup analysis showed that the significant decrease of salivary s-IgA level was correlated with children patients, mixed dentition and Asian people (children: SMD = −0.45, 95%CI: [−0.89; −0.01], P=0.04; mixed dentition: SMD = −0.61, 95%CI: [−1.24; 0.03], P=0.06; Asian: SMD = −0.62, 95%CI: [−1.17; −0.08], P=0.02). The funnel diagram included in the study was symmetrically distributed, and the sensitivity analysis confirmed the robustness of the results. Conclusion: Salivary s-IgA levels in caries patients were significantly lower than in healthy controls. It has also been demonstrated that salivary s-IgA may be used as an alternative measure to identify subjects at risk of caries susceptibility, suggesting that salivary s-IgA may be a protective factor for dental caries.     

广西顶蛳山遗址人骨的龋齿病理观察

顶蛳山遗址位于广西壮族自治区南宁市邕宁区,保存了丰富的新石器时代文化遗存以及大量的古人类骨骼遗存。本文主要从龋齿研究入手,对顶蛳山二、三期文化(8-7 ka BP)中大于15岁的169个体的2737枚恒齿进行了观察。分别统计了龋齿等级和个体和牙齿患龋率以评估人群患龋情况,进而分析顶蛳山遗址人群的口腔健康状况,并探讨了食物构成、饮食行为与社会经济等。统计结果表明,顶蛳山遗址人群的个体和牙齿患龋率都较高。患龋率在两性、葬式、年龄段间都存在差异,女性患龋程度要高于男性;不同葬式之间差异也显著,随着年龄的增长患龋的比例和程度也随之加深。通过与其他8组新石器时代国内遗址人群的个体和牙齿患龋率的对比,我们看到包含顶蛳山在内的三组华南渔猎采集遗址的个体和牙齿患龋率都要高于其他遗址,农业遗址的人群要低于华南遗址的患龋率,而混合经济遗址的患龋率最低。龋齿的出现与人类饮食中的碳水化合物关系密切。据此,我们推测顶蛳山及其他两组华南遗址的高患龋与碳水化合物的摄入关系密切,但这与一般所认为的农业的出现没有联系。三组遗址都是以渔猎采集主导的社会经济形态,并且这时期农业并未传播至华南地区。因此我们的分析表明高患龋率与农业并没有必然联系,而华南地区当时人群所食用的碳水化合物可能源于当地的块茎类和含蔗糖类植物。     

Evaluation of dental enamel caries assessment using Quantitative Light Induced Fluorescence and Optical Coherence Tomography

An in vitro study of morphological alterations between sound dental structure and artificially induced white spot lesions in human teeth, was performed through the loss of fluorescence by Quantitative Light‐Induced Fluorescence (QLF) and the alterations of the light attenuation coefficient by Optical Coherence Tomography (OCT). To analyze the OCT images using a commercially available system, a special algorithm was applied, whereas the QLF images were analyzed using the software available in the commercial system employed. When analyzing the sound region against white spot lesions region by QLF, a reduction in the fluorescence intensity was observed, whilst an increase of light attenuation by the OCT system occurred. Comparison of the percentage of alteration between optical properties of sound and artificial enamel caries regions showed that OCT processed images through the attenuation of light enhanced the tooth optical alterations more than fluorescence detected by QLF System.

QLF versus OCT imaging of enamel caries: a photonics assessment     

A link between copper and dental caries in human teeth identified by X-ray fluorescence elemental mapping

Quantitative X-ray fluorescence imaging of sections of human teeth revealed an increased concentration of copper and zinc in carious regions of dentine compared with unaffected portions of the tooth. Higher-resolution images provided strong evidence that the copper was transported and localized mainly in the dentinal tubules. While similar levels of zinc were found in these areas and concentrated in the tubules, zinc was also more evident in the hydroxyapatite, and the increase in zinc levels compared with the levels in background (normal) areas was less than that for copper. These results suggest a role for copper and zinc in the formation and progression of dental caries and present a potential point of intervention for treatment. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. Dedicated to the memory of the late Harold Eastgate.     

