Effect of Lactobacillus rhamnosus and Bifidobacterium lactis on gingival health, dental plaque, and periodontopathogens in adolescents: a randomised placebo-controlled clinical trial.

To determine the effect of a probiotic combination of Lactobacillus rhamnosus GG (LGG) and Bifidobacterium lactis BB-12 on the gingival health, dental plaque accumulation, and the oral carriage of four putative periodontal pathogens in healthy adolescents. 108 schoolboys, aged 13-15 years, participated in this study. They were divided into two groups: probiotics (n=54) and placebo (n=54). Both groups received two probiotic-laced or placebo lozenges twice a day during a four-week period. Plaque Index (PI) and Gingival Index (GI) were recorded at baseline and after four weeks. Salivary and plaque carriage of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum were also monitored likewise. 101 subjects completed the study. A statistically significant reduction in GI was seen in the probiotic group as compared to the placebo group (P=0.012). A reduction in PI was found for both groups, with no difference observed between the groups after intervention (P=0.819). Probiotic lozenges significantly reduced levels of A. actinomycetemcomitans and F. nucleatum in saliva and plaque (P<0.05) and levels of P. gingivalis in plaque (P<0.05), while no significant changes were found in the control group. A significant reduction (P<0.001) was also noted in the total salivary bacterial counts of the test group. The short-term daily consumption of LGG and BB-12 probiotic lozenges improved the gingival health in adolescents and decreased the microbial counts of A. actinomycetemcomitans, and P. gingivalis. Hence probiotic supplements may serve as a simple adjunct to standard oral care for promoting the oral health in adolescents.

Don't be rejected, how can we help authors, reviewers and editors?: Report of a Symposium for Editors Publishers and Others with an Interest in Scientific Publication, Held in Boston on Wednesday, 11 March 2015, during the Annual Meeting of the International Association for Dental Research.

This satellite symposium was the fifth in a series for editors, publishers, reviewers and all those with an interest in scientific publishing. It was held on Wednesday, 11 March 2015 at the IADR meeting in Boston, Massachusetts. The symposium attracted more than 210 attendees. The symposium placed an emphasis on strategies to ensure that papers are accepted by peer reviewed journals. The speaker, representing the Journal of Dental Research gave a history of peer review and explained how to access material to advise new authors. The speaker from India outlined the problems that occur when there is no culture for dental research and it is given a low priority in dental education. He outlined remedies. The speaker from SAGE publications described the help that publishers and editors can provide authors. The final speaker suggested that in developing countries it was essential to create alliances with dental researchers in developed countries and that local conferences to which external speakers were invited, stimulated research both in terms of quantity and quality. A wide ranging discussion then took place.

Salivary microbiota and caries occurrence in Mutans Streptococci-positive school children.

AIM: To compare the composition of the salivary microbiota in caries-affected vs. caries-free mutans streptococci (MS)- positive children with mixed dentition. MATERIALS AND METHODS: Twenty eight healthy, 11-12-year-old schoolchildren with high MS counts (>10⊃5 CFU/mL) were included in this study. The children were screened with the Dentocult SM Strip Mutans test (Orion Diagnostica, Espoo, Finland) and examined using the International Caries Detection and Assessment System (ICDAS). The microbial composition of the saliva was assessed using the Human Oral Microbe Identification Microarray (HOMIM). Microbial differences between caries-affected (n=18) and caries-free children (n=10) were compared by Mann-Whitney analysis. RESULTS: The microbiota of the caries-affected vs. caries-free children was rather similar. Abiotrophia defectiva and Actinomyces meyeri/A. odontolyticus were significantly higher in caries-affected than in caries-free children (p=0.006, 0.046, respectively). Shuttleworthia satelles was significantly higher in caries-free compared to caries-affected children (p=0.031). A. defectiva and A. meyeri/A. odontolyticus correlated positively with caries severity measured by ICDAS Caries Index (p = 0.494, 0.454, 0.400 respectively) while S. satelles was negatively correlated with caries severity (p= -0.489). CONCLUSIONS: Salivary A. defectiva and A. meyeri/A. odontolyticus and are associated with caries occurrence in MS-positive children with mixed dentition.

