Effects of Hydroxyapatite-Containing Toothpastes on Some Caries-Related Variables: A Randomised Clinical Trial.

OBJECTIVES: This randomised clinical trial was designed and carried out with the aim to evaluate the capacity of fluoride-substituted hydroxyapatite (HAF) toothpaste to modulate oral microflora composition and biofilm acidogenicity in schoolchildren. METHODS: In all, 610 children (4 to 5 and 6 to 7 years) were enrolled. Four toothpastes were randomly administered during 24 months: 2 contained fluoride-substituted hydroxyapatite (HAF1000 and HAF1450; 1000 and 1450 ppmF) and magnesium-, strontium-, and carbonate-substituted hydroxyapatite in a chitosan matrix, and 2 were monofluorophosphate fluoridated toothpastes (F1000 and F1450; 1000 and 1450 ppmF). Caries lesions were assessed by International Caries Detection and Assessment System scores, supragingival plaque was sampled from the approximal sites between primary molars using sterile Gracey curettes for microbiological analysis, and plaque pH curves after sucrose challenge were assessed at baseline and reevaluated after 1 year and after 2 years. The minimum and maximum pH decrease was calculated for caries-free patients and participants with a caries lesion(s) at baseline and at the end of the experimental period (24 months). Differences amongst measurements were analysed with 1-way analysis of variance. RESULTS: During the trial, the minimum pH value increased statistically significantly in all groups; in HAF1000 and HAF1450, the increase was greatest. At the end of trial, in the 2 HAF groups all primary cariogenic bacteria were statistically significantly lower with respect to F groups (P = .03 for Streptococcus mutans and sobrinus, for Lactobacillus casei, and for Lactobacillus fermentum). CONCLUSIONS: The trial provides robust but still inconclusive evidence on the efficacy of HAF toothpastes compared to traditional fluoridated toothpastes to reduce caries risk factors and to prevent caries lesions.

Inequalities in caries among pre-school Italian children with different background.

BACKGROUND: The study was aimed to describe caries prevalence and severity and health inequalities among Italian preschool children with European and non-European background and to explore the potential presence of a social gradient. METHODS: The ICDAS (International Caries Detection and Assessment System) was recorded at school on 6,825 children (52.8% females). Caries frequency and severity was expressed as a proportion, recording the most severe ICDAS score observed. Socioeconomic status (SES) was estimated by mean a standardized self-submitted questionnaire filled-in by parents. The Slope Index of Inequality (SII) based on regression of the mid-point value of caries experiences score for each SES group was calculated and a social gradient was generated, children were stratified into four social gradient levels based on the number of worst options. Multivariate regression models (Zero-Inflated Negative Binomial logistic and logistic regression) were used to elucidate the associations between all explanatory variables and caries prevalence. RESULTS: Overall, 54.4% (95%CI 46.7-58.3%) of the children were caries-free; caries prevalence was statistically significant higher in children with non-European background compared to European children (72.6% vs 41.6% p < 0.01) and to the area of living (p = 0.03). A statistically significant trend was observed for ICDAS 5/6 score and the worst social/behavioral level (Z = 5.24, p < 0.01). Children in the highest household income group had lower levels of caries. In multivariate analysis, Immigrant status, the highest parents' occupational and educational level, only one kid in the family, living in the North-Western Italian area and a high household income, were statistically significant associated (p = 0.01) to caries prevalence. The social gradient was statistically significant associated (p < 0.01) to the different caries levels and experience in children with European background. CONCLUSIONS: Data show how caries in preschool children is an unsolved public health problem especially in those with a non-European background.

Efficacy of HAF toothpastes in primary and permanent dentitions. A 2-years triple-blind RCT.

