Comparison of dexmedetomidine and a dexmedetomidine-esketamine combination for reducing dental anxiety in preschool children undergoing dental treatment under general anesthesia: A randomized controlled trial.

BACKGROUND: Dental anxiety is a widespread complication occurring in pediatric patients during dental visits and may lead to undesirable complications. Esketamine may be effective in anxiety. OBJECTIVE: The objective of this study was to investigate the effect of premedication with a dexmedetomidine-esketamine combination compared with dexmedetomidine alone on dental anxiety in preschool children undergoing dental treatment under general anesthesia. METHODS: This is a prospective, double-blinded, randomized controlled trial. A total of 84 patients were scheduled for elective outpatient dental caries treatment under general anesthesia. Patients were randomly premedicated with intranasal dexmedetomidine (group D) or intranasal dexmedetomidine-esketamine (group DS). The primary outcome was the level of dental anxiety assessed by the Modified Child Dental Anxiety Scale (MCDAS) at 2 h after surgery. Secondary outcomes included level of dental anxiety at 1 day and 7 days after surgery, the incidence of dental anxiety at 2 h, 1 day, and 7 days after surgery, sedation onset time, overall success of sedation, acceptance of mask induction, postoperative pain intensity, incidence of emergence agitation in PACU, adverse reactions, HR, and SpO2 before premedication (baseline) and at 10, 20, and 30 min after the end of study drug delivery. RESULTS: The dental anxiety in group DS was lower than that in group D at 2 h, 1 day, and 7 days postoperatively (P = 0.04, 0.004, and 0.006, respectively). The incidences of dental anxiety in group DS were lower than those in group D at 2 h (53 % vs 76 %, P = 0.03), 1 day (47 % vs 71 %, P = 0.04), and 7 days (44 % vs 71 %, P = 0.02) after surgery. Group DS had a higher success rate of sedation (P = 0.03) but showed a lower MAS score (P = 0.005) and smoother hemodynamics (P < 0.01) after drug administration than group D. Group DS showed a significantly lower incidence rate of emergence agitation (P = 0.03) and postoperative pain intensity (P = 0.006) than that in group D during the anesthesia recovery time. The occurrence of adverse reactions was similar in both groups (P > 0.05). LIMITATIONS: We did not analyze and correct for the learning effect caused by repeated applications of the MCDAS and MCDAS scores on the 1 day after surgery were obtained by telephone follow-up. CONCLUSIONS: Compared to premedication with dexmedetomidine alone, premedication with intranasal dexmedetomidine combined with esketamine could significantly improve dental anxiety in preschool children undergoing dental treatment under general anesthesia.

Medication impact on oral health in schizophrenia.

BACKGROUND: Patients with schizophrenia constitute a particularly vulnerable group for oral diseases. Among the different factors involved, we aimed to examine the evidence of how drugs could contribute to the poorer oral health of this population. MATERIAL AND METHODS: An overview of the potential impact of medication on dental/oral health among people with schizophrenia was proposed focusing on selected literature. RESULTS: Studies show a higher dental caries and degree of periodontal diseases in this population and point to drug-induced xerostomia as an important risk factor for oral health deterioration. The risk of dry mouth depends on not only antipsychotics, but also drugs with anticholinergic activity. We hypothesize that antipsychotic induced glycaemic alterations might contribute to reduced oral health, and that the antimicrobial activity of certain antipsychotics could have an impact on oral microbiota affecting oral condition. Pharmacovigilance data show that involuntary movements are caused by typical and some atypical antipsychotics. Dry mouth is most frequently reported for quetiapine and olanzapine, while clozapine is more frequently associated with sialorrhea. CONCLUSIONS: Literature clearly shows higher caries and periodontal disease in schizophrenic patients. However, overall, there is scarce literature about the potential influence of drugs in these disorders. Health professionals should be aware of this issue in order to implement adequate preventive measures in this vulnerable population.

Household smoking impact on the oral health of 5- to 7-years-old children.

BACKGROUND: Children's exposure to secondhand smoke, particularly by their parents, could adversely affect their oral health. Thereby, this study aimed to assess the oral health status of children subjected to household smoking and the impact of smoking patterns on the severity of oral health deterioration. METHODS: A total of 210 healthy children were enrolled in this case-control study and allocated into children subjected to household smoking (HS) and control groups. Participants' guardians were asked to complete a questionnaire regarding sociodemographic characteristics and parental smoking habits. All participants were subjected to clinical dental examination to assess dental caries (ICDAS), hypomineralized primary molars (HSPM), and gingival status (GI). Stimulated saliva samples were collected to assess saliva composition and characteristics. Urine samples were collected and analyzed for cotinine concentration. Data were analyzed using SPSS (v.25) software at a test value of p ≤ 0.05. The t-student test was used to find significant differences between participants' age, gingival index score, saliva pH, flow rate, sIgA, and cotinine level. The Chi-square test was used to test for the significance of parental employment, number of rooms, gender, sweets consumption, brushing frequency, and HMPM. The correspondence analysis was used to test for significance of parents' levels of education, type of house ventilation, ICDAS score, smoking form, frequency, and smoking pattern. The correlation between cotinine level and sIgA was tested for association using Bivariate correlation test. RESULTS: The HS group showed a significantly increased risk for dental caries (p < 0.000), HSPM lesions (p = 0.007), and GI score (p < 0.000). A significant reduction in salivary flow rate, saliva pH, and sIgA were evident in HS group (p < 0.000). Parental consumption of more than 20 cigarettes/day was accompanied by increased dental caries activity (p < 0.000) and higher risk for increased severity of gingival inflammation (p < 0.000) of children in the HS group. Children of parents who smoke cigarettes and use the hubble/bubble anywhere in the house found to have greater distribution of HSPM (p < 0.000). Reduced sIgA values were found to be significantly associated with increased cotinine concentrations in HS children (p < 0.000). CONCLUSIONS: Frequent exposure to household smoking could be associated with an increased risk of dental caries progression, enamel hypomineralization, gingival inflammation, and saliva characteristics changes in children.