Parental perceptions of dental visits and access to dental care among disabled schoolchildren in Kuwait.

The objective of this study was to describe dental visiting habits and access to dental care among the disabled schoolchildren in Kuwait. A total of 308 parents of children with a physical disability (n = 211), Down syndrome (n = 97) and teachers, who had normal children (n = 112) participated in the study. Less than one-fourth (21%) of the disabled children and 37% of the normal children had never visited a dentist (p = 0.003). Majority of Down syndrome (72%) and physically disabled children (59%) received curative dental care compared to 47% of normal children (p = 0.016). A bigger proportion of disabled children (42%) visited the dentist due to tooth ache than the normal ones (25%) (p < 0.01). Only 9.6% of Down syndrome children perceived no barriers to seek the dental care compared to 26.2% of physically disabled and 32.2% of normal children (p = 0.008). Difficulty to get an appointment was the most common perceived barrier to dental care by parents of Down syndrome children and the normal children (37.3%). Parents of disabled children considered difficulty in cooperation as a more important barrier to treatment (34.7%) than the parents of normal children (20.3%). Larger proportion of parents of normal children (82%) rated the present dental services as excellent/good compared to 52% of the parents of disabled children (p < 0.001). Toothache and curative treatment need were the main reasons for dental visits among disabled children. Regular dental check-ups and preventive oral health care should be encouraged for comprehensive coverage of the national school oral health program for the disabled in Kuwait.

Validating a measure of the prevalence of dental anxiety as applied to Kuwaiti adolescents.

OBJECTIVES: To assess self-reported dental anxiety (DA) among Kuwaiti adolescents and to test whether different dental anxiety scales are valid for measuring DA in Kuwait. BASIC RESEARCH DESIGN: Cross-sectional, structured, anonymous questionnaire survey in Arabic completed at government schools. PARTICIPANTS: 757 pupils aged 13-15 years from three schools filled the questionnaire. Useable response rate was 93.0%. MAIN MEASURES: DA was assessed by: 1, a single-item dental fear question (DF); 2, the Modified Dental Anxiety Scale (MDAS); and 3, the Modified Child Dental Anxiety Scale: faces (MCDAS(f)). RESULTS: A third of the girls and 6% of boys reported being very much afraid of visiting a dentist. Use of the drill and injection in the gum were the most anxiety arousing MDAS items; tooth extraction and injection of the MCDAS(f) items. Total mean for MDAS was 11.4 (sd 4.6) and for MCDAS(f) 16.6 (sd 6.5). A tenth of the children were highly dentally anxious when measured by MDAS (score ≥ 19). Girls reported statistically significantly higher DA scores with all the measures. There was a high correlation between the total score of the MDAS and the total score of the MCDAS(f) (p = 0.855). Statistically significant relationship (p < 0.001) was found between the single-item DF and the total score of the MDAS and a single item and the total score of the MCDAS(f). CONCLUSIONs: A tenth of children were highly dentally anxious; girls reporting higher scores. A single-item dental fear question, MDAS and MCDAS(f) were valid tools for measuring DA among Kuwaiti adolescents.

Effects of xylitol mouthrinse on Streptococcus mutans.

OBJECTIVES: This study aimed to measure the effect of xylitol mouthrinse on salivary Streptococcus mutans counts. METHODS: Subjects in the study group (n = 25) used xylitol mouthrinse for 4 weeks, while another group (n = 25) used saccharine mouthrinse. S. mutans were measured before and after intervention. RESULTS: At the baseline the mean S. mutans scores were 3.9 (SE = 0.03) and 3.9 (0.04) for the xylitol group and control group respectively, while the scores were 2.8 (0.13) and 3.9 (0.07) after the intervention. Significant reductions (p < 0.01) in the scores of S. mutans were found after the four week use of xylitol mouthrinse. CONCLUSIONS: Significant reductions in the scores of S. mutans were found after the four week use of 20% xylitol mouthrinse. The bacteriostatic effect of xylitol mouthrinse on S. mutans may be comparable to other xylitol products. Further studies are needed to confirm both the short and long term effects of xylitol mouthrinse.

