Immediate and Sustained Root Caries Prevention of Fluoride Varnish Combined with Toothpastes.

The aim of this study was to determine the immediate and sustained effect of a fluoride varnish and its combinations with toothpastes in preventing root caries development using a salivary microcosm in vitro model. Human root dentin specimens (n = 150) were randomly divided into 5 experimental protocols (n = 30): (1) Fluoride Varnish (V); (2) V followed by Paste One (V + PO); (3) V followed by Paste Plus (V + PP); (4) V followed by PO and PP (V + PO + PP); and (5) No treatment (control). One varnish layer was applied on the specimens (except for the control group) and kept for 18 h. Then, the varnish was removed and toothpaste treatments were initiated according to experimental groups. For the short-term incubation model (n = 15), the specimens were also immediately subjected to 7-day cariogenic challenge. For that, human saliva was used as bacterial inoculum and McBain artificial saliva containing 2% sucrose as growth medium. The other half of the specimens (n = 15) were used to study the varnish's sustained effect by long-term incubation (8 weeks) before cariogenic challenge. The protocols' anti-caries properties were evaluated by dentin porosity (rhodamine intensity; RI) and mineral density, while their anti-biofilm effects were evaluated using biofilm's biomass and viability assays. For short- and long-term incubation models, all experimental regimens resulted in statistically significant decreases (p < 0.05) in the RI (up to 180 µm and 120 µm, respectively) as well as higher mineral density compared to No treatment (p < 0.001). V + PO + PP and/or V + PO resulted in statistically lower RI compared to V for some depths (p < 0.05) in both models. There were changes in RI and mineral density within groups over time. All experimental treatments exhibited anti-biofilm effects. All prevention protocols exhibited immediate and sustained anti-caries effect against root caries development. The combination of a fluoride varnish with PO resulted in superior additional anti-caries effects.

Effect of a single application of silver diamine fluoride on root caries after 12 months in institutionalised older adults-A randomised clinical trial.

OBJECTIVE: Silver diamine fluoride (SDF) has been shown to be highly effective against caries, in particular for arresting root surface caries and for dentine caries in primary teeth. SDF may complement fluoride varnish routines for treatment of root caries in nursing home residents. The aim of this randomised, single-blinded, placebo-controlled trial was to evaluate the additive effect of a single annual application of SDF for prevention and treatment of incipient root caries in older adult nursing home residents. METHOD: Four hundred older adult nursing home residents (≥70 years old) with at least one exposed root surface (on teeth 15, 14, 13, 23, 24, or 25) were identified during routine dental examination visits in the domiciliary dental care setting. Eligible patients, who were able to understand the implication of consenting to the study, were invited to participate. Their cleaned root surfaces were randomly allocated to treatment with SDF (Advantage Arrest Silver Diamine Fluoride 38%, Advantage Arrest, LLC, Redmond, OR 97756, USA, Lot 16 152) or with placebo (tap water), each for 1 minute. RESULTS: Of the 400 eligible individuals, 42 declined to participate and two forms were destroyed. The remaining 356 participants (89.0%; mean age 87.7 years) were randomly allocated, with 174 going to the SDF group and 182 to the placebo group. At 1 year, 273 participants (76.7%) were available for assessment: 135 in the SDF group and 138 in the placebo group. By that time, 109 individuals (39.9%) demonstrated root caries progression or regression. Among those 118 (16.7%) of the 708 included root surfaces had developed caries There were no statistically significant differences in the primary outcome related to treatment with SDF or placebo, at either patient or root surface level. CONCLUSION: Based on the finding of this clinical trial, it is concluded that a single SDF application to complement a risk-based preventive programme including fluoride varnish applications did not have a statistically significant additional preventive effect on root caries development in a group of older adult nursing home residents with limited caries activity and cognitive capacity to cooperate in oral care activities.

Development of a Root Caries Prediction Model in a Population of Dental Attenders.

Root caries prevalence is increasing as populations age and retain more of their natural dentition. However, there is generally no accepted practice to identify individuals at risk of disease. There is a need for the development of a root caries prediction model to support clinicians to guide targeted prevention strategies. The aim of this study was to develop a prediction model for root caries in a population of regular dental attenders. Clinical and patient-reported predictors were collected at baseline by routine clinical examination and patient questionnaires. Clinical examinations were conducted at the 4-year timepoint by trained outcome assessors blind to baseline data to record root caries data at two thresholds - root caries present on any teeth (RC > 0) and root caries present on three or more teeth (RC ≥ 3). Multiple logistic regression analyses were performed with the number of participants with root caries at each outcome threshold utilized as the outcome and baseline predictors as the candidate predictors. An automatic backwards elimination process was conducted to select predictors for the final model at each threshold. The sensitivity, specificity, and c-statistic of each model's performance was assessed. A total of 1,432 patient participants were included within this prediction model, with 324 (22.6%) presenting with at least one root caries lesion, and 97 (6.8%) with lesions on three or more teeth. The final prediction model at the RC >0 threshold included increasing age, having ≥9 restored teeth at baseline, smoking, lack of knowledge of spitting toothpaste without rinsing following toothbrushing, decreasing dental anxiety, and worsening OHRQoL. The model sensitivity was 71.4%, specificity 69.5%, and c-statistic 0.79 (95% CI: 0.76, 0.81). The predictors included in the final prediction model at the RC ≥ 3 threshold included increasing age, smoking, and lack of knowledge of spitting toothpaste without rinsing following toothbrushing. The model sensitivity was 76.5%, specificity 73.6%, and c-statistic 0.81 (95% CI: 0.77, 0.86). To the authors' knowledge, this is the largest published root caries prediction model, with statistics indicating good model fit and providing confidence in its robustness. The performance of the risk model indicates that adults at risk of developing root caries can be accurately identified, with superior performance in the identification of adults at risk of multiple lesions.

