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Objectives An antimicrobial technique utilizing hydroxyl radicals generated by the photolysis of 3% H2O2 has been developed recently. The present study aimed to evaluate the effect of H2O2 photolysis treatment on tooth demineralization caused by Streptococcus mutans biofilm. Materials and methods To induce tooth demineralization, S. mutans biofilm was allowed to form on the maxillary first molars collected from Wistar rats via 24-h culturing. The samples were immersed in 3% H2O2 and irradiated with 365-nm LED (H2O2 photolysis treatment). Viable bacterial counts in the biofilm were evaluated immediately after treatment and after an additional 30-h culturing by colony counting. The acidogenicity of the biofilm, re-established 30 h after treatment, was assessed by measuring the pH. The effect of H2O2 photolysis treatment on tooth demineralization was assessed by measuring the depth of the radiolucent layer in micro-CT images. Results H2O2 photolysis significantly reduced viable bacterial counts in the biofilm to 3.7 log colony forming units (CFU)/sample, while the untreated group had 7.9 log CFU/sample. The pH of the biofilm re-established after treatment (6.6) was higher than that of the untreated group (5.3). In line with the pH measurement, the treatment group had a significantly lower depth of radiolucent layer in dentin than the untreated group. Conclusions H2O2 photolysis treatment was effective not only in killing the biofilm-forming S. mutans but also in lowering the acidogenicity of the biofilm. Thus, this technique could inhibit tooth demineralization. Clinical relevance H2O2 photolysis can be applicable as a new dental caries treatment.

To explore oral health by increasing degree of obesity and the influence of modifying factors.A cross-sectional design was used. Swedish females (Mean BMI was 42.2 kg/mYoung obese women exhibited poor oral health with higher caries levels by higher BMI. Dental care should adapt the prevention efforts for obese individuals.

Objective: Within the fields of anthropology and osteoarcheology, human teeth have long been studied to understand the diet, habits, and diseases of past civilizations. However, no complete review has been published to collect and analyze the extensive available data on caries prevalence in European man (Homo sapiens) over time. Method: In this current study, the two databases, Scopus and Art, Design, and Architecture Collection, were searched using predefined search terms. The literature was systematically reviewed and assessed by two of the authors. Results: The findings include a significant nonlinear correlation with increasing caries prevalence in European populations from 9000 BC to 1850 AD, for both the number of carious teeth and the number of affected individuals. Conclusion: Despite the well-established collective belief that caries rates fluctuate between different locations and time and the general view that caries rates have increased from prehistoric times and onwards, this is to our knowledge the first time this relationship has been proven based on published data.

Background With the aim to study dental pathological lesions in an early Swedish modern population, with special reference to sex variances of dental caries, the prevalence and distribution of dental caries and tooth wear were determined in complete and partial human dentitions from an early modern-time city graveyard (1500–1620) excavated in Gamlestaden, Gothenburg, Sweden. Methods Partial and complete dentitions were examined through visual inspection and using a dental probe. Pathologies were studied, evaluated and presented by teeth and alveoli. Results The study population consisted of 308 individuals. A total of 4,951 teeth in adults and 1,660 teeth in children were examined. Caries prevalence in the studied population was 55% and the highest prevalence of caries was found among the adults, where 68% of the individuals had at least one carious lesion. Caries experience (DMT > 0) in the entire population was 60%, and among adults caries experience was 76%. Women had significantly higher caries experience than men (p p Conclusions Findings show that dental pathological lesions affected a majority of the studied population, and indicate that women were more predisposed to dental disease than their male counterparts. Results are discussed from a multi-factorial explanation model including dietary, physiological and cultural etiological factors.

Oral mucosal lesions are commonly found in Swedish smokeless tobacco (snus) users where the pouch is placed. These lesions are reversible, that is, clinical and histological tissue changes return to normal following cessation. However, the exact mechanisms behind these changes are unknown. The main aim of this study was to investigate how snus-like non-tobacco-based nicotine pouches affect the oral mucosa and the severity of pre-existing lesions. Sixty regular users of Swedish smokeless tobacco were encouraged to substitute their snus with non-tobacco-based nicotine pouch products during a 6-week period. Meanwhile, oral mucosal lesions were assessed using a four-degree scale. Over time, a reduction of pre-existing mucosal lesions was observed between baseline and the final visit. In a second part, the effect of exposure to regular snus on the production of 48 different cytokines in peripheral blood mononuclear cells was compared in vitro with that resulting from exposure to the non-tobacco-based nicotine products. Results showed significantly increased production of proinflammatory cytokines in cells exposed to regular snus compared to untreated or cells exposed to the non-tobacco-based nicotine products. This may be related to the improved clinical appearance of the oral mucosa in the participants that used the non-tobacco-based nicotine test pouches.

This study aimed to evaluate the effect of different toothbrushing routines and different kinds of toothpaste on the interproximal fluoride concentration after toothbrushing and its clinical relevance to the recommendations given to patients regarding the process of toothbrushing. Eight adults participated a total of 8 times in order to test different toothbrushing routines with different amounts of toothpaste (1 or 2 cm), durations (1 or 2 min) and amounts of water after toothbrushing (10 or 20 mL). An additional 8 adults participated 6 times in total to test different forms of toothpaste administration (paste, gel and foam) with different amounts of water after toothbrushing (no rinsing or 10 mL). Interdental saliva samples were collected from proximal sites 25/26 and 46/45 using small paper points, before and up to 60 min after toothbrushing. The fluoride concentration was measured by an ion-specific electrode. The area under the curve, saliva fluoride concentration versus time, was calculated. Differences between the groups were tested by ANOVA with Tukey’s multiple comparisons test. An increase in fluoride concentration of 47.2% was observed when the amount of toothpaste increased from 1 to 2 cm (p < 0.01), 26.8% when increasing the duration from 1 to 2 min (p < 0.01) and 41.2% when reducing the amount of water rinsing from 20 to 10 mL (p < 0.01). The paste and gel resulted in higher fluoride concentration (p < 0.01) compared with foam. These findings suggest that the amount of toothpaste, the duration and the amount of water have a significant effect on fluoride concentration after toothbrushing. Furthermore, despite the lower amount of fluoride, the gel gives almost the same fluoride concentration after toothbrushing as the toothpaste. The results confirm the importance of giving clear advice to patients regarding the process of toothbrushing.

