Cytokines in saliva as biomarkers of oral and systemic oncological or infectious diseases: A systematic review.

Recent evidence suggests that salivary cytokines provide information about both oral conditions and systemic diseases. This review summarizes evidence for the use of salivary cytokines as biomarkers for oral and systemic diseases. We included studies in adults and children with a focus on the latter, due to the importance of non-invasive diagnostic methods in the paediatric age group. A systematic review was performed using Medline and Web of Science covering the period of January 1996 to December 2019 according to the preferred reporting items for systematic reviews. Thirty-four studies were included in the final analysis, for a total of 2407 patients and healthy controls. Pro-inflammatory cytokines including interleukin (IL)-1ß, IL-2, IL-6 and tumor necrosis factor (TNF)-α were associated with the severity of oral mucosal tissue damage in patients with cancer, and IL-1ß may be an early marker of graft-versus-host disease. Salivary interferon-γ levels were correlated with oral complications and the presence of the underlying disease in HIV-infected individuals, and salivary cytokine patterns may be useful for diagnosing tuberculosis. In summary, current data illustrate that salivary cytokines are associated with oral inflammation, making them potential biomarkers for disease diagnosis and treatment efficacy. Because of the simplicity of saliva collection, this method may be useful in pediatric studies and in resource-limited settings.

Clinical guidance for maintaining oral hygiene in patients under-going chemotherapy or radiation therapy: a scoping review.

The aim of this scoping review was to identify clinical guidance for maintaining oral hygiene in patients undergoing chemotherapy, radiation therapy, or both. Electronic searches were conducted in PubMed, Embase, Cochrane Library, and Google Scholar for articles published between January 2000 and May 2020. Systematic reviews, meta-analyses, clinical trials, case series, and expert consensus reports were considered eligible for inclusion. The SIGN Guideline system was used to evaluate the level evidence and the grade of recommendations. A total of 53 studies met the eligibility criteria. The results showed the presence of recommendation for oral care in three domains: management of oral mucositis, prevention and control of radiation caries, and management of xerostomia. However, most of the included studies had low levels of evidence. The review provides recommendations for healthcare professionals caring for patients undergoing chemotherapy, radiation therapy, or both, but a standard oral care protocol could not be established owing to a paucity of evidence-based data.

A survey on toothbrushing practices and dosing of fluoridated toothpaste 1 among preschool children in the cantons of Basel-Stadt and Berne, 2 Switzerland.

This study aimed to evaluate toothbrushing practices and toothpaste dosing among preschool children aged 0-6 years in Switzerland recruited from the Department of General Pediatric and Adolescent Dentistry, University Center for Dental Medicine Basel UZB, and in daycare centers or in private practices located in the canton of Berne. Three hundred parents of children were surveyed about socioeconomic characteristics, their children's toothbrushing behavior, the use of age-appropriate toothpaste, and whether they were instructed by an oral healthcare professional about appropriate toothbrushing practices and the amount of toothpaste to use. Additionally, the parents were asked to apply toothpaste to two different toothbrushes, one with a narrow and one with a wide brush head, as they usually would at home. The amount of toothpaste was weighed using a portable scale. Over 50% of the parents were not instructed by an oral health care professional on toothbrushing practices and toothpaste dosing. However, nearly all participants used age-appropriate toothpaste. Approximately 50% of the parents of 0- to 2-year-old children applied more than the recommended 0.25 g of fluoridated toothpaste (both brushes, mean ± SD: 0.25 g ± 0.14 g), while two-thirds of the parents of 2- to 3-year-olds (both brushes, mean ± SD: 0.36 g ± 0.23 g) and nearly 90% of the parents of 3- to 6-year-olds applied more than 0.25 g (both brushes, mean ± SD: 0.43 g ± 0.20 g). Overall, parents dispensed more toothpaste on the toothbrush with the wide brush head. The present study suggested that assuming toothpaste as the sole source of fluoride, the amounts generally used are not of concern. However, considering the substantial variation in the amounts of toothpaste applied, oral healthcare professionals should routinely provide instructions on toothbrushing practices and toothpaste dosing during children's dental examinations.

