Cariogenicity of a Milk-Based Drink Used as a Dietary Supplement for Older Adults Using a Root Caries Experimental Model.

The aim of this study was to evaluate the cariogenicity of a milk-based drink intended for older adults that was used as part of a governmental initiative in Chile to improve their nutritional conditions. This drink contains a high concentration of sugars, which can contribute to root caries development. To test this hypothesis, an experimental biofilm/caries model was used. Dentin slabs were used to grow biofilms of Streptococcus mutans UA159. Slabs/biofilms were exposed 3× per day to bovine milk with different fat content, the milk-based drink, and the milk-based drink supplemented with 10 g of sucrose added per serving. Slabs exposed to 10% sucrose or 0.9% NaCl were used as positive and negative controls, respectively. Biofilms were analyzed for bacterial counts and acidogenicity. Dentin demineralization was estimated by the loss of surface microhardness and integrated mineral loss. Results were compared by analysis of variance and Tukey's test. The milk-based drink showed higher acidogenicity than milk with its entire (whole) or reduced total fat content (skim). The milk-based drink supplemented with -sucrose had similar acidogenicity as the 10% sucrose positive control (p = 0.506). Whole milk exposure elicited lower bacterial counts than the positive control, the milk-based drink, and the milk-based drink supplemented with sucrose (p = 0.002; 0.006 and 0.014 respectively). Although skim milk induced higher demineralization than whole milk, both milk types produced lower demineralization than the milk-based drink. Regarding integrated mineral loss, demineralization induced by the milk-based drink and the milk-based drink supplemented with sucrose was similar to that induced by the positive control and skim milk (p > 0.05). Sugar-containing milk-based drinks used as dietary supplements for older adults may be highly cariogenic and could represent a potential risk for root caries.

Contextual and Individual Determinants of Root Caries in Older People.

The aim of this study was to identify the association of the presence of root caries in older people with contextual and individual determinants using a multilevel model. Data from the National Survey of Oral Health collected in Brazil were used. A sample of older Brazilians (aged 65-74 years) was included and selected through multistage probability cluster sampling, using probability proportional to size. Contextual variables of municipalities and individual variables of older people were included. Descriptive, bivariate, and multilevel analyses were conducted. Of the 3,926 older people included in the study, 934 (21.8%) had at least 1 tooth with root caries. There seemed to be no pattern of involvement between the anterior and posterior teeth in the dental arches. Multilevel analysis showed a higher presence of root caries among older people resident in municipalities that were noncapital cities (OR = 1.50), who were over 70 years of age (odds ratio, OR = 1.22), had nonwhite skin color (OR 1.35), had coronal caries (OR = 5.58), were dissatisfied with their teeth and mouth (OR = 1.47), and had self-perceived dental treatment needs (OR = 1.33). Contextual and individual determinants were associated with the occurrence of root caries in older people. Lesion presence demonstrated a profile of social inequality.

Starch Combined with Sucrose Provokes Greater Root Dentine Demineralization than Sucrose Alone.

Since there is no consensus about whether starch increases the cariogenic potential of sucrose, we used a validated 3-species biofilm model to evaluate if starch combined with sucrose provokes higher root dentine demineralization than sucrose alone. Biofilms (n = 18) composed by Streptococcus mutans (the most cariogenic bacteria), Actinomces naeslundii (which has amylolytic activity), and Streptococcus gordonii (which binds salivary amylase) were formed on root dentine slabs under exposure 8 ×/day to one of the following treatments: 0.9% NaCl, 1% starch, 10% sucrose, or a combination of 1% starch and 10% sucrose. Before each treatment, biofilms were pretreated with human whole saliva for 1 min. The pH of the culture medium was measured daily as an indicator of biofilm acidogenicity. After 96 h of growth, the biofilms were collected, and the biomass, bacteria viability, and polysaccharides were analyzed. Dentine demineralization was assessed by surface hardness loss (% SHL). Biofilm bioarchitecture was analyzed using confocal laser scanning microscopy. Treatment with a starch and sucrose combination provoked higher (p = 0.01) dentine demineralization than sucrose alone (% SHL = 53.2 ± 7.0 vs. 43.2 ± 8.7). This was supported by lower pH values (p = 0.007) of the culture medium after daily exposure to the starch and sucrose combination compared with sucrose (4.89 ± 0.29 vs. 5.19 ± 0.32). Microbiological and biochemical findings did not differ between biofilms treated with the combination of starch and sucrose and sucrose alone (p > 0.05). Our findings give support to the hypothesis that a starch and sucrose combination is more cariogenic for root dentine than sucrose alone.