Background The purpose of the study was to investigate the effect of probiotics on biofilm acidogenicity and on the number of salivary Streptococcus mutans and lactobacilli in orthodontic patients. Methods This RCT was conducted on 28 young adults who were undergoing orthodontic treatment. The short-term prospective clinical trial lasted for three weeks. The test group rinsed daily with drops containing two Lactobacillus reuteri strains diluted in water, while the placebo group used drops without probiotics. The subjects were enrolled eight months since the beginning of orthodontic treatment. Plaque-pH, saliva and dental biofilm samples were obtained at baseline, one week and three weeks post intervention. Results Twenty-seven subjects successfully completed the trial period, only one drop out in the test group. No side effects were reported. A statistically significant increase in plaque pH at three weeks post-intervention was found for the test group (p p > 0.05). In addition, the AUC7.0 showed a significant difference at three weeks between the test and placebo (p = 0.00002). The three-week samples of stimulated whole saliva showed a statistically insignificant difference in the number of S. mutans and lactobacilli between the two groups (p > 0.05). The qPCR analysis showed the ability of the two strains to get colonized in the dental biofilm without a significant effect on the microbial counts. Conclusion/clinical implications A mixture of Lactobacillus reuteri has the ability to reduce the pH fall at the three-week follow-up. However, the short-term use of probiotics does not appear to have an effect on the number of salivary Streptococcus mutans and lactobacilli in saliva and on the dental biofilm. Trial registration Clinicaltrial.gov (Identifier: NCT04593017/ (19/10/2020)).

The objective was to evaluate the effect of a fluoride mouth rinse and a high-fluoride toothpaste on caries incidence in patients undergoing orthodontic treatment with fixed appliances.In this 3-armed, parallel-group, randomized controlled trial, patients referred to the Specialist Clinic of Orthodontics, Mölndal, Sweden, were randomly allocated to 1 of the 3 groups. (1) Fluoride mouth rinse (FMR) group: 0.2 % sodium fluoride (NaF) mouth rinse plus 1450 ppm fluoride (F) toothpaste; (2) High-fluoride tootpaste (HFT) group: 5000 ppm F toothpaste; and (3) Control (CTR) group: 1450 ppm F toothpaste. The generation of a randomization sequence was performed in blocks of 30. Inclusion criteria included patients scheduled for treatment with fixed appliances in the maxillary and mandibular arch aged 12-20 years. The primary outcome variable was the change in Decayed Initial Filled Surfaces (ΔDiFS) based on radiographs taken before and after the treatment. For statistical comparisons between groups, the Kruskal-Wallis test were used for continuous variables, whereas the Mann-Whitney U-test was used for pairwise group comparisons. Furthermore, the risk ratio (RR) and 95% confidence interval (CI) based on clinically relevant cutoffs (DiFS ≥2) were calculated to compare the increase of caries during orthodontic treatment between 2 groups. The Cochran-Mantel-Haenszel method was used to adjust RR for baseline values. Blinding was employed during the caries registration and the data analysis.In total, 270 participants were randomized, with 15 patients dropping out, such that 255 patients were included in the statistical analyses. Recruitment was from October 2010 to December 2012. An increase in DiFS (≥1 DiFS) during treatment was observed in 48.3% of the FMR group, 42.0% of the HFT group, and 35.6% of the CTR group. There was no significant difference between the groups regarding increased DiFS (P = 0.17). The risk of increase in DiFS ≥2 during orthodontic treatment was 31.0% in the FMR group, 25.9% in the HFT group, and 18.4% in the CTR group. The RR for an increase of ≥2 DiFS during orthodontic treatment was 1.38 (95% CI, 0.81-2.34; P = 0.23) for FMR vs CTR, 1.21 (95% CI, 0.70-2.10; P = 0.51) for HFT vs CTR, and 0.93 (95% CI, 0.57-1.49; P = 0.76) for HFT vs FMR.In patients who demonstrate a low prevalence of caries and are undergoing orthodontic treatment, daily use of high-fluoride toothpaste or fluoride mouth rinse in combination with regular toothpaste does not appear to significantly alter the caries incidence compared with the use of regular toothpaste.The trial was registered in the FoU i Sverige research database (http://www.fou.nu/is/sverige), with registration no. 236251.The protocol was not published before trial commencement.Local Research and Development Board for Gothenburg and South Bohuslän (grant no. 768531); and The Swedish Patent Revenue Fund (grant number EKF-780/19).

Objective The short-term effect (60 days) of Lactobacillus brevis CD2 lozenges vs placebo on variables related to caries and gingivitis in type 1 diabetic children was evaluated. Material and methods Eight diabetics (4–14 years old) were assigned to two groups (n = 34 subjects each), probiotic lozenges and placebo. Stimulated saliva for microbiological analysis and plaque pH were assessed at baseline (t0), 30 days (t1), 60 days (t2) and in the follow-up period (90 days from baseline, t3). Gingival status was assessed at t0, t2 and t3. Two-way ANOVA assessed differences between groups. Results In the probiotic group, Streptococcus mutans bacterial density mean scores dropped from 3.11 ± 1.13 at baseline to 1.82 ± 0.72 (t2) and to 2.06 ± 0.56 (t3), while in the placebo group, the scores were 3.09 ± 0.8 (t0), 2.82 ± 0.47 (t2) and 3.11 ± 0.43 (t3) (p < 0.01). Lowest and maximum pH fall increased in the probiotic group, from 5.37 ± 0.41 at baseline to 5.49 ± 0.24 at t3 (p < 0.01) and from 1.20 ± 0.46 to 0.98 ± 0.29 (p = 0.02). Bleeding score decreased significantly in both groups, showing a statistically significant lower bleeding score at t2 in the probiotic group (25.6%, 95% CI 21.5–32.7 vs 29.5%, 95% CI 25.2–34.9, p = 0.02). Conclusions Lactobacillus brevis CD2 has shown to improve caries-related risk factors and gingival health in diabetic children. Clinical relevance Lactobacillus brevis CD2 might contribute to improved oral health in type 1 diabetic children.