The role of lead and cadmium in deciduous teeth and saliva on dental caries in children residing in Tehran,Iran

BackgroundLead (Pb) and Cadmium (Cd) are important environmental contaminants. There is no biological monitoring of exposure to these heavy metals and their potential effect on dental caries in children in Tehran, Iran, a polluted megacity. Therefore, the present study investigated the potential association between Pb and Cd levels in primary teeth and saliva and dental caries.MethodsIn a cross-sectional design, 211 children aged 6–11 years referred to Tehran University of Medical Sciences, School of Dentistry and residing in Tehran were examined. Pb and Cd levels of exfoliated primary teeth and stimulated saliva were determined by atomic absorption spectrophotometry (AAS). Dental caries prevalence was evaluated according to WHO criteria. Socioeconomic status, oral hygiene behavior, snacking frequency and salivary pH data were acquired as confounding factors. Frequency and percentages were reported for categorical variables, mean and standard deviation (SD) for continuous variables, and geometric mean for skewed continuous variables. A simple linear regression and Pearson correlation tests were used for statistical analyses. P-values < 0.05 were considered as significant.ResultThe mean (95 % confidence interval) Pb and Cd levels in teeth were 213.26 ppb (164.29–274.84) and 23.75 ppb (20.86–27.05), respectively. The mean Pb and Cd levels in saliva were 11.83 ppb (10.71–13.06) and 3.18 ppb (2.69–3.75), respectively. Furthermore, Pb and Cd in primary teeth and saliva were not associated (p > 0.05) with socioeconomic status, oral hygiene behavior and snacking frequencyConclusionThis study showed no association between Pb and Cd concentrations in primary teeth and in saliva with dental caries prevalence.     

郑州青台遗址新石器时代中晚期人群龋齿的统计与分析

本文通过对郑州青台遗址新石器时代中晚期91例个体、1913枚牙齿罹患龋齿的统计与分析可知,青台人群患龋率为71.43%,龋齿率为13.38%。其中,龋齿率女性高于男性,可能与女性孕期生理变化、食物选择及性别分工等有关。上颌龋齿率高于下颌,臼齿及咬合面为龋齿易患齿类及部位。通过对比可知青台人群显示出较高的龋齿罹患率,暗示该人群饮食中应包含较多的碳水化合物类食物,这可能与新石器时代中晚期黄河中游发达的旱作农业有关。此外,龋齿率在黄河及长江中、下游新石器时代农业人群中的区域性差异可能与龋病病因的复杂性和各地区不同的文化面貌、人群生活方式有关。     

Characterization of biofilm formed by multidrug resistant Pseudomonas aeruginosa DC-17 isolated from dental caries

The present work reports with the screening of biofilm-producing bacteria from the dental caries. The dental pathogens showed resistance against various antibiotics and biofilm forming ability at various levels. Among the bacterial strain, Pseudomonas aeruginosa DC-17 showed enhanced biofilm production. Extracellular polymeric substance (EPS) was synthesized by the selected bacterial isolate considerably and contributed as the major component of biofilm. EPS composed of eDNA, proteins and lipids. The total protein content of the EPS was found to be 1.928 mg/mL and was the major component than carbohydrate and DNA. Carbohydrate content was 162.3 mg/L and DNA content of EPS was 4.95 μg/mL. These macromolecules interacted in the matrix to develop dynamic and specific interactions to signalling biofilm to differentiating various environments. Also, the isolated bacteria showed resistant against various commercially available antibiotics. The isolates showed more resistance against penicillin (98%) and were sensitive against amoxicillin. Among the factors, temperature, pH and sugar concentration influenced biofilm formation. Biofilm forming ability of the selected bacterial stain was tested at various pH values and alkaline pH was favoured for biofilm production. Biofilm production was found to be maximum at 40 °C and 8% sucrose enhanced biofilm formation. Biofilm formed by P. aeruginosa DC-17 was resistant against various tested antimicrobials and chemicals.     

Antimicrobial and anti-biofilm effect of Bac8c on major bacteria associated with dental caries and Streptococcus mutans biofilms

Dental caries is a common oral bacterial infectious disease. Its prevention and treatment requires control of the causative pathogens within dental plaque, especially Streptococcus mutans (S. mutans). Antimicrobial peptides (AMPs), one of the promising substitutes for conventional antibiotics, have been widely tested and used for controlling bacterial infections. The present study focuses on evaluating the potential of the novel AMPs cyclic bactenecin and its derivatives against bacteria associated with dental caries. The results indicate that Bac8c displayed highest activity against the bacteria tested, whereas both cyclic and linear bactenecin had weak antimicrobial activity. The cytotoxicity assay showed that Bac8c did not cause detectable toxicity at concentrations of 32–128 μg/ml for 5 min or 32–64 μg/ml for 60 min. S. mutans and Lactobacillus fermenti treated with Bac8c showed variable effects on bacterial structure via scanning electron microscopy and transmission electron microscopy. There appeared to be a large amount of extracellular debris and obvious holes on the cell surface, as well as loss of cell wall and nucleoid condensation. The BioFlux system was employed to generate S. mutans biofilms under a controlled flow, which more closely resemble the formation process of natural biofilms. Bac8c remarkably reduced the viability of cells in biofilms formed in the BioFlux system. This phenomenon was further analyzed and verified by real-time PCR results of a significant suppression of the genes involved in S. mutans biofilm formation. Taken together, this study suggests that Bac8c has a potential clinical application in preventing and treating dental caries.     