Associations between salivary cytokines and oral health, age, and sex in healthy children.

Human saliva is a complex fluid containing proteins such as salivary cytokines, which can be used for diagnostic purposes, particularly among the pediatric population. This study aimed to assess the concentrations of salivary cytokines in healthy children and adolescents and determine their associations with age, sex, and oral and dental findings. Healthy children and adolescents aged 4-18 years were enrolled in this cross-sectional study. The concentrations of the following salivary cytokines were measured by Luminex technology: IFN-γ, IL-1α, IL-1ß, IL-4, IL-5, IL-6, IL-8, IL-10, IL-13, IP-10, TNF-α, and VEGF-A. Additionally, oral and dental parameters were recorded using a standardized protocol. A total of 128 participants (mean age, 10.7 years; males, 50.8%) were enrolled. The levels of 1ß, IL-6, IL-8, and IL-10 were significantly higher in those with gingivitis. Increased salivary flow rates were negatively correlated with IL-1α, IL-1ß, IL-6, IL-8, IL-10, TNF-α, and VEGF-A concentrations. The findings of this study showed that the concentrations of most of the salivary cytokines were positively correlated with age and the presence of oral pathologies (such as gingivitis and caries) and negatively correlated with salivary flow rate.

Acceptance of a tongue vacuum cleaner among children and evaluation of tongue cleaning at home

The anaerobic microenvironment of the grooved tongue surface provides optimal conditions for the survival of microorganisms. These microbes may promote caries, periodontitis marginalis, periimplantitis as well as halitosis. A new device, the TS1 tongue vacuum cleaner, is designed to remove bacterial biofilm from the tongue's surface. The aim of the present study was to both examine the acceptance of this tongue vacuum cleaner by children at the School Dental Clinic Basel as compared to a child's manual tooth brush, and tongue cleaning at home for a 1-month period. This study did not investigate the cleaning effect. One hundred and sixty-two children aged 5 to 18 years participated in this study. The acceptance of the tongue vacuum cleaner was significantly higher with 8.9 cm on the visual analogue scale (VAS) (0­10 cm) in comparison to a child's manual tooth brush with 7.8 cm (p < 0.001). After professional tongue cleaning, the children were asked to clean their tongues at home for a 1-month period, and to return a completed questionnaire (n = 66). The children estimated their acceptance of daily tongue cleaning with 8.3 cm on the VAS, their parents with 8.7 cm. Fifty eight children reported willingness to continue cleaning their tongues at home after the 1-month examination time. The data show that the use of the tongue vacuum cleaner, as part of a professional oral prophylaxis, is well accepted by children and may help promote, along with professional instruction, home tongue cleaning on a regular basis.

Practicability of a tooth rescue concept--the use of a tooth rescue box.

Healing following replantation of avulsed teeth is dependent upon short unphysiologic periods during the extraalveolar phase. A commercially available tooth rescue box was developed and distributed at schools in Hessen, a state in Germany. Aim of the study was to evaluate the availability times of rescue boxes and the storage periods of rescued teeth within the boxes. Two thousand one hundred tooth rescue boxes together with a questionnaire were distributed predominantly at schools. In case of usage of a box, the questionnaire should be filled out by patients and dentists and sent back for evaluation. One hundred seventy-two (8.2%) questionnaires were sent back. Eighteen questionnaires were incomplete. In the remaining 154 tooth rescue boxes, a total of 201 avulsed teeth and tooth crown fragments were rescued. When accidents occurred near a stored rescue box, the availability time was short (median: 5 min). It was significantly longer (median: 35 min) when the location of the accident was distant to a stored box. Storage of avulsed teeth in the tooth rescue box was longer (median: 2 h) than storage of fractured crown fragments (median: 1 h). Lay people (teachers, pupils) used the rescue boxes correctly without professional help or even advice through telephone. The usage of the tooth rescue box seemed to be self-explanatory and plausible to lay persons, very short availability times resulted when accidents occurred near stored boxes. Thus, an excellent healing prognosis can be anticipated after replantation. The storage periods of avulsed teeth before the commencement of treatment exceed by far the periods that are acceptable for alternative but unphysiologic media (saline, saliva, milk). It is concluded that tooth rescue boxes should be distributed at locations prone to tooth traumas (schools, kindergartens, sporting facilities, public pools) to enhance the prognosis of avulsed teeth. Emergency units (hospitals, ambulances) should be equipped with tooth rescue boxes as well as every dentist. Tooth rescue boxes are recommended for families with children.