To investigate the oral colonisation potential after four weeks' administration of Lactobacillus reuteri and to examine the short-term effect of probiotics on salivary Streptococcus mutans and lactobacilli.The study group comprised 13 young adults who volunteered after receiving verbal and written information. The short-term prospective clinical trial lasted 9 weeks, consisting of a 4-week intervention period with administration twice daily and a 5-week post-administration follow-up period with no probiotic consumption. Saliva and dental biofilm samples were obtained immediately before probiotic administration, after 2 weeks and after 4 weeks of L. reuteri administration. Follow-up samples were collected once every week on a regular basis after administration was terminated. The numbers of salivary S. mutans and lactobacilli were assessed by regular plating, while the presence of the two L. reuteri strains in saliva and dental biofilm was evaluated using quantitative polymerase chain reaction (qPCR).The occurrence of L. reuteri in the oral cavity increased gradually during the intervention period and reached the maximum level after four weeks of probiotic administration (p0.0001). The 4-week samples of stimulated whole saliva showed a statistically significant decrease in the number of S. mutans and a statistically significant increase in the salivary lactobacilli level in comparison to baseline. qPCR showed that the DSM 17938 strain has better colonisation for both saliva and dental biofilm than the ATCC PTA 5289 strain at the nine-week follow-up.Probiotics have the ability to colonise the oral cavity during usage, but it gradually disappears after the completion of intake. It also has ability to decrease the number of salivary S. mutans.

Ion-releasing materials (containing fluoride and boron, for example) have shown caries-preventive effects in vitro. The purpose of the present study was to investigate the impact of multi-ion-releasing coating material on pH stabilisation, plaque accumulation and the bacterial composition of dental plaque during a time period of 90 days. The null hypothesis tested here was that the evaluated material would not show any differences in pH stabilisation, plaque accumulation or bacterial composition compared with control material.The study was carried out as a double-blind, split-mouth, randomised, controlled clinical trial in 28 volunteers. Over the evaluation period (days 4, 30, 60 and 90), pH measurements, plaque index and plaque sampling for bacterial analyses were conducted in a calibrated, standardized manner. The study received ethical permission and was carried out in accordance with the Helsinki Declaration.A significant difference was observed, with less plaque accumulation over time in the subjects in whom the ion-releasing material was applied in comparison to the non-active group. No significant difference was evident in terms of either pH stabilisation or plaque levels of mutans streptococci.The null hypothesis relating to plaque accumulation was rejected, with a lower plaque index shown for the test group up to 60–90 days. No adverse effects during the observation period were observed. Since the studied cohort was healthy from a caries perspective, more clinical studies are needed to further evaluate the caries-prevention potential of the ion-releasing material in other patient groups.

The present study aimed to evaluate the effect of fluoride (F) dentifrice with different F concentrations on root dentine de-/remineralization. Ten healthy volunteers took part in this randomized, double-blinded, cross-over, and split-mouth in situ experimental study. During 4 phases of 7 days, they wore a palatal appliance containing 4 bovine dentine blocks (2 sound and 2 with caries) of 4 × 4 × 2 mm. Treatments were performed with silica-based dentifrices containing 0, 700, 1,300, and 5,000 µg F/g (F as NaF). To provide a cariogenic challenge, a 20% sucrose solution was dripped 3 and 8 times daily on the carious-like and sound blocks, respectively. After each experimental phase, the percentage of surface hardness loss (%SHL) or recovery (%SHR) was calculated and the fluoride concentration in the biofilm was determined. The statistical analysis was performed using ANOVA and the Tukey post hoc test with p at 5%. The relationship between variables was analyzed by linear regression. The results showed a lower %SHL when 5,000 µg F/g dentifrice was used but without a statistically significant difference from the conventional one (1,300 µg F/g). Regarding remineralization and F in biofilms, the high-fluoride dentifrice was expressively superior in mineral replacement on the surface and in the F concentration in the biofilms, respectively, compared to the other 3 products (p < 0.05). Also, a significant linear fit between mineral loss/gain, F in biofilms, and fluoride concentration in the dentifrices could be observed. In conclusion, a dose-response F effect was observed, and the high-fluoride dentifrice was effective in enhancing root dentine remineralization in this short-term in situ study.

To review the scientific evidence for the efficacy of stabilized stannous fluoride (SnF₂) dentifrice in relation to dental caries, dental erosion and dentin hypersensitivity.Medline OVID, Embase.com, and the Cochrane Library were searched until January 2018. Two researchers independently selected studies according to inclusion and exclusion criteria, data were extracted, the risk of bias in eligible studies was assessed and a meta-analysis was performed wherever feasible.Three studies on dental caries, eight studies on dental erosion and 11 on dentin hypersensitivity were included. Risk of bias was judged as high for most of the caries and erosion studies and low or medium for the hypersensitivity studies. A similar or slightly higher anti-caries activity compared with non-stannous fluoride dentifrices was observed. Stannous fluoride showed a greater anti-erosive potential in seven of the eight studies. A mean difference score in favor of stannous fluoride dentifrices compared with controls was found in a meta-analysis including six 8-week hypersensitivity studies.The use of stabilized stannous fluoride dentifrices to relieve dentin hypersensitivity and to prevent the initiation of dental erosion speaks in favor of this treatment strategy.