The effectiveness and safety of botulinum toxin injections for the treatment of sialorrhea with Parkinson's disease: a systematic review and meta-analysis.

BACKGROUND: Botulinum toxin (BoNT) injection is an important adjunctive method to treat sialorrhea. The purpose of this systematic review was to analyze the effect and safety of BoNT injections in the intervention of sialorrhea with Parkinson's disease (PD). METHODS: We searched PubMed, Web Of Science (WOS), Scopus, Cochrane CENTRAL, and Embase from inception until April 2022. Randomized controlled trials or randomized crossover trials comparing BoNT with placebo in sialorrhea with PD were eligible. PRISMA guidelines were used to carry out the meta-analysis. The Drooling Severity Frequency Scale (DSFS) score and the number of adverse events (AEs) were the primary and secondary outcomes, respectively. Standardized mean differences (SMDs) and risk differences (RDs) are used to express continuous and categorical outcomes, respectively. Heterogeneity among these studies was evaluated using I2 tests. We used the GRADE tool to assess the certainty of evidence (COE). RESULTS: Eight articles involving 259 patients compared BoNT injections with a placebo for PD with sialorrhea. This meta-analysis showed a significant reduction in DSFS scores between BoNT injections and placebo (SMD=-0.98; 95% CI, -1.27 to 0.70, p<0.001; COE: high). This meta-analysis showed a significant difference in AEs between BoNT injections and placebo (RD=0.15; 95% CI, 0.05 to 0.24, p=0.002; COE: low). CONCLUSIONS: The pooled results suggest that BoNT injections have some effect on DSFS scores with sialorrhea caused by PD. There are also mild adverse events, which generally recover within a week or so. The results indicate that BoNT injection is one of the treatments for sialorrhea caused by PD, but we need to pay attention to adverse events. In addition, the follow-up time was extended to observe oral hygiene, ulceration or dental caries, and digestive function. TRIAL REGISTRATION: Our review protocol was registered on PROSPERO (42021288334).

Intranasal esketamine combined with oral midazolam provides adequate sedation for outpatient pediatric dental procedures: a prospective cohort study.

BACKGROUND: Severe dental phobia or failure to cooperate with treatment are very common in outpatient pediatric dentistry. Personalized and appropriate noninvasive anesthesia methods can save medical expenses, improve treatment efficiency, reduce the anxiety of children, and improve the satisfaction of nursing staff. Currently, there is little conclusive evidence for noninvasive moderate sedation strategies in pediatric dental surgery. MATERIALS AND METHODS: The trial was conducted from May 2022 to September 2022. Each child was first given midazolam oral solution 0.5 mg·kg -1 , and when the Modified Observer's Assessment of Alertness and Sedation score reached 4, a biased coin design up-down method was used to adjust the dose of esketamine. The primary outcome was the ED 95 and 95% CI of intranasal esketamine hydrochloride with midazolam 0.5 mg·kg -1 . Secondary outcomes included the onset time of sedation, treatment and awakening times, and the incidence of adverse events. RESULTS: A total of 60 children were enrolled; 53 children were successfully sedated but 7 were not. The ED 95 of intranasal esketamine with 0.5 mg·kg -1 midazolam oral liquid for the treatment of dental caries was 1.99 mg·kg -1 (95% CI 1.95-2.01 mg·kg -1 ). The mean onset time of sedation for all patients was 43.7±6.9 min. 15.0 (10-24.0) min for examination and 89.4±19.5 min for awakening. The incidence of intraoperative nausea and vomiting was 8.3%. Adverse reactions such as transient hypertension and tachycardia occurred during the operations. CONCLUSION: The ED 95 of intranasal esketamine with 0.5 mg·kg -1 midazolam oral liquid for the outpatient pediatric dentistry procedure under moderate sedation was 1.99 mg·kg -1 . For children aged 2-6 years with dental anxiety who require dental surgery, anesthesiologists may consider using midazolam oral solution combined with esketamine nasal drops for noninvasive sedation after a preoperative anxiety scale evaluation.

Antibiotic Exposure and Dental Health: A Systematic Review.

