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The applied orthodontic force causes remodeling of the periodontium through the selective release of cytokines causing resorption of bone, enabling controlled movement of the tooth. This study compared the cytokine profile between patients treated with conventional labial and lingual fixed orthodontic appliances.The study included 80 patients in need of orthodontic treatment, out of which 40 patients were treated by the labial fixed appliance and 40 by the lingual fixed appliance. Gingival crevicular fluid (GCF) specimens were gathered from both the groups using a microcapillary pipette. The samples were collected at the beginning of the treatment and after 21 days. Enzyme-linked immunosorbent assay was performed to evaluate the cytokine levels.Interleukin (IL)-1α, 1β, 2, 8, and tumor necrosis factor-alpha (TNF-α) levels were significantly high (P0.001) in GCF of participants treated with conventional labial fixed appliance. IL-1α, 1β, 2, 6, 8, and TNF-α levels were significantly high (P0.001) in GCF of participants treated by the lingual fixed appliance. The concentrations of TNF-α and IL-1β were increased higher than other cytokines in both the treatment groups.Overall, the lingual fixed appliance had higher cytokine levels than a labial fixed appliance. Analyzing the GCF cytokine levels during orthodontic treatment could provide an ideal platform for monitoring the progress of the treatment.

Equally accessible and affordable dental services for all population groups have been a political goal in Sweden for almost a century. All political parties have shared the idea that a person's social background should not have consequences for his or her dental status. Strategic tools to achieve this ambitious goal have been the wide use of publicly provided oral healthcare services, covering even sparsely populated areas, focusing on preventive care and significant subsidies for necessary treatments. Besides free care for children and young adults, oral healthcare is reimbursed from public funds. The public subsidy was particularly generous in 1975-1999 when a 'full clearance' of adults' dentitions was undertaken both by the public and private providers under fixed prices and high reimbursement levels for all treatment measures. Today, preventive oral healthcare for the elderly is given higher priority as most Swedes have been able to keep their natural teeth.

3 triclosan-containing dentifrices were compared in a 6-month, unsupervised tooth brushing study. The effects on plaque, gingival bleeding and certain salivary micro-organisms (mutans streptococci, lactobacilli, total counts of streptococci and total counts of micro-organisms) were evaluated. 123 subjects were divided into 4 groups according to severity of gingival bleeding index. 112 subjects completed the study. Following a 4-week pre-experimental period, using a sodium monofluorophosphate dentifrice (placebo), the subjects were assigned to use one of 3 triclosan-containing dentifrices, available on the Swedish market: Colgate Paradent (a triclosan/copolymer dentifrice) (n = 26); Pepsodent Gum Health (a triclosan/zinc citrate dentifrice) (n = 31); Dentosal Friskt Tandkott (a triclosan/pyrophosphate dentifrice) (n = 28); or to continue with the placebo (n = 27). The results revealed that Colgate Paradent reduced baseline plaque values by 39% (Quigley and Hein) over the 6-month experimental period. The corresponding values for the other modalities were: a reduction of 6% for Pepsodent Gum Health, an increase of 5% for Dentosal Friskt Tandkott, and an increase of 2% for placebo. A significant difference in the plaque levels (p < 0.05) was found between Colgate Paradent and Pepsodent Gum Health and between Colgate Paradent and placebo. The gingival bleeding index was improved in all 4 groups. A significant difference (p < 0.05) was found with respect to bleeding between Colgate Paradent and placebo (p < 0.05) at the 3-month registration. A statistically significant increase over time in total number of streptococci and total colony forming units were found for the Dentosal, Pepsodent and placebo groups, but not for Colgate.(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of this study was to compare the effect of two different chlorhexidine regimens, varnish and gel, on mutans streptococci (MS) in the margins of restorations and in saliva. Eighteen subjects (mean age 44 years) with >250,000 MS/ml saliva and with many restored teeth were assigned to three groups, each comprising 6 individuals. They were treated with: (1) Cervitec® varnish, containing 1% chlorhexidine and 1% thymol; (2) placebo varnish, or (3) Corsodyl® gel, containing 1% chlorhexidine. The varnish was applied on two separate occasions to all tooth surfaces at an interval of 3–4 days. The gel was applied for 3×5 min in individual applicators on 2 consecutive days. Plaque samples from 8–9 margins of restorations per subject, mainly in the premolar and molar region, and stimulated saliva samples were collected at baseline and after 1, 4, 8 and 12 weeks. The general finding was that the Corsodyl gel gave the most pronounced reduction of MS followed by the Cervitec varnish. According to repeated measures ANOVA, no significant differences could be demonstrated either for MS in margins or in saliva among the three groups (p = 0.06 for margins and p = 0.07 for saliva). However, within the groups, the reduction of MS over time was statistically significant, both in margins and in saliva (p < 0.001 and p < 0.05, respectively). Student-Newman-Keuls test showed that MS in margins were significantly reduced at most sampling occasions in both chlorhexidine groups: the reduction was more pronounced in the Corsodyl gel group. The conclusion from this study is that the 1% chlorhexidine gel Corsodyl, administered 6 times during 2 days, is more effective in suppressing MS in the margins of restorations and in saliva than the 1% chlorhexidine varnish Cervitec, administered twice within 3–4 days.

