The SmoCar Study: A Caribbean-Based Multicenter Study on the Prevalence and Disparities Linked to Smoking and Gingival Health.

The aim of the SmoCar (Smoking in the Caribbean) study was to estimate the prevalence of smoking and the disparities in the smoking practices of three regions in the Caribbean: Jamaica, Dominican Republic, and Puerto Rico. The secondary objective was to assess the prevalence and severity of gingivitis in relation to the smoking practices. The study population comprised 1,847 (weighted N = 1,830) individuals (18 years and older) who were volunteer participants from the capitals of Jamaica, Dominican Republic, and Puerto Rico. A structured interview was used to assess the participants' smoking behaviors. The gingival index was used to determine the extent of gingival inflammation. Polytomous regression was used to estimate the adjusted odds ratios (aORs) for smoking status (current, past, or never), according to risk factors (sex, age-group, education, marital status, tooth-brushing frequency, and city of residence). Logistic regression models were used to assess the associations between different smoking status variables and mild to moderate/severe gingivitis. The majority of the participants were never-smokers, with current smokers being found most commonly in Kingston (33.22%), followed by San Juan (12.76%) and Santo Domingo (8.8%). Both current (aOR = 2.22, 95% confidence interval [1.45, 3.40]) and past (aOR = 1.87, 95% confidence interval [1.19, 2.93]) smoking (vs. never smoking) was strongly associated with severe gingivitis. Smoking was the most prevalent in Jamaicans and the least prevalent in Dominicans. The study population of current smokers was found to have a fourfold increased risk of severe gingivitis and a twofold increased risk of moderate gingivitis.

Prevalence, Severity, and Risk Factors of Gingival Inflammation in Caribbean Adults: A Multi-City, Cross-Sectional Study.

OBJECTIVE: To estimate the prevalence, severity, and associated risk factors of gingival inflammation in a group of adults from Kingston, Jamaica; Santo Domingo, Dominican Republic; and San Juan, Puerto Rico. METHODS: In this representative cross-sectional study, participants completed medical and oral health questionnaires and received an oral clinical examination by trained and calibrated examiners. Clinical assessments included: gingival health (modified Löe-Silness index), visible plaque and presence of calculus. Findings were summarized as mean overall and interproximal gingival indices (GI; IGI), gingival bleeding index (GBI), gingival inflammation prevalence (GI>=0.5) and severity (mild, moderate, severe), mean and interproximal visible plaque indices (VPI; IVPI), and calculus index. Multivariate logistic regression was used to evaluate the associations between risk factors and gingival bleeding on probing (BOP) at >= 40% sites;. odds ratios were estimated. RESULTS: All 1,847 participants presented gingival inflammation; most (81.9%) had moderate inflammation. Mean GI, VPI, IVPI, and calculus indices were 1.49, 0.94, 0.96, and 0.66, respectively; most participants presented a VPI >= 30%. BOP >= 40% of sites was significantly associated with education (ORmiddle/technical vs. university education=1.61; p =0.001 and ORnone/basic vs. university= 2.86; p<0.001), calculus index (OR: 10.35), VPI >= 30% (OR: 7.85; p<0.001 for both), and being a resident of Kingston or Santo Domingo (vs. San Juan, OR: 4. 74 and OR: 7.09, respectively), after adjusting for age, gender, smoking, dental visit frequency, diabetes, and hypertension. CONCLUSION: Gingival inflammation was highly prevalent. Most participants presented moderate gingival inflammation. Educational attainment, dental calculus, and VPI >= 30% were strongly associated with gingival inflammation.

Prevalence of gingivitis and calculus in 12-year-old Puerto Ricans: a cross-sectional study.

