Effects of stabilized stannous fluoride dentifrice on dental calculus, dental plaque, gingivitis, halitosis and stain: A systematic review.

OBJECTIVES: The aim of the present systematic review was to examine the scientific evidence for the efficacy of stabilized stannous fluoride (SnF2) dentifrice in relation to dental calculus, dental plaque, gingivitis, halitosis and staining. DATA AND SOURCES: Medline OVID, Embase.com, and the Cochrane Library were searched from database inception until June 2017. Six researchers independently selected studies, extracted data, and assessed methodological quality. A meta-analysis of the 6-month gingivitis studies was done. Risk of bias was estimated using a checklist from the Swedish Agency for Health Technology Assessment (SBU, 2018). STUDY SELECTION: Two studies on dental calculus, 21 on dental plaque and gingivitis, 4 on halitosis, and 5 on stain met the inclusion criteria. Risk of bias was high for the studies on dental calculus, halitosis, and stain, and varied for the dental plaque and gingivitis studies. Significant reductions in dental calculus and in halitosis were reported for the SnF2 dentifrice; no differences in stain reduction were noted. A meta-analysis on gingivitis found better results for the SnF2 dentifrice compared to other dentifrices, though the results of the individual trials in the meta-analyses showed a substantial heterogeneity. CONCLUSIONS: The present review found that stabilized SnF2 toothpaste had a positive effect on the reduction of dental calculus build-up, dental plaque, gingivitis, stain and halitosis. A tendency towards a more pronounced effect than using toothpastes not containing SnF2 was found. However, a new generation of well conducted randomized trials are needed to further support these findings. CLINICAL RELEVANCE: Adding a SnF2 toothpaste to the daily oral care routine is an easy strategy that may have multiple oral health benefits.

Sweet Taste Perception and Dental Caries in 13- to 15-Year-Olds: A Multicenter Cross-Sectional Study.

Dietary habits and, in particular, the intake frequency of sucrose are of major importance for the development of dental caries. The perception of sweet taste is believed to have an influence on sucrose intake and therefore affects the predisposition to dental caries. The aim was to study the caries experience and sweet taste perception and to further analyze the possible relationship between the 2 tested variables in 13- to 15-year-old children from 3 different geographical areas. A cross-sectional survey comprising 669 children (220 Italian, 224 Mexican, and 225 Saudi Arabian) was conducted. The children were examined in their school setting. A sweet taste perception level was determined by the sweet taste threshold (TT) and sweet taste preference (TP). The sweet test was performed with sucrose solutions varying in concentration from 1.63 to 821.52 g/L. The International Caries Detection and Assessment System (ICDAS) and DMFS indices were used to diagnose caries. The highest mean value for TT was found for Italian children followed by Saudi and Mexican. Saudi schoolchildren showed the highest mean values for TP and DMFS, followed by Italian and Mexican. A statistically significant difference for TP, TT, DMFS, and initial caries was found between the 3 countries. A weak yet positive correlation was found between taste perception (TT and TP) versus DMFS and manifest caries in all 3 countries (r = 0.137-0.313). The findings of the present study showed a variation in sweet taste perception between the 3 countries, which may influence the caries outcome of the children in the individual countries.

The impact of oral health on daily performances and its association with clinical variables in a population in Zambia.

OBJECTIVE: The aim of this study was to investigate oral impacts on daily performance and to relate these data to oral clinical variables. MATERIAL AND METHODS: The study was performed at a dental clinic in Livingstone, Zambia, and included 78 subjects (mean age 28, range 15-48 years) consecutively recruited in connection with a dental care visit. Data were collected through a structured interview using the Oral Impacts on Daily Performances (OIDP) index measuring oral health-related quality of life followed by a clinical examination. RESULTS: Oral health affected one or more daily performances during the last 6 months for 61.5% of the subjects. 'Difficulty of eating and enjoying food' was the performance reported most frequently (42.3%), and 'speaking and pronouncing clearly' was least often reported (10.3%). DMFT was 3.8, ±3.6 (mean ± SD; range 0-15). A majority of the individuals had periodontal pockets ≥4 mm (mean 4.3, ±2.6) (94.9%) and gingival bleeding on probing >20% (88.5%). Two or more decayed teeth were shown to be significantly associated (OR 4.6, CI 1.2-17.1) with one or more oral impacts on daily performances in a multivariate logistic regression analysis. CONCLUSIONS: This study shown that there is a significant association between decayed teeth and oral impacts on daily performances. More research is needed, however, for deeper understanding of oral health problems and their impacts on daily life in Zambia.