OBJECTIVES: The aim of this RCT was to compare the caries preventive efficacy and the slowing down of previous caries lesions of toothpastes containing fluoride biomimetic hydroxyapatite (HA) complex compared to sodium monofluorophosphate fluoridated toothpastes in Italian schoolchildren. To validate this hypothesis a triple-blind randomized clinical trial was designed. METHODS: In total 610 children (4-5 and 6-7 years) were enrolled. Four toothpastes, two containing fluoride-substituted hydroxyapatite (HAF) (1000 and 1450 ppmF) and magnesium-, strontium-, carbonate-substituted hydroxyapatite, in a chitosan matrix and two Mono fluoridated toothpastes (1000 and 1450 ppmF) were randomly administered during 24 months to two groups with younger children (Gyoung) and to two groups with older children (Gold), those containing 1450 ppmF. ICDAS was used to score lesions as initial (up to score 2), moderate (scores 3-4) and severe (scores 5-6). The children were instructed to brush for two minutes three times/day. Caries examination was repeated at 12 and 24 months. The efficacy of the treatment was assessed by calculating the reduction in Risk Ratio (RR) and the number needed to treat (NNT). Results; Overall, 518 patients (Gyoung = 268; Gold = 250) concluded the trial. The drop-rate was 11.84% for Gyoung and 17.22% for Gold. The caries increment at 24-month evaluation was statistically lower in the primary dentition in the HAF arms compared to the traditional fluoridated arms (0.18 vs 0.27 p = 0.04 in Gyoung and 0.16 vs 0.30 p = 0.01 in Gold for severe lesions). In the permanent dentition (Gold), caries increase was also statistically lower in the HAF arm, both for initial and severe lesions (0.09 vs 0.17 p = 0.02 and 0.18 vs 0.28 p = 0.01, respectively). In primary dentition, children receiving HAF Toothpaste had a RR of 39% (Gyoung) and 38% (Gold), compared to children receiving traditional Toothpastes. The RR in the permanent dentition was 29% in children treated with HAF toothpaste. Conclusions; The use of toothpastes containing biomimetic hydroxyapatite and fluoride reduces caries increment in children over a period of 2 years more than traditional fluoridated toothpastes.

Study protocol for a randomized clinical trial to evaluate the effect of the use of Xylitol gum in the prevention of caries lesions in children living in Ladakh-the Caries Prevention Xylitol in Children (CaPreXCh) trial.

BACKGROUND: Xylitol use is reported to be able to reduce dental plaque amount and cariogenic bacteria and, as a consequence, the caries increment. Only few data on the oral health of Ladakh's population are available. The aim of the present protocol will be to record the caries prevalence of primary and permanent molars of schoolchildren living in Ladakh and to implement a school-based Xylitol programme, named the Caries Prevention Xylitol in Children (CaPreXCh) trial, using chewing gums. METHODS: The protocol is designed as a triple-blind randomized, controlled, parallel-group clinical trial in children aged 5-14 years. The study should have been carried out from August 2021 to August 2024 in Zanskar Valley (Ladakh), but the COVID-19 pandemic does not allow today to make predictions on the exact start. Participants will be randomly allocated into two groups: subjects who will receive a chewing gum with Xylitol (70% w/v) as only sweetener, and those who will receive a sugared chewing gum containing Maltitol (23% w/v). The subjects will be instructed to chew a total of 6 pellets for 5 min divided into 3 intakes a day (2 in the morning, 2 after the midday meal and 2 in the afternoon) for one school year. Clinical examination will comprise an oral examination in which caries index (ICDAS scores), bleeding on probing and plaque pH evaluation after sucrose challenge will be recorded at baseline (t0); the clinical examination will be repeated after 12 months since the beginning of the chewing gum administration period (t1), after another 12-month period (t2) and finally after further 12 months (t3) (24 months from the end of the chewing gum use). The primary outcome will be the caries increment measured both at enamel and dentinal levels on primary and permanent molars. Data analysis will be conducted through Kaplan-Meyer graphs to evaluate caries increment. A comparison of the methods will be carried out with Cox regression with shared frailty. The net caries increment for initial, moderate and severe caries levels, using ICDAS (Δ-initial, Δ-moderate and Δ-severe), will be calculated. DISCUSSION: This trial will be the first trial conducted in India assessing the efficacy of a school-based caries preventive programme through the use of chewing gum containing only Xylitol as a sweetener. The findings could help strengthen the evidence for the efficacy of Xylitol use in community-based caries prevention programmes in children. TRIAL REGISTRATION: Clinical trials.gov NCT04420780 . Registered on June 9, 2020.

Life-conditions and anthropometric variables as risk factors for oral health in children in Ladakh, a cross-sectional survey.