Hydrogen peroxide photolysis-based antimicrobial chemotherapy that utilizes ultraviolet-A irradiation (UVA-H2O2 photolysis) has been previously proposed as a method of treatment of cariogenic biofilm. Therefore, in the present study, we aimed to assess time-dependent reactions in the dental pulp of rats after UVA-H2O2 photolysis. Maxillary first molars were treated. UVA irradiation (wavelength: 365 nm) with 3 wt% H2O2 was performed for 90 s at a radiant emittance of 500–2000 mW/cm2 on the rats for 3 consecutive days or only 1 day. The animals were sacrificed at Days 1, 3, 7, and 21 after the treatment for the histological evaluation of inflammatory cells and immunohistochemistry of heat shock protein (HSP)-25, a marker of odontoblasts. Tertiary dentin formation was evaluated at Day 21 by histomorphometry and micro-CT analysis. UVA-H2O2 photolysis elicited little infiltration of inflammatory cells, but disturbances in the odontoblast layer and/or presence of localized degenerative tissue were observed on Day 3. This condition was followed by a healing process that was characterized by the reappearance of HSP-25 positive odontoblast-like cells at Day 7 and tertiary dentin formation at Day 21. The amount of tertiary dentin formed was dependent on the intensity of treatment; repeated UVA irradiations of H2O2 at 2000 mW/cm2 resulted in the largest amount of tertiary dentin formation at the pulp horn regions. Our findings suggest that UVA-H2O2 photolysis treatment can be used to treat dental caries clinically because the post-treatment inflammatory reaction was minimal and tertiary dentin formation was substantial, which may prove effective in protecting dental pulp from external irritants. As a cautionary consideration, the radiant emittance of the UVA irradiation should be carefully optimized before clinical application.

Background The role of saliva composition and dietary sugar in development of infundibular caries in equine cheek teeth is not fully understood. This study analysed electrolyte and urea concentrations in saliva in relation to different forage and measured pH changes after sucrose application in vivo in sound and carious cheek teeth. Results Forage type had no effect on the equine saliva electrolyte concentrations, which varied considerably both intra- and inter-individually. Chewing resulted in increased values for all electrolytes except bicarbonate. Compared with stimulated human saliva, horse saliva after mastication, contained higher amounts of potassium, calcium and bicarbonate, and less phosphate. The in vivo pH measurements showed a lower resting pH and a more pronounced pH drop after sucrose application in carious teeth compared to sound teeth. Conclusions No large differences were found between the composition of equine saliva and human saliva. A more pronounced acidogenicity was found for the carious than sound teeth. Thus, the caries process in equine cheek teeth seems to follow the same pattern as in human teeth, caused by acid production by oral microorganisms after sugar consumption.

The prevalence, distribution, and location of dental caries were studied in complete and partial human dentitions dating from the Viking Age dating (900-1050 AD) excavated in Kopparsvik on island of Gotland, Sweden. 18 individuals and a total of 370 teeth were examined, using a strong light source and dental probe. Carious lesions were found in a large number of the individuals, 14 out of 18. The percentage of teeth affected by caries (11,9%) corresponds well with studied skull materials from the same period. The surface most susceptible to caries was the occlusal surface, whereas only a few proximal lesions and one single carious root surface was found. The tooth most commonly affected by caries was the mandibular first molar. The tooth most commonly missing ante-mortem was also the mandibular molar, and the tooth most commonly missing post mortem was the mandibular incisor. Other findings included apical infections, which were detected clinically in 3% of the teeth.

The association between vitamins and oral health have recently been discussed, yielding increased attention from medical and dental perspectives. The present review aimed to systematically evaluate and appraise the most recently scientific papers investigating the role of vitamins in the prevention and treatment of the main oral diseases as hard dental pathological processes and gum/periodontal disease. Randomized controlled trials, cross-sectional studies, cohort studies, comparative studies, validation studies and evaluation studies, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, reporting associations between vitamins and oral diseases or the use of vitamins to prevent or treat oral diseases in patients of any age were included. PubMed, Embase and Scopus were searched to November 2019 using an ad hoc prepared search string. All the papers meeting the inclusion criteria were subjected to a quality assessment. The search identified 1597 papers; 741 were selected after removing duplicates. A total of 334 articles were excluded after title and abstract evaluation; 407 were assessed and 73 papers were full-text assessed; other 14 papers were discharged after full text evaluation, leaving finally 58 papers included. In general, there is weak evidence supporting the association between vitamins and both gingival/periodontal disease and hard dental pathological processes.

Objectives: To investigate if, in Mexican adolescents, body weight and caries severity are associated, and if this association differs between rural and urban populations. Methods: Adolescents from the rural area of Tepancan and the city of Veracruz were enrolled. Caries was recorded using the International Caries Detection and Assessment System and the body mass index (BMI) was calculated. Oral habits (toothbrushing, flossing, dental check-ups) and dietary patterns (sweets intake) were assessed. A dummy variable between BMI and living area (BMI/Area) was generated. Data were analysed using STATA and a multinomial logistic regression model was run, using caries severity as the dependent variable. Results: Four-hundred and sixty-four subjects, 12–15 years of age, participated (rural = 240; urban = 224). The BMI and area of residence were significantly associated (χ(2) = 12.59, P < 0.01). Area was also associated with caries severity (χ(2) = 24.23, P < 0.01), with the highest number of caries in dentine recorded in participants from the rural area. The dummy variable BMI/Area was related to caries severity (χ(2) = 27.47, P < 0.01): overweight adolescents with caries in dentine were most frequently found in the rural area. A higher prevalence of caries in enamel and a lower prevalence of caries in dentine (P < 0.01) were recorded in adolescents from the urban area, where better oral habits, but higher sweets intake (P = 0.04), were encountered. According to the multinomial logistic regression model, BMI/Area was significantly associated with caries severity (P < 0.01). Conclusions: Overweight was not associated with caries severity in the overall population, but it became a statistically significant risk indicator in adolescents living in the rural area.