The Influence of Pregnancy on Sweet Taste Perception and Plaque Acidogenicity.

Objectives Women undergo different physiological and oral changes during pregnancy and this may increase the risk of dental caries and other oral diseases. The aim of the present study was to investigate changes in biofilm acidogenicity and correlate them to sweet taste perception in pregnant and non-pregnant women. Methods Three groups of Saudi women participated in this cross-sectional study: (1) women in early pregnancy (n = 40/mean age 29.6 years/DMFT 10.7), (2) women in late pregnancy (n = 40/29.5 years/DMFT 10.8) and (3) non-pregnant women (n = 41/27.7 years/DMFT 12.3). Changes in plaque pH were determined by using colour-coded indicator strips before and after a 1-min rinse with a 10% sucrose solution. A taste perception test determining sweet preference and threshold levels was also performed. Results A significant difference regarding plaque pH was seen between the early, late and non-pregnant women when calculated as the area under the curve (p < 0.05). Regarding the taste perception tests, taste preference and threshold were correlated (p < 0.001, r = 0.6). Between the three groups, a statistically significant difference was seen in taste threshold and taste preference respectively (p = 0.001 and p < 0.001). Conclusions The findings in this study suggest that pregnant women may undergo taste changes and experience lower plaque pH, which may result in an increased risk of dental caries.

Caries and costs: an evaluation of a school-based fluoride varnish programme for adolescents in a Swedish region.

UNLABELLED: In 2003, 19 public dental clinics in Västra Götaland Region implemented a population-based programme with fluoride varnish applications at school every six months, for all 12 to 15 year olds. In 2008, the programme was extended to include all 112 clinics in the region. OBJECTIVE: To evaluate caries increment and to perform a cost analysis of the programme. BASIC RESEARCH DESIGN: A retrospective design with caries data for two birth cohorts extracted from dental records. Three groups of adolescents were compared. For Group 1 (n = 3,132), born in 1993, the fluoride varnish programme started in 2003 and Group 2 (n = 13,490), also born in 1993, had no fluoride varnish programme at school. These groups were compared with Group 3 (n = 11,321), born in 1998, when the programme was implemented for all individuals. The total cost of the four-year programme was estimated at 400SEK (≈ 44€) per adolescent. RESULTS: Caries prevalence and caries increment in 15 year olds were significantly lower after the implementation of the programme. Group 2, without a programme, had the highest caries increment. The cost analysis showed that it was a break-even between costs and gains due to prevented fillings at the age of 15. CONCLUSIONS: This school-based fluoride varnish programme, implemented on a broad scale for all 12 to 15 year olds, contributed to a low caries increment at a low cost for the adolescents in the Västra Götaland Region in Sweden.

The effect of different mouth rinse products on intra-oral halitosis.

AIM: To evaluate the effect of different mouth rinses 12 h after rinsing on genuine intra-oral halitosis. MATERIALS AND METHODS: Twenty-four adults with halitosis were included in a double-blind, crossover, randomized clinical trial. Halitosis was evaluated 12 h after rinsing with placebo and five mouth rinse products containing zinc acetate and chlorhexidine diacetate; zinc lactate, chlorhexidine and cetylpyridinium chloride; zinc acetate and chlorhexidine diacetate with reduced amounts of mint and menthol; zinc chloride and essential oil; and chlorine dioxide using the organoleptic method and a gas chromatograph. Test periods were separated by 1 week. RESULTS: Hydrogen sulphide (H2 S), methyl mercaptan (MM) and the organoleptic scores (OLS) were significantly reduced 12 h following rinsing with all substances compared to placebo (P < 0.05). H2 S was more effectively reduced after rinsing with zinc acetate and chlorhexidine diacetate and zinc acetate and chlorhexidine diacetate with reduced amounts of mint and menthol compared to rinsing with zinc chloride and essential oil (P < 0.05), and significantly lower values of MM were obtained after rinsing with zinc acetate and chlorhexidine diacetate compared to zinc lactate, chlorhexidine and cetylpyridinium chloride (P < 0.05). The percentage effectively treated individuals (H2 S (<112 ppb), MM (<26 ppb) and OLS score <2) varied from 58% percentage (zinc acetate and chlorhexidine diacetate) to 26% (zinc chloride and essential oil). CONCLUSION: All treatments resulted in reduction in halitosis 12 h after rinsing compared to placebo. H2 S and MM were most effectively reduced by zinc acetate and chlorhexidine diacetate.

