Assessment of oral hypofunction and its association with age among Korean community-dwelling older adults.

BACKGROUND: Due to the increasing proportion of older adults in Korea and growing interest in aging, the concepts of oral aging and oral hypofunction have recently been introduced. Thus, it is necessary to investigate the age-specific oral function levels of Korean older adults and develop expert intervention methods for healthy aging. METHODS: Dysphagia, independence of daily living, and oral hypofunction were assessed in 206 older adults living in Wonju, Gangwon State, South Korea. Subjective dysphagia was assessed through self-report questionnaires using the Dysphagia Handicap Index (DHI), the Korean version of Eating Assessment Tool-10, and the Korean version of the Modified Barthel Index. In addition, the oral hypofunction assessment items included decreased chewing ability, occlusal pressure, tongue pressure, oral dryness, and oral cleanliness. RESULTS: DHI increased significantly with age, with those in their 80 s reporting the most difficulty swallowing. Oral function in terms of chewing ability (maximum occlusal pressure and number of remaining teeth), maximum occlusal pressure, and maximum tongue pressure also declined with increasing age. While there was no significant difference in oral dryness by age, those in their 80 s had dry mouth according to the criteria of the oral moisture checking device. CONCLUSIONS: In an assessment of oral function in community-dwelling, independent Korean older adults, the number of items that were assessed as oral hypofunction increased with age. The findings can be used to standardize the oral hypofunction assessment item and develop age-based individualized intervention plans for the early management of oral health and individual oral myofunctional rehabilitation in Korean community-dwelling older adults.

Effect of the coronavirus disease 2019 pandemic on oral health of Korean adolescents.

OBJECTIVES: To investigate the effect of the coronavirus disease (COVID-19) pandemic on Korean adolescents' oral health and identify the influential factors. METHODS: The raw data from The Korea Youth Risk Behaviour Web-based Survey before (2019) and after (2020) the outbreak of COVID-19 were used in the study. Demographic characteristics and subjective general, mental, and oral health were analysed and compared between the 2 years. Further, the impact of changes in subjective mental health and the duration of indoor activity on oral health were analysed. Data were analysed using IBM SPSS Statistics, and all statistical significance was set at α = 0.05. The analysis was performed using the complex sample analysis module. RESULTS: In 2020, compared with 2019, the proportion of adolescents who rated high on subjective academic performance, smoking, and drinking decreased (p < 0.001). However, there was no difference in the household economic status between 2020 and 2019 (p = 0.917), while subjective mental health improved. In addition, the risk of tooth fracture was 1.321 times higher after the pandemic. After the outbreak of COVID-19, adolescents who were indoors for >24 h for non-learning activities on weekends were 2.97 times more likely to have reported gingival pain and bleeding (p < 0.05). CONCLUSIONS: After the outbreak of COVID-19, smoking and drinking decreased in Korean adolescents, while changes occurred in their learning patterns at home, and their mental health improved. Some oral symptoms increased or showed no change.

Relationship between an Oral Health Risk Assessment Using a Salivary Multi-Test System and Woman's Subjective Oral Health Symptoms and Sleep Disorder.

Saliva is used as a diagnosis and monitoring tool for various diseases because it can maintain the balance of the oral ecosystem and reflect the physiological and pathological state of the body. Because women suffer more fatigue than men because of physiological, psychological, and social factors, individual management strategies are needed to evaluate mental health and oral diseases. Therefore, this study examined the oral health risk level from seven saliva factors using a saliva multi-test system for adult women to confirm the possibility of screening for sleep disorders. The saliva of 83 adult female participants was surveyed along with a self-reported questionnaire consisting of seven subjective oral health symptoms and three questions about sleep disorders. Seven saliva factors were evaluated using the saliva multi-test system (SiLL-Ha ST-4910) to assess the oral health risk levels. In the tooth health risk groups, the acidity was high, while the buffering capacity was low (p < 0.001). The periodontal health risk groups showed significant differences in acidity, occult blood, leukocytes, proteins, and ammonia (p < 0.05). The oral malodor risk group had higher levels of cariogenic bacteria, occult blood, leukocytes, and ammonia (p < 0.05). In groups with 'irregular sleep times' and 'insomnia', the acidity was high, and the buffering capacity was low (p < 0.001). This study confirmed the relevance of saliva factors and sleep disorder. Therefore, an evaluation using saliva was confirmed for oral health risk assessments and as an early screening tool for sleep disorders.

Anti-biofilm activity of chlorhexidine-releasing elastomerics against dental microcosm biofilms.

