Influence of maternal lead ingestion on caries in rat pups.

Lead is one of the most toxic and pervasive pollutants in society, and although there has been some lowering of blood lead levels in recent years, the levels continue to be of concern for African Americans, central city residents, residents in the Northeast region of the United States, persons with low income, and those with low educational attainment. Notably, these are the persons and the region where the highest prevalence of dental caries is observed. Information relating lead toxicity to oral health is sparse, but the preponderance of epidemiological data shows a relation between lead in the environment and the prevalence of dental caries. Using our well-defined rat caries model we found that pre- and perinatal exposure to lead results in an almost 40% increase in the prevalence of caries and a decrease in stimulated parotid function of nearly 30%. Levels of lead in milk from lead-treated dams were approximately 10 times as high as the corresponding blood lead levels, suggesting that lead is being concentrated by mammary glands. These findings may help in part to explain the comparatively high levels of dental caries observed in the inner cities of the United States where exposure to lead is common. Environmental sources of lead include drinking water, lead-based paint and, to a lesser extent, automobile and industrial emissions. In humans lead is accumulated and stored in bones (half-life of approximately 62 years), and even maternal exposure to lead decades before pregnancy can subsequently result in exposure of the developing fetus to elevated levels of lead. Moreover, lead concentration in maternal blood has been shown to increase during pregnancy and lactation because of mobilization of stored lead from bone, and typically, lead is found in milk at a higher concentration than the level found in maternal plasma at the same time point.

The association between caries and childhood lead exposure.

Epidemiologic studies suggest an association between lead exposure and caries. Our objective was to establish whether children with a higher lead exposure as toddlers had more caries at school age than children with a lower lead exposure. We used a retrospective cohort design. A sample of children who attended second and fifth grades in the Rochester, New York, public schools during the 1995-1996 and 1996-1997 school years were examined for caries through a dental screening program. For each child we assessed the number of decayed, missing, or filled surfaces on permanent teeth (DMFS), and the number of decayed or filled surfaces on deciduous teeth (dfs); the number of surfaces at risk (SAR) was also recorded. Lead exposure was defined as the mean of all blood lead levels collected between 18 and 37 months of age by fingerstick [provided the blood lead level was [less than/equal to] 10 microg/dL)] or venipuncture. A total of 248 children (197 second graders and 51 fifth graders) were examined for caries and had a record of blood lead levels to define lead exposure. The mean dfs was 3.4 (range 0-29); the mean DMFS was 0.5 (range 0-8). Logistic regression was used to examine the association between the proportion of children with DMFS [Greater/equal to] 1, and the proportion with dfs [Greater/equal to] 1, and lead exposure [< 0.48 micromol/L vs. [Greater/equal to] 0.48 micromol/L (< 10 microg/dL vs. [Greater/equal to] 10 microg/dL)] while controlling for SAR, age at examination, and grade in school. For DMFS, the adjusted odds ratio was 0.95 [95% confidence interval (CI), 0.43-2.09; p = 0.89); for dfs, the odds ratio was 1.77 (95% CI, 0.97-3.24; p = 0.07). This study did not demonstrate that lead exposure > 10 microg/dL as a toddler was a strong predictor of caries among school-age children. However, the results should be interpreted cautiously because of limitations in the assessment of lead exposure and limited statistical power.

The association of basic proline-rich peptides from human parotid gland secretions with caries experience.

To address whether there are associations between the peptide composition of human parotid saliva and dental decay (caries) experience, we have characterized the peptides from parotid ductal saliva collected from nine adults who have remained free from dental caries (mean age = 59.2; Decayed Missing Filled Surfaces index [DMFS] = 0) and nine individuals who have experienced caries (mean age = 51.2; mean DMFS = 38.4). Ethanol-soluble peptides were size-fractionated on columns of Bio-Gel P-2; the salivary peptides derived from caries-susceptible subjects appeared larger than those found in the saliva of caries-free subjects. Peptides were then resolved into 19 species by cation exchange HPLC. Sequence analysis identified 18 peptides that appear to be proteolytic cleavage products of the basic proline-rich proteins IB-4, IB-5, IB-7, IB-8b, and P-B. The peptides that were more abundant in saliva obtained from the caries-free group differed from those isolated from the caries-susceptible group. The median peptide concentration of one possible precursor protein, IB-7, was found to be higher in saliva collected from caries-free individuals than in that from caries-susceptible individuals. Although differences were found in the phenotypes of proline-rich proteins expressed by these groups of caries-free and caries-susceptible subjects, no statistically significant associations were observed among proline-rich phenotypes and the level of any peptide. Collectively, our results indicate that proteolytic processing of parotid salivary proteins differs among individuals who have remained caries-free and those who have experienced dental decay.