Oral health inequalities in Italian schoolchildren--a cross-sectional evaluation.

OBJECTIVE: To evaluate which of the following indicators of socio-economic status (SES) has the strongest association with dental caries status in a 6-year-old population: the educational level of each parent (individual-level); the mean price of housing/m2 in the area where the family resides; or the mean per capita income in the area where the family lives (area-level). MATERIAL AND METHODS: Dental caries was recorded in 2,040 schoolchildren (42.5% boys, 57.5% girls) using decayed/missed/filled surface index (d3 level) in primary dentition. Parents filled in a standardised questionnaire regarding nationality, level of education, frequency of dental check-up and perception of child's oral health and child's oral hygiene habits. RESULTS: At the individual-level of SES, mothers' educational level was associated with their children's caries severity (chi2(9) = 147.51 p < 0.01): as educational level rose the proportion of children with high numbers of carious lesions fell. The two income indicators (area-level SES) were not associated. A multinomial logistic regression model was run for caries risk factors. Caries severity was used as dependent variable and the model was stratified by mothers' educational level. Mothers' perception of child's oral health was the only covariate that was always associated in every caries severity strata and for each level of mothers' education. CONCLUSIONS: The present study shows that mothers' educational level is a useful individual SES indicator for caries in Italian children living in a low-income population.

Effect of Fluoridated Sealants on Adjacent Tooth Surfaces: A 30-mo Randomized Clinical Trial.

A double-blind randomized clinical trial was performed in 6- to 7-yr-old schoolchildren to evaluate, in a 30-mo period, whether the caries increment on the distal surface of the second primary molars adjacent to permanent first molars sealed with fluoride release compounds would be lower with respect to those adjacent to permanent first molars sealed with a nonfluoridated sealant. In sum, 2,776 subjects were enrolled and randomly divided into 3 groups receiving sealants on sound first molars: high-viscosity glass ionomer cement (GIC group); resin-based sealant with fluoride (fluoride-RB group); and a resin-based sealant without fluoride (RB group). Caries (D1 - D3 level) was recorded on the distal surface of the second primary molar, considered the unit of analysis including only sound surfaces at the baseline. At baseline, no differences in caries prevalence were recorded in the 3 groups regarding the considered surfaces. At follow-up, the prevalence of an affected unit of analysis was statistically lower (p = .03) in the GIC and fluoride-RB groups (p = .04). In the GIC group, fewer new caries were observed in the unit of analysis respect to the other 2 groups. Incidence rate ratios (IRRs) were 0.70 (95% confidence interval: 0.50, 0.86; p < .01) for GIC vs. RB and 0.79 (95% confidence interval: 0.67, 0.89; p = .005) for fluoride-RB vs. RB [Corrected]. Caries incidence was significantly associated with low socioeconomic status (IRR = 1.18; 95% confidence interval: 1.10, 1.42; p = .05). Dental sealant high-viscosity GIC and fluoride-RB demonstrated protection against dental caries, and there was evidence that these materials afforded additional protection for the tooth nearest to the sealed tooth (clinical trial registration NCT01588210).

Relationship between plaque pH and different caries-associated variables in a group of adolescents with varying caries prevalence.

