Cariogenic Potential of the commonly Prescribed Pediatric Liquid Medicaments in Kingdom of Saudi Arabia: An in vitro Study.

AIM: The aim of this study was to assess the cariogenic potential of the commonly prescribed pediatric liquid medicaments (PLMs) for dental disease in Jazan region, Kingdom of Saudi Arabia. MATERIALS AND METHODS: Seven most commonly prescribed PLMs were selected by prior questioning the pediatric dentists as well as general dentists in Jazan region. The endogenous pH and sucrose concentrations of the liquid medicaments were assessed. The endogenous pH was assessed by Hanna pH meter instrument. The sucrose concentration was assessed by anthrone reagent method. RESULTS: All the PLM were acidic. The pH of the PLM ranged from 4.22 to 6.10. All the PLM contained sucrose and its concentration ranged from 5.38 to 11.41 gm% in the samples. CONCLUSION: In this study, all the PLM were acidic and contained sucrose. Hence, they have cariogenic potential. CLINICAL SIGNIFICANCE: Parents and dentists are unaware of the hidden sugars and cariogenicity of these medications. Strict oral hygiene instructions are mandatory for the children taking these medications. The use of PLM should also be minimized and parents should seek early dental treatment to restore child's oral health.

Association between the number of early carious lesions and diet in children with a high prevalence of caries.

AIM: An investigation was conducted in a population of paediatric patients with a high risk of caries in order to assess the association between caries history (CH) and the number of early carious lesions (ECLs) and the frequency and timing of cariogenic food and beverage intake, sugar-containing medication, the frequency and efficacy of tooth brushing, and the use of topical fluorides. MATERIALS AND METHODS: Study design: descriptive study. One hundred children aged 6-15 years with≥ ECL of a permanent tooth and not enrolled in any dental health educational or preventive programme were selected. For diagnosis it was used an explorer according to the ICDAS II criteria. The participants completed a closed-list questionnaire on the frequency and timing of cariogenic food intake. RESULTS: There was a nonsignificant tendency to present more ECLs and a greater CH among patients who consumed cariogenic foods and beverages. A significant relationship (p<0.05) was observed between cariogenic beverages and the number of ECL or CH. Using the number of ECLs as dependent variable, regular fluoridated rinses (p=0.003), frequent sugar-containing medication (p=0.007), and cariogenic beverage consumption (p=0.024) were identified as explanatory parameters in the linear regression model. STATISTICS: The Student t-test was used to compare ECL and CH with dietetic factors, fluoridated rinses, sugar- containing medicines, and the frequency and efficacy of tooth brushing. Linear regression analysis correlated the number of ECLs to the mentioned explanatory variables. CONCLUSION: The frequent consumption of sugary beverages and medications, and failure to regularly use fluoridated rinses, were positively correlated to an increased number of ECLs in patients with a high prevalence of caries.

[Stevia in the fight against dental caries]. / Stevia in de strijd tegen cariës.

Stevia is a natural, non-caloric sweetener of plant origin. The sweetening power of stevia is several hundred times larger than that of table sugar (sucrose). On the basis of available research, the European Food Safety Authority concluded that stevia is safe for human consumption. Since then, stevia has been approved as a sweetener for the European market. As a substitute for sucrose, stevia can contribute to a reduced caloric intake and can play a role in the prevention and/or treatment of metabolic disorders. In addition, stevia is non-cariogenic and is, moreover, affordable. Promoting the consumption of stevia can therefore be a preventive means of fighting dental caries.

Child externalizing behavior problems linked to genetic and non-genetic variation in dental caries.

The association of environmental and genetic variation in caries with child externalizing behavior problems (inattention, hyperactivity, impulsivity, and defiance) was studied in a sample of 239 pairs of 3- to 8-year-old impoverished Brazilian twins. It was hypothesized that externalizing problems would show a stronger positive association with environmental than genetic variation in caries. Univariate twin models were estimated to parse variation in caries into three components: additive genetic (A), shared environment (C) and non-shared environment/error (E). Age-adjusted associations between externalizing problems and each variance component were tested. Contrary to the hypothesis, modest but very consistent negative associations were found between externalizing problems and both genetic and environmental variation in caries. Mutans streptococci and sweetness preference did not explain the negative associations of caries and externalizing problems. Externalizing problems in non-medicated children were associated with less dental decay that could be explained by both genetic and environmental factors.