BACKGROUND: The aim of this survey was to evaluate the severity of dental caries among children living in Zanskar Valley (Ladakh, India) and its association with anthropometric and background variables. METHODS: This cross-sectional survey was conducted on schoolchildren divided into four age groups (< 6, ≥ 6 < 11, ≥ 11 < 14 and > 14 years of age). A total of 1474 schoolchildren (607 males, 41.2%) were examined. Actual caries prevalence (dt/DT) and gingival bleeding were recorded by four calibrated dentists. An ad hoc questionnaire evaluated general health, eating habits, oral hygiene and the self-perception of oral conditions. Height, weight, waist circumference, heart-rate and oxygen-saturation were also collected directly by examiners. Responses to questionnaire items were treated as categorical or ordinal variables. The relationship between children's caries data, gingival bleeding, gender, Body Mass Index (BMI) following the International Obesity Task Force, waist circumference and questionnaire items was assessed using the Kruskal-Wallis test and Pearson correlation. Conditional ordinal logistic regression was used to analyse associations among caries severity, gender, BMI, waist circumference, oxygen saturation and questionnaire items. A forward stepwise logistic regression procedure was also carried-out to estimate the ORs of gingival bleeding prevalence and the covariates derived from examination or questionnaire. RESULTS: Caries was almost ubiquitarian with only 10.0% of caries-free children (dt/DT = 0). Caries severity, in both primary and permanent dentitions, was statistically significantly related to gender, waist circumference, BMI, oral hygiene frequency and self-reported chewing problems (p < 0.01 in both dentitions). An increasing relative risk for caries in permanent dentition compared to caries-free subjects was observed in children with a low BMI (RRR = 1.67, 95%CI = 1.54/2.83 for subjects with 1-3 caries lesions and RRR = 1.52, 95%CI = 1.36/1.74 for subjects with > 3 caries lesions); also, children with reduced waist circumference had a higher relative risk to have 1-3 caries lesions (RRR = 2.16, 95%CI = 1.84/2.53) and an even higher risk to have more than 3 caries lesions (RRR = 4.22, 95%CI = 3.33/5.34). CONCLUSIONS: A significant impact of untreated caries lesions was observed in Ladakh schoolchildren; low BMI values and reduced waist circumference showed to be the main caries risk predictors. Preventive and intervention programmes should be implemented to improve children's oral health.

Effect of Lactobacillus brevis CD2 containing lozenges and plaque pH and cariogenic bacteria in diabetic children: a randomised clinical trial.

OBJECTIVE: The short-term effect (60 days) of Lactobacillus brevis CD2 lozenges vs placebo on variables related to caries and gingivitis in type 1 diabetic children was evaluated. MATERIAL AND METHODS: Eight diabetics (4-14 years old) were assigned to two groups (n = 34 subjects each), probiotic lozenges and placebo. Stimulated saliva for microbiological analysis and plaque pH were assessed at baseline (t0), 30 days (t1), 60 days (t2) and in the follow-up period (90 days from baseline, t3). Gingival status was assessed at t0, t2 and t3. Two-way ANOVA assessed differences between groups. RESULTS: In the probiotic group, Streptococcus mutans bacterial density mean scores dropped from 3.11 ± 1.13 at baseline to 1.82 ± 0.72 (t2) and to 2.06 ± 0.56 (t3), while in the placebo group, the scores were 3.09 ± 0.8 (t0), 2.82 ± 0.47 (t2) and 3.11 ± 0.43 (t3) (p < 0.01). Lowest and maximum pH fall increased in the probiotic group, from 5.37 ± 0.41 at baseline to 5.49 ± 0.24 at t3 (p < 0.01) and from 1.20 ± 0.46 to 0.98 ± 0.29 (p = 0.02). Bleeding score decreased significantly in both groups, showing a statistically significant lower bleeding score at t2 in the probiotic group (25.6%, 95% CI 21.5-32.7 vs 29.5%, 95% CI 25.2-34.9, p = 0.02). CONCLUSIONS: Lactobacillus brevis CD2 has shown to improve caries-related risk factors and gingival health in diabetic children. CLINICAL RELEVANCE: Lactobacillus brevis CD2 might contribute to improved oral health in type 1 diabetic children.

Caries severity and socioeconomic inequalities in a nationwide setting: data from the Italian National pathfinder in 12-years children.

This study presents the result of the second National pathfinder conducted in Italy on children's oral health, reporting the prevalence and severity of caries in 12-year old children and describing the caries figure related to the socioeconomic inequalities, both at individual level and macroeconomic level. The two-digit codes related to ICDAS (International Caries Detection and Assessment System) for each tooth and the gingival bleeding score were recorded at school on 7,064 children (48.97% males and 51.03% females). The Gross National Product (GNP) per capita, the Gini Index and Unemployment rate in each Italian section, parents' educational levels, working status, smoking habit and their ethnic background were recorded. Zero-inflated-negative-binomial (ZINB) models were run, using caries-free teeth, teeth with enamel lesions, cavitated lesions and restorations as functions of socioeconomic explanatory variables, to evaluate the effects of justifiable economic factors of geographical distribution. The mean number of enamel lesions, cavitated lesions and filled per teeth were statistically significant (p < 0.01) dissimilar among the Italian section. GNP per capita, Gini Index and Unemployment rate were significantly correlated to ICDAS scores and filled teeth. Important differences in ICDAS score values remain among children from different socioeconomic backgrounds. Efforts should be made to improve awareness and knowledge regarding oral health practice and to implement preventive programs and access to dental services in Southern Italy where the disease is still unresolved.