How do carious root lesions develop after the end of professional preventive measures?-Preliminary findings of a randomized clinical trial.

Aim of this randomized clinical trial was to assess the development of root caries lesions with and without (adjuvant) professional prevention treatment over 24 months. 20 participants with two or three non-cavitated root carious lesions were included (n = 52), whereby lesions were randomly assigned to one out of three groups depending on varnish application (CF: Cervitec F [n = 20], P: placebo [n = 20], DP: Duraphate [n = 12]). All lesions were assessed by quantitative light-induced fluorescence (QLF; QRayCam); following outcome parameters were analyzed: fluorescence loss (ΔF %), lesion volume (ΔQ %µm2) and bacterial activity (ΔR %). Professional tooth cleaning and adjuvant varnish application were performed at baseline, after 3, 6, and 9 months. A follow-up examination was performed 1 year after preventive care with varnish application 24 months after baseline. ∆F showed a significant time effect in CF (p = 0.03), which was not confirmed in post hoc analysis (p > 0.05). For P and DP, no time effect was detected (p > 0.05). ∆Q was significantly higher 12 months after baseline in CF (p = 0.02). In P, a significant time effect occurred (p = 0.01), without significant results in post hoc testing. ∆R showed higher values at baseline vs. 12 months in CF (p = 0.03) and 24 months compared to 12 months in DP (p = 0.02). Professional preventive treatment inhibited the progression of root caries lesions beyond their termination for 12 months, irrespective of an adjunctive varnish application. Preventive measures have a long-term effect on root carious lesions, even 1 year after their termination.

Reversal of Root Caries with Casein Phosphopeptide-Amorphous Calcium Phosphate and Fluoride Varnish in Xerostomia.

Different formulas of topical fluoride have been used to manage root carious lesions. This clinical trial aimed to investigate the efficacy of a dental varnish containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride compared with fluoride alone in reversing/arresting root caries in xerostomic patients over 1 year. A total of 80 patients (age range 45-92 years) with primary root caries (n = 184 root carious lesions) and unstimulated salivary flow rate of <0.2 mL/min were randomly allocated to receive either dental varnish containing CPP-ACP and 5% fluoride (group 1: MI varnish; GC, Japan) (n = 41, 83 lesions), or dental varnish with 5% fluoride alone (group 2: NUPRO White; Dentsply, USA) (n = 39, 101 lesions). Clinical assessments with Severity Index (SI) for root caries, DIAGNOdent measurements, and varnish application were carried out at baseline, 3, 6, and 12 months. Standard oral hygiene instructions with 1,450 ppm fluoride toothpastes were provided for both groups. After 3 months, 63.9% (n = 46) of root caries in group 1 became hard (SI: 0) compared with 39.3% (n = 35) in group 2 (p < 0.01). After 6 and 12 months, the differences in SI were insignificant (group 1, n = 60, 83.3%) (group 2, n = 66, 74.2%) (p = 0.36), and (group 1, n = 60, 89.6%) (group 2, n = 67, 81.7%, n = 1 soft, 1.2%) (p = 0.29), respectively. In both groups, noncavitated leathery lesions were more likely to become hard when compared to the cavitated root caries. A significant decrease in plaque index, surface roughness, lesion dimension, and DIAGNOdent readings with a significant increase in lesion distance from the gingival margin was reported in both groups (p < 0.05). This study has provided evidence that fluoride dental varnish either with or without calcium and phosphate has the potential to arrest/reverse root caries, especially noncavitated lesions for patients with xerostomia.

Dental caries and periodontal diseases in the ageing population: call to action to protect and enhance oral health and well-being as an essential component of healthy ageing - Consensus report of group 4 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases.