Analysis of health behaviour change interventions for preventing dental caries delivered in primary schools.

To improve oral health in children, the key behaviours (tooth brushing and sugar control) responsible for development of dental caries need to be better understood, as well as how to promote these behaviours effectively so they become habitual; and, the specific, optimal techniques to use in interventions. The aim of this paper is to describe and analyse the behaviour change techniques that have been used in primary school-based interventions to prevent dental caries (utilizing a Cochrane systematic review that we have undertaken) and to identify opportunities for improving future interventions by incorporating a comprehensive range of behaviour change techniques. Papers of five interventions were reviewed and data were independently extracted. Results indicate that behaviour change techniques were limited to information-behaviour links, information on consequences, instruction and demonstration of behaviours. None of the interventions were based on behaviour change theory. We conclude that behaviour change techniques used in school interventions to reduce dental caries were limited and focused around providing information about how behaviour impacts on health and the consequences of not developing the correct health behaviours as well as providing oral hygiene instruction. Establishing which techniques are effective is difficult due to poor reporting of interventions in studies. Future design of oral health promotion interventions using behaviour change theory for development and evaluation (and reporting results in academic journals) could strengthen the potential for efficacy and provide a framework to use a much wider range of behaviour change techniques. Future studies should include development and publication of intervention manuals which is becoming standard practice in other health promoting programmes.

Diet and the microbial aetiology of dental caries: new paradigms.

The microbial and dietary factors that drive caries have been studied scientifically for 120 years. Frequent and/or excessive sugar (especially sucrose) consumption has been ascribed a central role in caries causation, while Streptococcus mutans appeared to play the key role in metabolising sucrose to produce lactic acid, which can demineralise enamel. Many authors described caries as a transmissible infectious disease. However, more recent data have shifted these paradigms. Streptococcus mutans does not fulfil Koch's postulates - presence of the organism leading to disease, and absence of the organism precluding disease. Furthermore, molecular microbiological methods have shown that, even with a sugar-rich diet, a much broader spectrum of acidogenic microbes is found in dental plaque. While simple sugars can be cariogenic, cooked starches are also now recognised to be a caries threat, especially because such starches, while not 'sticky in the hand', can be highly retentive in the mouth. Metabolism of starch particles can yield a prolonged acidic challenge, especially at retentive, caries-prone sites. These changes in the paradigms of caries aetiology have important implications for caries control strategies. Preventing the transmission of S. mutans will likely be inadequate to prevent caries if a sufficiently carbohydrate-rich diet continues. Similarly, restriction of sucrose intake, although welcome, would be unlikely to be a panacea for caries, especially if frequent starch intake persisted. Instead, approaches to optimise fluoride delivery, to target plaque acidogenicity or acidogenic microbes, to promote plaque alkali generation, to increase salivary flow or replace fermentable carbohydrates with non-fermentable alternatives may be more promising.

A practice-based study on the effect of a short sucrose/xylitol exposure on survival of primary teeth caries free.

BACKGROUND: In a randomized double-blinded clinical trial, preschool children used sucrose or xylitol chewing gum regularly for 2 months to study the preventive effect of xylitol on acute otitis media (AOM). Salivary mutans streptococci (sm) levels of the children were measured before the exposure. Those with ≥10(5) sm CFU in 1 mL saliva were considered to have high sm levels (sm+); and those with <10(5) CFU low sm levels (sm-). AIM: This practice-based study aims to evaluate long-term dental effects of the sucrose/xylitol exposure on primary teeth. DESIGN: For analyses, individuals were divided into sub groups according to their study group in the original AOM trial and baseline sm levels. Outcome events owing to dental caries of their all primary teeth were followed from dental records up to 12 years. Survival of teeth caries free was determined by Kaplan-Meier method and analysed statistically by Wilcoxon testing. RESULTS: Survival of primary teeth caries free of children with high sm levels in the sucrose group was significantly shorter compared with all other groups when followed until shedding. CONCLUSIONS: Two months' regular exposure to sucrose was sufficient to induce dental caries in primary teeth of children with elevated sm levels at baseline.