OBJECTIVE: To evaluate the anti-biofilm activity of chlorhexidine-releasing elastomerics (CRE) developed to prevent biofilm-related diseases in orthodontic patients, using dental microcosm biofilms. METHODS: Elastomerics coated with one of two solutions (CRE 1 and 2) were attached to bovine enamel specimens. Uncoated elastomerics were used for negative (distilled water [DW]) and positive (0.1% chlorhexidine [CHX]) control groups. After saliva inoculation on the surface of the specimen for biofilm formation, DW and CRE groups were treated with DW, and the positive control group was treated with CHX twice a day for 5 min. After 7 days of biofilm formation, colony-forming units (CFUs, total and aciduric bacteria), red/green (R/G) ratio, biofilm thickness, live/dead cell ratio, and bacterial morphology in the biofilms were evaluated. Enamel demineralization was evaluated by fluorescence loss (ΔF). RESULTS: The CFUs of total and aciduric bacteria and R/G ratios in the CRE groups were significantly lower than those in the DW group with a reduction by 13%, 13%, and 19%, respectively (p < 0.05). The CFUs of total bacteria was significantly lower in the CRE groups than in the 0.1% CHX group (p < 0.05). Among the CRE groups, only CRE 1 exhibited a significantly reduced biofilm thickness of 54% compared to the DW group (p < 0.05) and apparent changes in bacterial morphology. ΔF in the CRE groups was significantly higher by 36% compared to that in the DW group (p < 0.05). CONCLUSIONS: CREs exhibited anti-biofilm and demineralization-inhibiting effect. Particularly, CRE 1 using dichloromethane as the solvent was most effective against biofilms. CLINICAL SIGNIFICANCE: Chlorhexidine-releasing elastomerics exhibited increased anti-biofilm and demineralization-inhibiting effect compared to 0.1% chlorhexidine mouthwash. Therefore, it is possible to prevent biofilm-related diseases simply and effectively by applying chlorhexidine-releasing elastomerics to orthodontic patients.

Evaluation of the Erosive and Cariogenic Potential of Over-the-Counter Pediatric Liquid Analgesics and Antipyretics.

To evaluate the cariogenic and erosive potentials of over-the-counter pediatric oral liquid antipyretics and analgesics, we tested nine over-the-counter pediatric oral liquid medications classified as antipyretic or analgesic medicines available in Korea. For each substance, we measured the pH with a pH meter and the sugar content with a sugar content meter. We determined the titratable acidity (TA) levels based on the volumes of NaOH solution that had to be added to reach a pH of 7.0. We also evaluated the dental erosion potentials with an International Organization for Standardization method based on observing changes in the pH of a CaPO4 solution upon introducing a small volume of the solution to be tested. The oral liquid medications had pH values of 3.40-5.68. In the TA assessments, several oral liquid medications required greater volumes of NaOH solution to reach a pH of 7.0. The dental erosion potentials varied but correlated strongly with the NaOH volumes needed to reach a neutral pH (r = 0.84; p < 0.0001). Many oral liquid antipyretics and analgesics have features that can promote dental erosion. A correct understanding of pediatric antipyretics and analgesics is required in dentistry for children's oral health.

Cutoff fluorescence loss for the recovery of incipient carious lesions after fluoride application in primary teeth: A clinical study.

PURPOSE: Early detection and diagnosis of incipient caries are the keys to achieving a favorable prognosis. Monitoring of pathological changes based on clinical evidence leads to an accurate prognosis. Therefore, this clinical study investigated changes in minerals of incipient carious lesions using quantitative light-induced fluorescence-digital (QLF-D) after applying professional fluoride treatment to children, with improvement of the lesion severity assessed based on the fluorescence loss (ΔF) value obtained using QLF-D. METHODS: This study examined 90 incipient enamel lesions on the primary teeth of 27 children aged between 4 and 10 years. QLF-D images were obtained before and after the application of 1.23% acidulated phosphate fluoride gel for 1 min, and the ΔF values at 0 and 4 weeks (ΔF(0) and ΔF(4), respectively) and the recovery rates (RΔF) of the lesions were evaluated. Receiver operating characteristic curve analysis was used to calculate the cutoff ΔF(0) value at which recovery of the lesion with fluoride treatment remained feasible. RESULTS AND CONCLUSION: The recovery patterns of ΔF 4 weeks after fluoride application differed depending on the ΔF(0) values. The incipient lesions with ΔF(0) values of less than -13.00 recovered 4 weeks after fluoride application (P <  0.001) and had an average RΔF value of 19.27%. The results indicate that a ΔF(0) cutoff value can be determined for predicting the effects of remineralization after fluoride application and quantitative prognostic data can be provided to patients.

Development of a fluorescence-image scoring system for assessing noncavitated occlusal caries.