BACKGROUND: Over the last two decades, progress in prevention and treatment of caries and periodontal diseases has been translated to better oral health and improved tooth retention in the adult population. The ageing population and the increasing expectations of good oral health-related quality of life in older age pose formidable challenges to clinical care and healthcare systems. AIMS: The objective of this workshop was to critically review scientific evidence and develop specific recommendations to: (i) prevent tooth loss and retain oral function through prevention and treatment of caries and periodontal diseases later in life and (ii) increase awareness of the health benefits of oral health as an essential component of healthy ageing. METHODS: Discussions were initiated by three systematic reviews covering aspects of epidemiology of caries and periodontal diseases in elders, the impact of senescence on caries and periodontal diseases and the effectiveness of interventions. Recommendations were developed based on evidence from the systematic reviews and expert opinion. RESULTS: Key messages included: (i) the ageing population, trends in risk factors and improved tooth retention point towards an expected increase in the total burden of disease posed by caries and periodontal diseases in the older population; (ii) specific surveillance is required to monitor changes in oral health in the older population; (iii) senescence impacts oral health including periodontitis and possibly caries susceptibility; (iv) evidence indicates that caries and periodontal diseases can be prevented and treated also in older adults; (v) oral health and functional tooth retention later in life provides benefits both in terms of oral and general quality of life and in terms of preventing physical decline and dependency by fostering a healthy diet; (vi) oral healthcare professionals and individuals should not base decisions impacting tooth retention on chronological age but on level of dependency, life expectancy, frailty, comfort and quality of life; and (vii) health policy should remove barriers to oral health care for vulnerable elders. CONCLUSIONS: Consensus was reached on specific actionable priorities for public health officials, oral healthcare professionals, educators and workforce planners, caregivers and relatives as well as for the public and ageing patients. Some priorities have major implications for policymakers as health systems need to adapt to the challenge by systemwide changes to enable (promote) tooth retention later in life and management of deteriorating oral health in increasingly dependent elders.

Effectiveness of fluorides in root caries prevention, Department of Veterans Affairs (2009-2018).

AIMS: The aim of this study was to examine the effectiveness of topical fluorides in prevention of root caries-related treatment in high caries risk Veterans. METHODS: This retrospective analysis of longitudinal data examined the effectiveness of professionally applied or prescription (Rx) fluoride treatment, in VHA clinics from FY 2009-2018. Professional fluoride treatments included 5% Sodium Fluoride (NaF) varnish (22 600 ppm fluoride), 2% NaF gel/rinse (9050 ppm fluoride), and 1.23% APF gel (12 300 ppm fluoride). The Rx for daily home use was 1.1% NaF paste/gel (5000 ppm fluoride). Outcomes studied were new root caries restorations or extractions and percent of patients with treatment over 1 year. Logistic regressions were adjusted for age, gender, race, ethnicity, chronic medical or psychiatric conditions, number of medication classes, anticholinergic drugs, smoking, baseline root caries treatment, preventive care, and time between first-last restoration in the index year. RESULTS: Root caries at baseline was associated with a high risk for new root caries. Veterans without root caries during the index year who received a fluoride gel/rinse intervention were 32-40% less likely to receive caries-related treatment for root caries during the follow-up period. Once Veterans had root caries, fluorides did not exhibit a positive effect. CONCLUSION: In older adults with high caries risk, early fluoride prevention is key, before root caries requires treatment.

Analyzing the anti-caries effect of fluoride varnish containing tricalcium phosphate using PIXE/PIGE.

This study evaluated the effect of tricalcium phosphate-containing fluoride varnish on the prevention of root caries using an in-air micro-proton induced X-ray/gamma-ray emission system and microcomputed tomography. Either fluoride varnish (FV) or tricalcium phosphate-containing fluoride varnish (WV) was applied to root dentin, whereas dentin without varnish were considered controls. After immersion in saline, dentin sections were prepared, and concentration of fluoride ion was measured. These specimens were demineralized, and the mineral loss was measured. Caries inhibition in sound and demineralized dentin was observed in both FV and WV groups compared to the control group. Significantly low mineral loss was found especially in the demineralized dentin, which is probably due to the combination effect of calcium and fluoride ions at a concentration range of 100,000 ppm, as supplied by the varnish. The use of calcium-containing fluoride varnish, especially in demineralized dentin, is effective in arresting initial dentin caries.

[Prevention and treatment of root surface caries].

With the acceleration of population aging in China, the incidence of root surface caries is increasing year by year. Different from coronal caries, lesions of root surface caries mostly occur on the exposed root surfaces after gingival recession in elderly patients, mainly involving cementum and dentin. Root surface caries shows specificity in the pathogenic characteristics, clinical manifestations, diagnosis, treatment, and prevention. This review mainly summarizes the etiology and prevalence, pathology and clinical manifestations, classification, as well as three-level-prevention of root caries, in order to provide relevant guidance for the clinical prevention and treatment of root caries.

Antibacterial and remineralizing nanocomposite inhibit root caries biofilms and protect root dentin hardness at the margins.