Fluoride concentrations in plaque, whole saliva, and ductal saliva after application of home-use topical fluorides [published eerratum appears in J Dent Res 1993 Jan;72(1):87].

It is now well-accepted that the primary anti-caries activity of fluoride (F) is via topical action. The retention of F in the mouth after topical fluoride treatment is considered to be an important factor in the clinical efficacy of F. The purpose of this study was to evaluate F levels in ductal saliva, whole saliva, and pooled plaque after treatment with topical F agents intended for home use. Ten consenting adults, mean (SD) age 31.0 (8.2) years, participated in all aspects of the study. Two days before each test, subjects received a professional tooth cleaning and subsequently abstained from all oral hygiene procedures to permit plaque to accumulate, and from the use of F-containing dental products. Treatments consisted of a placebo dentifrice (PD), fluoride dentifrice (FD; 0.24% NaF), fluoride rinse (FR; 0.05% NaF), and fluoride gel (FG; 1.1% NaF). Unstimulated whole saliva and pooled plaque were sampled at multiple points over a 24-hour period. In a separate experimental series, stimulated parotid saliva was sampled over a two-hour period after treatment. Fluoride levels generally followed the same pattern in whole saliva and pooled plaque samples, with FG > FR > FD > PD. Night-time F application resulted in prolonged F retention in whole saliva but not in plaque. Fluoride levels in parotid saliva were only slightly higher after F treatment and returned to baseline levels within two h. The results of this study indicate that the method of F delivery, the F concentration of the agent, and the time of application (daytime vs. night-time) are important factors influencing F levels in the mouth.(ABSTRACT TRUNCATED AT 250 WORDS)

Studies of fluoride retention by oral soft tissues after the application of home-use topical fluorides.

Previous studies have focused on enamel and plaque as the primary sites of fluoride (F) retention in the mouth. The present study was undertaken to evaluate the role of oral soft tissue as a site of F retention by comparing an edentulous subject panel (n = 9) with a fully dentate panel (n = 10). Unstimulated whole saliva samples were collected by having subjects pool saliva for two min. Samples were collected over a 24-hour period after application of a placebo dentifrice (PD; 0.4 ppm F), fluoride dentifrice (FD; 1100 ppm F), fluoride rinse (FR; 226 ppm F), or fluoride gel (FG; 5000 ppm F) delivered in custom trays. There was no statistically significant difference in salivary flow rate between the two panels for any of the treatments. The edentulous panel had higher salivary F levels than the dentate panel, which reached statistical significance (p less than 0.05) for the FD and FG treatments. In a separate study involving the same treatments, F levels at specific soft-tissue sites were measured over a one-hour period by use of absorbent discs placed in different soft-tissue areas of the mouth. The tongue and lower posterior vestibule retained the highest F levels, followed by the upper posterior buccal vestibule and upper anterior labial vestibule, with the lowest F levels retained in the lower anterior vestibule and the floor of the mouth. There was a strong-to-moderate correlation between whole saliva F concentration and F levels at specific soft-tissue sites. This study establishes the importance of oral soft tissue as the major site of F retention in the mouth.

Association of free arginine and lysine concentrations in human parotid saliva with caries experience.