Dental caries experience among 12-year-old children in Northwest Russia.

OBJECTIVE: To estimate the prevalence and experience of dental caries among 12-year-olds in Northwest Russia. METHODS: Altogether 355 schoolchildren at the age of 12 were selected at random from 3 urban and 4 rural areas in the Arkhangelsk region. Girls comprised 53.7% of the sample. Caries experience was assessed at D3 level by a single calibrated examiner. The prevalence of caries was estimated with 95% confidence intervals (CI) using Wilson's method. Caries experience was estimated using DMFT index and presented as means and 95% CIs. Dichotomous and numerical data were analysed by chi-squared tests and Mann-Whitney tests, respectively. RESULTS: The prevalence of caries was 83.4% (95% CI 79.2-86.9) with the mean DMFT of 2.95 (95% CI 2.70-3.20). On average, there were 1.56 (95% CI 1.37-1.76) decayed, 0.03 (95% CI 0.01-0.06) missing and 1.34 (95%CI 1.16-1.52) filled teeth. No gender differences in the prevalence of caries in any of the settings or in the full sample were observed. The overall caries experience was higher in urban than in rural areas (3.38 vs. 2.64, p = 0.001). The mean number of decayed teeth in urban areas was lower (1.29 vs. 1.77, p = 0.009), but the number of filled teeth was greater (2.02 vs. 0.85, p = 0.001) than in rural areas. CONCLUSIONS: The prevalence and experience of caries among 12-year-olds in the Arkhangelsk region is greater than in most European countries. Urgent public health measures at both population and individual levels are needed to improve the situation.

Global oral health inequalities: dental caries task group--research agenda.

The IADR Global Oral Health Inequalities Task Group on Dental Caries has synthesized current evidence and opinion to identify a five-year implementation and research agenda which should lead to improvements in global oral health, with particular reference to the implementation of current best evidence as well as integrated action to reduce caries and health inequalities between and within countries. The Group determined that research should: integrate health and oral health wherever possible, using common risk factors; be able to respond to and influence international developments in health, healthcare, and health payment systems as well as dental prevention and materials; and exploit the potential for novel funding partnerships with industry and foundations. More effective communication between and among the basic science, clinical science, and health promotion/public health research communities is needed. Translation of research into policy and practice should be a priority for all. Both community and individual interventions need tailoring to achieve a more equal and person-centered preventive focus and reduce any social gradient in health. Recommendations are made for both clinical and public health implementation of existing research and for caries-related research agendas in clinical science, health promotion/public health, and basic science.

Dental patient education: a survey from the perspective of dental hygienists.

OBJECTIVES: The aim of this study was to describe the current patient education practices of dental hygienists by exploring their views concerning their skills and knowledge related to patient education and by determining the implementation of patient education in their work, with regard to both method and content. METHODS: The target group consisted of 416 dental hygienists (n = 222, 53%) The research strategy used was a survey. The material was gathered using questionnaire. RESULTS: According to the dental hygienists, their skills and knowledge about patient education were good. However, the implementation of education was not in line with these assessments. The content of the education given focused mostly on the functional dimension. Little use was made of various educational methods, and the dental hygienists felt that they were not in good enough command of the methods. The patient's expectations and learning were not assessed systematically. The education provided and the assessment of the need for education often focused on the professional him/herself and the standpoint of the patient empowerment was disregarded. CONCLUSIONS: These results lay the foundation for additional research aimed at developing the patient education given by these professionals and making it support the empowerment of each patient.

Gingival recession, oral hygiene and associated factors among Tanzanian women.