OBJECTIVES: Senior patients have a high incidence of tooth root caries. The objectives of this study were to: (1) develop a bioactive composite with calcium (Ca) and phosphate (P) ion-release and antibacterial capabilities via nanoparticles of amorphous calcium phosphate (NACP) and dimethylaminohexadecyl methacrylate (DMAHDM); (2) inhibit root biofilms of Streptococcus mutans, Lactobacillus acidophilus and Candida albicans in a biofilm-based recurrent root caries model to protect root dentin hardness under biofilms for the first time. METHODS: Five groups were tested: (1) Heliomolar nanocomposite (Commercial control); (2) Experimental composite control (0% NACP, 0% DMAHDM); (3) Remineralizing composite (30% NACP); (4) Antibacterial composite (3% DMAHDM); (5) Remineralizing and antibacterial composite (NACP + DMAHDM). Colony-forming units (CFU), lactic acid and polysaccharide of biofilms were evaluated. Demineralization of bovine root dentin with restorations was induced via multi-species biofilms, and root dentin hardness was measured. RESULTS: Adding NACP and DMAHDM into composite did not compromise the mechanical properties (p >  0.05). Biofilm lactic acid, polysaccharides and CFU were greatly reduced via DMAHDM (p < 0.05). Ca and P ion releases were substantially increased at cariogenic low pH. With multi-species biofilm acid attack, root dentin hardness (GPa) decreased to 0.12 ± 0.03 for Commercial control, and 0.11 ± 0.03 for Experimental control. Root dentin hardness was 0.20 ± 0.04 for NACP group, 0.21 ± 0.04 for DMAHDM group, and 0.30 ± 0.03 for NACP + DMAHDM group which was more than 2-fold that of control groups (p < 0.05). CONCLUSIONS: The novel NACP + DMAHDM nanocomposite had strong antibacterial effects and Ca and P ion release. When tested in a multi-species recurrent root caries model, NACP + DMAHDM nanocomposite substantially reduced root dentin demineralization and protected dentin hardness around the restorations under biofilms. Therefore, this novel bioactive composite is promising to inhibit root caries and protect tooth structures.

Manejo de cárie radicular: um guia para o dentista brasileiro baseado na tradução e adaptação cultural do consenso internacional/ORCA E EFCD / Management of root caries: a guide for the Brazilian dentist based on the translation and cultural adaptation of the international consensus/ORCA and EFCD

Objetivo: A cárie radicular é um problema da Odontologia moderna, porém é notável a falta de diretrizes sobre o seu manejo. Objetivamos elaborar e adaptar um guia a partir da tradução das recomendações do consenso in-ternacional European Organization for Caries Research (ORCA) e European Federation of Conservative Dentistry (EFCD) para as tomadas de decisão clínica na intervenção do processo de cárie na pessoa idosa, com foco na cárie radicular. Materiais e métodos: O protocolo de tradução das recomendações do consenso internacional consistiu nas etapas: (1) tradução inicial, (2) síntese da tradução, (3) retradução, (4) revisão por comitê de especialistas, com adaptação cultural. A partir da tradução, foi desenvolvido um guia com diretrizes para tratamento de cárie radicular no Brasil. Resultados: Para prevenção de novas lesões é recomendada a escovação diária com dentifrício >1.500ppm/F. Dentifrícios com 5.000ppm/F ou vernizes (>20.000ppm/F) podem ser indicados para paralisar lesões radiculares ativas e para prevenção em pessoas idosas com alta suscetibilidade à cárie radicular, e o Diamino Fluoreto de Prata (>30%) para paralisar lesões ativas. Intervenções invasi-vas diretas são indicadas dependendo da situação clínica. Discussão: Nota-se uma falta de interesse em estudos primários sobre tratamentos para cárie radicular, criando assim uma lacuna em relação ao seu manejo, que reflete no nível de evidência detectado pelo consenso. Conclusão: Guias clíni-cos são importantes para reduzir a lacuna entre a pesquisa e a prática clínica. Essa tradução para o português facilitará o acesso dos dentistas bra-sileiros em relação a evidência consolidada até o momento para o manejo de cárie radicular.

Aim: Root caries are a problem in modern dentistry, but the lack of guidelines regarding their management is notable. We aim to develop and adapt a guide based on the translation of the recommendations of the international consensus as outlined by the European Organization for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD) for clinical decision-making in the intervention of the caries process in the elderly, with a focus on root caries. Materials and methods: The protocol for translating the recommendations of the international consensus consisted of the following steps: (1) initial translation, (2) synthesis of the translation, (3) back-translation, (4) review by an expert committee with cultural adaptation. Based on the translation, a guide was developed with guidelines for the treatment of root caries in Brazil. Results: To prevent new lesions, daily brushing with toothpaste >1,500ppm/F is recommended. Toothpaste with 5,000ppm/F or varnishes (>20,000ppm/F) may be recommended to paralyze active root lesions and for prevention in elderly people with high susceptibility to root caries, and Silver Diamine Fluoride (>30%) to paralyze active lesions. Direct invasive interventions are indicated depending on the clinical situation. Discussion: There is a lack of interest in primary studies on treatments for root caries, thus creating a gap in relation to its management, which is reflected by the level of evidence detected in the consensus. Conclusion: Clinical guidelines are important to reduce the gap between research and clinical practice. This translation into Portuguese will facilitate access by Brazilian dentists to the consolidated evidence gathered to date for the management of root caries.