The aim of this study was to evaluate the effect on oral health, at age 9 years, of daily oral supplementation with the probiotic Lactobacillus reuteri, strain ATCC 55730, to mothers during the last month of gestation and to children through the first year of life. The study was a single-blind, placebo-controlled, multicenter trial involving 113 children: 60 in the probiotic and 53 in the placebo group. The subjects underwent clinical and radiographic examination of the primary dentition and carious lesions, plaque and gingivitis were recorded. Saliva and plaque were sampled for determination of mutans streptococci (MS) and lactobacilli (LB) in saliva and plaque as well as salivary secretory IgA (SIgA). Forty-nine (82%) children in the probiotic group and 31 (58%) in the placebo group were caries-free (p0.01). The prevalence of approximal caries lesions was lower in the probiotic group (0.67 ± 1.61 vs. 1.53 ± 2.64; p0.05) and there were fewer sites with gingivitis compared to the placebo group (p0.05). There were no significant differences between the groups with respect to frequency of toothbrushing, plaque and dietary habits, but to intake of fluoride supplements (p0.05). There were no intergroup differences with respect to L. reuteri, MS, LB or SIgA in saliva. Within the limitation of this study it seems that daily supplementation with L. reuteri from birth and during the first year of life is associated with reduced caries prevalence and gingivitis score in the primary dentition at 9 years of age.

This study evaluated the effects of three post-brushing mouthwashes containing 0 ppm F, 225 ppm F, and 500 ppm F, respectively, on salivary fluoride retention after brushing with 1450 ppm fluoride (as NaF) toothpaste and rinsing with water immediately after brushing.In this three-phase, randomized, cross-over study, an ion-specific electrode was used to measure salivary F levels in thirty trial participants before brushing (Time 0), and after brushing, rinsing with water, and then rinsing with one of the three mouthwashes. Time points evaluated after brushing were one, three, five, 10, 20, 30, 45, and 60 minutes. For saliva sample collections, subjects were asked to pool saliva in their mouths for 10 seconds before spitting out into a container for each of the time points.The AUC0-60 means for F in saliva were 554, 252, and 20 for the 500, 225, and 0 ppm F mouthwash groups, respectively. The 500 ppm F mouthwash resulted in a 2660% increase in total fluoride salivary retention over 60 minutes when compared with the 0 ppm F group, and a 120% increase when compared with the 225 ppm F group. A significant difference (p0.001) in the AUC0-60 means between the three groups was observed using analysis of variance (ANOVA). Paired t-tests also showed significant differences in the mean fluoride retention over 60 minutes for all three pair-wise group comparisons (p0.001).Use of a fluoride mouthwash containing 225 ppm F or 500 ppm F produced a significant increase in salivary fluoride retention following brushing with a 1450 ppm F toothpaste and rinsing with water compared to rinsing without fluoride. The use of the 500 ppm F mouthwash may be of particular benefit to those at high caries risk.

To evaluate the preventive effect of a "modified fluoride (F) toothpaste technique" on the incidence and progression of buccal/ lingual enamel caries among Saudi adults with high caries prevalence.Adults were randomly assigned to test and control groups. Test group patients were instructed to use the provided F toothpaste twice a day as follows: 1, use 2cm toothpaste; 2, brush for 2 min; 3, swish the toothpaste slurry around the teeth for about half a minute before spitting it out; and 4, no post-brushing water rinsing and no eating/drinking for 2hr. The patients in the control group (n = 57) were instructed to continue using their regular F toothpaste twice a day without any further instructions. The patients' compliance in the test group was assessed after 2 years.Of 175 adults, 113 completed the study. The test group (n = 56) had a lower enamel mean caries incidence 0.56 (sd 1.04) than the control group (n = 57), 1.01 (1.00) (p0.05), with a preventive fraction of 44%. There was no difference regarding enamel caries progression or arrested caries. The caries incidence in the test group was higher in the subgroup of patients who rinsed with water post-brushing and who only brushed once a day (p0.05).The "modified fluoride toothpaste technique", as practised over the 2 years in a Saudi population with high caries prevalence, had a preventive effect on the incidence of buccal/lingual enamel caries but not on the progression.