Comparison of the effects of whole and juiced fruits and vegetables on enamel demineralisation in situ.

We compared the effect on enamel demineralisation in situ of both whole and juiced fruits and vegetables. Volunteers wore removable mandibular appliances carrying pre-demineralised human enamel slabs and consumed one of the test foods 7 times a day for 10 days. The test foods were apples, oranges, grapes, carrots, and tomatoes, consumed either whole (sugars located intrinsically) or as a juice (extrinsic or free sugars). Raisins containing 64% sugars, but intrinsic by definition, were also studied. The mineral profile of the enamel slabs was studied before and after the test period using transverse microradiography and showed further demineralisation for all test foods, irrespective of the form of consumption. Significant demineralisation was also observed with raisins. No significant differences were found between the solid and juiced foods. In conclusion, sugars present intrinsically on consumption had a similar demineralising potential as free sugars and could not be considered less cariogenic.

Low-fluoride toothpaste and deciduous enamel demineralization under biofilm accumulation and sucrose exposure.

Because low-fluoride toothpaste (500 p.p.m. F) has not clearly been shown to be effective for controlling caries in caries-active children, this experimental in situ study was conducted to evaluate whether its effect, when compared with a conventional toothpaste (1,000-1,500 p.p.m. F), would depend on the cariogenic challenge. During four phases of 14 d each, 14 volunteers used 500 or 1,100 p.p.m. F toothpaste and wore palatal appliances containing deciduous enamel slabs, on which biofilm was accumulated and exposed to 20% sucrose solution at frequencies increasing from two to eight times per day. The F concentration was determined in the biofilm formed, and enamel demineralization was assessed by surface hardness loss (% SHL) and integrated area of hardness x lesion depth (DeltaS). The F uptake by enamel was also determined. Fluoride in biofilm fluid and solids was statistically higher when conventional F toothpaste was used. The toothpastes did not differ statistically in terms of % SHL, DeltaS, and F in enamel, but only the conventional F toothpaste significantly reduced caries-lesion progression according to the frequency of sucrose exposure. The findings suggest that the high-F availability in biofilm, resulting from the use of conventional toothpaste compared with low-F toothpaste, may be important for reducing caries-lesion progression in conjunction with a high frequency of sucrose exposure.

Diet and caries experience among preschool children in Ajman, United Arab Emirates.

The study investigated the association between food and drink consumption and the caries experience among young children in Ajman, United Arab Emirates. A one-stage cluster sample was used to select children who were 5 or 6 yr of age. Clinical examinations for caries were conducted. Parents completed questionnaires seeking information on dietary habits. Principal components analysis was used to derive a summary score for the dietary variables (designated 'snack consumption level') and thus overcome the multicollinearity problems associated with using multiple dietary variables. Dental examination and questionnaire data were obtained for 1,036 children (79.9% participation rate). The overall mean number of decayed, missing or filled teeth (dmft) was 4.5. Snacking three or more times per day was associated with a dmft score that was almost one-third higher than the dmft score for children who snacked only once daily. One-third of children had a low overall snack consumption level (41% moderate and 25% high). There was a consistent dmft gradient across those categories. The severity of Early Childhood Caries (ECC) in young Ajman children is high, with dietary habits being important determinants. Cariogenic snack consumption can be represented using a summary exposure variable that appears to be valid. Young children in Ajman would benefit from health-promotion strategies directed towards appropriate dietary practices.

A content analysis of children's television advertising: focus on food and oral health.