Terapias no Invasivas en base a fluoruros de alta concentración para lesiones de caries radicular / Non-invasive therapies based on high fluoride concentration for root caries lesions

La mayor expectativa de vida de la población mundial ha llevado a una mayor conservación dentaria y como consecuencia, a una mayor prevalencia de caries radicular en la población mayor. La información epidemiológica ha mostrado que el enfoque invasivo de la odontología restauradora no ha sido capaz de dar una solución a esta problemática de salud pública. El enfoque de la Minimal Intervention Dentistry (MID), a través de las terapias no invasivas (TNIs) en base a fluoruros de alta concentración, podrían ser la clave para abordar esta problemática debido a su enfoque conservador, centrado en el paciente y a través del curso de vida. Este artículo pretende mostrar la evidencia existente acerca de las TNIs en base a fluoruros de alta concentración más utilizadas para lesiones de caries radicular (RCLs), a saber, los dentífricos de 5.000 ppm, barnices de flúor y fluoruro diamino de plata. La evidencia científica demuestra que estas TNIs son una alternativa terapéutica en población mayor a pesar de la aun limitada evidencia científica existente para este grupo etario. Por lo tanto, se requieren mayores estudios en población mayor que sustenten estas intervenciones clínicas, principalmente en aquella población con compromiso funcional y/o cognitivo.

The longer life expectancy of the world population has led to a greater dental conservation and, as a consequence, to a higher prevalence of root caries in the elderly population. Epidemiological data have shown that the invasive approach of restorative dentistry has not been able to provide a solution to this public health problem. The Minimal Intervention Dentistry (MID) approach, through non-invasive therapies (NIT) based on high-concentration fluorides, could be the key to address this problem due to its conservative, patient-centered and life-course approach. This article aims to show the existing evidence about the most commonly used high-concentration fluoride-based NITTs for root caries lesions (RCLs), namely 5,000 ppm dentifrices, fluoride varnishes and silver diamine fluoride. The scientific evidence shows that these NITs are a therapeutic alternative in the elderly population despite the still limited scientific evidence for this age group. Therefore, further studies are required in the elderly population to support these clinical interventions, mainly in the population with functional and/or cognitive compromise.

Survival of atraumatic restorative treatment restorations in the elderly patients: a systematic review

Abstract: This study aimed to assess the survival of glass ionomer cement (GIC) restorations performed using the atraumatic restorative treatment (ART) in elderly patients. The systematic review protocol was registered in the PROSPERO database. The records were searched until August 2020 in eight electronic bibliographic databases, and included randomized and non-randomized clinical trials and observational studies, with no restrictions on the language or year of publication. Study selection and data extraction were performed independently by two reviewers. Data were extracted, summarized, collected for qualitative analysis, and evaluated for individual risk of bias using the Joanna Briggs Institute's Critical Appraisal Tool. The literature search retrieved 5,186 records; however, only seven studies fulfilled the eligibility criteria and were included. The studies were published between 2002 and 2019. A total of 1,239 restorations were investigated at intervals of 6, 12, 24, and 60 months of follow-up. Some studies had a low risk of bias, while others had moderate and high risk of bias. In general, GIC restorations placed using ART were considered satisfactory. The 6-month, 12-month, and 24-month survival rates ranged from 81.3% to 97.2%, 72.2% to 94%, and 63% to 87%, respectively; additionally, the survival rate for the longest follow-up period (60 months) was 85%. Given the best evidence-based information regarding caries removal, we highlight the need to provide a conservative and effective technique for use in elderly patients. ART is a promising and viable alternative that guarantees the survival of restorations in elderly patients.

Gene expression profile of Scardovia spp. in the metatranscriptome of root caries

Abstract A few investigations of caries biofilms have identified Scardovia spp.; however, little is known about its involvement in caries pathogenesis. The purpose of this study was to assess the gene expression profile of Scardovia spp. in root caries, and compare it with other microorganisms. Clinical samples from active root caries lesions were collected. Microbial mRNA was isolated and cDNA sequenced. The function and composition of the Scardovia were investigated using two methods: a) de novo assembly of the read data and mapping to contigs, and b) reads mapping to reference genomes. Pearson correlation was performed (p < 0.05). Proportion of Scardovia inopinata and Scardovia wiggsiae sequences ranged from 0-6% in the root caries metatranscriptome. There was a positive correlation between the transcriptome of Lactobacillus spp. and Scardovia spp. (r = 0.70; p = 0.03), as well as with other Bifidobacteriaceae (r = 0.91; p = 0.0006). Genes that code for fructose 6-phosphate phosphoketolase (the key enzyme for "Bifid shunt"), as well as ABC transporters and glycosyl-hydrolases were highly expressed. In conclusion, "Bifid shunt" and starch metabolism are involved in carbohydrate metabolism of S. inopinata and S. wiggsiae in root caries. There is a positive correlation between the metabolism abundance of Lactobacillus spp., Bifidobacteriaceae members, and Scardovia in root caries.