The study consisted of eight experiments, divided into three series, aimed at investigating the effect on the salivary fluoride (F) concentration of three post-brushing regimes: (1) rinsing once or twice with water, (2) rinsing either with a slurry of the toothpaste foam and water or with an 0.05% NaF solution, or a single NaF mouthrinse with no prior brushing, and (3) chewing and drinking ('eating') for 2 min. Brushing was done with 1.5 g of an 0.32% NaF dentifrice. The concentration of F in whole saliva was determined in 15 subjects at various time points up to 45 min after completing each experimental procedure. Results showed that the initial (0 min post-brushing) F concentration in saliva decreased about 1-2 times after a single, and 4-5 times after a double post-brushing water-rinse, as compared with no rinsing at all (p < 0.001). Brushing followed by a mouthrinse with an 0.05% NaF solution elevated the F concentration more than brushing alone (p < 0.001). Rinsing with the slurry of toothpaste foam and water gave only a somewhat (but not significantly) lower concentration of F in saliva than just rinsing with the 0.05% NaF solution. Eating immediately after brushing reduced the salivary F level about 12-15 times (p < 0.001) compared with brushing alone.(ABSTRACT TRUNCATED AT 250 WORDS)

To analyse the relationship between caries determinants in early childhood and caries prevalence in proximal surfaces in adolescents at the age of 15 years.The present longitudinal study is part of a series of surveys of oral health in 671 children followed from 1 to 15 years of age. Data were selected from examinations, interviews and questionnaires at 1, 3 and 6 years and bitewing radiographs at 15 years of age. Uni- and multivariable logistic regression analyses were performed to identify caries-related determinants. The outcome variable was carious lesions and fillings (DFa) in approximal tooth surfaces at 15 years of age. Statistical comparisons were made between caries-free teenagers, DFa = 0 and teenagers with DFa0, DFa ≥ 4 and DFa ≥ 8, respectively.In the final logistic regression analyses, caries experience at 6 years and mother's self-estimation of her oral health care as being less good to poor remained statistically significant and were related to caries in all three caries groups (i.e. DF0, ≥4 and ≥8) at 15 years of age. The consumption of sweets at 1 year remained statistically significant, with a caries experience of DF ≥ 4 and ≥ 8. The variables 'parents born abroad' and female gender were statistically significantly associated with DFa ≥ 4 and DFa ≥ 8, respectively. Furthermore, infrequent toothbrushing habits at 3 years of age and failure to attend the examination at 1 year were statistically significantly associated with caries at 15 years in the univariable analyses.Early caries experience, consumption of sweets at an early age and mother's self-estimation of her oral health care as being less good to poor are associated with approximal caries in adolescents. The study indicates that caries determinants identified during early childhood have a strong impact on approximal caries in adolescence.

The aim of the present investigation was to study the brushing and toothpaste technique employed by caries-active and caries-inactive patients in a toothbrushing population. The study consisted of 47 patients at a public dental clinic in the County of Bohuslan, Sweden; 23 with low (group L) and 24 with high caries activity (group H). They were asked to brush their teeth with a fluoride dentifrice at the clinic using an identical technique to that which they employed at home. Various factors, such as brushing time, amount of dentifrice, water consumption and mouthrinsing habits after brushing, were carefully registered. Saliva samples for fluoride analyses were collected up to 45 min after brushing. The members of group L used less rinsing water (0.7 +/- 0.6 dl; mean +/- SD) than those of group H (1.9 +/- 1.0 dl, p < 0.001). Comparing the mouthrinsings with water after the brushing, a significantly higher frequency was observed in group H (3.6 +/- 1.9 rinsings) than in group L (1.5 +/- 0.7 rinsings; p < 0.001). There were no differences between the two groups regarding the amount of dentifrice used and the total brushing time. When the salivary fluoride concentration was plotted vs. time and the area under the curve (AUC) calculated, a significantly higher mean value was found in group L than in group H (p < 0.01). Calculation of the correlation coefficient (r) between the AUC value and the amount of water used gave r = 0.53 (p < 0.001) and between the AUC and the frequency of mouthrinsing r = 0.46 (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

There is a lack of clinical studies comparing dentifrices with high fluoride (F) concentration. The aim was to evaluate a dentifrice containing 5,000 ppm F compared to a dentifrice containing 1,450 ppm F in caries-active adolescents. The design was a 2-year, single-blind randomized controlled trial and 211 adolescents of 279 (76%) completed the trial. The subjects were divided into two groups and were given one of the assigned F dentifrices for daily unsupervised toothbrushing: (1) Duraphat 5,000 ppm F and (2) Pepsodent Superfluor 1,450 ppm F, both as NaF. The outcome variables were caries incidence and progression of proximal and occlusal caries. The subjects were asked to fill in a questionnaire to evaluate their compliance and they were divided into two subgroups: subgroup A, excellent compliance, and subgroup B, poor compliance. The latter group (28%) comprised the subjects who did not brush twice a day or did not use the dentifrice regularly. Adolescents using 5,000 ppm F toothpaste had significantly lower progression of caries compared to those using 1,450 ppm F toothpaste (A: p < 0.01, B: p < 0.001), with a prevented fraction of 40%. Subjects using 5,000 ppm F toothpaste had significantly lower caries incidence for compliance B compared to those using 1,450 ppm F toothpaste (p < 0.05); the prevented fraction was 42%. This may indicate that 5,000 ppm F toothpaste has a greater impact on individuals who do not use toothpaste regularly or do not brush twice a day. Thus, 5,000 ppm F toothpaste appears to be an important vehicle for caries prevention and treatment of adolescents with a high caries risk.