OBJECTIVES: To analyse the nature and content of advertising during children's popular television viewing times with the specific aims of (i) identifying the proportion of advertising time devoted to confectionery and potentially cariogenic products (those which readily give rise to dental caries, more commonly known as tooth decay); and (ii) determining whether there is a variation in the advertisement of confectionery and other high-sugar products within children's school holiday time v. outside holiday time.MethodIn five separate one-week periods, the output of the four most popular British children's commercial television channels was video-recorded during the most popular viewing times for children. In total, 503 h of television were recorded and analysed. RESULTS: Analysis of the recordings revealed that 16.4 % of advertising time was devoted to food products; 6.3 % of all advertising time was devoted to potentially cariogenic products. Sugared cereals were the most commonly advertised high-sugar product, followed by sweetened dairy products and confectionery (chi2 = 6524.8, df = 4, P < 0.001). The advertisement of confectionery and high-sugar foods appeared to be influenced by school holidays. CONCLUSIONS: Health-care professionals should be aware of the shift away from the advertisement of confectionery towards the promotion of foods that might be considered healthier but contain large amounts of hidden sugar.

Enamel demineralization with two forms of archwire ligation investigated using an in situ caries model--a pilot study.

A modified in situ model to assess enamel demineralization around orthodontic devices was developed and a pilot study was conducted to evaluate two types of archwire ligation. Enamel blocks were placed in palatal removable appliances where orthodontic brackets were bonded. The brackets on one side of the appliance were ligated with elastomeric rings and those on the other side with stainless steel wires. Four volunteers (two males, two females), mean age 27 years, wore the appliances for 14 days during which time a 20 per cent sucrose solution was dripped eight times a day onto the enamel blocks. The biofilm formed around the brackets was collected for microbiological analyses and the mineral loss around the brackets was determined by cross-sectional microhardness measurement. The ligatures evaluated did not differ significantly from each other regarding biofilm weight, total bacteria, total streptococci, mutans streptococci, or lactobacilli counts (P > 0.05, Wilcoxon paired test). Enamel demineralization was also not different around the brackets for the different ligation methods (P > 0.05, split-split-plot analysis of variance). However, a statistical power analysis based on the data showed a trend to higher demineralization around brackets ligated with elastomeric rings. The developed modified in situ model may be suitable to assess the caries potential of clinical procedures used in orthodontic treatment.

Compliance with preventive care following dental treatment of children under general anaesthesia.

OBJECTIVE: This study evaluated the self-reported preventive dental care compliance of parents/families whose children received dental treatment under general anaesthesia. STUDY DESIGN: Complete records of 68 pediatric patients who attended the University of Stellenbosch's Paediatric Dentistry Department for dental treatment were included in the survey. Parents of 41 (60%) patients were interviewed telephonically to evaluate parental dental health knowledge and preventive practices. RESULTS: The majority (85%) of parents had a good idea about the aetiology of dental caries. An assessment of the children's dental health behaviour reveals that parents were mostly responsible for brushing the childs' teeth (44%).The majority of parents (51%) reported that following dental treatment of the child under general anaesthesia, there was no change in their child's frequency of sugar consumption. Sixty-three percent of children treated under GA had returned for the one-week follow-up. However, only 22% of children returned for the three-month follow up appointment. Parents were informed about the importance of these follow-up appointments. CONCLUSION: Parental belief that proper dental health behaviour helps maintain the teeth, did not influence parents preventive compliance, despite them having received preventive instruction. Parents were mostly responsible for brushing their child's teeth following dental treatment of their children under general anaesthesia. This research found however that, in the majority of cases there was no change in the children's frequency of sugar intake.

[The restorative care index in children 1. Factors concerning the child]. / De restauratieve verzorgingsgraad bij de jeugd 1. Patiëntgebonden factoren.

