Salivary Proteins and Metabolites as Caries Biomarkers in Adolescents.

INTRODUCTION: The identification of salivary molecules that can be associated to dental caries could provide insights about caries risk and offer valuable information to develop caries prediction models. However, the search for a universal caries biomarker has proven elusive due to the multifactorial nature of this oral disease. We have therefore performed a systematic effort to identify caries-associated metabolites and proteins in saliva samples from adolescents that had a caries experience and those that were caries-free. METHODS: Quantification of approximately 100 molecules was performed by the use of a wide range of techniques, ranging from nuclear magnetic resonance metabolomics to ELISA, Luminex or colorimetric assays, as well as clinical features like plaque accumulation and gingival index. In addition, simplified dietary and oral hygiene habits questionnaires were also obtained. RESULTS: The caries-free group had significantly lower consumption of sweetened beverages and higher tooth brushing frequency. Surprisingly, very few compounds were found to individually provide discriminatory power between caries-experienced and caries-free individuals. The data analysis revealed several potential reasons that could underly this lack of association value with caries, including differences in metabolite concentrations throughout the day, a lack of correlation between metabolite concentrations in plaque and saliva, or sex-related differences, among others. However, when multiple compounds were combined by multivariate analysis and random forest modeling, a combination of 3-5 compounds were found to provide good prediction models for morning (with an AUC accuracy of 0.87) and especially afternoon samples (AUC = 0.93). CONCLUSION: While few salivary biomarkers could differentiate between caries-free and caries-experienced adolescents, a combination of markers proved effective, particularly in afternoon samples. To predict caries risk, these biomarkers should be validated in larger cohorts and longitudinal settings, considering factors such as gender differences, and variations in oral hygiene and diet.

Effect of splinting times on the healing of intra-alveolar root fractures in 512 permanent teeth in humans: A Scandinavian multicenter study.

BACKGROUND/AIM: Long-term splinting of teeth with intra-alveolar root fractures has been considered important for the deposition of hard tissue between the root fragments. The aim of this study was to compare the healing outcomes in teeth with intra-alveolar root fractures relative to splinting times in three dental centers in Scandinavia, using historical data. MATERIALS AND METHODS: A total of 512 maxillary and mandibular incisors from three dental trauma centers were included in the study. Two of the centers used long-term splinting protocols of two to three months while the other center used a short-term splinting protocol of one month or less. Three outcomes were evaluated: (1) Healing with hard tissue (dentin and/or cementum). (2) Healing with connective tissue (periodontal ligament) interposition with or without bone between the fragments. (3) Non-healing due to the coronal pulp being necrotic and infected with granulation tissue interposed between the fragments. RESULTS: The mean splinting times were 18, 81, and 110 days in the three centers. Long-term splinting resulted in hard tissue healing more frequently than short-term splinting. Short-term splinting resulted in more connective tissue/bony healing than long-term splinting, while there was no difference in the frequency of non-healing between long-term and short-term splinting protocols. CONCLUSIONS: While the results suggest that long-term splinting favors hard tissue deposition, one cannot, however, conclude that long-term splinting definitely favors hard tissue healing since the treatment protocols were not randomized among the three centers. More clinical studies on the role of splinting time need to be done.

Prevalence of dental erosion and association with lifestyle factors in Swedish 20-year olds.

OBJECTIVE: To investigate the prevalence, distribution and severity of dental erosion and its association with lifestyle, oral and general health in young adults. MATERIALS AND METHODS: Four hundred and ninety-four individuals, 20-years of age, participated. Dental erosion in molars and maxillary incisors was evaluated. Caries, plaque and gingivitis were registered. Saliva samples were taken and the subjects were interviewed about behavioural and dietary habits and oral and general health. Body mass index (BMI) was calculated. The individuals were sub-divided into two groups according to the presence and absence of dental erosion: within the group with erosion was a sub-group of individuals with extensive erosion. RESULTS: Of the individuals 25% had no erosion, 75% had erosion and 18% had extensive erosion. Erosion was found in molars in 74% of the individuals and on buccal and palatal surfaces in maxillary incisors in 4% and 7%, respectively. Cupping was seen in 65% of individuals and severe erosion in molars in 1.6%. Compared to subjects with no erosion, those with extensive erosion had a higher consumption of soft drinks (p = 0.05), caries prevalence (p < 0.01), prevalence of mutans Streptococci (p < 0.01) and BMI (p < 0.05). Furthermore, subjects with erosion had higher caries prevalence (p < 0.01) and BMI (p < 0.01) than those with no erosion. CONCLUSIONS: Swedish young adults have a high prevalence of dental erosion, but the level of severe erosion is low. The study disclosed a relationship between dental erosion and behavioural factors, oral health and BMI.

On dental caries and dental erosion in Swedish young adults.