BACKGROUND: Gingivitis is a common oral health problem. Untreated gingivitis may progress to periodontitis, a common cause of tooth loss. The prevalence of gingivitis and calculus among Puerto Rican children is unknown. Understanding this prevalence can support early public health preventative strategies. This study aims to estimate the prevalence of gingivitis and calculus among 12-year-old Puerto Ricans by health region and to explore differences in distribution by school type (proxy for socio-economic status) and gender. METHODS: A probability-based sample of 113 schools was selected proportional to enrollment size and stratified by health region, school type, and gender. Two trained examiners evaluated the presence of gingivitis and both supragingival and subgingival dental calculus. Gingivitis was defined as the presence of gingival bleeding upon gentle probing (BOP) in at least one site, and the extent of the problem was classified according to the percentage of teeth whose gingiva presented BOP (limited: 25-49% of the teeth tested; extensive: >50% of teeth tested). Logistic and linear regression models, adjusted for health regions, were used to compare gingivitis and calculus prevalence and extent between genders and school types. RESULTS: Gingivitis was found in 80.41% of the 1586 children evaluated. Urban-public schoolchildren had a slightly higher prevalence (83.24%) compared to private (79.15%, p = 0.16); those in rural-public (77.59%) and private schools had similar prevalence (p = 0.15). Extensive gingivitis was present in 60.81% of all children. The mean percentage of sites presenting BOP (BOP%) was 17.79%. Rural and urban public schoolchildren presented significantly higher BOP% compared to children from private schools (p = 0.0005, p = 0.002, respectively). Dental calculus was detected in 61.59% of the sample, boys presenting significantly higher (p = 0.005) total and supragingival calculus. Rural-public schoolchildren had a significantly higher prevalence of subgingival calculus compared to private schoolchildren (p = 0.02). CONCLUSIONS: Gingivitis prevalence is higher among 12-year-old Puerto Ricans compared to data reported for U.S. adolescents. Public schoolchildren presented significantly higher BOP% sites compared to private schoolchildren. Boys presented a significantly higher total and supragingival calculus prevalence than girls. Oral health disparities related to gender and school type were identified by this study. Studies exploring the reasons for these disparities are recommended.

Prevalence of Gingivitis in a Group of 35- to 70-Year-Olds Residing in Puerto Rico.

OBJECTIVE: Gingivitis, an inflammation of the gingival tissues, typically progresses to periodontitis. The objective of this study is to estimate the prevalence of gingivitis in 35- to 70-year-olds residing in San Juan, Puerto Rico, and assess the differences in gingivitis distribution between age and gender groups. METHODS: A cross-sectional epidemiological study was conducted with a sample of patients from a private practice and patients/employees of the Puerto Rico Medical Center. Participants completed a medical history questionnaire and received soft/hard tissue and gingival assessments based on a modified Löe-Silness index. Descriptive statistics were employed to estimate the overall gingivitis prevalence, severity (mild, moderate, severe), and mean gingival index (GI). Bleeding on probing (BOP) prevalence and the mean percentage of BOP sites were calculated by gender and age. Multinomial logistic regression was used to evaluate the associations between age, gender, and severity in 3 categories; multivariate logistic regression was used for having >=40% sites with BOP (vs. having <40% sites with BOP as reference). Odds ratios were also estimated. RESULTS: All 300 participants (52% women; 48% men) had gingivitis. The mean GI was 1.38. Moderate gingivitis was detected in 83% of the participants, mild in 7.3%, and severe in 9.3%. BOP was observed in 99% of the subjects (mean % BOP sites = 34%). After adjusting for age, men had significantly higher odds of moderate (OR = 4.66) and severe gingivitis (OR =10.06), compared to women, as well as 1.76 times higher odds of having 40% or more sites with BOP. CONCLUSION: Gingivitis was observed in all participants. Men had significantly higher GI, compared to women. The prevalence of gingivitis was higher in Puerto Rico than in the US.

Effectiveness of silver diamine fluoride in caries prevention and arrest: a systematic literature review.

This study aimed to evaluate the scientific evidence regarding the effectiveness of silver diamine fluoride (SDF) in preventing and arresting caries in the primary dentition and permanent first molars. A systematic review (SR) was performed by 2 independent reviewers using 3 electronic databases (PubMed, ScienceDirect, and Scopus). The database search employed the following key words: "topical fluorides" AND "children" AND "clinical trials"; "topical fluorides" OR "silver diamine fluoride" AND "randomized controlled trial"; "silver diamine fluoride" AND "children" OR "primary dentition" AND "tooth decay"; "silver diamine fluoride" OR "sodium fluoride varnish" AND "early childhood caries"; and "silver diamine fluoride" AND "children". Inclusion criteria were articles published in English, from 2005 to January 2016, on clinical studies using SDF as a treatment intervention to evaluate caries arrest in children with primary dentition and/or permanent first molars. Database searches provided 821 eligible publications, of which 33 met the inclusion criteria. After the abstracts were prescreened, 25 articles were dismissed based on exclusion criteria. The remaining 8 full-text articles were assessed for eligibility. Of these, 7 publications were included in the SR. These included 1 study assessing the effectiveness of SDF at different concentrations; 3 studies comparing SDF with other interventions; 2 investigations comparing SDF at different application frequencies and with other interventions; and 1 study comparing semiannual SDF applications versus a control group. The literature indicates that SDF is a preventive treatment for dental caries in community settings. At concentrations of 30% and 38%, SDF shows potential as an alternative treatment for caries arrest in the primary dentition and permanent first molars. To establish guidelines, more studies are needed to fully assess the effectiveness of SDF and to determine the appropriate application frequency.