The pH response of the dental biofilm after a sugar challenge can be considered to mirror the acidogenic potential and thereby the caries risk of an individual. The aim of this cross-sectional study was to evaluate the relationship between plaque pH and different caries variables in adolescents with varying caries prevalence. One hundred individuals, aged 14-15 years, were examined regarding different caries-related variables: (i) caries score (DSm, DSi, DSm + i, DTm), (ii) salivary secretion rate and buffer capacity, (iii) oral microflora of plaque and saliva, (iv) plaque amount, (v) plaque pH and (vi) dietary intake, oral hygiene habits and fluoride use. Plaque pH was assessed using the microtouch method before and after a 1-min mouthrinse with 10 ml 10% sucrose. Depending on the minimum pH, the participants were divided into three groups: low pH (≤5.3), medium pH (>5.3-6.3) and high pH (>6.3). Statistically significant differences between the three groups (p < 0.01) were found for initial caries (DSi) and combined manifest and initial caries (DSm + i). A statistically significant difference was also found in the log values for salivary lactobacilli (p = 0.02) within the three groups, and for the total number of bacteria in plaque (p = 0.04); for both variables, the low-pH group had the highest values. The only covariate significantly associated was the Cariogram score in the medium-pH group (p < 0.01) and the number of meals per day in the high-pH group (p = 0.02). To conclude, plaque pH measured by the microtouch method is a method that can be used for discriminating between individuals with varying caries prevalence.

An in vitro and in vivo comparison of the effect of Stevia rebaudiana extracts on different caries-related variables: a randomized controlled trial pilot study.

The effect of Stevia extracts on in vitro Streptococcus mutans biofilm formation and in vivo plaque pH was evaluated in this paper. Three 10% solutions containing stevioside, rebaudioside A or sucrose were prepared. MTT assay was used to evaluate microbiological counts in vitro. Twenty volunteers rinsed for 1 min with each solutions, and plaque pH was measured at 7 time points after each rinse. Higher in vitro S. mutans biofilm formation was observed in sucrose solution (p < 0.01). After 5, 10, 15 and 30 min, the sucrose in vivo rinse produced a statistically significantly lower pH value compared to the Stevia extracts (F = 99.45, p < 0.01).Stevia extracts can be considered nonacidogenic.

Fluoride concentration from dental sealants: a randomized clinical trial.

A randomized clinical trial was performed in schoolchildren (6-7 yrs) to evaluate fluoride concentration in interproximal fluid after the placement of 3 different sealants. The sample consisted of 2,776 children randomly divided: 926 in the high-viscosity Glass-ionomer Cement group (GIC group), 923 in the fluoride Resin-based group (fluoride-RB group), and 927 in the no-fluoride Resin-based group (RB group). In total, 2,640 children completed the trial. Sealants were applied following manufacturer's instructions. Interproximal fluid samples were collected at baseline and 2, 7, and 21 days after application of sealants, by insertion of a standardized paperpoint into the interproximal mesial space of the sealed tooth for 15 seconds. Fluoride concentration was evaluated by means of a fluoride ion-selective electrode. At 2 days after sealant application, fluoride concentration was significantly higher in GIC and fluoride-RB groups compared with that in the RB group (p < .01). Mean fluoride concentrations after 7 days were 2.54 (SE 0.68) ppm, 0.85 (SE 0.26) ppm, and 0.53 (SE 0.11) ppm for the three groups, respectively. After 21 days, fluoride concentration in the GIC group remained higher than that in the other two groups. High-viscosity GIC sealants increased the fluoride concentrations in interproximal fluid more than did a Resin-based sealant containing fluoride.

Evaluation of plant and fungal extracts for their potential antigingivitis and anticaries activity.

The link between diet and health has lead to the promotion of functional foods which can enhance health. In this study, the oral health benefits of a number of food homogenates and high molecular mass and low molecular mass fractions were investigated. A comprehensive range of assays were performed to assess the action of these foods on the development of gingivitis and caries using bacterial species associated with these diseases. Both antigingivitis and anticaries effects were investigated by assays examining the prevention of biofilm formation and coaggregation, disruption of preexisting biofilms, and the foods' antibacterial effects. Assays investigating interactions with gingival epithelial cells and cytokine production were carried out to assess the foods' anti- gingivitis properties. Anti-caries properties such as interactions with hydroxyapatite, disruption of signal transduction, and the inhibition of acid production were investigated. The mushroom and chicory homogenates and low molecular mass fractions show promise as anti-caries and anti-gingivitis agents, and further testing and clinical trials will need to be performed to evaluate their true effectiveness in humans.

Cariogram validity in schoolchildren: a two-year follow-up study.