BACKGROUND: All children in Sweden are entitled to regular, free dental care up to 20 years of age. While dental caries generally continues to decline, still there is a pronounced skewness in caries prevalence. Furthermore, the reported increase in dental erosion in young adults is cause for concern. AIM: The aim was to study the prevalence of dental caries and dental erosion in a cohort of Swedish 20 year-olds, with special reference to the influence of previous caries experience and lifestyle as well as parental, socioeconomic and psychosocial factors. MATERIAL AND METHODS: The study was prospective, longitudinal and cross-sectional in design and based on registration of caries lesions, dental erosion, body adiposity status, saliva sampling, interviews, and questionnaires at 20 years of age. Data were available for the same cohort at 1, 3, 6 and 15 years of age. 499 subjects (74 percent of the original cohort) were included. Five individuals were subsequently excluded, leaving a final sample of 494. RESULTS: 74 percent of the subjects had initial and/or manifest caries lesions and/or restorations. The mean number of DimFS was 5.8 and the mean number of DmFS on occlusal surfaces of molars was 1.1. There was a strong relationship between caries activity at 3 and 6 years of age and approximal caries prevalence in premolars and molars at 20 years of age. Overweight/obese individuals had significantly higher caries prevalence than normal weight individuals. Parental, socioeconomic and psychosocial factors during infancy were related to approximal caries at age 20. Dental erosion was found in 75 percent of the individuals: 18 percent of these had extensive erosion. There was a significant association between caries and dental erosion. A relationship was found between dental erosion and lifestyle factors and overweight/obesity. CONCLUSIONS: There is a strong relationship between caries prevalence at age 20 and caries experience in early childhood. Young adults show a high prevalence of dental erosion, but the severity is generally low. Overweight and obese individuals have more caries than normal weight individuals. Parental influence during the formative years has an impact on caries prevalence in young adulthood. In this cohort, dental caries and dental erosion at age 20 are related to overweight/obesity and lifestyle factors.

Overweight and obesity in twenty-year-old Swedes in relation to birthweight and weight development during childhood.

AIM: To describe the frequency of overweight and obesity from birth to 20 years of age and analyse weight at 20 years of age in relation to weight and weight development during early childhood and adolescence. METHODS: A longitudinal, population-based study, which followed 496 children from birth to 20 years of age. Information about weight and height was collected from health records at child health centres and school health care. At 20 years of age, weight and height measurements were taken by one of the authors. RESULTS: At 20 years of age, 124 (25%) of the youth were obese or overweight. Of these youths, 60% had normal weight at 5.5 years. Of the teenagers who were overweight/obese at 15 years, 79% remained overweight/obese at 20 years of age. Out of the 124 overweight/obese at 20, 47% had normal weight at 15 years. [Corrections added after online publication on April 18, 2012: 'Out of the 124 obese at 20' has been changed to 'Out of the 124 overweight/obese at 20']. No relation was found between rapid weight gain during preschool age and overweight and obesity in 20-year-olds. CONCLUSIONS: The majority of those who were overweight/obese at 20 years of age were recruited after 5.5 years of age, and half of them in their late teens. Thus, during the preschool period, the entire population should be the target of primary prevention from overweight/obesity and, in the case of teenagers, prevention strategies should be developed for the whole population as well as treatment strategies for teenagers with established overweight/obesity.

BMI status in Swedish children and young adults in relation to caries prevalence.

Overweight and obesity are increasing as health problems at global level. Dental caries and obesity are both multifactorial diseases and are associated with dietary habits. The aim of the present study was to investigate the relationship between body weight status and caries prevalence in an unselected population followed from pre-school years to young adulthood. The present investigation was designed as a longitudinal analysis of the association between overweight/obesity and dental caries in one population at 3, 6, 15 and 20 years of age. The result shows that adolescents (15 years) and young adults (20 years) who are overweight/obese had a statistically significantly higher caries prevalence than normal-weight young people. At 6 years of age, the odds (OR) of having caries among obese children are 2.5 times higher than the odds for caries among six-year-old children of normal weight (p = 0.04). At 3 years of age, no association between overweight/obesity and caries was found. To conclude, overweight and obese adolescents and young adults had more caries than normal-weight individuals. The present study emphasises the need for multidisciplinary approaches to change the lifestyle factors causing both overweight/obesity and dental caries.

Parental factors in early childhood are associated with approximal caries experience in young adults-A longitudinal study.

OBJECTIVES: To test the hypothesis that parental factors in early childhood influence approximal caries experience in young adults. METHODS: A cohort of 494 individuals was followed longitudinally from 1 to 20 years of age. Data were retrieved from parental interviews and questionnaires when the child was 1 and 3 years of age. At age 20, the participants underwent bitewing radiographic examination. Based on the number of approximal caries lesions (Da), stratified into initial (Di ) or manifest caries (Dm ) and approximal fillings (Fa), the participants were divided into two main groups: those with: (a) 0 Dim Fa (n = 244) and (b) >0 Dim Fa (n = 250). A subgroup was also created (≥8 Dim Fa; n = 33). RESULTS: Toothbrushing with fluoride toothpaste at 3 years of age less than twice a day (OR 1.6, 95% CI 1.0-2.6) and the participants' mothers' self-estimation of their oral health care as "less than optimal" were important risk factors for developing caries (>0 Dim Fa OR 2.0, 95% CI 1.3-3.1). An interaction effect between toothbrushing at 3 years of age less than twice a day and consumption of caries risk products > 3 times a day further increased the caries experience in young adults (≥8 Dim Fa OR 8.3, 95% CI 1.8-37.8) together with maternal anxiety about dental treatment (OR 7.4 95% CI 1.6-34.6). CONCLUSIONS: Parental factors in early childhood are associated with caries experience at 20 years of age.