Persistent oral health disparity in 12-year-old Hispanics: a cross-sectional study.

BACKGROUND: Dental caries is the most prevalent chronic illness worldwide. In the US dental caries has been described as a "silent epidemic", affecting 58.2 % of 12-15 year-olds, particularly in minority and immigrant groups. Caries is associated with complex yet preventable biological and behavioral factors such as dental plaque and diet, as well as social determinants of health. In developed nations, a higher risk caries has been associated with populations of low socio-economic status (SES), especially in areas with greater income disparity. An island-wide study conducted in Puerto Rico in 1997 revealed a high prevalence of dental caries in 12-year-olds and a significant health disparity between children attending private and public schools. The purpose of the present study was twofold: 1) to estimate caries levels of 12-year-old school Puerto Ricans in 2011; and 2) compare results to data obtained in 1997 to explore any possible change in caries outcomes after a government health insurance (GHI) reform was implemented. METHODS: In this cross-sectional study, a probability sample of 133 out of 1,843 schools was selected proportional to enrollment size, and stratified by 1997 GHI regions, school type, and gender. Calibrated examiners conducted oral soft tissue and caries examinations. Dental caries prevalence was estimated. Mean Decayed Missing Filled Tooth/Surface (DMFT/S) indices and mean Significant Caries Index (SiC) were calculated and compared retrospectively to data obtained in 1997. RESULTS: The final sample included 1,587 school-enrolled children. About 53 % of participants were female and 77 % attended public schools. Between 1997 and 2011, reductions were observed in caries prevalence (81 to 69 %), mean DMFT scores (3.8 to 2.5), mean DMFS scores (6.5 to 3.9), and mean SiC index (7.3 to 5.6) in both private and public schools, with a more prominent decrease in private schools. Between 1997 and 2011, overall the filled component increased (50 to 67 %), while decayed and missing component decreased (42 to 30 %) and (8 to 3 %), respectively. CONCLUSIONS: Among 12-year-old schoolchildren in Puerto Rico between 1997 and 2011, caries prevalence, extent, and severity decreased as well as the DMFT missing component, while the filled component increased. Dental caries prevalence was high and the health disparity persists between children enrolled in public and private schools after more than a decade of the GHI implementation. The relationship between GHI implementation and other potentially relevant co-factors for caries warrants further research, as does the seemingly entrenched disparity across groups.

Efficacy of two fluoride-free, alcohol-free mouthwashes containing 0.075% or 0.07% CPC in controlling established dental plaque and gingivitis over a 6-week period on adults in Puerto Rico.

PURPOSE: To evaluate the clinical efficacy of two commercially available, fluoride-free, alcohol-free mouthwashes containing either 0.075% or 0.07% cetylpyridinium chloride (CPC) in controlling established dental plaque and gingivitis compared to a non-antibacterial control mouthwash. METHODS: A 6-week double-blind, randomized clinical trial was conducted in Trujillo Alto, Puerto Rico. Recruited subjects were randomly assigned to one of three treatment groups: (1) a fluoride-free, alcohol-free mouthwash containing 0.075% CPC (TG); (2) a fluoride-free, alcohol-free mouthwash containing 0.07% CPC (PC); and (3) a fluoride-free, alcohol-free mouthwash without antibacterial agent (NC). Subjects were instructed to rinse with the assigned mouthwash, after tooth brushing, twice daily (morning and evening). After 4 and 6 weeks of product use, subjects were examined for gingivitis (Whole Mouth Gingival, Gingival Interproximal, Gingival Severity Indexes) and plaque (Whole Mouth Plaque, Plaque Interproximal, and Plaque Severity Indexes) parameters. ANCOVA and post hoc Tukey's pair-wise comparisons (α = 0.05) were performed for treatment group comparisons. RESULTS: A total of 132 subjects were screened; 120 were enrolled; and 116 completed the study. After 6 weeks of product use, participants who rinsed with the CPC-containing mouthwashes exhibited statistically significant (P < 0.05) reductions in all the gingivitis and plaque parameters evaluated, whereas in those using the non-antibacterial mouthwash, significant reductions were only observed in whole mouth and interproximal plaque scores. No statistically significant (P > 0.05) differences were observed, with respect to the gingival and plaque parameters, between the two CPC-containing mouthwashes.

Efficacy of CPC and essential oils mouthwashes compared to a negative control mouthwash in controlling established dental plaque and gingivitis: A 6-week, randomized clinical trial.