CONTEXT: The use of antibiotics in young children is widespread and may lead to adverse effects on dental health, including staining, developmental defects, and dental caries. OBJECTIVE: To systematically review the effects of early childhood antibiotic exposure on dental health. DATA SOURCES: Medline (Ovid/PubMed), Embase (Ovid) and Cochrane databases. Study bias was assessed using the Newcastle-Ottawa Scale. STUDY SELECTION: English language articles that reported antibiotic exposure before 8 years of age and 1 or more of the relevant outcomes (dental caries, intrinsic tooth staining, or developmental defects of enamel) were included. DATA EXTRACTION: Data on study population, design, type of antibiotic, outcome measurement, and results were extracted from the identified studies. RESULTS: The initial search yielded 1003 articles of which 34 studies were included. Five of the 18 studies on tetracycline described a dose response relationship between exposure to tetracycline doses of > 20 mg/kg per day and dental staining. Early childhood exposure to doxycycline (at any dose) was not associated with dental staining. There was no clear association between any early childhood antibiotic exposure and dental caries or enamel defects. LIMITATIONS: In all included studies, the main limitations and sources of bias were the lack of comparison groups, inconsistent outcome measures, and lack of adjustment for relevant confounders. CONCLUSIONS: There was no evidence that newer tetracycline formulations (doxycycline and minocycline) at currently recommended dosages led to adverse effects on dental health. Findings regarding antibiotic exposure and developmental defects of enamel or dental caries were inconsistent. Further prospective studies are warranted.

Methamphetamine-induced dental caries: a review of the literature.

Clinical picture of patients taking methamphetamine for long duration includes rampant caries of the smooth surfaces of the whole dentition. The increasing use of methamphetamine in homosexuals is leading to the spread of HIV (human immunodeficiency virus). Easy availability and rapidly spreading nature of this drug (methamphetamine) results in worldwide increase of patients with medical and dental problems. Its effect on human dentition is highly damaging as patients with a beautiful smile begin to present a horrible picture of black, broken, and painful teeth within one year of methamphetamine use. Restoration of aesthetics and function of these teeth is not an easy task, and usually the first step to deal with this condition is counselling the patient to stop using this drug. Knowledge of methamphetamine-induced undesirable effects on the human body is important for the general dental practitioner as referral to mental health services is necessary in this condition.

Effect of posterior implant restorations on adjacent teeth and tissues: A case-control study.

INTRODUCTION: Dental implants are an artificial substitute for extracted or missing teeth in the oral cavity and are valuable for improving dental health and quality of life. While many studies on implants can be found, few studies examine their effects on adjacent teeth and tissues. The study aimed to examine complications of teeth adjacent to dental implants in the posterior region. METHODS: In this retrospective case-control study, clinical data of patients treated with implants in the posterior segment were extracted from the medical records in a single community dental clinic between January 9, 2010 and January 9, 2020. The patients were examined clinically and radiographically every 6 months. Data on the adjacent teeth to the dental implants were collected and divided into two groups, complications ("study group") versus no-complications ("control group"). Multivariate logistic regression analysis was performed to find a possible correlation between the complications and the variables checked, followed by checking specific variables in the complication group. RESULTS: A total of 1072 patients were included in the study. There were 179 patients (16.7%) with complications in adjacent teeth, while 893 patients had no documented complications. Predisposing factors for secondary caries were smoking (OR = 2.2, CI = 1.3-3.8) and a higher number of implants (OR = 1.6, CI = 1.1-2.5). Tooth crack and tooth fracture were analyzed together and found to be related to osteoporosis (OR = 8.9, CI = 2.9-27.6), whereas males were more prone to teeth fracture (OR = 2.8, CI = 1.1-7.4). Tooth mobility was related to a higher number of implants (OR = 16.5, CI = 3.7-73.8). Further analyzing the complication group solely, there was a statistical significance for age in primary caries and tooth mobility (p = 0.045). In addition, a higher number of implants was more prevalent with tooth mobility (p = 0.002), wider implant platform was more significant with primary caries (p = 0.012), and periodontal Stage III was more prone to tooth mobility (p < 0.001). The distance between the implant and adjacent tooth was also statistically significant-close proximity with tooth mobility and high distance with dental caries (p = 0.04). CONCLUSIONS: We found a relatively high rate of complications in teeth adjacent to dental implants. Secondary caries was the most common complication. Good understanding and proper position of the implants is essential to avoid adjacent teeth complications.

Association between tamoxifen and tooth loss in women with breast cancer.

OBJECTIVES: Investigate the effect of tamoxifen on the occurrence of tooth loss (TL) in breast cancer (BC) survivors. METHODS: A cross-sectional study was conducted with 140 BC survivors using tamoxifen therapy. Sociodemographic, medical, and dental data were evaluated. TL was determined using the M component of the Decayed, Missing and Filled Teeth (DMFT) index. Logistic regression models were run to determine associations between the independent variables and outcome (TL). RESULTS: Mean TL was 12.96 (SD 8.88). Only three participants had lost no teeth and 10.7% were completely edentulous. Participants who used tamoxifen for more than 1 year had a higher mean missing teeth (13.99 vs. 10.45; P = 0.030). After the adjustments, the occurrence of more than 12 missing teeth was 2.75-fold higher among women who used tamoxifen for more than 1 year (95% CI: 1.06-7.12). Moreover, age over 65 years, referral for treatment by the public healthcare system, less use of dental services, xerostomia, and a lower occurrence of dental caries remained associated with the loss of more than 12 teeth. CONCLUSION: Longer use of tamoxifen was associated with greater tooth loss in breast cancer survivors. CLINICAL RELEVANCE: Based on estimates of the increase in cases of breast cancer, the prolonged use of tamoxifen for the treatment of this disease can exert an impact on oral health through the occurrence of tooth loss. These findings can contribute to the planning and implementation of oral health care and prevention strategies for such patients.