Assessing the Predictive Performance of Probabilistic Caries Risk Assessment Models: The Importance of Calibration.

Probabilistic caries risk assessment models (P-CRA), such as the Cariogram, are promising tools to planning treatments in order to control and prevent caries. The usefulness of these models for informing patients and medical decision-making depends on 2 properties known as discrimination and calibration. Current common assessment of P-CRA models, however, ignores calibration, and this can be misleading. The aim of this paper was to provide tools for a proper assessment of calibration of the P-CRA models and improve calibration when lacking. A combination of standard calibration tools (calibration plot, calibration in-the-large, and calibration slope) and 3 novel measures of calibration (the Calibration Index and 2 related metrics, E50 and E90) are proposed to evaluate if a P-CRA model is well calibrated. Moreover, an approach was proposed and validated using data from a previous follow-up study performed on children evaluated by means of a reduced Cariogram model; Platt scaling and isotonic regression were applied showing a lack of calibration. The use of the Cariogram overestimates the actual risk of new caries for forecast probabilities <0.5 and underestimates the risk for forecast probabilities >0.6. Both Platt scaling and isotonic regression were able to significantly improve the calibration of the reduced Cariogram model, preserving its discrimination properties. The average specificity and sensitivity for both Platt scaling and isotonic regression using the cut-off point p= 0.5 were >83 and their sum well exceeded 160. The benefits of the proposed calibration methods are promising, but further research in this field is required.

Comparison of ICDAS, CAST, Nyvad's Criteria, and WHO-DMFT for Caries Detection in a Sample of Italian Schoolchildren.

Caries measurement methods vary considerably in terms of the stages of lesion considered making the comparison problematic among different surveys. In this cross-sectional study, four caries measurement methods, the WHO-DMFT, the International Caries Detection and Assessment System (ICDAS), the Caries Assessment Spectrum and Treatment (CAST), and the Nyvad Criteria were tested in a sample of children. Five-hundred 12-year old children (236 males and 264 females) were examined four times by four calibrated examiners. The calibration process showed that Cohen's Kappa exceeded the criterion of K = 0.75 and K = 0.80 for inter/intra-examiner agreement, respectively. In the survey, the total number of misclassification errors for the four methods amounted to 312 observations (67.94% regarding enamel lesions). The greatest difference among methods was shown by number of sound teeth (p < 0.01): WHO-DMFT n = 9505, 74.14%; ICDAS n = 2628, 20.49%; CAST n = 5053, 39.41%; and Nyvad Criteria n = 4117, 32.11%. At the level of dentinal Distinct/Active Cavity lesions, no statistically significant difference was observed (p = 0.40) between ICDAS (n = 1373, 10.71%), CAST (n = 1371, 0.69%), and Nyvad Criteria (n = 1720, 13.41%). In the severe caries levels, all methods were partially in agreement, while no accordance was found for the initial (enamel) lesions. A common language in caries detection is critical when different studies are compared.

Effect of a Daily Dose of Snacks Containing Maltitol or Stevia rebaudiana as Sweeteners in High Caries Risk Schoolchildren. A Double-blind RCT Study.

PURPOSE: To evaluate the effect of sugar-free snacks on caries-related factors in 6- to 9-year-old schoolchildren. MATERIALS AND METHODS: Two hundred seventy-one children at risk for caries as measured through the Cariogram were randomly assigned to three groups consuming twice-daily snacks containing Stevia, maltitol or sugar for 42 days. Parents filled out a standardised questionnaire regarding personal, medical and oral behavioural information. Bleeding on probing, plaque pH and salivary mutans streptococchi (MS) and lactobacilli (LB) were assessed at baseline (t0), 42 days of snack use (t1) and 120 days after the end of use (t2). The Cariogram calculation was repeated at t1. Treatment effects were estimated using linear mixed-effects regression models. RESULTS: At t2, a decrease in cariogenic bacteria (MS X2 = 8.01, p < 0.01 and LB X2 = 4.60, p = 0.03) and an increase of the minimum pH (F = 4.48, p < 0.01), maximum pH (F = 2.88 p < 0.01) and pH drop (F = 2.95 p < 0.01) was recorded in the Stevia group compared to baseline. In the maltitol group, an improvement effect was noted: LB concentration decreased (p = 0.04) and maximum pH (F = 3.16 p < 0.01) increased. Subjects classified by the Cariogram as have a low probability of developing caries increased in the Stevia and maltitol groups (X2(4) = 25.44, p < 0.01, C*sV = 0.38 and X2(4) = 12.85, p = 0.01, C*sV = 0.27, respectively). Regression analysis underlines the effect of Stevia snacks on the cariogenic microflora, mainly on MS and plaque pH variations. CONCLUSION: The short-term administration of Stevia or maltitol snacks improves some important factors related to caries. This preventive strategy might be an additional means of combatting this common childhood disease.