BACKGROUND: Females are generally more motivated with regard to oral hygiene practices and thus brush their teeth more frequently than males. OBJECTIVE: To determine the prevalence of gingival recession, oral hygiene status, oral hygiene practices and associated factors in women attending a maternity ward in Tanzania. DESIGN: Cross-sectional descriptive study. SETTING: Maternity ward of Muhimbili National Hospital, Tanzania. SUBJECTS: Four hundred and forty six women were interviewed on oral hygiene practices and maternal factors, and a full-mouth examination was done to determine the presence of plaque, calculus, gingival bleeding and gingival recession at six sites per tooth. RESULTS: The prevalence of gingival recession (GR) > or =1 mm was 33.6%, calculus 99.3%, plaque 100%, and gingival bleeding 100%. Oral hygiene practices included toothbrushing (98.9%), brushing frequency > or =2 times/day (61.2%), horizontal brushing method (98%), and using a plastic toothbrush (97.8%). Factors that were significantly associated with gingival recession were age (OR = 2.0, 95% CI = 1.3-3.2), presence of calculus (OR(a) = 3.8, 95% CI=2.5-7.1), and gingival bleeding on probing (OR = 4.2, 95% CI = 2.5-7.1). Tooth cleaning practices and maternal factors, especially the number of pregnancies or deliveries were not significantly associated with gingival recession. CONCLUSION: In this study population, oral hygiene was poor and gingival recession was associated with age, calculus and gingival inflammation rather than with tooth cleaning practices.

Profile of the oral healthcare team in countries with emerging economies.

Health is a critical dimension of human well-being and flourishing, and oral health is an integral component of health: one is not healthy without oral health. Significant barriers exist to ensuring the world's people receive basic healthcare, including oral healthcare. Amongst these are poverty, ignorance, inadequate financial resources and lack of adequate numbers of educated and trained (oral) healthcare workers. Emerging economies are encouraged to develop a national strategic plan for oral health. International organizations have developed goals for oral health that can be referenced and adapted by emerging economies as they seek to formulate specific objectives for their countries. Demographic data that assess the nature and extent of oral diseases in a country are essential to sound planning and the development of an oral healthcare system that is relevant, effective and economically viable. Prevention should be emphasized and priority consideration be given to oral healthcare for children. The types and numbers of members of the oral healthcare team (workforce) will vary from country to country depending on the system developed. Potential members of the workforce include: generalist dentists, specialist dentists, dental therapists, dental hygienists, denturists, expanded function dental assistants (dental nurses) and community oral health workers/aides. Competences for dentists, and other members of the team, should be developed to ensure quality care and developed economies should cooperate with emerging economies. The development, by more advanced economies, of digital, virtual curricula, which could be used by emerging economies for educating and training members of the oral healthcare team, should be an important initiative. The International Federation of Dental Educators and Associations (IFDEA) should lead in such an effort.

Do life- or school-satisfaction and self-esteem indicators explain the oral hygiene habits of schoolchildren?

OBJECTIVES: The aim of this study was to ascertain how frequently toothbrushing and flossing are practiced among schoolchildren in Kuwait and whether life- and school-satisfaction and self-esteem indicators are associated with oral hygiene habits. METHODS: A sample of 2312 schoolchildren between 11 and 13 years old filled out a structured questionnaire anonymously in school classrooms during 2002 and 2003. For this study, nationally representative samples of children were drawn from all six governorates of Kuwait. Only government schools were included. The questionnaire of the Health Behaviour in School-Aged Children Study was used in this study after it was modified to suit Kuwait. A chi-squared test and logistic regression model were used for analyzing the data. RESULTS: Over half of the pupils reported brushing their teeth more than once a day; girls reported brushing more frequently than boys did. One-fifth of the pupils did not brush their teeth even on a daily basis. The life- and school-satisfaction and self-esteem indicators were associated with more-than-once-a-day toothbrushing frequency. The strongest predictors for recommended brushing were: feeling very happy (OR 2.0, 95% CI 1.38-2.77), feeling that other pupils always accept him/her (1.5; 1.16-2.02), never/sometimes feeling lonely and feeling that it is very easy to make friends (1.4; 1.06-1.94). The summary variables of life-satisfaction, school-satisfaction and self-esteem seemed to be strongly associated with brushing. Dental floss was never used by 45% of the children, weekly by 18% and daily by 17%; 20% did not even know what dental floss was. CONCLUSIONS: Among intermediate schoolchildren in Kuwait, oral hygiene practices were far behind the international recommendations. Special emphasis should be placed on children who have personal problems with their life, school and self-esteem.