Oral changes in cocaine abusers: an integrative review.

INTRODUCTION: Cocaine is one of the most often used psychoactive drugs worldwide, being extracted from the leaves of Erytroxylus coca plant. Its abusive use can trigger several consequences for the human body, including the oral cavity. OBJECTIVE: To identify the oral disorders that are most commonly found in individuals who abuse cocaine, in addition to the main diagnostic and treatment methods. METHODS: An integrative review was carried out on the databases: LILACS, BBO, LIS, MEDLINE, SciELO, Science Direct and PubMed. The following keywords were used: "Cocaína", "Boca", "Palato" and "Odontologia", together with their synonyms and variations in English, obtained from DeCS and MeSH. The inclusion criteria were original articles, articles in Portuguese, English and Spanish, studies involving individuals, without restriction related to the year of publication. Animal studies, literature reviews, book chapters, theses and dissertations were excluded. RESULTS: In total, 1373 records were identified. Of these, 22 articles were selected to comprise the review. Several oral alterations caused by cocaine abuse were found, primarily perforation of the palate, predisposition to periodontal diseases, temporomandibular disorders, bruxism, damage to oral tissues, dental caries, destructive lesions of the facial midline, xerostomia and ageusia. Among the diagnostic methods used by the professionals, anamnesis, intraoral examinations and head and neck computed tomography were the most frequently mentioned. As for treatment, in patients with palatal perforation, the reconstruction of the affected area or the use of prosthetic obturators is carried out. CONCLUSION: The management of these patients is not an easy task, as many of the users do not even seek professional help. The health professionals must be able to recognize these manifestations and alterations to establish timely and accurate diagnosis and treatment planning.

Chemotherapy as a risk factor for caries and gingivitis in children with acute lymphoblastic leukemia: A retrospective cohort study.

BACKGROUND: Dental and oral anomalies are among the most common long-term side effects of childhood cancer therapy. AIM: To evaluate chemotherapy as a risk factor for caries lesions and gingivitis in children with acute lymphoblastic leukemia (ALL) treated with the ALL IC-BFM 2009 chemotherapy protocol. DESIGN: A retrospective cohort study was designed. Clinical records of 23 paediatric patients with ALL exposed to chemotherapy in the Regional Hospital in Valdivia, Chile, and 46 unexposed patients assessed every 3 months for 24 months were analyzed. The data on gender, age, index of the number of decayed, missing, or filled teeth, and the presence of gingivitis were recorded (Mann-Whitney U test and logistic regression analysis, p ≤ .05). RESULTS: A significantly greater frequency of gingivitis (69.57%; p < .002) and a mean of new caries lesions were observed in children treated with chemotherapy than in the unexposed children (p < .01). The chemotherapy protocol presented a relative risk of 2.15 (95% CI = 1.22 - 2.66; p = .01) for new caries lesions and 2.29 (95% CI = 1.76 - 3.82; p = .002) for gingivitis. CONCLUSION: The ALL IC-BFM 2009 chemotherapy protocol in patients with ALL is a risk factor for new caries lesions and gingivitis.

Evaluación semicuantitativa de los microelementos del esmalte en un modelo de obesidad inducido por glutamato monosódico en ratas / Semi-quantitative evaluation of enamel microelements in an obesity model induced by monosodium glutamate in rats

RESUMEN: En la actualidad, existen múltiples modelos experimentales de obesidad, unos de ellos es la utilización de glutamato monosódico (GMS), un potenciador del sabor ampliamente utilizado en industria alimentaria. Este GMS ha sido relacionado con obesidad, diabetes, insulino resistencia, así como en alteraciones en múltiples órganos, tales como testículos, riñón e hígado, entre otros. Ha sido reportado el efecto del GMS en estructuras orales, tales como las glándulas salivales, alterando su morfología y función. La relación del efecto del GMS frente a tejidos dentarios no ha sido reportada, siendo esto relevantes debido a la información que proporciona a disciplinas tales como arqueología científica, identificación forense, paleoecología y odontología. El objetivo del estudio fue observar la modificación de los elementos en la superficie dental, en un modelo de obesidad inducida por GMS, en ratas. Se utilizaron 12 ratas neonatas Sprague Dawley machos, divididas en dos grupos según exposición a GMS (Grupo Control y Grupo GMS 1: 4 mg/g peso de GMS, 5 dosis, mantenidas 16 semanas. Fue calculado el índice de masa corporal (IMC) e Índice de Lee, además de ser analizados el porcentaje de masa de los elementos C, O, Na, P, Ca, Fe y K en la superficie dental, mediante análisis semicuantitativo. Los resultados indican que GMS indujo obesidad en las ratas, así como alteraciones en los porcentajes de masa de los elementos en la superficie dental, evidenciándose disminución de Ca, P y O, además de aumentos en C y Fe. Según reportes previos, la obesidad inducida por GMS, causa alteraciones en secreción y composición salival, elemento íntimamente relacionado con la composición del esmalte, lo que vendría a explicar nuestros resultados. Entender la composición superficial del esmalte superficial podría ayudarnos a comprender de mejor manera la relación entre caries dentaria y obesidad.