Objective: The aim of this study was to evaluate patients´ experiences of two excavation methods, Er:YAG laser and rotary bur and time required by the methods as well as objective assessments of quality and durability of restorations over a two-year period. Methods: A prospective, single-blind, randomized and controlled investigation was performed. Patients aged 15 to 40 years with at least two primary caries lesions, which had been radiographically assessed as of the same size, were recruited. In each patient, one cavity was excavated using rotary bur and one using Er:YAG laser technique. The time required for excavations and, where applicable, local anaesthesia, was measured during the treatments. Patient experiences were measured using questionnaires. The quality and durability of restorations were assessed over a two-year period in accordance with modified Ryges criteria and radiographs. Twenty-five patients (mean age 22.6 years) participated in the study. In total, 56 cavities were included of which 28 were treated with Er:YAG laser and 28 were treated with a rotary bur. Results: The patients associated the laser method with less discomfort. The mean time for excavation by laser was three times longer than by rotary bur (13.2 min vs. 4.3 min, P Conclusion: The Er:YAG laser technique was more time-consuming than the rotary bur. Despite this, the laser technique caused less discomfort and was preferred as an excavation method by patients.

Objectives The caries preventive effect of long-term use (1 year) of low-dosage (2.5 g/die) of xylitol chewing gum in a high-caries-risk adult population was evaluated. Materials and methods In this randomized clinical trial, 179 high-caries-risk adults were assigned to two experimental groups, xylitol and polyols. Caries status, salivary mutans streptococci (MS), and plaque pH were re-evaluated after 2 years from baseline in 66 xylitol and 64 polyol subjects. Outcomes (the net caries increment for initial, moderate, and extensive caries lesions and for the caries experience) were evaluated using the nonparametric Mann–Whitney U test. Results The total caries experience increment was 1.25 ± 1.26 in the xylitol group and 1.80 ± 2.33 in the polyol group (p = 0.01). Subjects treated with xylitol chewing gums had a reduction of risk rate at tooth level of 23% with respect to those treated with polyols with a number needed to treat of 55 teeth. The area under the curve at pH 5.7 was statistically significantly lower (p = 0.02) during the experimental period in the xylitol group. A decrease of the concentration of salivary MS was noted in the xylitol group (p

Periodontal diseases and dental caries are the most common diseases of humans and the main cause of tooth loss. Both diseases can lead to nutritional compromise and negative impacts upon self‐esteem and quality of life. As complex chronic diseases, they share common risk factors, such as a requirement for a pathogenic plaque biofilm, yet they exhibit distinct pathophysiologies. Multiple exposures contribute to their causal pathways, and susceptibility involves risk factors that are inherited (e.g. genetic variants), and those that are acquired (e.g. socio‐economic factors, biofilm load or composition, smoking, carbohydrate intake). Identification of these factors is crucial in the prevention of both diseases as well as in their management. Aim. To systematically appraise the scientific literature to identify potential risk factors for caries and periodontal diseases. Methods. One systematic review (genetic risk factors), one narrative review (role of diet and nutrition) and reference documentation for modifiable acquired risk factors common to both disease groups, formed the basis of the report. Results & Conclusions. There is moderately strong evidence for a genetic contribution to periodontal diseases and caries susceptibility, with an attributable risk estimated to be up to 50%. The genetics literature for periodontal disease is more substantial than for caries and genes associated with chronic periodontitis are the vitamin D receptor (VDR), Fc gamma receptor IIA (Fc‐γRIIA) and Interleukin 10 (IL10) genes. For caries, genes involved in enamel formation (AMELX, AMBN, ENAM, TUFT, MMP20, and KLK4), salivary characteristics (AQP5), immune regulation and dietary preferences had the largest impact. No common genetic variants were found. Fermentable carbohydrates (sugars and starches) were the most relevant common dietary risk factor for both diseases, but associated mechanisms differed. In caries, the fermentation process leads to acid production and the generation of biofilm components such as Glucans. In periodontitis, glycaemia drives oxidative stress and advanced glycation end‐products may also trigger a hyper inflammatory state. Micronutrient deficiencies, such as for vitamin C, vitamin D or vitamin B12, may be related to the onset and progression of both diseases. Functional foods or probiotics could be helpful in caries prevention and periodontal disease management, although evidence is limited and biological mechanisms not fully elucidated. Hyposalivation, rheumatoid arthritis, smoking/tobacco use, undiagnosed or sub‐optimally controlled diabetes and obesity are common acquired risk factors for both caries and periodontal diseases.

Dyes currently used to stain carious dentine have a limited capacity to discriminate normal dentine from carious dentine, which may result in overexcavation. Consequently, finding a selective dye is still a challenge. However, there is evidence that hydrazine-based dyes, via covalent bonds to functional groups, bind specifically to carious dentine. The aim of this study was to investigate the possible formation of covalent bonds between carious dentine and 15N2-hydrazine and the hydrazine-based dye, 15N2-labelled Lucifer Yellow, respectively. Powdered dentine from extracted carious and normal teeth was exposed to the dyes, and the staining reactions were analysed using time-of-flight secondary ion mass spectrometry (ToF-SIMS), solid-state 13C-labelled nuclear magnetic resonance (NMR) and 15N-NMR spectroscopy. The results showed that 15N2-hydrazine and 15N2-labelled Lucifer Yellow both bind to carious dentine but not to normal dentine. It can thus be concluded that hydrazine-based dyes can be used to stain carious dentine and leave normal dentine unstained.