Field trial on caries prevention with xylitol candies among disabled school students.

BACKGROUND: In a 1999 survey high caries levels were found among physically disabled school students in Kuwait. OBJECTIVES: A field study was planned to test the efficacy of xylitol candies in preventing caries among individuals in two special schools in Kuwait. METHODS: Altogether 176 students were examined in 2002 and 145 (105 in xylitol group and 40 in the control group) after 18 months' intervention. The WHO criteria were used in recording caries according to surfaces (third molars were excluded) by 2 calibrated examiners (E.H., M.S.). The students were allocated to the xylitol group only if the parent/caregiver returned the informed consent form. School health nurses distributed xylitol candies to the students 3 times during the school day (after breakfast and lunch, and before leaving the school). RESULTS: In the xylitol group, the baseline DS and DMFS scores were 3.4 and 8.2 and in the follow-up 1.9 and 7.1, respectively. In the control group, the baseline scores were DS 3.9 and DMFS 9.8, and the follow-up scores DS 3.9 and DMFS 13.2. CONCLUSION: Xylitol seemed to have a strong preventive and a clear remineralizing effect on caries.

An exploratory study on cultural variations in oral health attitudes, behaviour and values of freshman (first-year) dental students.

OBJECTIVE: To identify similarities and differences in oral health attitudes, behaviour and values among freshman dental students. DESIGN: Cross-cultural survey of dental students. SETTING: 18 cultural areas. PARTICIPANTS AND METHODS: 904 first-year dental students completed the Hiroshima University-Dental Behavioural Inventory (HU-DBI) translated into their own languages. Individual areas were clustered by similarity in responses to the questions. RESULTS: The first group displayed an 'occidental-culture orientation' with the exception of Brazil (Cluster 1 comprised: Australia, United Kingdom, Ireland, Belgium and Brazil, Cluster 2: Germany, Italy, Finland and France). The second group displayed an 'oriental-cultural orientation' with the exception of Greece and Israel (Cluster 3 comprised: China and Indonesia, and Cluster 4: Japan, Korea, Israel, Hong Kong, Malaysia, Thailand and Greece). Australia and United Kingdom were the countries that were most alike. Ireland was the 'neighbour' to these countries. Greece and Malaysia had similar patterns of oral health behaviour although geographic conditions are very different. Although it was considered that in Hong Kong, occidental nations have affected the development of education, it remained in the oriental-culture group. Comparison with the data from the occidentals indicates that a higher percentage of the orientals put off going to the dentist until they have toothache (p < 0.001). Only a small proportion of the occidentals (8%) reported a perception of inevitability in having false teeth, whereas 33% of the orientals held this fatalistic belief (p = 0.001). CONCLUSIONS: Grouping the countries into key cultural orientations and international clusters yielded plausible results, using the HU-DBI.

A field trial on semi-annual fluoride varnish applications among the special needs schoolchildren.

This study assessed cariostatic effect of one fluoride varnish Duraphat among children with a low caries risk and compared this effect to group of a moderate caries risk, belonging to same ethnic group with same socioeconomic background. Results of this study showed that fluoride varnish had cariostatic effect in a group of children with a moderate caries risk but not among those with a low caries risk.

The atraumatic restorative treatment (ART) approach to restoring primary teeth in a standard dental clinic.