BACKGROUND: This study aimed (1) to develop a scoring system based on a quantitative light-induced fluorescence (QLF) score for the occlusal caries (QS-Occlusal) that standardizes the fluorescence properties of noncavitated lesions from QLF images, (2) to confirm the validity and reliability of QS-Occlusal, and (3) to determine whether it is possible to replace existing clinical examinations by image evaluations based on the developed QS-Occlusal for assessing occlusal caries lesions. METHODS: This clinical study investigated 791 teeth of 94 subjects. The teeth were assessed by visual and tactile examinations using ICDAS criteria and quantitative light-induced fluorescence-digital (QLF-D) image examinations. QS-Occlusal was divided into four stages (from 0 to 3) based on the progression level of the lesion and the fluorescence loss and red fluorescence on captured QLF-D images. Two trained examiners who were not involved in the visual examination evaluated occlusal fluorescence images using QS-Occlusal. The maximum loss of fluorescence (|ΔFmax|) and the maximum change in the ratio of red and green fluorescence (ΔRmax) were quantitatively analyzed by the QA2 software to detect differences between the QS-Occlusal groups. The modalities were compared in terms of sensitivity, specificity, and area under the receiver operating characteristics (AUROC) curve for three different thresholds of the ICDAS codes: 0 vs 1-4 (D1), 0-2 vs 3/4 (D2), and 0-3 vs 4 (D3). RESULTS: |ΔFmax| increased significantly by about 4.7-fold (from 15.94 to 75.63) when QS-Occlusal increased from 0 to 3. ΔRmax was about 6.2-fold higher for QS-Occlusal=1 (49.74) than for QS-Occlusal=0 (8.04), and 21.6-fold higher for QS-Occlusal=3 (P<0.05). The new QS-Occlusal showed an excellent AUROC (ranging from 0.807 to 0.976) in detecting occlusal caries when optimum cutoff values were applied. The intra- and interexaminer agreements indicated excellent reliability, with ICC values of 0.94 and 0.86, respectively. CONCLUSIONS: The QS-Occlusal proposed in this study can be used in the clinical detection of noncavitated lesions with an excellent diagnostic ability. This makes it possible to replace clinical examinations and intuitively evaluate the lesion severity and status relatively easily and objectively by applying this scoring system to fluorescence images.

Improving the efficacy of chlorhexidine-releasing elastomerics using a layer-by-layer coating technique.

The aims of this study were to identify the optimal concentration of coated orthodontic elastomerics using a layer-by-layer technique that can release chlorhexidine (CHX) as an antimicrobial material, and to measure the physical properties and antimicrobial effects of the coated elastomerics. Ethyl cellulose (EC) was used as the polymer, and five study groups with various combinations of solvents (i.e., ethanol and dichloromethane [DCM]) were included. The coated elastomerics were evaluated with a spectrophotometer to confirm the release of CHX, and their surfaces were observed by SEM. The CHX+EC+DCM group sustained antimicrobial release for the longest period (168 h, p<0.001) and exhibited the largest antimicrobial effect in an inhibition zone test using S. mutans for 7 days (p<0.05). This group had most effective physical properties and antimicrobial effects of coated elastomerics produced using a layerby-layer technique, and so its composition should be considered for use in clinical applications in orthodontics.

A new screening method to detect proximal dental caries using fluorescence imaging.

OBJECTIVES: This study aimed to assess the screening performance of the quantitative light-induced fluorescence (QLF) technology to detect proximal caries using both fluorescence loss and red fluorescence in a clinical situation. Moreover, a new simplified QLF score for the proximal caries (QS-Proximal) is proposed and its validity for detecting proximal caries was evaluated as well. METHODS: This clinical study included 280 proximal surfaces, which were assessed by visual-tactile and radiographic examinations and scored by each scoring system according to lesion severity. The occlusal QLF images were analysed in two different ways: (1) a quantitative analysis producing fluorescence loss (ΔF) and red fluorescence (ΔR) parameters; and (2) a new QLF scoring index. For both quantitative parameters and QS-Proximal, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) were calculated as a function of the radiographic scoring index at the enamel and dentine caries levels. RESULTS: Both ΔF and ΔR showed excellent AUROC values at the dentine caries level (ΔF=0.860, ΔR=0.902) whereas a relatively lower value was observed at the enamel caries level (ΔF=0.655, ΔR=0.686). The QS-Proximal also showed excellent AUROC ranged from 0.826 to 0.864 for detecting proximal caries at the dentine level. CONCLUSION: The QS-Proximal, which represents fluorescence changes, showed excellent performance in detecting proximal caries using the radiographic score as the gold standard.