Dietary habits and, in particular, the intake frequency of sucrose are of major importance for the development of dental caries. The perception of sweet taste is believed to have an influence on sucrose intake and therefore affects the predisposition to dental caries. The aim was to study the caries experience and sweet taste perception and to further analyze the possible relationship between the 2 tested variables in 13- to 15-year-old children from 3 different geographical areas. A cross-sectional survey comprising 669 children (220 Italian, 224 Mexican, and 225 Saudi Arabian) was conducted. The children were examined in their school setting. A sweet taste perception level was determined by the sweet taste threshold (TT) and sweet taste preference (TP). The sweet test was performed with sucrose solutions varying in concentration from 1.63 to 821.52 g/L. The International Caries Detection and Assessment System (ICDAS) and DMFS indices were used to diagnose caries. The highest mean value for TT was found for Italian children followed by Saudi and Mexican. Saudi schoolchildren showed the highest mean values for TP and DMFS, followed by Italian and Mexican. A statistically significant difference for TP, TT, DMFS, and initial caries was found between the 3 countries. A weak yet positive correlation was found between taste perception (TT and TP) versus DMFS and manifest caries in all 3 countries (r = 0.137-0.313). The findings of the present study showed a variation in sweet taste perception between the 3 countries, which may influence the caries outcome of the children in the individual countries.

An improvement in oral health, not least dental caries and periodontal disease, has been seen during the last 50 years. Oral health is essential for both general health and quality of life. The mouth is a window into the health of the body and signs of nutritional deficiencies can be seen in the mouth at an early stage. Dental caries still constitutes the most common oral condition worldwide. It is the net result of an ecological imbalance in the oral biofilm where metabolism of fermentable carbohydrates may result in demineralisation. Early diagnosis of disease symptoms and preventive strategies are important for disease management. Dental erosion, where loss of tooth substance is a result of exposure to acidic substances, has become a common condition. Intrinsic factors, including diet/drinks and intake habits, are common etiological causes. Periodontal diseases constitute chronic, biofilm-initiated inflammatory conditions with multifactorial origin including inherited and acquired risk factors. Preventive strategies focus on mechanisms, which may influence the amount and composition of the subgingival biofilm. Oral cancer is one of the most commonly found forms of malignancies worldwide. It is a highly complex condition where lifestyle factors, particularly smoking cessation and moderate alcohol consumption, play a major role as deterrents. Hyposalivation is of multifactorial aetiology and may influence oral health as well as various aspects of quality of life. To control oral health, it is important to increase our knowledge of oral disease aetiology and focus on oral health promotion and preventive strategies including the control of diet and nutritional risk factors.

To evaluate the effect of sugar-free snacks on caries-related factors in 6- to 9-year-old schoolchildren.Two hundred seventy-one children at risk for caries as measured through the Cariogram were randomly assigned to three groups consuming twice-daily snacks containing Stevia, maltitol or sugar for 42 days. Parents filled out a standardised questionnaire regarding personal, medical and oral behavioural information. Bleeding on probing, plaque pH and salivary mutans streptococchi (MS) and lactobacilli (LB) were assessed at baseline (t0), 42 days of snack use (t1) and 120 days after the end of use (t2). The Cariogram calculation was repeated at t1. Treatment effects were estimated using linear mixed-effects regression models.At t2, a decrease in cariogenic bacteria (MS X2 = 8.01, p0.01 and LB X2 = 4.60, p = 0.03) and an increase of the minimum pH (F = 4.48, p0.01), maximum pH (F = 2.88 p0.01) and pH drop (F = 2.95 p0.01) was recorded in the Stevia group compared to baseline. In the maltitol group, an improvement effect was noted: LB concentration decreased (p = 0.04) and maximum pH (F = 3.16 p0.01) increased. Subjects classified by the Cariogram as have a low probability of developing caries increased in the Stevia and maltitol groups (X2(4) = 25.44, p0.01, C*sV = 0.38 and X2(4) = 12.85, p = 0.01, C*sV = 0.27, respectively). Regression analysis underlines the effect of Stevia snacks on the cariogenic microflora, mainly on MS and plaque pH variations.The short-term administration of Stevia or maltitol snacks improves some important factors related to caries. This preventive strategy might be an additional means of combatting this common childhood disease.

Introduction Dental caries is an undesirable side effect of orthodontic treatment with fixed appliances. Caries lesions can result in long-term esthetic disturbance, costly interventions, and even interrupted treatment. Therefore, it is crucial to assess accurately both a patient's caries risk before treatment and their suitability for orthodontic treatment. This study aimed to evaluate the validity of 5 caries risk assessment methods for predicting caries outcome during orthodontic treatment: Cariogram, Caries Management by Risk Assessment (CAMBRA), R2, decayed filled teeth (DFT), and decayed initial filled surfaces (DiFS). Methods A prospective longitudinal clinical study of 270 adolescents who were referred to the Specialist Clinic for Orthodontics, Molndal Hospital, Sweden for treatment with fixed orthodontic appliances. The following data were collected before treatment: plaque index, radiographs to determine caries prevalence (DFT, DiFS), photographs to determine white-spot lesions, saliva samples (Streptococcus mutans and Lactobacilli), and responses to a questionnaire (regarding diet and oral hygiene). The variables were compiled to assess caries risk according to Cariogram, CAMBRA, and R2. Radiographs were also taken posttreatment to assess caries incidence. The caries outcomes after treatment were analyzed and compared with the caries risk, assessed by the caries risk assessment methods at baseline. Results DiFS proved to be the most reliable method for predicting caries during orthodontic treatment, presenting the highest area under the receiver operating characteristic curve for both manifest caries (0.77) and initial caries (0.71). Conclusions The DiFS prevalence index was demonstrated to be useful in identifying patients who are at risk for developing manifest and initial caries during orthodontic treatment.