OBJECTIVES: The aims of this study are to assess the feasibility of the Atraumatic Restorative Treatment (ART) approach in primary teeth and to compare the ART approach with traditional amalgam restorations in primary molars. METHODS: This study was conducted in a paediatric dentistry clinic in Kuwait between April 1999 and December 2001. The ART and amalgam restorations were placed randomly on comparable pairs of primary molars, if available. In addition, the ART approach was used for other primary teeth that had no pulpal involvement and no perceived pain before treatment. The restorations were assessed by both the ART evaluation criteria and USPHS criteria in August-September 2000 and in August-December 2001. The mean follow-up period for the restorations was 8.3 months in the first assessment (2000) and 22 months in the second assessment (2001). The assessment was possible for 35 children (mean age = 5.7 years), 18 of whom had comparable pairs (n = 35 pairs) of restorations in their primary molars. In addition, 48 other ART restorations were assessed in 2000 and 42 in 2001. RESULTS: In a 2-year follow-up, 89.6% of all ART restorations were considered successful. The failure rate of the comparable pairs of ART and amalgam restorations was 5.7%. There was no significant difference in success rate between ART and amalgam techniques. CONCLUSIONS: Based on a 2-year follow-up evaluation, the class I ART restorations seemed to have a high success rate, indicating the appropriateness of the ART approach in primary teeth.

Toothbrushing as part of the adolescent lifestyle predicts education level.

Socio-economic differences in health and health behavior are well-known. Our hypothesis was that toothbrushing frequency in adolescents predicts their education level in adulthood. The aim was also to study the role of toothbrushing in adolescents' health-related lifestyle. Data from nationally representative samples of 12- to 16-year-olds (N = 11,149) were linked with register data on the highest level of education attained at age 27-33 years. Adolescents with a low toothbrushing frequency reached only the lowest education levels. School achievement or sociodemographic background only partly accounted for the association. Exploratory factor analysis found four dimensions of health behaviors. At age 12, a low toothbrushing frequency was loaded highly with "street-oriented" behaviors, concentrated around smoking and alcohol use. At ages 14 and 16, it was associated with a "traditional" lifestyle of the less-well-educated. Altogether, a low toothbrushing frequency indicated selection into the less-well-educated stratum of society. This is likely to be reflected in socio-economic health differences in adulthood.

One-year evaluation of atraumatic restorative treatment and minimum intervention techniques on primary teeth.

Atraumatic restorative treatment (ART) and minimal intervention treatment (MIT) techniques were evaluated under field conditions in 5 regions of the Western Cape Province of South Africa, where caries prevalence exceeds 60% and remains mostly untreated. The purpose of the study was to compare and evaluate results of ART and MIT techniques in the primary dentition of 6-9 year-old schoolchildren using glass-ionomer (GI) (Fuji IX) and compomer (Dyract AP) materials. At baseline 401 children were treated, and 1,119 restorations placed by 5 calibrated dentists, 53% with ART (using hand instruments only) and 47% with MIT (minimal use of slow hand-piece) techniques. Evaluations were done with a CPI periodontal probe to measure marginal defects and to detect decay. A pain assessment for the restoration procedures indicated that 80% of subjects experienced no pain, 18% discomfort and slight pain, and 2% required local anaesthetic. After one year 90.5% of subjects and 80% of restorations were followed up (11.1% lost as a result of exfoliation); of these restorations 86% were clinically acceptable (84.1% of the ART and 88% of the MIT). With the art technique 82.7% of GI restorations and 85.6%, of compomer restorations were acceptable. With the MIT technique 86.5% of GI restorations and 89.9% of compomer restorations were acceptable. Success of restorations per region varied significantly: regions 1 and 2-90%, region 3-80%, region 4-70% and region 5-95%. There were no significant statistical differences in respect of materials or methods employed. ART and MIT techniques were well accepted as complementary caries approaches by operators. One-year results show that ART and MIT techniques were successful, substantiating its use for the primary dentition in areas with high caries prevalence. Longer-term assessments are required.