SUMMARY: Monosodium glutamate (MSG) is a flavor enhancer widely used in the food industry. It has been associated with obesity, diabetes, insulin resistance, as well as alterations in multiple organs, such as testicles, kidney, liver, among others. While its effect on oral structures such as the salivary glands has been reported, the impact on dental tissues has not been described. Since this information is also relevant in fields such as forensic identification, palaeoecology and dentistry, the objective of the study was to observe alterations on the tooth surface in a model of obesity in rats induced by MSG. Twelve neonate male Sprague Dawley rats were used, divided into two groups according to MSG exposure (Control Group and MSG1 Group: 4 mg / g weight of MSG, 5 doses were maintained for 16 weeks. Body mass index (BMI) and Lee's index as well as mass percentage of elements C, O, Na, P, Ca, Fe and K on the tooth surface were evaluated by semi-quantitative analysis. In addition to increases in C and Fe, results indicate that MSG induced obesity and alterations in the percentages of mass on the tooth surface in rats, showing a decrease in Ca, P and O, According to previous reports, MSG induced obesity causes alterations in secretion and salivary composition, an aspect closely related to enamel composition, thus explaining our results. Enhanced knowledge of enamel surface composition may help improve our understanding of the relationship between dental caries and obesity.

Artificial Caries Lesion Characteristics after Secondary Demineralization with Theobromine-Containing Protocol.

Developing artificial caries lesions with varying characteristics is needed to adequately study caries process in vitro. The objective of this study was to investigate artificial caries lesion characteristics after secondary demineralization protocol containing theobromine and fluoride. Sixty bovine enamel slabs (4 × 3 mm) were demineralized using a Carbopol-containing protocol for 6 days. A baseline area (2 × 3 mm) was protected with acid-resistant nail varnish, after which specimens were exposed for 24 h to a secondary demineralization protocol containing acetic acid plus one of four fluoride/theobromine combinations (n = 15): theobromine (50 or 200 ppm) and fluoride (0 or 1 ppm). Specimens were sectioned and analyzed using transverse microradiography for changes in mineral content, lesion depth, and surface layer mineralization. Data was analyzed using paired t-test and analysis of variance followed by Bonferroni test at 0.05 significance level. After secondary demineralization, fluoride-containing groups had significantly deeper lesions (p = 0.002 and 0.014) compared to the group with 0 ppm fluoride and 50 ppm theobromine. Mineral content and lesion depth were significantly different compared to baseline for all groups. Theobromine did not show an added effect on mineral uptake. Theobromine-containing groups exhibited particularly deep lesions with a more uniform mineral profile in the presence of fluoride.

Association of sugar-sweetened drinks with caries in 10- and 15-year-olds.

BACKGROUND: Sugar-sweetened drinks (SSDs) are known to be cariogenic, but this association has not been well investigated in population-based repeated cross-sectional studies in recent years. Therefore, this study examined whether SSD intake is associated with higher caries experience in 10- and 15-year-olds. METHODS: The study sample included participants from the Munich study centre of two birth cohorts with data on non-cavitated caries lesions (NCCL/S), caries experience (DMF/S index), overall caries burden (DMF + NCCL/S) and SSD intake. In total, 915 and 996 children were included from the 10- and 15-year follow-ups, respectively. Intake (g/day) of SSDs, comprising cola, lemonade, ice-tea, sport/energy drinks, fruit squashes and nectars, was calculated from food frequency questionnaires. For analyses, the SSD intake was converted into portions (250 ml/day). Multiple logistic regression and prospective analysis models were performed to test associations between SSD intake and various definitions of caries, adjusting for sex, parental education, body mass index (BMI) categories, study cohort, plaque-affected sextants, mode of SSD consumption, energy content of SSDs, and total energy intake. RESULTS: The mean overall caries burden at 10 and 15 years of age was 1.81 (SD: 2.71) and 6.04 (SD: 8.13), respectively. The average consumption of SSDs at the 10- and 15-year follow-ups was 0.48 (SD: 0.85) and 0.83 (SD 1.40) portions/day, respectively. After adjusting for confounders, in 10-year-olds, SSD intake was significantly associated with higher caries experience based on the indices DMF/S (adjusted odds ratio: 1.29; 95% CI: 1.06-1.57), NCCL/S (1.24; 1.03-1.49) and DMF + NCCL/S (1.27; 1.05-1.55). At the 15-year follow-up, SSD consumption was significantly associated with increased DMF/S index (1.12; 1.01-1.25) only. Prospective model associating 10-year SSD intake with 15-year caries experience was not significant. CONCLUSIONS: SSD intake significantly increases the caries burden in 10-year-olds, with attenuated effects in 15-year-olds. To prevent caries, SSD consumption should be reduced, especially in children and adolescents.