A total of 26 healthy volunteers participated in this randomized 4-leg crossover study designed to measure fluoride (F) retention in interdental plaque and saliva. Two NaF dentifrices (5,000 and 1,450 ppm F) were used, with and without postbrushing water rinsing. The 4 tooth brushing methods were carried out twice a day during 2 weeks. Interdental plaque was collected from all proximal sites after each method, using dental floss. Immediately after the plaque sampling, the subjects were asked to brush their teeth with the same toothpaste and use the postbrushing water rinsing procedure as previously. Proximal saliva was collected from 4 interdental sites, using small paper points, before and up to 60 min after the brushing. The present study showed that the 5,000 ppm F toothpaste without postbrushing water rinsing resulted in the highest F concentration in both plaque and saliva and the 1,450 ppm F toothpaste with water rinsing in the lowest. The difference in the area under the curve of saliva F concentration versus time between the 2 methods was 4.2 times (p < 0.001). The corresponding difference in F concentration per unit weight of plaque (n = 16) was 2.75 times (p < 0.05). Water rinsing immediately after tooth brushing with 5,000 ppm reduced the F concentration in saliva by 2.4 times (p < 0.001). The difference in F values in saliva between 5,000/rinsing and 1,450/no rinsing was minor and not significant. The increase of F in both proximal saliva and plaque, using a dentifrice with 5,000 ppm F without postbrushing water rinsing, may be of clinical importance.

Patterns may explain part of the dietary variation between subjects.To create a typology of carbohydrate intake among the elderly and to analyse whether it seems valuable or not.Factor and cluster-analyses of dietary interviews from two elderly cohorts of free-living elderly people in Göteborg, Sweden.Three hundred and thirty seven women and three hundred and twenty three men aged 70-79 was studied cross-sectionally and longitudinally. The altogether 917 dietary interviews were based on the dietary history method. Cluster analysis, based on factor scores, was used to create the typology.Seven clusters were identified: 1) Small eaters (high relative intake of starch and a low energy intake), 2) Lean and green eaters (high intake of dietary fibre), 3) Fruit eaters (high intake of monosaccharides), 4) Sweet tooth eaters (high intake of sucrose), 5) Gourmands (high absolute intake of starch, dietary fibre and energy), 6) Milk drinkers (high intake of lactose) and 7) Fat eaters (high intake of fat and low intake of carbohydrates). The different patterns were associated with different food consumption, different intake of micronutrients and different social and physiological factors. There were also changes over time of the proportion of subject within the clusters.The typology found by using cluster analysis, seems to be valid and was related to all analysed dimensions. Therefore, the methods may be valuable for describing and analysing the dietary intake among elderly.

A large number of the population, especially the elderly, suffers from dry mouth. The aim of the present investigation was to stimulate the minor salivary glands by the topical application of the cholinesterase inhibitor physostigmine. In eight healthy subjects. 100 microl of the substance, in the concentration interval 2-8 mg/ml, was applied locally to the inside of the lower lip for 1 min. In a separate study comprising 12 dry-mouth patients. 10 ml of 0.4 1.6 mg/ml physostigmine was administered as a mouth rinse solution for 2 min. Secretion from the labial glands. assessed using the Periotron method, increased in a dose-dependent manner in response to physostigmine in both groups. Average peak secretion exceeded baseline by more than 50% throughout the 30- to 45-min observation period; from 1.71 to 2.62 microl cm(-2) min(-1) among the healthy subjects and from 1.17 to 1.84 microl cm 2 min among the dry mouth patients. No systemic effects were registered as reflected by ECG, heart rate or blood pressure. It is assumed that intraorally applied physostigmine diffuses through the oral mucosa and acts by preserving acetylcholine released from the cholinergic, parasympathetic nerves that innervate the minor salivary glands. The topical application of physostigmine to the oral mucosa may, therefore, be an interesting approach for the treatment of dry mouth.

The aim of the present study was to clinically evaluate fissure sealants on the occlusal fissures and buccal pits of permanent first and second molars after 20 and 15 years, respectively. The population consisted of 72 children, each of whom had had their four first molars sealed between 1977 and 1980. At the annual examinations, all caries-free, newly erupted second molars were sealed. When sealant was applied to the second molars, the first molars were checked and sealant was reapplied to those that had deficient sealants. At the follow-up, when the subjects were 26-27 years of age, 27 in the original group had moved from the community. Thus, the present result is based on 45 subjects. One hundred and fifty-three sealed first molars and 161 sealed second molars were available for inspection. At the follow-up examination of the first molars 20 years after sealant had been applied, 65% showed complete retention, 22% partial retention without caries, and 13% caries or restoration in the occlusal fissures or buccal pits. At the 15-year follow-up of the second molars, the corresponding figures were 65%, 30%, and 5%, respectively. Of the restored or carious molars, significantly more were found in the mandible than in the maxilla (P0.001). This longitudinal study showed that pit and fissure sealants--applied during childhood--have a longlasting, caries-preventive effect.