In 2007 a study was undertaken of the restorative care index of the teeth of children under the age of 18. The aim of this study was to gain insight into the factors associated with the restorative care index in children. Factors investigated were (post-) brushing, inspection frequency, sweets-consumption frequency, socio-economic status and treatment or lack thereof by a general practitioner or dentist who works in a clinic for child health care. This study made use of statistics assembled for an earlier study of children formerly covered by public health insurance in the municipality of The Hague and research carried out at child dental clinics. Socio-economic status and the level of oral care were correlated with dental quality. No patient-bound factors were significantly correlated with the level of care. There was however a positive correlation between the'type' of dentist (family dentist or dentist associated with a clinic for child dental care) and the chance of curative treatment (in the case of developing caries).

Role of sucrose in the fitness of Streptococcus mutans.

INTRODUCTION: Dental caries has been closely linked to fermentable carbohydrates as key environmental factors. Sucrose has been identified as the most cariogenic carbohydrate. Streptococcus mutans, considered to be the primary pathogen causing dental caries, is able to utilize sucrose as a nutrient source, partially for the production of intracellular storage components and for the production of extracellular glucans via the glucosyltransferases GtfB, GtfC, and GtfD. The following study explores the competitiveness and fitness of S. mutans when grown with different concentrations of sucrose. METHODS: Growth competition with oral streptococci and antimicrobial susceptibility in static biofilm models grown without sucrose or with 0.1% or 0.5% sucrose were investigated using confocal laser scanning microscopy. The numbers of surviving S. mutans of both wild-type and an isogenic Gtf-negative mutant after antimicrobial treatment were determined as colony-forming units. RESULTS: S. mutans was able to establish microcolonies with increasing sucrose concentration in the presence of other streptococcal competitors during biofilm development. The antimicrobial susceptibility decreased when sucrose was available as substrate and was dependent on the presence of the Gtfs. CONCLUSION: The increased resistance against antimicrobial treatment was associated with the availability of sucrose, but was not influenced much by the concentration used during this study. The resistance was strongly associated with the Gtf activity, excluding any intracellular metabolic effect of sucrose in the resistance mechanism.

Dietary habits in a child population in relation to caries experience.

Sugar consumption in Spain has remained constant at around 80 g/day since the 1970s. Although intake as sugar has fallen considerably, to around 13.5 g/person/day, the intake in processed foods has risen. Meanwhile, caries prevalence is falling or stabilizing. This situation is common in developed countries, where the impact of diet on caries has altered, probably through greater use of fluoridated products. In the Valencia region, children habitually eat sugary foods and drinks and snacks that contain starches or sugars and starches. The present study analyzed the association between caries experience, quantified as the sum of the dfs and DMFS indices, and the consumption of cariogenic foods in a population of children between the ages of 6 and 10 with low caries prevalence. A self-administered food consumption frequency questionnaire filled in by the parents was used to evaluate how often the foods on the list were consumed by the children, which was then related to their caries experience. Sweet snacks, industrial bread and soft drink consumption showed a positive association with caries while cheese and nuts showed a negative association. Logistic regression suggested that consuming sugary liquids and foods rich in semi-hydrolyzed starch increased the chances of suffering caries by 1.05 and 1.13 respectively.

Pediatricians' perceptions of the use of sweetened medications related to oral health.

OBJECTIVE: To evaluate pediatricians' perceptions and attitudes about the use of liquid pediatric medicines and their relationship with dental caries and dental erosion. STUDY DESIGN: A cross sectional study was conducted. Data was collected by questionnaires handed out in hospitals, medical clinics and offices. A convenience sample of 104 pediatricians was obtained. RESULTS: Most respondents (80.8%) stated that pediatric medicines could be related with dental disorders. Dental caries (64.70%) and tooth discoloration (43.7%) were the most frequent mentioned alterations, while only 3 (4.2%) respondents pointed out dental erosion. A considerable number of respondents (62.50%) recognized the presence of fermentable carbohydrates as a contributing factor to tooth decay, however not all of them recommended oral hygiene after their consumption (50.80%). Besides, 48 respondents (46.20) also believed that pediatric medicines could cause dental wear. CONCLUSIONS: Pediatricians in this study did not perceive the correct relationship between the presence of acidity in medicines and dental erosion; however, most of them presented a reasonable awareness about the relationship between sugared pediatric medicines and dental caries. Besides, they were unaware about the need of recommending oral hygiene after medicines' use.

