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.

Effect of a daily dose of Lactobacillus brevis CD2 lozenges in high caries risk schoolchildren.

OBJECTIVES: A double-blind, randomised, placebo-controlled clinical trial was performed to validate the hypothesis that the use of lozenges containing Lactobacillus brevis CD2 (Inersan®, CD Investments srl) may reduce plaque pH, salivary mutans streptococci (ms) and bleeding on probing, during a 6-week period, in a sample of high caries risk schoolchildren. METHODS: A total of 191 children (aged 6-8 years), presenting two to three carious lesions and a salivary ms concentration of ≥10(5) CFU/ml, were enrolled and divided into two groups, an L. brevis CD2 lozenge group and a no L. brevis lozenge group, and examined at baseline (t0), after 3 weeks (t1), after 6 weeks of lozenge use (t2) and 2 weeks after the cessation of lozenge use (t3). Plaque pH was assessed using the microtouch technique following a sucrose challenge. The area under the curve (AUC5.7 and AUC6.2) was recorded. Salivary ms were counted, and bleeding on probing was assessed. RESULTS: At t0, the plaque-pH and ms concentration values were similar in both groups. Mean areas (AUC5.7 and AUC6.2) were significantly greater in the control group at t1, t2 and t3. L. brevis CD2 lozenges significantly reduced salivary ms concentrations and bleeding. The subjects from the test group showed a statistically significant decrease (p = 0.01) in salivary ms concentration. At t2, a statistically significantly lower bleeding value was recorded in the test group compared with the control group (p = 0.02). CONCLUSIONS: Six weeks' use of lozenges containing L. brevis CD2 had a beneficial effect on some important variables related to oral health, including a reduction in plaque acidogenicity, salivary ms and bleeding on probing. (Trial Registration Number NCT01601145 08/21/2012).

[Multicentre, prospective cohort study, to validate the Italian version of the Braden Q scale for the risk of the pressure sores in newborns and up to 8 years old children]. / Studio di coorte prospettico multicentrico per la validazione italiana della Braden Q per la valutazione del rischio di lesioni da decubito nei neonati e nei bambini fino ad 8 anni.

UNLABELLED: Multicenter prospective cohort study, to validate the Italian version of the Braden Q scale for the risk of pressure sores in newborns and up to 8 years old children. INTRODUCTION: Children admitted to Intensive care Units (ICU), oncology and neurology/neurosurgery wards are at risk of developing pressure sores. AIM: To validate the Italian version of the Braden Q scale for the assessment of the risk of developing pressure sores in children. METHODS: Children from 21 days to 8 years, admitted to intensive and sub intensive units were recruited. Premature babies, children admitted with a pressure sore and with a story of congenital cardiomiopathy were excluded. In this cohort, multicentre and with repeated measurements study, the first assessment was performed after 24 hours from hospital admission, using the Braden Q Scale (Suddaby's version). The pressure sores were assessed with the Skin assessment Tool and staged according to the National Pressure Ulcer Advisory Panel. RESULTS. On the 157 children 524 observation were conducted. The incidence of pressure sores was 17.2%. Only the analysis on specific subgroups of patients showed a good diagnostic accuracy: 71.4% on children 3-8 years; 85.6% in sub intensive wards. CONCLUSIONS: The Braden Q scale may be reliably used and shows a good diagnostic accuracy in children 3-8 years of age admitted to sub-intensive, neurology, oncology and heamatology wards.

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.

Caries-risk profiles in Italian adults using computer caries assessment system and ICDAS.

The aim of this study was to examine the correlation among socio-behavioral factors, caries status and caries risk, calculated through Cariogram, in an adult population. Four hundred eighty subjects (mean age 40.73, SE ± 0.33) randomly selected from the municipal electoral registry consented to participate in the survey. Subjects were examined, and the International Caries Detection Assessment System (ICDAS) index was registered. A highly structured questionnaire was submitted to investigate (1) personal data (i.e., age, gender, educational level, job categorization), (2) life-style behavior (i.e., smoking and dietary habits), and (3) oral health behavior (i.e., tooth brushing, use of fluoride and dental check-up frequency). An evaluation of the mutans streptococci concentration in saliva was also performed. Information on caries-related factors was entered into the Cariogram in order to generate an individual caries risk profile for each subject. Multinomial logistic regression was performed using Cariogram levels as the dependent variable. The possible correlated variables were analyzed using the principal component analysis (PCA). Considering ICDAS scores, 5.62% of the sample had at least an initial decay (ICDAS = 1-2), whereas 40.83% of the sample presented at least one moderate decay (ICDAS = 3-4) and 17.08% a severe decay (ICDAS = 5-6). Decay at ICDAS levels 5-6 and more than 5 missing teeth were statistically associated with Cariogram scores (OR = 2.36, 95%CI = 1.83-3.03 and OR = 1.43, 95%CI = 1.13-1.82, respectively). The results suggest that the Cariogram model was able to identify caries-related factors in an adult population. A direct association among the risk categories from Cariogram, the caries status and some socio-behavioral variables was verified.

Caries-risk profiles in Italian adults using computer caries assessment system and ICDAS

The aim of this study was to examine the correlation among socio-behavioral factors, caries status and caries risk, calculated through Cariogram, in an adult population. Four hundred eighty subjects (mean age 40.73, SE ± 0.33) randomly selected from the municipal electoral registry consented to participate in the survey. Subjects were examined, and the International Caries Detection Assessment System (ICDAS) index was registered. A highly structured questionnaire was submitted to investigate (1) personal data (i.e., age, gender, educational level, job categorization), (2) life-style behavior (i.e., smoking and dietary habits), and (3) oral health behavior (i.e., tooth brushing, use of fluoride and dental check-up frequency). An evaluation of the mutans streptococci concentration in saliva was also performed. Information on caries-related factors was entered into the Cariogram in order to generate an individual caries risk profile for each subject. Multinomial logistic regression was performed using Cariogram levels as the dependent variable. The possible correlated variables were analyzed using the principal component analysis (PCA). Considering ICDAS scores, 5.62% of the sample had at least an initial decay (ICDAS = 1-2), whereas 40.83% of the sample presented at least one moderate decay (ICDAS = 3-4) and 17.08% a severe decay (ICDAS = 5-6). Decay at ICDAS levels 5-6 and more than 5 missing teeth were statistically associated with Cariogram scores (OR = 2.36, 95%CI = 1.83–3.03 and OR = 1.43, 95%CI = 1.13–1.82, respectively). The results suggest that the Cariogram model was able to identify caries-related factors in an adult population. A direct association among the risk categories from Cariogram, the caries status and some socio-behavioral variables was verified.