BACKGROUND: Obesity is a multifactorial disease that is increasing worldwide and is caused by different environmental and genetic factors, with an increase in the consumption of high-energy-containing food and a decrease in physical activity constituting two of the main reasons. Sweet taste perception may have an effect on the subject's dietary choices and affect his or her predisposition to obesity. OBJECTIVES: The aim was to study the sweet taste perception and dental caries in relation to body mass index (BMI) in 13-15-year-old schoolchildren from three different countries and to compare the BMI among the countries. DESIGN: The sweet taste perception level, determined as the sweet taste threshold and preference, was assessed in a total of 669 schoolchildren from Italy, Mexico and Saudi Arabia, examined in school settings. Height and weight were collected and BMI was calculated, after which the children were grouped as underweight, normal, overweight, and obese. For caries registration, the International Caries Detection and Assessment System and Decayed Missing Filled Surfaces indices were used. RESULTS: A statistically significant difference was found for BMI among the children from the three countries (p < 0.001), with the highest mean found among Saudi children, followed by Mexican and Italian children. A statistically significant difference regarding sweet taste threshold when comparing the BMI groups was only found for Saudi Arabia (p < 0.01). No significant correlation was found between BMI and sweet taste threshold or preference and dental caries variables, respectively. CONCLUSIONS: BMI was found to differ between countries, with a further significant difference among the groups among the Saudi Arabia schoolchildren.

The present study investigated the compounds present in the low molecular mass fraction of Lentinus edodes mushroom (shiitake) extract and their anti-virulence activity against oral pathogens (reference and clinical Streptococcus mutans, Actinomyces naeslundii, and Prevotella intermedia strains). Oxalic, succinic, and quinic acids, and adenine, inosine, and uridine were identified by HPLC-DAD-ESI-MS/MS. Their anti-biofilm production and preformed biofilm disaggregation activities were studied using commercial standard compounds at different concentrations. As regards S. mutans, the highest activity was shown by adenine at 5 mg mL-1 both in the biofilm inhibition (BI 50%) and biofilm disaggregation tests (BD 20%). Considering A. naeslundii, BI values close to 80% were registered for oxalic acid at 1 mg mL-1 and 2 mg mL-1 and BD 50% for quinic acid at 3 mg mL-1. A weaker activity was found against P. intermedia. Furthermore, different mixtures of the commercial standards were tested showing that the activity of a compound can be strongly and sometimes negatively affected by the presence of the other compounds.

Objective: The aim of this study was to investigate oral impacts on daily performance and to relate these data to oral clinical variables.Material and methods: The study was performed at a dental clinic in Livingstone, Zambia, and included 78 subjects (mean age 28, range 15–48 years) consecutively recruited in connection witha dental care visit. Data were collected through a structured interview using the Oral Impacts on Daily Performances (OIDP) index measuring oral health-related quality of life followed by a clinical examination.Results: Oral health affected one or more daily performances during the last 6 months for 61.5% of the subjects. ‘Difficulty of eating and enjoying food’ was the performance reported most frequently (42.3%), and ‘speaking and pronouncing clearly’ was least often reported (10.3%). DMFT was 3.8, 3.6 (mean  SD; range0–15). A majority of the individuals had periodontal pockets ≥4mm (mean 4.3, 2.6) (94.9%) and gingival bleeding on probing >20%(88.5%). Two or more decayed teeth were shown to be significantly associated (OR 4.6, CI 1.2–17.1) with one or more oral impacts on daily performances in a multivariate logistic regression analysis.Conclusions: This study shown that there is a significant association between decayed teeth and oral impacts on daily performances. More research is needed, however, for deeper understanding of oral health problems and their impacts on daily life in Zambia.

Aim: To evaluate the effect of different mouth rinses 12 h after rinsing on genuine intra-oral halitosis. Materials and methods: Twenty-four adults with halitosis were included in a double-blind, crossover, randomized clinical trial. Halitosis was evaluated 12 h after rinsing with placebo and five mouth rinse products containing zinc acetate and chlorhexidine diacetate; zinc lactate, chlorhexidine and cetylpyridinium chloride; zinc acetate and chlorhexidine diacetate with reduced amounts of mint and menthol; zinc chloride and essential oil; and chlorine dioxide using the organoleptic method and a gas chromatograph. Test periods were separated by 1 week. Results: Hydrogen sulphide (H2 S), methyl mercaptan (MM) and the organoleptic scores (OLS) were significantly reduced 12 h following rinsing with all substances compared to placebo (P < 0.05). H2 S was more effectively reduced after rinsing with zinc acetate and chlorhexidine diacetate and zinc acetate and chlorhexidine diacetate with reduced amounts of mint and menthol compared to rinsing with zinc chloride and essential oil (P < 0.05), and significantly lower values of MM were obtained after rinsing with zinc acetate and chlorhexidine diacetate compared to zinc lactate, chlorhexidine and cetylpyridinium chloride (P < 0.05). The percentage effectively treated individuals (H2 S (

The purpose of this systematic review and meta-analysis was to evaluate the reliability of the Carisolv system with respect to drilling regarding the full removal of decayed hard tissues in primary dentition. A systematic review of the literature was conducted to identify controlled trails, randomized controlled trials and clinical trials that compared the Carisolv system to the traditional mechanical caries removal in the primary dentition.The main relevant databases were searched: MEDLINE via PUBMED, Web of Science and SCOPUS. Complete caries removal, length of working time and need of local anesthesia were the outcomes evaluated.A total of 195 studies were identified and complete analysis of 28 studies was performed; finally, 10 papers were included. The trials included involved a total of 348 patients for 532 treated teeth. There was no significant difference in terms of clinical efficacy between the Carisolv and the rotary instrument (z = 0.68, p = 0.50), whereas the treatment with Carisolv was significantly longer in terms of time with respect to the rotary instruments (z = 10.49, p0.01). The chemo mechanical technique reduces the need for local anesthesia, with a difference between two types of treatment near to statistical significance (z = 1.91 p = 0.06).This systematic review indicates that the clinical efficacy of chemo-mechanical removal with Carisolv seems as reliable as the rotary instruments. However, the results should be interpreted cautiously due to the heterogeneity among study designs and to the shortage of available data. Further large-scale, well-designed randomized controlled trials are needed.