The validity of Cariogram in relation to caries increment over a 2-year period was evaluated. In 2007, the caries risk profile in a group of Sardinian schoolchildren (957) aged 7-9 years was assessed using the Cariogram software. A re-examination using the same criteria was performed 2 years later on 861 individuals from the original sample (drop-out 10.0%). The possible correlated variables were analyzed using the principal component analysis (PCA). The performances of Cariogram in predicting caries increment were evaluated by receiver operating characteristic (ROC) analysis. At follow-up examination, 54.4% of the sample had developed new carious lesions (mean DFS 1.6, 95% CI 1.5-1.8). The mean caries increment (ΔDFS) was 0.5, 95% CI 0.4-0.5. PCA showed that Cariogram, gingival status and dietary sugar frequency, both at baseline and at follow-up, tend to form a separate cluster (goodness of fit ≥0.75). Sensitivity and specificity measured by ROC analysis were 0.83 and 0.85, respectively, so the gain in certainty was 1.68, while the area under the ROC curve was 0.93. A strong correlation between caries risk profiles at baseline and caries incidence in the permanent teeth after 2 years was found. The validity of Cariogram was confirmed, the software fulfilling the criteria for a good risk assessment model: precision, accuracy and ease of use.

Effect of a sugar-free chewing gum containing magnolia bark extract on different variables related to caries and gingivitis: a randomized controlled intervention trial.

The effect of magnolia bark extract (MBE) on different variables related to caries and gingivitis administered daily through a sugar-free chewing gum was evaluated. The study was performed with healthy adult volunteers at high risk for caries as a randomized double-blind interventional study. 120 subjects with a salivary mutans streptococci (MS) concentration ≥10(5) CFU/ml and presence of bleeding on probing >25% were enrolled and divided into three groups: magnolia, xylitol and control. The study design included examinations at baseline, after 7 days, after 30 days of gum use and 7 days after the end of gum use. Plaque pH was assessed using the strip method following a sucrose challenge. Area under the curve (AUC(5.7) and AUC(6.2)) was recorded. Whole saliva was collected and the number of salivary MS (CFU/ml) was counted. Bleeding on probing was recorded as a proxy of dental plaque. Data were analyzed using ANOVA repeated measures. Magnolia gum significantly reduced plaque acidogenicity, MS salivary concentration and gingival bleeding compared to xylitol and control gums. Subjects from the magnolia and xylitol groups showed both MS concentration (p = 0.01 and 0.06, respectively) and AUC(5.7) (p = 0.01 and 0.04, respectively) to be significantly lower compared to baseline. Thirty-day use of a chewing gum containing MBE showed beneficial effects on oral health, including reduction of salivary MS, plaque acidogenicity and bleeding on probing.

Caries prevalence, caries-related factors and plaque pH in adolescents with long-term asthma.

The aim of the present case-control study was to investigate dental caries, various caries-related factors as well as gingival condition, in 12- to 16-year-olds with long-term asthma (n = 20) and a matched healthy control group (n = 20). Data on dietary and oral hygiene habits, numbers of mutans streptococci and lactobacilli in saliva were also obtained. The plaque pH drop after a sucrose rinse was measured up to 40 min at 2 approximal tooth sites. A lower salivary flow rate was found in the asthma group compared to the control group (p < 0.05). The mean (± SD) of DFS, including manifest and initial caries, was 4.9 ± 5.5 in the asthma and 1.4 ± 2.3 (p < 0.01) in the control group. Only 1 adolescent in the asthma group was caries free compared to 13 in the control group. Concerning pH in plaque, adolescents with asthma had a lower initial value (p < 0.01) and final pH (p < 0.05) than the control group. The Cariogram data showed that 55% of the subjects in the control group had 'a high chance of avoiding caries' compared to 10% in the asthma group (p < 0.01). The asthmatic adolescents had higher numbers of sites with gingival bleeding (p < 0.01). To conclude, adolescents with long-term asthma had a higher total DFS and caries risk (according to Cariogram), decreased salivary rate, more gingival bleeding and lower plaque pH than adolescents without asthma.

The 'strip method': a simple method for plaque pH assessment.

AIM: The aim of the study was to evaluate if pH indicator strips could be used for measurements of plaque pH acidogenicity in situ. METHOD: Interproximal plaque pH was measured before and up to 60 min after a 10% sucrose rinse in 30 healthy volunteers using pH indicator strips and the microtouch method in parallel. RESULTS: It was found that the 'strip method' could determine changes in plaque pH to the same extent as the microtouch method (correlation coefficient 0.99). CONCLUSION: Since the 'strip method' is inexpensive and easy to handle, it may be applicable for assessment of plaque acidogenicity in the clinic.