Caries de superficies radiculares: etiología, diagnóstico y manejo clínico / Root caries lesions: etiology, diagnosis and clinical managment

Como todas las lesiones de caries, la caries de superficies radiculares (CSR) refleja un cambio tisular continuo. Es esencial diagnosticar los síntomas antes que esas lesiones lleguen a estar cavitadas. Por la misma razón, y para poder decidir entre modalidades invasivas y no-invasivas, deberá ser perfectamente comprendida la dinámica de la formación de la lesión cariosa. Este artículo revisa la etiología, los criterios de diagnóstico y los factores de riesgo en caries de superficies radiculares, y también discute la prevención y la terapéutica, haciendo un especial énfasis en procedimientos de remineralización y en un enfoque no-invasivo de este problema.

As all caries lesions, root caries reflect a continuous tissue change. It is essential to diagnose symptoms before these lesions become cavitated. For the same reason, and in order to be able to decide between invasive and non-invasive modalities, the dynamics of the formation of the carious lesion must be perfectly understood. This paper reviews the etiology, diagnostic criteria and risk factors for root surface caries, and also discusses prevention and therapeutics, with a special emphasis on remineralization procedures and a non-invasive approach to this problem.

Rehabilitación oral mediante implantes dentales en paciente con síndrome de Sjõgren / Oral rehabilitation with dental implants in patients with Sjõgren's syndrome

El Síndrome de Sjögren (SS) es una patología autoinmune caracterizada por un proceso crónico inflamatorio de las glándulas exocrinas, cuya manifestación fenotípica es la queratoconjuntivitis seca y la xerostomía, lo que trae consigo el desarrollo de caries, enfermedad periodontal e infecciones bacterianas y fúngicas. Estos pacientes presentan alto riesgo cariogénico, siendo de gran interés y preocupación en la práctica odontológica, donde el tratamiento es principalmente sintomático. El caso a presentar es de una paciente de 65 años de edad diagnosticada con SS hace 8 años; la cual presenta múltiples caries y restos radiculares en dientes mandibulares y maxilares, a la cual se indican exámenes radiográficos y médicos, se realizan exodoncias múltiples en sector inferior y en el mismo acto quirúrgico se instalan cinco implantes, se esperan tres meses para permitir la oseointegración para posteriormente rehabilitar con una prótesis sobre implantes tipo ad-modum en palafito y en el sector superior se rehabilitará con resinas compuestas previo encerado diagnóstico y prueba de Mock-up para llegar al plano oclusal y así recuperar funcionalidad y estética

Sjõgren's syndrome (SS) is an autoimmune disease characterized by a chronic inflammatory process of the exocrine glands, whose phenotypic expression is keratoconjunctivitis sicca and xerostomia, which entails the development of caries, periodontal disease and bacterial and fungal infections. These patients are at high risk cariogenic, being of great interest and concern in dental practice, where treatment is mainly symptomatic. The present case is a patient of 65 years of age diagnosed with SS 8 years; which has multiple cavities and root fragments in mandibular teeth and jaws, which radiographic examinations anddoctors indicated, multiple extractions are performed in lower sector and in the same operation five implants are installed, three months are expected to allow osseointegration to further rehabilitate a prosthesis implantsad modum type on stilts and in the upper section will be rehabilitated with wax composites prior diagnosisand test mock up to reach the occlusal plane and recover functionality and aesthetics...

Asociación entre el consumo de macronutrientes de la dieta y caries en adultos y adultos mayores diabéticos tipo 2 / Association between dietary macronutrients and caries in type 2 diabetic adults and elderly

Objetivos: Se ha reportado una mayor tasa de caries en pacientes con diabetes mellitus tipo 2 (DM), probablemente debido a cambios en los patrones de dieta. El objetivo de este estudio fue determinar si existe una asociación entre la composición de macronutrientes de la dieta y la caries en sujetos con DM. Métodos: Una muestra compuesta por 33 sujetos con DM y 37 controles sin la patología fue examinada para determinar la experiencia de caries mediante el índice COPD y la prevalencia de caries radiculares con ICDAS II. Se aplicó una encuesta de dieta de reporte de 24 horas. Para determinar la composición de la dieta, los alimentos fueron clasificados acorde al contenido de macronutrientes; carbohidratos, proteínas y lípidos (gramos/día, kilocalorías y porcentaje del nutriente/día). Resultados: Los resultados fueron analizados mediante Kruskal-Wallis y Mann-Whitney. Un análisis de correlación y un modelo de regresión lineal se utilizaron para analizar la asociación entre composición de macronutrientes y la tasa de caries coronales y radiculares, con un nivel de significancia del 95 por ciento. Resultados: Los pacientes diabéticos tipo 2 mostraron mayor número de dientes perdidos por caries, más dientes obturados y más caries radiculares (p<0.05) que los controles sin DM. Los diabéticos presentaron menor consumo de carbohidratos (p=0.021), pero mayor consumo de proteínas (p=0.0405) que los controles. Se verificó una asociación directa entre un mayor consumo de proteínas con una tasa mayor de caries radiculares en pacientes con DM (p<0.001). Conclusión: Las diferencias en el consumo de macronutrientes en pacientes con DM no se relacionan con tasas diferenciales de caries coronales, pero un mayor consumo de proteínas se asocia con una mayor prevalencia de caries radiculares.