Safety and Efficacy of RimabotulinumtoxinB for Treatment of Sialorrhea in Adults: A Randomized Clinical Trial.

Importance: RimabotulinumtoxinB (RIMA) may be preferable as an anti-sialorrhea treatment compared with current oral anticholinergic drugs in people with neurological disorders. Objective: To assess the safety, efficacy, and tolerability of RIMA injections for the treatment of sialorrhea in adults. Design, Setting, and Participants: This randomized, parallel, double-blind, placebo-controlled clinical trial of RIMA 2500 U and 3500 U was conducted from November 14, 2013, to January 23, 2017. A total of 249 adult patients with troublesome sialorrhea secondary to any disorder or cause were screened. Of them, 13 refused further participation in the study or were lost to follow-up and 49 did not fulfill the criteria for participation; 187 were ultimately enrolled. Patients had to have a minimum unstimulated salivary flow rate (USFR) of 0.2 g/min and a minimum Drooling Frequency and Severity Scale score of 4. Exposures: Patients were randomized 1:1:1 to RIMA, 2500 U (n = 63); RIMA, 3500 U (n = 64); or placebo (n = 60). Main Outcomes and Measures: Primary outcomes were the change in USFR from baseline to week 4 and the Clinical Global Impression of Change (CGI-C) at week 4. The CGI-C scores were recorded on a 7-point scale ranging from very much improved to very much worse. Adverse events were recorded throughout the trial period. Results: Of 187 patients enrolled (147 men [78.6%]; mean [SD] age, 63.9 [13.3] years), 122 patients had Parkinson disease (65.2%), 13 (7.0%) were stroke survivors, 12 had amyotrophic lateral sclerosis (6.4%), 6 had medication-induced sialorrhea (3.2%), 4 had adult cerebral palsy (2.1%), and 30 had sialorrhea owing to other causes (16.0%). A total of 176 completed the study. Treatment with both doses of RIMA significantly reduced USFR at week 4 vs placebo (mean treatment difference, -0.30 g/min [95% CI, -0.39 to -0.21] for both doses vs placebo, P < .001). The CGI-C scores were statistically significantly improved at week 4 for both treatment groups vs placebo (-1.21 [95% CI, -1.56 to -0.87] for 2500 U, -1.14 [95% CI, -1.49 to -0.80] for 3500 U, both P < .001). Treatment benefits were seen as early as 1 week after injection and were maintained over the treatment cycle of approximately 13 weeks. The RIMA injections were well tolerated compared with placebo. The most common adverse events were self-limited mild to moderate dry mouth, dysphagia, and dental caries. Conclusions and Relevance: Treatment with RIMA (2500 U and 3500 U) in adults was well tolerated and reduced sialorrhea, with the onset of the effect at 1 week after the injection. These data support the clinical use of RIMA in the management of sialorrhea in adults. Trial Registration: ClinicalTrials.gov Identifier: NCT01994109.

]Risk of dental caries in pediatric asthmatic patients undergoing treatment with salbutamol and budesonide inhalation therapy, Peru.] / Riesgo de caries dental en pacientes pediátricos asmáticos en tratamiento con la terapia inhalatoria de salbutamol y budesonida, Perú.

Introduction: Asthma is related to caries but the risk factors are not completely determined. Therefore, the objective of the study was to determine the risk of dental caries in pediatric asthmatic patients in inhalation treatment with salbutamol and budesonide who went to the National Hospital Arzobispo Loayza. Methods: Case-control study that consisted of 184 pediatric patients, between 5 and 12 years old, who attended the pneumology and pediatric dentistry service of the National Hospital Arzobispo Loayza during the years 2016-2017. The group of cases (n = 92) was composed of patients with moderate asthma medicated with inhaled salbutamol and budesonide, while the control group (n = 92) was composed of healthy patients. The risk of dental caries was evaluated with the dietary record, oral hygiene index and number of carious lesions. Results: The risk according to the type of cariogenic diet was moderate in both groups (p = 0.768). The oral hygiene index in the control group was regular in 63% (n = 58) and in the case group, bad in 60.9% (n = 56); p=0.001. The number of carious lesions in the control group was moderate in 50% (n = 46) and in the case group, high in 47.8% (n = 44); p = 0.001. Therefore, the risk of dental caries in the case group was high in 50% (n = 46) and in the control group it was moderate in 72.8% (n = 67); p = 0.001. Conclusion: The risk of dental caries in asthmatic patients on inhaled therapy with salbutamol and budesonide is significantly higher than that of healthy patients.