We determined the free-amino acid content of stimulated parotid (ductal) saliva from two groups of adult subjects whose caries experiences were markedly different. The levels of free arginine and free lysine in the parotid saliva of caries-free adults were significantly higher than those found in the parotid saliva of individuals with a history of dental decay. There was no correlation, however, between the levels of these amino acids and the DMFS score within the caries-susceptible groups. Microbial catabolism of dibasic amino acids contributes to the neutralization of plaque acids and may partially account for the higher resting plaque pH observed in caries-free subjects. Alternatively, the elevations observed in free levels of arginine and lysine may reflect a systemic alteration in amino acid metabolism which is common to the caries-free group of subjects.

Effect of sucralose--alone or bulked with maltodextrin and/or dextrose--on plaque pH in humans.

Sucralose is a safe, intensely sweet, noncaloric sucrose derivative that has been shown to be noncariogenic. The purpose of the present study was to compare the effects on plaque pH in vivo of sucralose in iced tea (alone or bulked with maltodextrin or with maltodextrin/dextrose) with sucrose in iced tea. Fourteen subjects, with DMFT > 7 and an acidogenic plaque, participated in the study. Plaque pH response to one of five solutions: unsweetened tea, tea with sucralose (final concentration 0.007% by weight), tea with sucralose/maltodextrin (final concentrations 0.007% and 0.59% by weight, respectively), tea with sucralose/maltodextrin/dextrose (final concentrations 0.007, 0.018 and 0.57% by weight, respectively) and tea with sucrose (final concentration 4.7% by weight); was assessed in five experimental sessions. All solutions, except the unsweetened tea, had a sweetness equivalent to 2 teaspoons of sucrose in 6 OZ of beverage. Using a touch electrode, plaque pH was measured at baseline and at specific time intervals up to 60 min after rinsing with the test solution for 1 min. Comparisons between groups were done for minimum pH, delta pH, and area under the pH curve (AUC), by using the nonparametric Friedman's test and the Wilcoxon signed rank test. Rinsing with tea and sucrose resulted in significantly lower minimum pH, higher delta pH and larger AUC than rinsing with the solutions containing sucralose. It can be concluded that sucralose alone or in combination with maltodextrin or with maltodextrin/dextrose is significantly less acidogenic than sucrose when used as a sweetener in iced tea.

The effects of benzoate and fluoride on dental caries in intact and desalivated rats.

The decline in prevalence of dental caries in some segments of the population has been attributed mainly to extensive exposure to fluoride. Over the past decades, the use of fluoridated products has increased. During the same period, the consumption of food preservatives such as benzoates and sorbates has also increased substantially. Benzoates, in vitro, possess antibacterial properties similar to those of fluoride and in combination with fluoride could affect caries development. In the present study we explored the effects of sodium benzoate and fluoride in combination and alone on dental caries in our animal model. The results showed a combination of benzoate and fluoride reduced caries activity more effectively in rodents fed a cariogenic diet ad libitum than fluoride alone (p = 0.038).

Litter effects on caries in rats and implications for experimental design.

The purpose of this study was to obtain quantitative estimates of litter effects on caries development in rats and to examine the implications for design of rat caries experiments. Twelve female Sprague-Dawley rats, aged 60 days, were bred with 4 male rats. Nine of the 12 dams had litters in close proximity. The litters were culled to 10 pups. One pup from each litter was placed with each of the other dams for nursing, leaving 2 pups from each litter with the birth dam. This design allowed the litter effect to be separated into a prenatal component, reflecting the shared genetic makeup and in utero environment of littermates, and a postnatal component reflecting a shared environment from shortly after birth to weaning. Pups were infected with Streptococcus sobrinus and fed Diet 2000 and 10% (w/v) sucrose water for 5 weeks. There was no significant evidence of a postnatal litter effect for smooth surface caries (p = 0.37) or sulcal caries (p = 0.43). The prenatal litter effect was significant for both smooth surface caries and sulcal caries (p<0. 01). When litter effects are present, the statistical power of caries studies is improved if animals from the same litter are divided evenly among experimental groups. In addition, if litter effects are present but not allowed for in data analysis, incorrect statistical inferences may be drawn. Based on our results and other reports of litter effects, we recommend planning for litter effects in the design and analysis of rat caries studies.