The role of Candida albicans in root caries biofilms: an RNA-seq analysis

Abstract Objective This study sought to analyze the gene expression of Candida albicans in sound root surface and root caries lesions, exploring its role in root caries pathogenesis. Methodology The differential gene expression of C. albicans and the specific genes related to cariogenic traits were studied in association with samples of biofilm collected from exposed sound root surface (SRS, n=10) and from biofilm and carious dentin of active root carious lesions (RC, n=9). The total microbial RNA was extracted, and the cDNA libraries were prepared and sequenced on the Illumina Hi-Seq2500. Unique reads were mapped to 163 oral microbial reference genomes including two chromosomes of C. albicans SC5314 (14,217 genes). The putative presence of C. albicans was estimated (sum of reads/total number of genes≥1) in each sample. Count data were normalized (using the DESeq method package) to analyze differential gene expression (using the DESeq2R package) applying the Benjamini-Hochberg correction (FDR<0.05). Results Two genes (CaO19.610, FDR=0.009; CaO19.2506, FDR=0.018) were up-regulated on SRS, and their functions are related to biofilm formation. Seven genes ( UTP20 , FDR=0.018; ITR1 , FDR=0.036; DHN6 , FDR=0.046; CaO19.7197 , FDR=0.046; CaO19.7838 , FDR=0.046; STT4 , FDR=0.046; GUT1 , FDR=0.046) were up-regulated on RC and their functions are related to metabolic activity, sugar transport, stress tolerance, invasion and pH regulation. The use of alternative carbon sources, including lactate, and the ability to form hypha may be a unique trait of C. albicans influencing biofilm virulence. Conclusions C. albicans is metabolically active in SRS and RC biofilm, with different roles in health and disease.

Bacterial analysis of biofilms from tooth root surfaces presenting different caries activity / Análise bacteriológica de biofilmes de superfícies dentárias radiculares apresentando diferentes estágios de atividade de cárie

This study evaluated the numbers and determined the proportion of mutans streptococci and Lactobacillus spp., which are possible relevant cariogenic organisms, in biofilms recovered from lesions at root surfaces with active caries lesions (ARC), inactive caries lesions, and sound root surfaces (SRS). Samples were cultured in MSB agar for mutans streptococci counts, Rogosa agar for Lactobacillus spp. counts, and brain-heart infusion agar for total viable anaerobic counts. After incubation, the number of colony-forming units (CFUs) was determined and compared between groups by the Mann-Whitney U test with a significance level set at 95%. The proportion of counts of mutans streptococci and Lactobacillus spp. in the total viable microorganisms was also analyzed by Chi-square test. Ninety samples (30 from each surface) from 37 patients were cultured and analyzed. The CFU was similar between mutans streptococci and Lactobacillus spp.These species were present in at least half of the samples and no difference was found in the frequency of isolation of these species. Only 6 samples showed a proportion of more than 10% of mutans streptococci; 4 of the samples were from ARC. Most (93%) SRS samples did not contain viable Lactobacillus spp. The data indicate the low counts of mutans streptococci and Lactobacillus spp. in root sur-faces, regardless of the activity of caries lesions.

O estudo analisou contagens e proporções de mutans strep-tococci e Lactobacillus spp., que podem ser microorganismos importantes em lesões de cárie radicular com diferentes atividades. Biofilmes foram coletados em três locais: ARC ­ superfície radicular com lesão ativa de cárie; IRC ­ superfícies radiculares com lesão inativa de cárie; SRS ­ superfícies de raizes hígidas. As amostras foram cultivadas em agar MSB para contagens de mutans streptococci; agar Rogosa para Lactobacillus spp., e agar BHI para contagens de microrganis-mos viáveis anaeróbicos totais. Após a incubação, o número de unidades formadoras de colônias (UFCs) foi determinado e comparado entre os grupos pelo teste de Mann-Whitney U test. O nível de significância foi estabelecido em 95%. A pro-porção de contagem de mutans streptococci e Lactobacillusspp. no total de microrganismos viáveis também foi analisado através do teste de qui-quadrado. Um total de 90 amostras de 37 pacientes foram cultivadas e analisadas: 30 amostras de ARC, 30 de IRC e 30 de SRS. Números de UFC foram seme-lhantes entre os grupos para ambos, mutans streptococci e Lactobacillus spp. Estas espécies estavam presentes em pelo menos metade de todas as amostras e nenhuma diferença foi encontrada na frequência de isolamento dessas espécies dentro dos grupos. Apenas 6 amostras apresentaram mais de 10% de mutans streptococci e 4 foram de ARC. Em relação aos Lactobacillus spp., 93% das amostras não apresentaram proporção dessas bactérias nas SRS. Mutans streptococci e Lactobacillus spp. estão presentes em baixa proporção nas superfícies radiculares, independentemente da atividade das lesões de cárie.