Measurement of unstimulated salivary flow rate in healthy children aged 6 to 15 years

The aim of the present study was to measure unstimulated saliva flow rate (uSFR), pH value and buffer capacity in healthy children aged 6 to 15 years to serve as reference values for subsequent investigations, in particular to define threshold values for abnormality. Our basic data will power the limited amount of currently available data on salivary flow rate in healthy children. The uSFR was evaluated for correlations with pH value and buffer capacity. The unstimulated saliva of 274 children aged 6 to 15 years was collected (n: 154) by the spitting method within three minutes. The samples were examined immediately after saliva collection in terms of uSFR, pH value and buffer capacity. From the 274 participating children 18 were excluded due to the intake of medication. The medians (IQR) of uSFR of the tested children were 0.87 (0.54, 1.11) ml/min for boys, 0.65 (0.37, 0.98) ml/min for girls and 0.76 (0.49, 1.05) ml/min in total. The uSFR correlated with the pH value and the buffer capacity (p < 0.001). For different genders there was a statistically significant difference regarding uSFR (p = 0.008) and pH value (p = 0.016). Based on the available data, the pH value and the buffer capacity were closely related to the uSFR. Boys seemed to have a higher uSFR than girls.

Risk indicators of early childhood caries (ECC) in children with high treatment needs.

Early childhood caries (ECC) represents a major health and economic problem worldwide. Its consequences such as early pain experience may affect the immediate and long-term quality of life of the child. In very young and uncooperative children the therapy of ECC is often viable only under general anesthesia. After treatment these affected children have a higher risk for future caries either soon thereafter, or later in life. The aim of the present study was to determine risk indicators and their correlation among children with high caries prevalence and high treatment needs, in order to facilitate the development of targeted prophylaxis programs that would reduce future occurrences of ECC or at least positively influence the outcome. For this purpose, between 2010 and 2014 the parents of these children (n=82) were interviewed in the University Children’s Hospital in Basel (UKBB) prior to the children's treatment under general anesthesia. The standardized questionnaire included questions regarding the age of the child, the mother's country of origin, the oral hygiene, and the drinking habits of the child. The analysis shows that the high mean dmft/ dmfs values (dmft: 9.49 and dmfs: 26.35) correlated significantly with the geographic origin of the mother (p<0.05), the beginning of tooth brushing (p<0.05), lack of supervised tooth brushing (p<0.01), and nighttime consumption of sugar-sweetened beverages (p<0.05). In contrast, the duration of breastfeeding and prolonged use of a baby bottle (about 2.5 years) did not have a clear impact on high caries prevalence.

Frühkindliche kieferorthopädische Therapie mittels Schnuller?

Dental malocclusions (open bite and lateral cross-bite) or functional disturbances (persistent infantile swallowing) in young children do not occur rarely. They are often induced or reinforced by oral habits, such as thumb sucking or bottle feeding. The aim of this case series is to show the effect of a new type of pacifier on the development of open bite, cross-bite or tongue dysfunction. Three cases selected from the case series are reported to describe the effect of early treatment through the pacifier on the above-mentioned malocclusions in the 2nd and 5th years of age. The longitudinal observation after 3, 9 and 24 months of use has shown that the open bite and the posterior cross-bite can be reduced. A shift from an infantile swallowing pattern to a mature one has also been observed. The results are promising: the method is simple and possibly cost-reducing. However, the limited number of cases presented does not support the reproducibility of the results. For this reason the reported observations have to be verified by a longitudinal study in a larger population.