The aim of the present study was to evaluate the long-term results of a systematic fissure sealing programme of the occlusal surfaces of newly erupted permanent first molars. All 15-year-olds (n=815) who had been regularly treated at seven Public Dental Service clinics in Jönköping County, Sweden, since the eruption of their permanent first molars participated in the study. Data on fissure sealing and restorative treatment were extracted from the dental records of the patients. When the patients were 15 years of age, it was found that 6% of the original 2456 sealed occlusal permanent first molars had received Class II restorations. Seventy-eight per cent of the remaining 2322 sealed occlusal surfaces were judged to be caries-free by the child's ordinary dentist. This long-term retrospective study indicates that a structured fissure sealing programme is of great benefit for oral health.

The aims of the present investigation were: (i) to study the release of fluoride from a resin-modified glass ionomer cement (Vitremer) after exposing ("recharging") the material with NaF toothpastes and NaF solutions with different fluoride concentrations, and (ii) to study the effect of covering the material with a sealant layer (glaze) in this respect. Totally 160 specimens were made, which were placed in water for 13 weeks to receive a low fluoride release value. The specimens were then randomly divided into 10 groups with 16 discs each. Five of the groups were exposed once a day for 7 days to one of the following fluoride agents: 0.05, 0.2 or 2% NaF solutions and slurries of two NaF toothpastes (Acta and Pepsodent). The other five groups received the same treatment twice a day. All treatments had a recharging effect. However, the 2% NaF solution resulted in significantly more fluoride release than the other solutions and toothpastes. Treatment twice a day gave higher total release than once a day, but the difference were only significant for the 0.2 and 2% NaF solutions. With glaze material covering the specimens, almost no fluoride release was observed. However, when the glaze was removed, a burst of fluoride occurred.

Objective: To study the intake of sweet foods in obese and normal-weight women, while also taking menstrual cycle effects on eating behaviour into consideration. An objective test of the intake of sugar-containing foods was introduced by measuring salivary counts of mutans streptococci and lactobacilli. Design: A cross-sectional comparison of the intake of sweet foods in obese and normal-weight women. The obese women were also studied longitudinally after 10 weeks in a weight reduction programme. Subjects: Obese (n=72, body mass index (BMI) 42.0±5.2 kg/m2) and normal-weight women (n=67, BMI 22.2±1.6 kg/m2) participated. Results: Mutans streptococci in saliva were higher in obese than in normal-weight women (P

The aim of this study was to investigate attitudes to and experiences of dental care in a population, born 1942. The following items were studied: opinions of general and oral health, attitudes to and experiences of dental care, dental care habits, experiences of latest visit to a dentist, tobacco habits and use of various dental hygiene articles. A cross-sectional mail questionnaire was sent in 1992 to all 50-year-olds in two Swedish counties, Orebro and Ostergotland, totally 8888 persons; the response rate was 71%. Of the population 89%, indicated good health. Satisfaction with dental care was high, 94%. 26% stated attendance to a dentist twice or more per year, and 64% at least once a year. As to expenses, 78% paid less than 1000 SEK the last year. Concerning the latest visit, 38% reported painless treatment, 37% no inconvenience, and 55% good care. The duration of the latest visit included on an average 27 min in travel time, 7 min in waiting time and 27 min in treatment time. Information about oral hygiene was given to 29% and about cost for treatment to 47% of the interviewed. There were 28% daily smokers. Snuff was daily used by 10% of the males. Toothbrushing twice a day with fluoride toothpaste seemed to be the standard oral hygiene procedure and was reported by 80% of the respondents.

Clinical studies have shown conflicting results for the reduction of approximal caries when chlorhexidine gel has been applied either in trays or by flossing. To investigate whether these modes of treatment affect the colonization of mutans streptococci (MS) differently, we quantified MS in saliva and on various tooth surfaces before and after a single chlorhexidine gel application. Twenty-one schoolchildren (15-16 yr old), with high numbers of salivary MS, were randomised into three groups. The subjects were treated with a 1% chlorhexidine gel applied either by: 1) interdental flossing; 2) individually designed mouth trays; or 3) a combination of polishing and flossing. Analysis of saliva and of dental plaque from 12 sites over an 8-wk period showed a greater reduction of both salivary MS counts and total number of colonised sites in the tray group than in the flossing group. The effect on MS in the polishing-flossing group approached that obtained in the tray group. In the interdental areas, more sites had no detectable MS (score 0) after tray treatment than after flossing, whereas the reduction of heavily colonised sites (scores 3+/-4) was higher in the flossing group. The reappearance of sites with score 3+/-4 after the gel treatment was more rapid in the flossing group than in the other two groups. In conclusion, the results showed a transient reduction of MS colonisation by all three methods, and that the application of the chlorhexidine gel both in mouth trays or as a combination of polishing and flossing was more effective in reducing the MS population than flossing alone.