Introducción: El asma está relacionada con la caries pero los factores de riesgo no están determinados completamente. Por ello, el objetivo del estudio fue determinar el riesgo de caries dental en pacientes pediátricos asmáticos en tratamiento inhalatorio con salbutamol y budesonida que acudieron al Hospital Nacional Arzobispo Loayza. Métodos: Estudio de casos y controles que estuvo conformado por 184 pacientes pediátricos, entre 5 a 12 años, que asistían al servicio de neumología y odontopediatría del Hospital Nacional Arzobispo Loayza durante los años 2016-2017. El grupo de casos (n=92) estuvo integrado por pacientes con asma moderado medicados con salbutamol y budesonida inhalatorios, mientras el grupo control (n=92) estuvo integrado por pacientes sanos. El riesgo de caries dental se evaluó con la ficha dietética, índice de higiene oral y número de lesiones cariosas. Resultados: El riesgo según el tipo de dieta cariogénica fue moderado en ambos grupos (p=0,768). El índice de higiene oral en el grupo control fue regular en 63% (n=58) y en el grupo de casos, malo en 60,9% (n=56); p=0,001. El número de lesiones cariosas en el grupo control fue moderado en 50% (n=46) y en el grupo de casos, alto en 47,8% (n=44); p=0,001. Por lo tanto, el riesgo de caries dental en el grupo de casos fue alto en 50% (n=46) y en el grupo control fue moderado en 72,8% (n=67); p=0,001. Conclusión: El riesgo de caries dental en los pacientes asmáticos en tratamiento inhalatorio con salbutamol y budesonida es significativamente superior al de los pacientes sanos.

Capacidad buffer de la saliva y su relación con la prevalencia de caries, con la ingesta de diferentes bebidas comerciales / Buffer capacity of saliva and its relation to the prevalence of caries, with the intake of different commercial drinks

Resumen En la actualidad tanto el consumo de jugos, como de bebidas gaseosas, es muy común en la dieta diaria de la población infantil, estas ofrecen diferentes sabores, además de un alto contenido de azúcar. En este estudio se hizo un análisis de la capacidad buffer de la saliva ante la ingesta de diferentes tipos de bebidas consideradas saludables y no saludables. Se utilizaron dos tipos de instrumentos, un examen clínico aplicado a 62 estudiantes para determinar la prevalencia de caries según ICDAS y un segundo instrumento que consta de una tabla aplicada a los mismos 62 estudiantes con la finalidad de analizar la capacidad buffer de la saliva mediante la toma del pH a intervalos de 15, 35 y 45 minutos después de ingerir las bebidas. Como conclusión se obtuvo que para las bebidas consideradas no saludables el pH tardó más en neutralizarse, mientras que la bebida saludable logró su neutralización más rápido, con una baja prevalencia de caries.

Abstract Nowadays the consumption of juices, and soft drinks, is very common in the children's diet, they offer different flavours and a high content of sugar. In this study, an analysis of the buffer capacity of the saliva was made in view of the intake of different types of beverages considered healthy and unhealthy. Two types of instruments were used, a clinical test applied to 62 students to determine the prevalence of caries according to ICDAS and a second instrument that consists of a chart applied to the same 62 students with the purpose of analyzing the buffer capacity by taking the pH on intervals of 15, 35 and 45 minutes after drinking the beverages. As a conclusion, it was obtained that for the drinks considered unhealthy, the pH took longer to neutralize, while the healthy drink achieved its neutralization faster, with a low prevalence of caries.

Serão as bactérias cariogénicas o fator de risco maior para cáries dentárias em doentes com retocolite ulcerativa? / Are cariogenic bacteria the major risk factor to dental caries in patients with ulcerative colitis?

ABSTRACT BACKGROUND: High prevalence of dental caries in ulcerative colitis (UC) has been attributed to diet and changes in salivary environment. OBJECTIVE: We aimed to characterize the prevalence of dental caries, salivary flow rates, salivary buffering capacity and cariogenic bacteria counts of Mutans streptococci and Lactobacillus spp and to evaluate their relationship with drug therapy, disease activity and duration. METHODS: A cross-sectional study was performed with UC patients followed in a tertiary center. Participants were submitted to a questionnaire (including demographic data, oral hygiene, eating habits) and a clinical observation with assessment of plaque index and Decayed, Missing and Filled Teeth index. Unstimulated/stimulated saliva was collected. Medical records, disease activity (Partial Mayo Score) and disease duration were collected. Laboratory data included salivary flow rates, salivary buffering capacity (CRT® buffer) and cariogenic bacteria count (Mutans streptococci and Lactobacillus spp) in saliva using the CRT® bacteria test (results: high or low counts). RESULTS: Thirty UC patients were recruited. Oral hygiene routines were daily teeth brushing once or more (96.7%) and fluoride toothpaste (73.3%). Decayed, Missing and Filled Teeth index (mean 16.17±6.428) was not affected by the frequency of soft drinks, cakes, sweets and sugars between meals (P>0.2). Long-term disease showed a trend towards higher prevalence of caries (P=0.06). Most presented normal salivary flow rates, unstimulated (73.3%) and stimulated (60.0%), and high salivary buffering capacity (66.7%). Any association was found with age, gender, disease activity, disease duration and drug therapy. High Mutans streptococci and low Lactobacillus spp count were observed in 73.3% and 60% of patients, respectively. Patients with active disease (100%) and longer duration (88.9%) displayed higher Mutans streptococci count. CONCLUSION: The prevalence of dental caries observed in UC patients was significant and did not seem to be influenced by their eating habits. The high prevalence of Mutans streptococci count may be a major risk factor for dental caries and may be looked as part of the UC dysbiosis. Dental care of UC patients should be planned according with this microbiota variation.