PURPOSE: To evaluate the clinical efficacy of a mouthwash containing 0.075% cetylpyridinium chloride (CPC) in a fluoride-free, alcohol-free base and a mouthwash containing essential oils in a fluoride-free, 21.6% alcohol base as compared to a fluoride-free, alcohol-free non-antibacterial mouthwash in controlling established dental plaque and gingivitis after 6 weeks of twice daily use. METHODS: A 6-week, parallel-group, randomized double blind clinical trial was conducted in Santo Domingo, Dominican Republic. Recruited subjects were randomly assigned to one of three treatment groups: (1) a mouthwash containing 0.075% CPC in a fluoride-free, alcohol-free base (CPC); (2) a commercially-available mouthwash containing essential oils in a fluoride-free, 21.6% alcohol base (EO); or (3) a fluoride-free, alcohol-free non-antibacterial mouthwash (NC). Subjects were instructed to rinse with the assigned mouthwash, after tooth brushing, twice daily (morning and evening). After 4 and 6 weeks of product use, subjects were examined for gingivitis (Whole Mouth Gingival, Gingival Interproximal, Gingival Severity Indexes) and plaque (Whole Mouth Plaque, Plaque Interproximal, and Plaque Severity Indexes) parameters. For treatment group comparisons, ANCOVA and post hoc Tukey's pair-wise comparisons (α = 0.05) were performed. RESULTS: 132 subjects were screened; 120 were enrolled; and 116 completed the study. After 6 weeks of product use, subjects using the CPC and EO mouthwashes exhibited statistically significant (P < 0.001) reductions of all gingival and plaque measurements compared to subjects using the NC mouthwash. Subjects using the CPC mouthwash did not exhibit a statistically significant (P > 0.05) reduction with respect to gingival severity and all plaque measures (Whole, Interproximal, and Severity) when compared to EO mouthwash. Subjects using the CPC mouthwash exhibited statistically significant (P < 0.05) reductions in Gingival Index scores of 5.1% (P = 0.005), and Gingival Interproximal Index scores of 5.5% (P = 0.016) relative to subjects using the EO mouthwash. These reductions were not considered clinically significant.

Oral Health Knowledge and Oral Hygiene Habits in a Sample of 12-Year-Old Hispanics: A Cross-sectional Study.

OBJECTIVE: To explore the association between hygiene knowledge and habits and gingivitis in Puerto Rican school children. METHODS: Questionnaires on oral health knowledge and hygiene habits were provided to almost half of the 12-year-olds who participated in an island-wide cross-sectional oral health study. The evaluations included gingival examinations in 2 quadrants. Odds ratios (ORs) (with 95% CIs) were computed using logistic regression models and oral health-related knowledge and hygiene habits to gingivitis. RESULTS: Of the 823 participants who completed the questionnaire 53.43% were female, and 81% had gingivitis. Most reported having received instructions on brushing (98%), flossing (89.5%), and using mouthwash (90%). The majority (75%) rated their gums as healthy, and 44.68% agreed that oral health affects general health. Nearly half (44%) reported brushing their teeth at least 2 times a day, and 80.25%, flossing daily. In multivariate analysis, not having been instructed on how to brush was related to greater odds of having gingivitis (OR: 7.32; 95% CI: 1.5-35.67). Flossing more than once a day was associated with half the odds of gingivitis (OR: 0.50; 95% CI: 0.29-0.88). CONCLUSION: The children had knowledge of oral hygiene methods but were mostly unaware that gingival health could affect systemic health. Fewer than half reported brushing 2 or more times a day. Not having been instructed on how to brush was associated with higher odds of gingivitis.

Comparison of Chu's Proportion Gauge with a T-bar Tip and a Two-Tip Compass in the Determination of Anterior Dentition Tooth Size in a Group of Puerto Ricans.

OBJECTIVE: Compare maxillary anterior dentition measurements, using Chu's proportion gauge with a T-bar tip (PG-TT) and a Two-Tip Compass (T-TC), in a group of Puerto Ricans, to determine the reliability of the PG-TT. METHODS: This cross-sectional study was conducted at the University of Puerto Rico, School of Dental Medicine, Medical Sciences Campus. The participants (18-35 years old) were dental students or employees of the university. Previously, the examiner had been trained and calibrated in instrument usage. Calibration participants (n = 16) received an oral exam, prophylaxis, and a chlorhexidine mouthwash for home use. After 3 days, the upper-anterior teeth were measured using the 2 instruments. The agreement was determined using weighted kappa statistics (Kw), and 0.80 was the minimum acceptable level. The examiner achieved almost perfect agreement (inter-examiner KwT-TC = 0.95 [0.96-0.93]; KwPG-TT = 0.82 [0.81-0.87]) with a reference examiner. RESULTS: Fifty participants (25 women and 25 men) were evaluated. Length: The teeth of the men presented an unacceptable level of agreement, except for in the right central incisors. For the women, a strong level of agreement was observed only in the lateral incisors and left canines. When the teeth of both sexes were considered, a strong level of agreement was detected, except for in the right canines and left central incisors. Width: The level of agreement was unacceptable, except for in the right canines (distal). CONCLUSION: T-TC is a more reliable instrument to measure tooth dimensions as compared to the PG-TT.