The present study focused on the type of restorative material used and the reasons for replacements of restorations in the primary and the young permanent dentition. All patients with restorations and who were 8 and 19 years of age in 1995 and were regularly treated at 11 Public Dental Health clinics in Jönköping County, Sweden, participated in the study. Data were extracted from the records for all types of restorations in canines and molars for the preceeding of 5 years for the 8-year-olds (i.e. from 3 to 8 years of age; n = 546) and for approximal restorations in premolars and molars for the preceeding 13 years for the 19-year-olds (i.e. from 6 to 19 years of age; n = 606). In all, 6012 restorations were evaluated. The two most common restorative materials used in the primary dentition were compomer and glass ionomer cement and in the young permanent dentition composite and amalgam. In the primary dentition, 29% of the restorations had been replaced and 4% of the teeth with restorations had been extracted. Thus, 33% of the restorations in the primary dentition failed. The corresponding figure for the young permanent dentition was 13%. The most common reason for replacements in the permanent dentition was secondary caries. That restorations often fail because of caries and that the development of secondary caries is not prevented by replacement of an old restoration indicate that more attention should be paid to preventive dental care for patients with restorations in the primary as well as in the young permanent dentition.

The concentration of glucose in parotid saliva was measured after glucose/food intake in two separate studies (A and B). In Study A, 10 subjects with impaired glucose tolerance (IGT), 10 subjects with newly diagnosed Type 2 diabetes and 12 healthy controls were included. Study B comprised 15 subjects with Type 1 or Type 2 diabetes on insulin treatment, nine subjects with Type 2 diabetes on treatment with oral antidiabetic drugs and 12 healthy controls. After a 10-h overnight fast, the participants in Study A were given a 75 g oral glucose load, while those in Study B received a standardized breakfast. Citric acid-stimulated parotid saliva was collected up to two hours after the intake. Capillary blood and gingival exudate samples were also taken. On the basis of AUC values (area under the curve over baseline), the glucose concentration in parotid saliva increased significantly in individuals with IGT and Type 2 diabetes compared with controls in Study A and in diabetic patients on treatment with insulin and oral antidiabetic drugs compared with controls in Study B. No effect by the glucose/food intake on the glucose concentration in gingival exudate could be demonstrated in any of the studies. The correlation coefficient between the AUC values of glucose in saliva and blood, when all three groups were combined, was 0.38 in Study A and 0.52 in Study B. It is concluded that the concentration of glucose in parotid saliva is elevated at least 2 h after glucose/food intake in individuals with both IGT and manifest diabetes mellitus.

The aim of this work was to study the fluoride (F) concentration in the approximal area after using toothpicks and other F-containing products. The exposure time was standardised to 2 min. 24 subjects participated, divided into 4 groups, with 6 individuals per group. In 3 of the groups, the following 4 products were compared: (1) a toothpick impregnated in 4% NaF; (2) a dentifrice containing 0.32% NaF; (3) a mouthrinse solution containing 0.025% NaF; (4) a tablet containing 0.55 mg NaF. In the 4th group, 3 commercial F toothpicks and 2 F dental flosses were compared. In all 4 groups, the F concentration was determined up to 60 min at 4 approximal sites. On each sampling occasion, 3 triangle-shaped paper points were used, absorbing 3 x 1 microl. In general, the toothpick gave similar or somewhat higher F concentrations in the approximal area than the dentifrice, mouthrinse solution and tablet. Comparing the various commercial toothpicks and dental flosses, 2 of the toothpicks gave higher approximal F concentrations than the other 3 products. When comparing the series in which the very first sample was collected from 2-20 min after the F treatment, it was found that the sampling procedure itself reduced the subsequent approximal F concentration. The main conclusion from this study is that an F-impregnated toothpick is a promising vehicle for delivery of fluoride to the approximal area.

The aim of this study was to follow changes in saliva and serum after strenous prolonged exercise. Twenty individuals, three women and 17 men, 24-62 years old, well-trained but not at elite level, participating in the Stockholm Marathon, were selected for the study. Two of the subjects broke the race after 20 km. Three samples of saliva were collected, i.e. (i) just before the race, (ii) directly after the race, and (iii) 1 h after the race. Paraffin-stimulated whole saliva, resting non-stimulated whole saliva and citric acid-stimulated parotid saliva were investigated. In all three types of saliva, there was a decrease in secretion rate and only 14 of the 18 participants could produce resting non-stimulated whole saliva directly after the race. The salivary concentration of chloride, phosphate, potassium, amylase, hexosamine, sialic acid and salivary peroxidase were significantly higher after than before the race. There were no significant changes in salivary pH and buffer capacity. The total protein concentration was increased in all types of saliva after the race. To conclude, there were several changes in the saliva composition just after the marathon, but most of the values were back to baseline after 1 h of rest. However, the values for sodium, calcium, phosphate, salivary peroxidase, amylase and salivary IgA were still elevated 1 h after the race.