Genetic and developmental disorders of the oral mucosa: Epidemiology; molecular mechanisms; diagnostic criteria; management.

A large number of disorders may affect the oral cavity, including genetic diseases, infections, cancers, blood diseases, skin diseases, endocrine and metabolic disorders, autoimmune and rheumatologic diseases, local lesions, to name a few. Oral mucosa shows a considerable variation in its normal structure and a wide range of conditions may affect it. Such conditions are often harmless or minor and could be primary or secondary to systemic disease. Several of them are quite rare and, hence, the diagnosis is not easy. Clinically, lesions may appear as ulcers, discoloration of the oral mucosa and alterations in size and configuration of oral anatomy. Genetic disorders have specific manifestations and can be caused by a derangement of one or more components of the tissue. Many of them follow the skin or systemic signs of the underlying genetic disease, but in a few cases oral signs could be the first manifestation of the disorder. Among them genodermatoses are prominent. They are inherited disorders characterized by a multisystem involvement. This review describes chondro-ectodermal dysplasia, dyskeratosis congenita, Ehlers-Danlos syndrome, hereditary benign intraepithelial dyskeratosis, keratosis follicularis, lipoid proteinosis, multiple hamartoma syndrome, pachyonychia congenita, Peutz-Jeghers syndrome, tuberous sclerosis and white sponge nevus. Other genetic disorders not included in the genodermatosis group and reported in the present review are: acanthosis nigricans, angio-osteo-hypertrophic syndrome, encephalotrigeminal angiomatosis, familial adenomatous polyposis, focal dermal hypoplasia, focal palmoplantar and oral mucosa hyperkeratosis syndrome, gingival fibromatosis, Maffucci's syndrome, neurofibromatosis (type 1) and oro-facial-digital syndrome (type 1). Disorders during embryonic development might lead to a wide range of abnormalities in the oral cavity; some of them are quite common but of negligible concern, whereas others are rare but serious, affecting not only the oral mucosa, but also other structures of the oral cavity (ie palate, tongue and gingiva). Fordyce's granules, leukoedema, cysts of the oral mucosa in newborns, retrocuspid papilla, geographic tongue, fissured tongue, median rhomboid glossitis, hairy tongue, lingual varices and lingual thyroid nodule are described. This review may help dentists, dental hygienists, but also general internists and pediatricians to diagnose different disorders of the oral mucosa, to understand the pathogenesis and to schedule a treatment plan.

Polarized Polychromatic Noncoherent Light (Bioptron Light) as Adjunctive Treatment in Chronic Oral Mucosal Pain: A Pilot Study.

Objective: Aim of this study was to assess the efficacy of polarized polychromatic noncoherent light (Bioptron light) in the treatment of chronic oral mucosal pain (COMP). Patients and methods: Twenty-two patients affected by COMP were treated with standardized pharmacological protocols in association with Bioptron light (90 W; light wavelength = 480-3400 nm; degree of polarization = 95%; specific power density = 40 mW/cm2; energy density = 2.4 J/cm). The outcome measures were intensity of pain [measured by visual analog scale (VAS) score] and signs reduction (measured by Eisen score) recorded at baseline (t0), after 4 weeks (t1), and after 8 weeks (t2). Signs and symptoms scores were compared with those of a cohort of comparable patients selected from institutional medical record files. Results: Patients in pharmacological treatment associated with Bioptron showed a significant VAS score decrease at t1 and t2 (t0 = 6.9, t1 = 3.9, t2 = 1.8, p < 0.05), whereas the patients in exclusive pharmacological treatment showed a significant VAS score improvement only at t2. Comparing the VAS score at t1 and t2 in the two groups, a significant improvement was recorded in patients undergoing Bioptron adjunctive treatment (t1 = 3.9 vs. 5.9; p < 0.05 and t2 = 1.8 vs. 3.6; p < 0.05). In both groups Eisen score improved at t1 and t2, but in the Bioptron-treated patients the improvement was statistically better at t1 (1.9 vs. 0.8; p < 0.05) and at t2 (2.7 vs. 1.4; p < 0.05). Conclusions: In COMP patients, Bioptron use associated with pharmacological treatment allows a better and faster signs and symptoms reduction when compared with the exclusive pharmacological treatment. Further controlled studies are needed to establish the relative and absolute effectiveness of Bioptron in COMP management.

Are standardized caries risk assessment models effective in assessing actual caries status and future caries increment? A systematic review.