Dental tooth decay profile in an institutionalized elder population of Northern Portugal / Perfil de cárie dentária numa população idosa institucionalizada do Norte de Portugal

Objectives: the purpose of this study was to assess the dental tooth decay profile of an elderly population from Northern Portugal. Material and Methods: this is a descriptive, cross-sectional study where a questionnaire, intended to assess the institutionalized elders oral health condition, was applied with the purpose of quantifying certain oral conditions. Tooth decay was assessed using the DMFT Index for the crown's tooth and the individual radicular caries index (RCIi) for the root's condition assessment. Univariate analysis and multivariable logistical regressions were performed (p < 0.05) using the IBM© SPSS© Statistics vs.19.0. Results: three hundred and seventy-two elderly participants were assessed with an average age of 78.8 years, of which 260 were women (69.9%). Of the sample 30.4% had no literacy and 18.3% were dependent on their daily oral hygiene care, 30.9% (95%CI:26.2%-35.6%) were edentulous and 84.9% (95%CI:81.3%-88.5%) had less than 20 teeth. The average number of teeth was 8.9 (± 8.7) and the DMFT was 25.6 (± 7.3). The RCIi for men was 44.3% (± 30.4%) and 39.4% (± 31.2%) for women. Using multivariate logistical regression model the outcome RCIi≥20% was shown to be significantly and positively associated with the use of removable partial dentures (metal partial dentures: OR = 5.348 (95% CI: 1.176-24,329; p = 0.030) as well as with daily tooth brushing (no toothbrushing: OR = 2.802 (95% CI: 1.445-5.433); p = 0.002). Conclusion: the prevalence of tooth decay in this elder institutionalized population of Northern Portugal is high, mostly due to bad oral hygiene habits associated to the use of metal removable partial dentures. Institutionalized elderly need protocols tailored to their oral health needs and integrated efforts in the institutions are needed to effectively answer the demands related to the elderly cognitive and motor skills (ageing deterioration) decline of physiological functions.(AU)

Objetivos: O objetivo deste estudo foi avaliar o perfil de cárie dentária numa população idosa do norte de Portugal. Material e Métodos: Trata-se de um estudo descritivo, transversal, onde foi aplicado um questionário destinado a avaliar a condição de saúde oral dos idosos institucionalizados, com o objetivo de quantificar determinadas condições orais. A cárie dentária foi avaliada usando o índice CPOD para a coroa do dente e o índice de cárie radicular individual (IRCi) para a avaliação da condição da raiz. Foi realizada análise univariada e regressão logística multivariável (p <0,05) usando o IBM© SPSS© Statistics vs.19.0. Resultados: avaliaram-se 372 idosos, com idade média de 78,8 anos, dos quais 260 eram mulheres (69,9%). Da amostra, 30,4% não tinham escolaridade e 18,3% dependiam de outros para realizar os seus cuidados diários de higiene oral; 30,9% (IC95%: 26,2%-35,6%) eram desdentados e 84,9% (IC95%: 81,3%-88,5%) tinham menos de 20 dentes. O número médio de dentes foi de 8,9 (± 8,7) e o CPOD foi de 25,6 (± 7,3). O ICRi para o género masculino foi de 44,3% (± 30,4%) e de 39,4% (± 31,2%) para o feminino. Usando o modelo de regressão logística multivariada, o resultado ICRi≥20% mostrou-se significativa e positivamente associado ao uso de próteses parciais removíveis (próteses parciais esqueléticas: OR= 5,348 (IC95%: 1,176-24,329; p = 0,030), bem como com escovagem diária (sem escovagem: OR= 2,802 (IC95%: 1,445-5,433); p = 0,002). Conclusão: a prevalência de cárie dentária nesta população idosa institucionalizada do Norte de Portugal é alta, principalmente devido à má higiene oral e hábitos associados ao uso de próteses parciais removíveis esqueléticas. Idosos institucionalizados precisam de protocolos adaptados às suas necessidades de saúde oral e esforços integrados nas instituições para atender efetivamente às necessidades relacionadas com o declínio das funções fisiológicas do idoso, cognitivas e motoras (deterioração do envelhecimento). (AU)

Approach to the most prevalent oral disorders among the elderly: an integrative review focusing on primary health care / Abordagem das afecções bucais mais prevalentes em idosos: uma revisão integrativa com foco na atenção primária