The effect on dental enamel of the frequency of consumption of fluoridated milk with a cariogenic challenge in situ.

OBJECTIVES: To evaluate the effect on enamel of varying the frequency of consumption of 1.0 mg F in milk once per day, twice per day or once every other day under cariogenic challenge in situ. MATERIALS AND METHODS: In a controlled, randomised, cross-over, single-blind study, 25 subjects wore an intra-oral lower removable appliance with enamel slabs for 21 days during each study arm. Subjects used F-free toothpaste, the cariogenic challenge comprising of five 2 min dippings per day in a 12% sucrose solution. Subjects dipped the appliances in 50 ml of 5.0 ppm fluoridated milk for five minutes during the test period once per day, twice per day, and once every other day and drank 200 ml of the same milk, once per day, twice per day (100 ml each time), or once every other day (200 ml) immediately on re-inserting their appliance in order to replicate topical and systemic effects. Slabs were analysed with surface microhardness (SMH) for protection against further demineralisation and transverse microradiography (TMR) to assess changes in mineralisation. RESULTS: Using SMH, 200 ml of 5.0 ppm F milk once per day was significantly better than 100 ml of 5.0 ppm F twice/day (p < 0.05) and 200 ml once every other day, but not significantly. Using TMR there was a statistically significant difference in mineral loss of enamel between baseline and treatment for all groups, but not between groups. CONCLUSIONS: Drinking 200 ml of 5.0 ppm milk once per day every day protected enamel against further demineralisation whereas all three frequencies were effective in promoting remineralisation.

Cariogenic bacteria as biomarkers for sugar intake.

Cariogenic bacteria (lactobacilli and mutans streptococci) in saliva are possible biomarkers for sugar intake. We evaluated the strength of the evidence for an association between sugar intake and the two groups of bacteria, and concluded that there is a limited to moderately scientific basis for this association. Because of many confounding factors, bacteria counts can never be used as a precise measurement of sugar intake, but might still be useful on a group level.

The association between loading of restorations and secondary caries lesions is moderated by the restoration material elasticity.

OBJECTIVES: Secondary caries limits the longevity of restorations and is thought to be associated with faulty restorations, e.g. dentin-restoration interfacial gaps. Recent evidence indicates that loading of restorations might aggravate the effects of gaps on interfacial mineral loss. It is unclear if this effect of loading is dose-dependent or not, and if restoration material properties like elasticity moderate the association between load and mineral loss. We hypothesized that mineral loss of secondary lesions increases with increasing load, and that this association is moderated by the elastic modulus of the placed restoration material. METHODS: Dentin-restoration specimens with simulated interfacial gaps were submitted to cariogenic Lactobacillus-rhamnosus-biofilms for 10days, and concurrently loaded with different loads (0/42/84/126g per specimen, n=12/group). Two different composites (LEC: low elastic-modulus composite, HEC: high elastic-modulus composite) were employed. Transversal microradiography was used to evaluate the superficial and interfacial (wall) lesion mineral loss. Generalized linear modeling (GLM) was used to evaluate the association between loading, material and their interaction on mineral loss. RESULTS: Surface mineral loss was not significantly associated with loading, material, or their interaction (p-values ranged between p=0.062 and 0.526). For deep interfacial (wall) lesions, the applied load (p=0.023) but not the material (p=0.382) showed a significant effect. The interaction between both significantly affected mineral loss (p=0.01). Loads of ≥84g per specimens were associated with higher wall lesion mineral loss. CONCLUSIONS: Loads above a certain threshold significantly increased interfacial (wall) lesion mineral loss. This association was moderated by the elasticity of the placed restoration materials. CLINICAL SIGNIFICANCE: The clinical relevance of our findings remains unclear, as future studies are needed to understand how exactly both load and material elasticity affect secondary lesion induction.