BACKGROUND: Assessing caries risk is an essential element in the planning of preventive and therapeutic strategies. Different caries risk assessment (CRA) models have been proposed for the identification of individuals running a risk of future caries. This systematic review was designed to evaluate whether standardized caries risk assessment (CRA) models are able to evaluate the risk according to the actual caries status and/or the future caries increment. METHODS: Randomized clinical trials, cross-sectional studies, cohort studies, comparative studies, validation studies and evaluation studies, reporting caries risk assessment using standardized models (Cariogram, CAMBRA, PreViser, NUS-CRA and CAT) in patients of any age related to caries data recorded by DMFT/S or ICDAS indices, were included. PubMed, Scopus and Embase were searched from 2000 to 2016. A search string was developed. All the papers meeting the inclusion criteria were subjected to a quality assessment. RESULTS: One thousand three-undred ninety-two papers were identified and 32 were included. In all but one, the Cariogram was used both as sole model or in conjunction with other models. All the papers on children (n = 16) and adults (n = 12) found a statistically significant association between the risk levels and the actual caries status and/or the future caries increment. Nineteen papers, all using the Cariogram except one, were classified as being of good quality. Three of four papers comprising children and adults found a positive association. For seven of the included papers, Cariogram sensibility and specificity were calculated; sensibility ranged from low (41.0) to fairly low (75.0), while specificity was higher, ranging from 65.8 to 88.0. Wide 95% confidence intervals for both parameters were found, indicating that the reliability of the model differed in different caries risk levels. CONCLUSIONS: The scientific evidence relating to standardized CRA models is still limited; even if Cariogram was tested in children and adults in few studies of good quality, no sufficient evidence is available to affirm the method is effective in caries assessment and prediction. New options of diagnosis, prognosis and therapy are now available to dentists but the validity of standardized CRA models still remains limited.

The burden of tooth loss in Italian elderly population living in nursing homes.

BACKGROUND: This survey aims to evaluate the prevalence and severity of tooth loss in the Italian elderly population living in nursing homes and to associate the oral data with demographic, socioeconomic factors, the Mini-Mental State Examination (MMSE), the Body Mass Index (BMI) and the Mini Nutritional Assessment (MNA) scores. METHODS: A cluster sample method was performed using each nursing home as a cluster. Twenty-three nursing homes located in the five areas of the Italy (North-West, North-East, Centre, South and Islands) were selected. An informed consent to participate was distributed by the personnel of the selected nursing homes and signed directly by subjects/caregivers; 2114 forms were distributed, 1998 forms signed and finally 1976 subjects were examined. Chewing ability was scored as good (≥10 functional units (FUs)), sufficient (7-10 FUs), and insufficient (< 7 FUs). The presence of prosthetic dental restorations was summarized as: absent of prosthesis, fixed prosthesis, removable prosthesis, combined prosthesis. Age, gender, socioeconomic status, MMSE, BMI and MNA were obtained from medical charts. RESULTS: Almost three quarters of the subjects were ≥ 80 years old (74.37%) and women (74.04%). The prevalence of edentulism was 42.10% with a large variation among the five areas of Italy (from 34.43% in Centre to 53.46% in North-West). Insufficient presence of FUs was preeminent in each age group (prevalence 42.10%) and statistically associated to age and to female gender (p <  0.01). Overweight/obese (7.47%) subjects showed the highest FUs. Area of living, MMSE (both < 0.01), BMI (p = 0.01) were statistically significant associated to the type of prosthetic dental restorations in the oldest group. Subjects with no mental impairment showed the highest percentage of prosthetic dental restorations (32.36%). CONCLUSIONS: More than half of the sample has an insufficient number of functional units for chewing and this is more pronounced in females. The presence and the type of prosthetic dental restorations are linked to cognitive impairment: the higher is the mental impairment the higher is the number of subjects with absence of prosthetic restorations. The findings of this national survey highlight the need for public health policy, aiming to increase awareness regarding oral health though health education.

Effect of body weight and behavioural factors on caries severity in Mexican rural and urban adolescents.