RESUMO CONTEXTO: Uma elevada prevalência de cáries dentárias em doentes com retocolite ulcerativa (RCU) tem sido atribuída à dieta e alterações no ambiente salivar. OBJETIVO: Este estudo pretende caracterizar a prevalência de cáries dentárias, taxas de fluxo salivar, capacidade de tamponamento da saliva e contagem de bactérias cariogénicas, Streptococcus mutans e Lactobacillus spp e avaliar a sua relação com a terapêutica farmacológica e a atividade e duração da doença. MÉTODOS: Estudo transversal com doentes com RCU seguidos num centro terciário. Os participantes foram submetidos a um questionário (incluindo questões sobre dados sociodemográficos, higiene oral e hábitos alimentares), e a uma observação clínica com avaliação do índice de placa e índice Decayed, Missing and Filled Teeth. Amostras de saliva não estimulada e estimulada foram colhidas. Os registos clínicos, a atividade da doença (score parcial de Mayo) e a sua duração foram avaliados. Os dados laboratoriais incluíram taxas de fluxo salivar, capacidade de tamponamento da saliva (CRT® buffer) e a contagem de bactérias cariogénicas (Streptococcus mutans e Lactobacillus spp) utilizando o teste CRT® (resultado: contagem elevada ou reduzida). RESULTADOS: Foram recrutados 30 doentes com RCU. As rotinas de higiene oral incluíram a escovagem dos dentes uma ou mais vezes por dia (96,7%) e o uso de pasta com flúor (73,3%). O índice Decayed, Missing and Filled Teeth (média 16,17±6,428) não foi afetado pela frequência de ingestão de refrigerantes, bolos, doces e açucares entre as refeições (P>0,2). Doentes com doença de longa duração apresentaram uma tendência para maior prevalência de cáries dentárias (P=0,06). A maioria possuía taxas de fluxo salivar normais, quer de saliva estimulada (60%) quer de saliva não estimulada (73,3%), assim como taxas de tamponamento salivar elevadas (66,7%). Não foi encontrada associação entre estas características com a idade, género, atividade/duração da doença e tipo de terapêutica farmacológica. Contagens elevadas de Streptococcus mutans e reduzidas de Lactobacillus spp foram observadas em 73,3% e 60% dos doentes, respectivamente. Doentes com doença ativa e maior tempo de evolução apresentaram contagens superiores de Streptococcus mutans. CONCLUSÃO: A prevalência de cárie dentária observada em doentes com RCU foi significativa e não parece ser influenciada pelos hábitos alimentares. A prevalência aumentada de Streptococcus mutans foi o fator de risco maior para a cárie dentária e provavelmente constitui parte da conhecida disbiose oral associada à RCU. Os cuidados dentários a estes doentes deverão ter em consideração esta variação da microbiota.

Role of polyphenols and nonpolyphenols against toxicity induced by fluoride: a comprehensive review.

Since its discovery as an antimicrobial agent, fluoride has been used in the control of dental caries. Many studies have shown that the chronic exposure of fluoride in high concentrations causes adverse effects in multiple organs; the use of bioactive compounds present in foods as a tool to mitigate the effects of fluoride could potentially be useful for populations in different parts of the world are exposed to fluoride in a chronic and systemic way. Thus, the aim of this comprehensive review is to present and discuss the published papers that focused on the use of polyphenols and nonpolyphenols that can mitigate the harmful activities promoted by fluoride exposure. Certainly, these data will contribute toward a better understanding of the role of food compounds in the pathological outcomes induced by fluoride. The new information will be added to that already available for regulatory purposes as a safe way to promote oral healthcare and prevent oral carcinogenesis.

Long-term scopolamine treatment and dental caries.

OBJECTIVES: To investigate whether scopolamine, an anticholinergic agent which induces hyposalivation, represents a risk factor for the occurrence of dental caries. MATERIALS AND METHODS: A retrospective cohort study was carried out among sailors treated with scopolamine for seasickness. The study population included 370 young healthy male adults (18-30 years old) who served in the Israel Navy between 2012 and 2016. Of these, 66 subjects who were chronically treated with intermittent administration of scopolamine, either by the oral or transdermal route, were assigned to the study group. Documented subject characteristics included age, socioeconomic status, level of education, body mass index, smoking history, and dental hygiene. Follow-up lasted 1 to 3.5 years. RESULTS: Two- to 3.5-year follow-up revealed a higher risk of dental caries in 15 of 16 subjects (93.8%) treated with an average of 50.9 mg scopolamine, in contrast to only 71 of 108 control subjects (65.7%) (RR = 1.43, p = 0.02 [95% CI = 1.18-1.72]). Follow-up for 1-1.5 years revealed a lower occurrence of dental caries in both the study group (11/22, 50.0%) and the control group (46/104, 44.2%). Follow-up of 1.5-2 years also revealed less dental caries, in 16/28 subjects (57.1%) in the study group and 51/92 subjects (55.4%) in the control group. The differences were not statistically significant. CONCLUSIONS: In healthy young adults, prolonged intermittent use of scopolamine was found to be a risk factor for the development of dental caries. CLINICAL SIGNIFICANCE: Dental care and hygiene should be intensified when administering hyposalivatory anticholinergic agents.