Health and differential survival in prehistoric populations: prenatal dental defects.

Linear hypoplasia of the deciduous teeth is rare in most human populations, but common where nutritional status is poor. Deciduous enamel hypoplasia, hypocalcification, and hypoplasia-related caries are described in Middle and Late Woodland skeletal series from the Lower Illinois Valley. Gross enamel defects that can be referred to pre-natal development are found in 83 of 170 children under six years of age at death. Circular caries secondary to hypoplasia is significantly more common in the Late Woodland series, reflecting the apparent higher cariogenicity of Late Woodland diets. There is a significant association between prenatal dental defects and bony evidence for anemia and infectious disease. Children with enamel defects show relatively higher weaning age mortality than those without. These relationships suggest that at least moderate levels of malnutrition existed in Illinois Woodland populations.     

Study on the relationship between Helicobacter pylori in the dental plaque and the occurrence of dental caries or oral hygiene index

Background: The aims of our study were to determine the presence of Helicobacter pylori DNA in the dental plaque of Chinese children aged 3–6 years by nested polymerase chain reaction (PCR) and to investigate the relationship between this infection and the occurrence of dental caries or oral hygiene index.
Methods: Two hundred and fourteen children from a kindergarten in Guangzhou City of China were evaluated. The children's plaques were assessed by plaque indices of Quigley–Hein. Dental plaque was analyzed using nested PCR for two sets of primers directed to the 860-bp fragment of H. pylori genomic DNA, which have been reported to be highly sensitive and specific by other researchers.
Results: H. pylori was detected in dental plaque samples from 126 children, and 70 children with dental caries carried H. pylori in dental plaque. Of these children without infection, only 36 of 88 suffered dental caries. Besides, the average dental plaque index of 126 H. pylori -positive children was higher than that of 88 children without infection. In the present study, there was a significant correlation between H. pylori infection and dental caries or dental hygiene.
Conclusion: The oral cavity may be a reservoir for H. pylori infection in children. H. pylori in dental plaque may play a role in the occurrence of dental caries, and poor oral hygiene may represent a risk factor for H. pylori in the oral cavity.     

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.     

Fluoride exposure and factors affecting dental caries in preschool children living in two areas with different natural levels of fluorides

BackgroundSuccessful oral health interventions must be based on the specific needs of the population that they serve. Evaluation of habits related to dental caries development and estimation of fluoride exposure in a target group of young patients helps to plan effective and safe caries prevention strategies.ObjectivesThe study aimed to evaluate factors affecting dental caries experience and sources of fluoride exposure in preschool children living in two areas: with optimal and low natural content of fluoride in drinking water.Materials and methodsThe study included a group of 73 children of both sexes aged 4–7 years attending two kindergartens in Środa Wielkopolska and Turek (Wielkopolska Voivodeship, Poland), where the content of fluoride in drinking water according to data obtained in the sanitary station ranged from 0.68 to 0.74 mg/L (optimal concentration of fluoride) and from 0.19 to 0.30 mg/L (low concentration of fluoride), respectively. Parents of patients completed a survey about diet, hygiene, and dental care, taking into account the child's fluoride exposure. The calibrated dentist assessed the oral health condition using a mirror, a CPI probe, and a headlamp. Oral hygiene was recorded using the Silness and Löe plaque index, caries experience by calculating the numbers of decayed, missing, and filled primary, and permanent teeth (dmf and DMF, respectively) while caries frequency by calculating the percentage of children with caries experience above 0. In order to assess the fluoride concentrations in urine and drinking water, parents were asked to provide a urine sample collected on fasting and a tap water sample. Fluoride concentrations were assessed using a 09–37 (MARAT) fluoride ion-selective electrode and a RAE 111 silver-chloride reference electrode. Statistical analysis was conducted using the data analysis software system Statistica (version 12, StatSoft, Inc. 2014), assuming a statistical significance level p < 0.05.ResultsNo statistically significant differences were found between caries indices of the examined children in each kindergarten (p > 0.05). Urinary fluoride levels were higher in children who tended to swallow toothpaste or used fluoride rinses and positively correlated with fluoride concentrations in the drinking water. Dental caries experience in the examined children depended on the effectiveness and frequency of oral hygiene procedures and dietary habits.ConclusionsThe strategy aimed at improving the oral health of the examined group of children should include accomplishing oral hygiene, promoting a non-cariogenic diet, and, finally, controlling fluoride exposure from at-home fluoride products. Caries prevention program ought to be adjusted to individual characteristics of each child, taking into consideration oral hygiene practices, dietary habits and total fluoride intake.