OBJECTIVES: To investigate if, in Mexican adolescents, body weight and caries severity are associated, and if this association differs between rural and urban populations. METHODS: Adolescents from the rural area of Tepancan and the city of Veracruz were enrolled. Caries was recorded using the International Caries Detection and Assessment System and the body mass index (BMI) was calculated. Oral habits (toothbrushing, flossing, dental check-ups) and dietary patterns (sweets intake) were assessed. A dummy variable between BMI and living area (BMI/Area) was generated. Data were analysed using STATA and a multinomial logistic regression model was run, using caries severity as the dependent variable. RESULTS: Four-hundred and sixty-four subjects, 12-15 years of age, participated (rural = 240; urban = 224). The BMI and area of residence were significantly associated (χ2 = 12.59, P < 0.01). Area was also associated with caries severity (χ2 = 24.23, P < 0.01), with the highest number of caries in dentine recorded in participants from the rural area. The dummy variable BMI/Area was related to caries severity (χ2 = 27.47, P < 0.01): overweight adolescents with caries in dentine were most frequently found in the rural area. A higher prevalence of caries in enamel and a lower prevalence of caries in dentine (P < 0.01) were recorded in adolescents from the urban area, where better oral habits, but higher sweets intake (P = 0.04), were encountered. According to the multinomial logistic regression model, BMI/Area was significantly associated with caries severity (P < 0.01). CONCLUSIONS: Overweight was not associated with caries severity in the overall population, but it became a statistically significant risk indicator in adolescents living in the rural area.

Evaluation of the difference in caries experience in diabetic and non-diabetic children-A case control study.

AIM: To evaluate the caries prevalence and related variables in Type 1 diabetic and non-diabetic children and among the diabetic children according to their metabolic status. METHODS: Sixty-eight diabetic and 136 non-diabetic children, matching by gender and age (4-14 years) were enrolled. The diabetic children were divided: a) 20 children in good metabolic control (Hb1ac≤7.5) and b) 48 children in bad metabolic control (Hb1ac>7.5). Dietary and oral hygiene habits were investigated. Caries status was registered using the International Caries Detection and Assessment System. Oral microflora was analysed using the checkerboard DNA-DNA hybridisation method. Plaque acidogenicity was recorded after a sucrose rinse. RESULTS: Sugared beverage and snack intake was higher in diabetic group compared to non-diabetic group (p = 0.03 and p = 0.04, respectively) and in subjects in bad metabolic control (p = 0.03 and p<0.01, respectively). Oral hygiene habits were similar, except for the use of fluoridated adjuvants, higher in non-diabetic children (p = 0.04). No statistically significant differences were observed regarding caries figures, but a higher number of caries free subjects was found in diabetic subjects in good metabolic control (p<0.01). Significant difference for the main cariogenic bacteria was found between diabetic and non-diabetic subjects (p<0.05). The pH values showed statistically significant differences between diabetic and non-diabetic subjects and between diabetic subjects in good and bad metabolic control (p<0.01). CONCLUSIONS: Diabetic children in good metabolic control might even be considered at low caries risk, while those in bad metabolic control showed an oral environment prone to a high caries risk.

The strip method and the microelectrode technique in assessing dental plaque pH.

BACKGROUND: The pH strip method has been proposed for use in a clinical setting for the evaluation of dental plaque pH. The aim of this in-vivo study was to compare the reliability of the pH-indicator strip method to the microelectrode technique in plaque pH measurement. METHODS: 136 subjects (7-9 years) were enrolled and, for each subject, measurements of plaque pH were made at two interproximal sites; a total of 272 sites were analyzed. Plaque pH was assessed in triplicate using pH-indicator strips (pH range: 4.0-7.0) and an iridium microelectrode with a diameter of 0.1 mm. The caries status of 544 proximal surfaces between two primary molars, in proximity at the plaque pH sites, was assessed. All measurements were performed before and 2, 5, 10, 15, 20, and 30 minutes after a mouth rinse with water solution of sucrose (10%). One-way ANOVA was performed to analyze statistically significant differences between the two techniques. Instrument reliability was measured by assessing the intraclass correlation coefficient. RESULTS: Comparable, not statistically significant pH values (P values range from 0.98 to 1.00) were obtained by the two methods for AUC5.7, AUC6.2, maximum pH fall and minimum pH. High intraclass coefficients were recorded (Pearson's r=0.96, Yule's Q=0.99), implying an almost perfect association when the measurements were grouped as a carious lesion being present or not on the surface near the site of measurement. CONCLUSIONS: The use of the pH strip method has high validity and may replace the traditional microtouch electrode technique for clinical use.

The caries preventive effect of 1-year use of low-dose xylitol chewing gum. A randomized placebo-controlled clinical trial in high-caries-risk adults.