Six months of daily high-dose xylitol in high-risk schoolchildren: a randomized clinical trial on plaque pH and salivary mutans streptococci.

A randomized clinical trial was designed to evaluate the effect of daily high-dose xylitol chewing gum on plaque pH and salivary mutans streptococci (MS) in a sample of schoolchildren at high risk of caries. The study was performed on 204 subjects (acceptance rate 88.3%). Inclusion criteria were: >1 and <4 carious lesions, and a salivary MS concentration >10(5) CFU/ml. Subjects were randomly assigned to the xylitol or control group. Study design included one examination at baseline (t(0)), one after 3 months of chewing (t(1)), one after 6 months of chewing (t(2)) and the last 3 months after the end of chewing period (t(3)). Plaque pH was assessed using the MicroTouch technique, following a sucrose challenge. The area under the curve (AUC(5.7) and AUC(6.2)) was recorded. Whole saliva was collected in sterile vials and MS CFU/ml were counted. Data were analysed using repeated-measures ANOVA. The main result was that plaque acidogenicity was reduced in both groups. The differences between treatments were statistically significant both for plaque pH and MS concentration; the interaction term for treatment and time was statistically significant (p < 0.01). At t(2), the xylitol group children with a salivary MS concentration >10(5) and those with < or =10(5) showed significantly lower AUC(5.7) and AUC(6.2) values than the control group. These results suggest that the long-term use of high-dose non-sucrose chewing gums had beneficial effects on plaque pH, and that this effect was statistically greater when using xylitol chewing gums, both on plaque pH and MS salivary concentration.

Uptake and release of fluoride from fluoride-impregnated chewing sticks (miswaks) in vitro and in vivo.

The purpose was to investigate the uptake and release of fluoride (F) from F-impregnated chewing sticks (miswaks). In the first series, 3-cm-long pieces were impregnated in 1, 2, 3 and 4% NaF solutions for 3 h, 1 day and 3 days (10 pieces/test). There was a dose-response effect with respect to both impregnation time and the concentration of the F solution. In the second and third series, totally 40 miswak pieces were impregnated in 3% NaF for 1 day and 3 days; the outer layer (bark) was separated from the inner spongy part (pulp) and analyzed separately. F was released from both parts, but somewhat more was released from the bark than from the pulp; a plateau was reached at around 30 min. In vivo, 9 healthy subjects used three products for 2 min in a crossover design: (1) a miswak impregnated in 3% NaF for 1 day, (2) a miswak impregnated in 3% NaF for 3 days, and (3) 1 g of F toothpaste (containing 1,450 ppm F as NaF) on a toothbrush. The highest F concentration at the approximal area was obtained after using the miswak impregnated in 3% NaF for 3 days compared with the other products (p < 0.05 or p < 0.01). To conclude, NaF-impregnated miswaks produced a rapid release of F in vitro as well as in vivo and may be an interesting vehicle for home care use for caries prevention in countries where they are used regularly.

Approximal fluoride concentration using different fluoridated products alone or in combination.

The aim of the present investigation was to measure the approximal fluoride (F) concentration after using different F-containing products, either alone or in combination. Ten subjects participated on a total of 17 occasions, which were randomized, distributed and divided into two trials (called trial I and trial II). The F concentration was studied after treatment with toothpicks, dental flosses, an interdental brush dipped in 0.2 or 0.32% F gels, brushing with toothpaste containing 0.32% F and a mouthrinse with 0.2% NaF solution. The results of trial I revealed that the rinsing solution resulted in the highest approximal F values, followed by toothpicks and brushing. When brushing was combined with either flossing or toothpick, the sequence order of the two methods had less influence. However, when combined with rinsing it appeared to be better to use the floss or the toothpicks first, prior to the mouthrinse. In trial II, treatment with the gels alone, and in combination with brushing, resulted in higher approximal F concentrations compared with brushing alone. The data indicate that the order of usage when combining products may be of importance when it comes to obtaining high F levels at the approximal sites and that an interdental brush with F gel after toothbrushing may be a suitable method, called 'Inter Dental Brush Gel Method', to produce elevated F concentrations at approximal sites.