Prevalence of Dental Caries in 12-Year-Olds in San Pedro de Macorís, DR.

OBJECTIVE: Dental caries is one of the most prevalent chronic diseases in children. Currently, no data are available on dental caries prevalence in the Dominican Republic. The purpose of this study was to estimate the prevalence of dental caries in schoolattending 12-year-olds in San Pedro de Macorís, Dominican Republic. METHODS: A cross-sectional epidemiological study using a probabilistic sample, stratified by type of school (public/private) and gender, was conducted. Two calibrated examiners conducted the evaluations of oral soft/hard tissues. Caries experience was summarized in terms of prevalence; the number of decayed, missing, and filled teeth (DMFT) and surfaces (DMFS); and the significant caries (SiC) index, in all the participants, and by gender and school type. Logistic and Poisson regression models were used to compare caries experience by sex and school type. RESULTS: Four hundred and two 12-year-olds enrolled in 14 public and 11 private schools were evaluated. The overall dental caries prevalence was 73%. The mean DMFS was 3.87, the mean DMFT was 2.64, and the SiC index was 5.07. Girls had significantly higher mean DMFS, DMFT, and SiC indices than did boys. Public school attendees had significantly higher DMFS, DMFT, and SiC indices than did those children attending private schools. The decayed (D) component accounted for 71% of the DMFT value. CONCLUSION: The WHO's goal of all 12-year-olds having a DMFT less than or equal to 3 was met by all the participants in our study. Girls and public-school attendees carry the burden of the disease. The high D component of the index suggests that there are unmet dental-caries needs. This information will assist in the design and implementation of future primary and secondary prevention programs.

Xylitol: effects on the acquisition of cariogenic species in infants.

PURPOSE: The purpose of this study was to examine the effects of xylitol gum (XG) on the acquisition pattern of 39 bacterial species, including mutans streptococci (MS), in infants. METHODS: Ninety-seven mothers (MS counts > 10(5) CFU/ml) were randomly divided into 4 groups and received: (1) XG (4.2 gm/day); (2) XG (6 months after baseline exams); (3) sorbitol gum (4.2 gm/day); or (4) no gum. Groups 1 and 3 chewed gum 3 times a day for 9 months. Microbiota of plaque and saliva samples from the mother-child pairs were analyzed by culturing and via checkerboard DNA-DNA hybridization. RESULTS: MS was isolated from 33% of the predentate infant (< or =5 months old) baseline saliva samples and from 41% of the saliva and 65% of the plaque samples at the final visit. At baseline, positive responses to "mother's checking of baby's food temperature using baby's spoon" and "starting a bottle after stopping breast-feeding" were significant predictors (P = .009 and P < .001, respectively) of infant's total streptococci counts. At the final visit (9 months later), there were no significant differences between treatment groups for infants' 39 microbial plaque species, including MS. CONCLUSIONS: Maternal use of xylitol gum did not result in statistically significant differences in the microbial plaque composition of 9- to 14-month-old infants.

Carcinoma espinocelular bucal. Variables epidemiológicas (Venezuela) / Oral squamous cell carcinoma: epidemiological survey

Se hace una revisión de la literatura concerniente a Carcinoma Espinocelular, en donde se destacan los aspectos epidemiológicos e histopatológicos del mismo. De un total de 7.400 muestras procesadas en la Facultad de Odontología de la Universidad Central de Venezuela, se obtienen 58 casos de Carcinoma Espinocelular Bucal. Todas estas lesiones fueron estudiadas de acuerdo a ciertas variables epidemiológicas que incluyen: edad, sexo y localización. Se hace un análisis histopatológico, se establecen comparaciones con otros estudios realizados y se obtienen conclusiones. Dentro de estas últimas se destacan los sitios de alto riesgo que fueron: en el sexo masculino, la encía y reborde alveolar inferior, la lengua y el piso de la boca, mientras que en el sexo femenino fueron: el paladar y la encía y reborde alveolar superior, seguido por el piso de la boca. Igualmente se pudo constatar una relación entre Carcinoma Espinocelular y hábitos tabáquicos en más del 30 por ciento de los casos