OBJECTIVES: The caries preventive effect of long-term use (1 year) of low-dosage (2.5 g/die) of xylitol chewing gum in a high-caries-risk adult population was evaluated. MATERIALS AND METHODS: In this randomized clinical trial, 179 high-caries-risk adults were assigned to two experimental groups, xylitol and polyols. Caries status, salivary mutans streptococci (MS), and plaque pH were re-evaluated after 2 years from baseline in 66 xylitol and 64 polyol subjects. Outcomes (the net caries increment for initial, moderate, and extensive caries lesions and for the caries experience) were evaluated using the nonparametric Mann-Whitney U test. RESULTS: The total caries experience increment was 1.25 ± 1.26 in the xylitol group and 1.80 ± 2.33 in the polyol group (p = 0.01). Subjects treated with xylitol chewing gums had a reduction of risk rate at tooth level of 23% with respect to those treated with polyols with a number needed to treat of 55 teeth. The area under the curve at pH 5.7 was statistically significantly lower (p = 0.02) during the experimental period in the xylitol group. A decrease of the concentration of salivary MS was noted in the xylitol group (p < 0.01). CONCLUSIONS: Subjects using the low-dose xylitol chewing gum showed a significantly lower increment of initial and extensive caries lesions and overall a lower increment of caries experience. CLINICAL RELEVANCE: One-year use of chewing gums provides an effective means for the prevention of caries disease. TRIAL REGISTRATION NUMBER: NCT02310308.

Interaction of lifestyle, behaviour or systemic diseases with dental caries and periodontal diseases: consensus report of group 2 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases.

Periodontal diseases and dental caries are the most common diseases of humans and the main cause of tooth loss. Both diseases can lead to nutritional compromise and negative impacts upon self-esteem and quality of life. As complex chronic diseases, they share common risk factors, such as a requirement for a pathogenic plaque biofilm, yet they exhibit distinct pathophysiologies. Multiple exposures contribute to their causal pathways, and susceptibility involves risk factors that are inherited (e.g. genetic variants), and those that are acquired (e.g. socio-economic factors, biofilm load or composition, smoking, carbohydrate intake). Identification of these factors is crucial in the prevention of both diseases as well as in their management. AIM: To systematically appraise the scientific literature to identify potential risk factors for caries and periodontal diseases. METHODS: One systematic review (genetic risk factors), one narrative review (role of diet and nutrition) and reference documentation for modifiable acquired risk factors common to both disease groups, formed the basis of the report. RESULTS & CONCLUSIONS: There is moderately strong evidence for a genetic contribution to periodontal diseases and caries susceptibility, with an attributable risk estimated to be up to 50%. The genetics literature for periodontal disease is more substantial than for caries and genes associated with chronic periodontitis are the vitamin D receptor (VDR), Fc gamma receptor IIA (Fc-γRIIA) and Interleukin 10 (IL10) genes. For caries, genes involved in enamel formation (AMELX, AMBN, ENAM, TUFT, MMP20, and KLK4), salivary characteristics (AQP5), immune regulation and dietary preferences had the largest impact. No common genetic variants were found. Fermentable carbohydrates (sugars and starches) were the most relevant common dietary risk factor for both diseases, but associated mechanisms differed. In caries, the fermentation process leads to acid production and the generation of biofilm components such as Glucans. In periodontitis, glycaemia drives oxidative stress and advanced glycation end-products may also trigger a hyper inflammatory state. Micronutrient deficiencies, such as for vitamin C, vitamin D or vitamin B12, may be related to the onset and progression of both diseases. Functional foods or probiotics could be helpful in caries prevention and periodontal disease management, although evidence is limited and biological mechanisms not fully elucidated. Hyposalivation, rheumatoid arthritis, smoking/tobacco use, undiagnosed or sub-optimally controlled diabetes and obesity are common acquired risk factors for both caries and periodontal diseases.

Does a social/behavioural gradient in dental health exist among adults? A cross-sectional study.

Objective To explore the potential presence of a social/behavioural gradient in dental health among Italian adults using a cross-sectional study. Methods Caries indices were recorded among 480 subjects (52.9% men, 47.1% women) who also completed a structured self-administered social and behavioural questionnaire. A social/behavioural gradient was generated as the sum of the worst circumstances recorded on the questionnaire (cariogenic diet, smoking, lowest occupational profile, brushing teeth < twice daily, lowest educational level, uneven dental examination attendance). Results Caries figures (DMFT) and the number of filled sound teeth (FS-T) were statistically significantly linked to the social/behavioural gradient (DMFT: χ2(9) = 20.17 p = 0.02, Z = 0.02 p = 0.99; FS-T: χ2(9) = 25.68 p < 0.01, Z = -4.31 p < 0.01). DMFT was statistically significantly associated with gender and with social and behavioural variables. FS-T was higher in women (p = 0.03) and was linked to smoking ( p < 0.01). Conclusions The proposed social/behavioural gradient demonstrated how subjects reporting the worst circumstances on the questionnaire exhibited the worst dental health. The use of the gradient demonstrates that health promotion and prevention cannot be compartmentalized.