The aim of the present investigation was to study the effect of combined application of a fluoride varnish (Fluor Protector) and an antimicrobial varnish (Cervitec) on the oral microflora, caries and gingival condition in patients receiving treatment with fixed orthodontic appliances. A total of 198 individuals (12 to 15 years old), scheduled for fixed orthodontic treatment, were randomized into 2 groups. Prior to bonding, the Cervitec and the control group received one application with Cervitec or a placebo every week for 3 weeks, respectively. In the Cervitec group. Fluor Protector was applied at bonding and Cervitec at the next visit, 6 weeks later. Each varnish was then applied every 12 weeks for 24 weeks. In the control group, the fluoride varnish was applied only at bonding and every 12 weeks. The Visible Plaque Index (VPI), the Gingival Bleeding Index (GBI), the White Spot Lesion Index (WSL) and the level of mutans streptococci in plaque and saliva were recorded 3 weeks prior to bonding and after 24 weeks. At bonding and after 12 weeks, only VPI, GPI, plaque and salivary mutans streptococcus counts were recorded. During the 3-week prebonding period, the mean VPI, GBI and mutans streptococci in plaque decreased in both groups. At bonding, the mean level of mutans streptococci in plaque was significantly lower in the Cervitec group than in the control group. The mean level of mutans streptococci was significantly lower after 12 weeks' bonding in the Cervitec group than in the control group. No effects on the other parameters were found during the 24 weeks.

Acid production by washed suspensions of human strains of Streptococcus mutans (n = 18) and Streptococcus sobrinus (n = 12) was measured. The strains were isolated from infants and adolescents with varying caries experience. Some of these strains and two laboratory strains (1 S. mutans and 1 S. sobrinus) had been tested in an earlier study for their cariogenicity in hamsters. Further, 3 Streptococcus sanguis strains and 1 S. sobrinus laboratory strain were included. Acid production was determined in repeated titration experiments at a constant pH of 5.5. Higher mean acid production activities (p < 0.05) were obtained by S. sobrinus compared with both S. mutans and S. sanguis. However, large variations among the strains were found both between and within the species. No clear relationship was found between the glycolytic activity of strains and the caries prevalence of the children from whom the strains had been isolated or the caries scores in a hamster model. In conclusion, although both S. mutans and S. sobrinus have aciduric and acidogenic properties, it is difficult to relate the acid production activity of pure cultures in vitro to the caries process in vivo.

A 3-year, double-blind caries trial was conducted to evaluate the caries-reducing effect of a modified technique to use toothpaste. At the outset, 369 children, 4 years of age, were randomly assigned to four groups. At the end of the study, when the children were 7 years old, 281 (76%) had completed the trial. Two of the groups (test groups, n = 131) were given the following instructions regarding 'toothpaste technique': (1) to spread the paste evenly on the teeth prior to brushing, (2) not to expectorate more than necessary during brushing, (3) to filter the remaining dentifrice foam in the dentition, together with a sip of water, by active cheek movements for 1 min before expectorating, and (4) not to carry out any further water rinsings afterwards, and not to eat or drink for 2 h after brushing. The children in the other two groups (control groups, n = 150) were not given any instruction how to use the dentifrice and how to rinse after the brushing, but were, as the children in the test groups, encouraged to use the test dentifrice and to brush their teeth twice daily. Two commercial fluoride dentifrices (A and B) were compared: one of the test groups and one of the control groups used each product. Approximal carious lesions were scored on bite-wing radiographs at baseline and at the end of the study on the distal surface of the first and on the mesial surface of the second primary molars. No difference in caries increment was found between toothpastes A and B. The children in the two test groups developed a mean of 1.14 new dfs during the 3 years compared to 1.55 in the two control groups (p0.05). Thus, the results indicate that the modified toothpaste technique reduced approximal caries in preschool children by an average of 26%.

The effects of this long-term dietary change on secretion rate, buffer capacity, concentration of sodium and potassium and amylase activity of stimulated parotid and whole saliva was studied in 20 healthy, normal-weight, non-smoking omnivores. Salivary counts of mutans streptococci and lactobacilli were also made. Dietary surveys were carried out and saliva samples collected before (baseline) and 3, 6 and 12 months after the dietary change as well as 3 yr after the end of the lactovegetarian diet period. The dietary data showed an increase in the consumption of fruits, vegetables and dairy products and a decrease in meat, fish, eggs, sweets and biscuits. These changes led to an increased intake of carbohydrates, fibre and water. After 12 months on the vegetarian diet, the secretion rate, buffer capacity and sodium concentration of whole saliva and the secretion rate of parotid saliva had increased significantly. At the 3-yr follow-up, the buffer capacity and sodium concentration were still elevated, while the secretion rate had almost returned to the baseline values. The potassium content of whole saliva showed a tendency to increase during the vegetarian diet period, but had decreased again at the 3-yr follow-up.

The aim of this pilot study was to evaluate an individual programme for speeding up prolonged oral sugar clearance in hospitalised elderly patients. Six patients at a university hospital for geriatric medicine, aged 67-85 years, completed a 6-week study. Every second week one of the authors gave: 1) information on the importance of oral sugar clearance for oral health, 2) instruction in oral hygiene, and 3) professional tooth cleaning. Moreover, the staff responsible for each patient provided 1) massage and training of the lips, cheeks and tongue shortly before each main meal, 3 times daily, 2) supervision of chewing on a sugar-free chewing gum for at least 20 min, 4 times daily, and 3) support and encouragement of the patients throughout the day. Salivary glucose clearance was measured both sublingually and vestibularly in the lower jaw after chewing a glucose tablet and after a mouth rinse with 10% glucose solution. There was a clear tendency that the oral sugar clearance was reduced after the 6-week period and some of the reductions in the clearance variables were statistically significant. All patients, especially those suffering from cerebral haemorrhage, reported an improved ability to chew while proceeding with the programme, which was also confirmed by the staff. The main conclusion from this pilot study is therefore that it might be possible to speed up prolonged oral sugar clearance in elderly hospitalised patients using an individual training programme.