Background The pH strip method has been proposed for use in a clinical setting for the evaluation of dental plaque pH. The aim of this in-vivo study was to compare the reliability of the pH-indicator strip method to the microelectrode technique in plaque pH measurement. Methods 136 subjects (7-9 years) were enrolled and, for each subject, measurements of plaque pH were made at two interproximal sites; a total of 272 sites were analyzed. Plaque pH was assessed in triplicate using pH-indicator strips (pH range: 4.0-7.0) and an iridium microelectrode with a diameter of 0.1 mm. The caries status of 544 proximal surfaces between two primary molars, in proximity at the plaque pH sites, was assessed. All measurements were performed before and 2, 5, 10, 15, 20, and 30 minutes after a mouth rinse with water solution of sucrose (10%). One-way ANOVA was performed to analyze statistically significant differences between the two techniques. Instrument reliability was measured by assessing the intraclass correlation coefficient. Results Comparable, not statistically significant pH values (P values range from 0.98 to 1.00) were obtained by the two methods for AUC5.7, AUC6.2, maximum pH fall and minimum pH. High intraclass coefficients were recorded (Pearson's r=0.96, Yule's Q=0.99), implying an almost perfect association when the measurements were grouped as a carious lesion being present or not on the surface near the site of measurement. Conclusions The use of the pH strip method has high validity and may replace the traditional microtouch electrode technique for clinical use.

A recently developed antimicrobial technique utilizing hydroxyl radicals generated by hydrogen peroxide (H2O2) photolysis represents a promising new therapy for preventing and treating dental caries. The present study compared the antimicrobial time-kill kinetics of H2O2 photolysis, conventional antiseptics, and antimicrobial photodynamic therapy (aPDT) against biofilm-forming Streptococcus mutans (cariogenic bacteria) grown on hydroxyapatite disks. H2O2 photolysis was performed by irradiating the biofilm immersed in 3% H2O2 with 365-nm light-emitting diode (LED) light at an irradiance of 1000mW/cm2 for up to 1.5min. Antiseptic treatments consisted of 0.2% chlorhexidine gluconate, 0.5% povidone-iodine, and 3% H2O2. The biofilm was immersed in each antiseptic for up to 4min. aPDT was performed by irradiating the biofilm immersed in 100μM methylene blue or toluidine blue O with 655-nm laser light at 1000mW/cm2 for up to 4min. Based on the time-kill assay, the decimal reduction value (D-value) of each treatment was determined. With a D-value of 0.06min, H2O2 photolysis exhibited the highest bactericidal effect against biofilm-forming S. mutans. In contrast, antiseptics and aPDT exerted a slower bactericidal effect, with D-values of 0.9-2.7min. In conclusion, the antimicrobial technique based on H2O2 photolysis using 365-nm LED represents a strong adjunctive chemotherapy for dental caries treatment.

Aim To evaluate the caries prevalence and related variables in Type 1 diabetic and non-diabetic children and among the diabetic children according to their metabolic status. Methods Sixty-eight diabetic and 136 non-diabetic children, matching by gender and age (4–14 years) were enrolled. The diabetic children were divided: a) 20 children in good metabolic control (Hb1ac≤7.5) and b) 48 children in bad metabolic control (Hb1ac>7.5). Dietary and oral hygiene habits were investigated. Caries status was registered using the International Caries Detection and Assessment System. Oral microflora was analysed using the checkerboard DNA-DNA hybridisation method. Plaque acidogenicity was recorded after a sucrose rinse. Results Sugared beverage and snack intake was higher in diabetic group compared to non-diabetic group (p = 0.03 and p = 0.04, respectively) and in subjects in bad metabolic control (p = 0.03 and p

Aim To provide a narrative review of the role of macro- and micronutrients in relation to dental caries, gingival bleeding and destructive periodontal disease. Materials & Methods This review is based on systematic reviews (when available) and comparative human studies. Results Dental caries cannot develop without the presence of dietary fermentable carbohydrates, in particular sugar. The susceptibility to develop caries in the presence of carbohydrates may be influenced by genetics and micronutrients such as vitamin D. Gingival bleeding and destructive periodontal disease are sensitive markers to both abnormalities in macronutrient content (excessive carbohydrates or poly-unsaturated fat intake, deficient protein intake) and micronutrient intake (e.g. vitamin C and B12). Conclusion Dental caries and periodontal diseases are a sensitive alarm bell for an unhealthy diet, which predicts the future onset of the diseases of civilizations.

Objective To study the effect of weekly professional oral hygiene care on the proportion of micro-organisms associated with good oral health, caries, and periodontal and soft tissue diseases in oral biofilms in dentate, dependent elderly residents. Background Assisted oral hygiene care reduces the plaque score and number of micro-organisms in the oral biofilms in elderly residents. Less is known about the effect on the quality/composition of the remaining oral flora. Materials and methods Participants comprised 33 residents in the study and 35 in the control group. Dental status (≥10 natural teeth and no removable dentures to be included), plaque score, salivary secretion rate and prescription medicines were recorded. Duplicate samples, collected from supragingival plaque and tongue, were analysed using cultivation technique. Differences between and within groups were analysed using one-way and two-way ANOVA, respectively. Results At the baseline, the number of teeth in the participants (mean age, 83.7 ± 7.4 years) was 22.0 ± 4.5. The number of prescription medicines was 9.4 ± 4.5. Seventy-six per cent had low salivary secretion rate. Fifty per cent had “visible thick” supragingival plaque. At the 12-month registration, “no visible” or “visible but thin” plaque was recorded in 92% in the study group. The proportions of bacteria associated with good oral health and periodontal diseases were decreased over time, while the frequency and proportions of micro-organisms associated with caries and soft tissue infection were unaffected or increased. Conclusion The results indicate that assisted oral hygiene care alone is not sufficient to regain an oral microbial flora associated with good oral health in dentate, dependent elderly residents.