Abstract Objective: an integrative review of the treatment of oral candidiasis, root caries and xerostomia among the elderly population, focusing on Primary Health Care, was carried out. Method: scientific articles were collected from the MEDLINE/PUBMED database using the keywords "Geriatric dentistry" and "Oral health", crossed with corresponding descriptors, together with specific terms for the pathologies studied, and with "the clinical trial" filter activated. The abstracts of the articles were read by three researchers. Result: oral candidiasis: six randomized clinical trials and one quasi-experimental design study, on the treatment of prosthetic stomatitis by medication and/or the disinfection of dentures by different techniques, were identified; root caries: three randomized clinical trials were included, which tested the use of mouthwash with chlorhexidine solution and oral hygiene instruction associated or otherwise with other drugs; and xerostomia: two articles were analyzed using various medications, and the functional massage of the salivary glands and associated muscles. Conclusion: The results demonstrate a variety of treatment options for the studied clinical situations, although these should be adapted to the characteristics of the services and the population, as standard treatment in Primary Health Care has not been established. Strategies based on soft technologies, such as health education, seem to provide good results. The present study provides additional knowledge for health professionals in search of more resolutive and qualified dental care for the elderly in primary health care. AU

Resumo Objetivo: revisão integrativa sobre o tratamento de candidíase bucal, cárie radicular e xerostomia com foco na Atenção Primária à Saúde, na população idosa. Método: busca de artigos na base de dados MEDLINE/PUBMED sobre as alterações citadas, com os descritores "Geriatric dentistry", "Oral health", cruzados com descritores correspondentes às três patologias, ativado o filtro "Clinical trial", como também termos específicos para as situações clínicas estudadas. Foram excluídos os estudos que não possuíam o escopo da Atenção Primária ou da odontogeriatria. Resultado: candidíase bucal: foram analisados seis ensaios-clínicos randomizados e um quase-experimento sobre o tratamento da estomatite protética por medicamentos e/ou pela desinfecção das próteses por diferentes técnicas; cárie radicular: três ensaios clínicos randomizados foram incluídos, os quais testaram o uso de bochechos com solução de clorexidina e instrução de higiene bucal associada ou não a outros fármacos; e xerostomia: foram analisados dois artigos que utilizaram diversos fármacos e a massagem funcional de glândulas salivares e músculos associados. Conclusão: Os resultados demonstram variadas opções de tratamento para as situações clinicas destacadas devendo ser adequadas as características dos serviços e da população atendida, tendo em vista que não foi estabelecido um tratamento padrão a ser utilizado na Atenção Primária à Saúde. Estratégias com foco em tecnologias leves, tais como a educação em saúde, parecem prover bons resultados. Todavia, o estudo agrega conhecimento aos profissionais de saúde na busca de um atendimento odontológico cada vez mais resolutivo e qualificado para o idoso na atenção primária à saúde. AU

Climatério, doenças periodontais e cáries radiculares / Climacteric, periodontal diseases and root cavity

O climatério caracteriza-se pela redução progressiva na produção dos hormônios sexuais, principalmente do estrogênio. Quanto à saúde bucal, constata-se que essa queda hormonal pode resultar no desenvolvimento de osteoporose e doenças periodontais, provocando mobilidade e perdas dentárias, possivelmente agravadas, em virtude de alterações periodontais pregressas. Além disso, o hipoestrogenismo levará à perda de inserção dentária e/ou retração gengival, ocasionando exposição da porção radicular do dente, o que irá favorecer o desenvolvimento de cárie a nível radicular. A instituição do tratamento odontológico preventivo nas fases mais precoces de vida da população feminina, evitando perda de elementos dentários prematuramente, incluindo mudanças nos hábitos de vida, tais como o tabagismo, capaz de determinar efeitos deletérios sobre a saúde bucal, portanto é satisfatória. O estabelecimento de correta terapia envolve promoção e manutenção da saúde bucal por meio da conscientização das pacientes. O objetivo deste artigo foi revisar a literatura atual acerca dos efeitos causados pelo climatério nas mulheres, passíveis de desencadear alterações na sua saúde periodontal, bem como acometimento por cárie

Climacteric is characterized by the progressive reduction in the production of sexual hormones, especially estrogen. Regarding oral health, it is observed that this hormonal decrease may result in the development of osteoporosis and periodontal illnesses, which can arise mobility and dental loss, possibly aggravated in consequence of previous illnesses. In addition, hypoestrogenic will lead to the loss of dental insertion and/or gum retraction, causing the exposure of the root part of the tooth, favoring cavity development up to the root level. Institution of preventive dental treatment in the earliest phase in women’s life, avoiding premature loss of dental elements, including changes in lifestyle, such as smoking, which can determine the harmful effects on oral health, therefore satisfactory. The establishment of the correct therapy involves promotion and maintenance of oral health raising one’s awareness. The aim of this paper was to review the current literature on the effects caused by climacteric in women, which may trigger changes in your periodontal health, as well as involvement by caries