Dental health and dietary habits were surveyed in 40 Greek immigrant (GI) children, 2-8 years old, born and living in Helsingborg, Sweden; comparisons were made with 45 Swedish (S) and 54 rural Greek (G) children of the same age. The caries situation was virtually the same in the GI and the S group, where the primary teeth were caries-free in 31-33%, mainly children 2-3 years old. The G group had a higher incidence of decayed and filled tooth surfaces in both primary and permanent teeth than the other two groups and only 15% were caries-free in the primary teeth. The S group had the lowest gingival bleeding index. The distribution of the mutans streptococci and lactobacilli counts in saliva did not differ significantly between the three groups, except that the proportion of GI children with "not detectable" mutans streptococci was lower in either the S or the G group. The toothbrushing frequency was highest in the S group, followed by the GI group. Approximately 80% of the S children who brushed their teeth used a fluoride toothpaste compared to 50 and 55% respectively in the G and the GI group. The intake frequency for 5 out of 6 preselected snack-food items was highest in the G group. The carbohydrate content of the diet, including sucrose, was approximately the same in the three groups. Thus, the dental health and dietary habits of the Greek immigrant and the Swedish children were generally very similar, while the Greek rural children showed a less favourable cariological status.

Secondary caries lesions were produced in vitro by immersing human tooth-blocks with amalgam restorations every third day for 4 weeks in glucose- or sucrose-containing broth inoculated with a strain of Streptococcus mutans. The lesions at the cavity walls were related to various standardized micro-spaces (0, 30, 40, 60 and 80 microns) around the restorations. When a thick, sucrose induced layer of plaque covered the margin, dentine caries was found in all cases where a gap was present (30 microns or more). In the presence of a thin, glucose induced layer of plaque, dentine caries was detected only in the specimens with 60 and 80 microns gap-widths. Caries lesions were detected on the outer free enamel surfaces in all specimens. Lesions in the enamel of the cavity walls were observed with polarized light in 46% in the presence of sucrose- and in 21% in the presence of glucose-induced plaque.

In 76 adults, randomly distributed between two groups, a comparison was made of the effect on the level of mutans streptococci in saliva between two dentifrices containing: (1) xylitol (9.9%) and glycerol (20%) or (2) sorbitol (28%) as humectants. After the use of the dentifrices twice daily for 3 months, the levels of mutans streptococci had not changed significantly in the sorbitol-treated group, whereas a significant reduction (p less than 0.0005) was found in subjects using the xylitol/glycerol dentifrice. The difference between the two dentifrice groups based on the changes observed during the 3-month period was also significant (p less than 0.02).

The aim of this study was to analyze a number of microbial, salivary, and dietary factors in patients with clinically active and inactive root caries. 147 patients, aged 30-78 years, referred for specialist treatment of periodontal disease, were randomly selected. 645 decayed and 539 filled root surfaces were found. Out of the carious lesions, 372 (58%) were recorded as clinically active and 273 (42%) as inactive. 30 patients showed no lesions (group 1), 46 had only fillings or inactive lesions (group 2), and 35 showed 1-2 (group 3) and 36 greater than or equal to 3 active lesions (group 4). The lactobacillus count differed significantly between all groups, except group 1 vs. 2, and the mutans streptococcus count between groups 1 vs. 4 and 2 vs. 3 and 4. Group 4 differed in plaque score from the other groups, and the salivary buffer effect differed between the inactive groups 1 and 2 and the active group 4. By stepwise multiple regression analysis, it was shown that lactobacillus count, plaque index, salivary buffer effect, dietary habit index, and number of exposed root surfaces contributed significantly to the coefficient of determination.

During the last decade the prevalence of dental caries in children, teenagers and young adults has declined substantially in most industrialised countries. This has led to an increasing proportion of caries-free individuals and to improved dental health. However, recent epidemiological data show that caries continues to be a problem in adult populations, where about 10–15% may still be considered at high risk of caries.

Since dental caries is associated with frequent use of sugar-containing products and since there is a potential risk for such a consumption among sportsmen, we conducted a clinical study of a group (n = 30) of 17-30-year old elite soccer players, including DFS and various caries-related factors, such as plaque index, numbers of cariogenic microorganisms in saliva and sugar intake frequency. Each player was asked to identify one friend of the same age, sex and social background but not active in any sport (n = 28). The mean values for DFS, plaque index, mutans streptococci and lactobacilli were less favourable for the players, but none of the differences were statistically significant, except for the dietary score (p less than 0.05). Thus, soccer players on an elite level seem to have a somewhat higher risk to develop dental caries than nonplayers. However, their regular use of fluoride-containing toothpaste probably to some part compensates for this increased risk.