Objectives: Higher caries rates have been reported for type 2 diabetes mellitus patients (DM). Changes in dietary patterns may be partly responsible. The aim of this study was to examine a potential association between dietary macronutrient composition and caries experience in DM patients. Methods: Thirty three adults with DM and thirty seven controls, not affected by DM, were examined to assess coronal caries through DMFT index and root caries by ICDAS II. A 24-hr diet recall survey was used to determine dietary macronutrient composition supplemented with standardized tables and expressed as grams /day, kilocalories/nutrient and percentage of nutrient/day. Results were compared using Kruskal-Wallis and Mann-Whitney. A correlation analysis was performed and a linear regression model was built for a potential association between macronutrient composition and coronal or root caries. A 95 percent significance level was set. Results: DM patients showed lower remaining teeth, more fillings and more root caries (p<0.05) than controls. Lower carbohydrate consumption (p=0.021), but higher protein intake (p=0.0405) was observed in DM patients as compared with controls. A statistically significant association between an increased protein consumption and higher percentage of root caries was found in DM patients (p<0.001). Conclusion: Although differences in macronutrient consumption in DM patients are not correlated with differential rates of coronal caries, higher protein consumption appears to be associated with higher prevalence of root caries.

Aspectos microbiológicos, histopatológicos e clínicos da cárie radicular / Microbiology, histopathology and clinical aspects of human root caries

O avanço científico da Odontologia e um maior acesso ao tratamento odontológico fizeram com que o número de pacientes com idade avançada, ainda portadores de dentições naturais, aumentasse. Assim, aumentou também a quantidade de superfícies radiculares expostas, seja por processos fisiológicos, patológicos ou terapêuticos, tornando estas superfícies mais susceptíveis e vulneráveis ao processo de cárie. Este estudo teve como objetivo revisar as características microbiológicas, histopatológicas e clínicas das lesões de cárie radicular. Os estudos revisados apontaram que, dentre os fatores etiológicos dessa patologia, destaca-se a ação do Streptococcus mutans. Contudo, o microrganismo não é o único responsável pelo aparecimento das lesões. A falta de higiene oral, assim como a presença de dieta rica em carboidratos fermentáveis contribui para o desenvolvimento e progressão das cáries de raiz. O tratamento destas lesões é realizado de acordo com a severidade destas, variando desde aplicação de flúor em cáries incipientes, até em restaurações estéticas nos casos mais avançados. Novos estudos, clínicos e laboratoriais, são necessários para se avaliar a longevidade dos tratamentos propostos, principalmente o restaurador.

This study reviewed the microbiological, histopathological and clinical aspects of root caries. Dental caries is one of the most significant health problems facing older adults. More than half of the elderly who are dentate are affected with either coronal or root caries, and caries is the primary cause of tooth loss in this population. However, age per se is not considered to be the main reason for caries development on root surfaces. The same main factors as for coronal caries, ie, cariogenic microorganisms, diet and saliva seem to play important roles in root caries development. Due to different anatomy, histology, and chemical composition of the tissues, there may be a higher risk of caries development on root surfaces than on coronal surfaces. In treatment of root surface caries, a causative treatment strategy should be determined. Prevention should focus on oral hygiene, fluoride exposure, and restriction of intake frequency of foods containing sugars or other easily fermentable carbohydrates. When a more invasive treatment is necessary, caries are removed and the cavities are restored with glass ionomer cement or with flowable composites, where aesthetics procedures become indispensable. New materials and techniques are emerging to help with geriatric preventive and restorative needs.

In vitro evaluation of secondary caries development in enamel and root dentin around luted metallic restoration.

Materials that release fluoride have been recommended for patients with high caries risk, but there is no conclusive evidence of their effect on fixed prostheses abutments. This study evaluated the influence of a resin-modified glass-ionomer cement on in vitro caries development in enamel and root dentin around metallic restoration. The cervical portion of 12 human third molars were sectioned in four blocks that were randomly divided into four Groups (n = 12; 1 block from each tooth/group): ZP (restoration + zinc phosphate cement), GI (restoration + resin-modified glass-ionomer cement), C1 (no restoration and no pH cycling), and C2 (no restoration and pH cycling). In ZP and GI, metallic restorations were luted at the crown-root junction. ZP, GI and C2 were submitted to a pH-cycling model. All blocks were sectioned, embedded and polished. Enamel and root dentin demineralization were evaluated through cross-sectional microhardness Knoop measures at 20 to 80 microns of depth (from the outer surface) and at 20 to 220 microns of distance from the cavity margins. Mineral loss values were calculated from Knoop hardness numbers. Data were analyzed by ANOVA, Tukey's test and regression analysis. Groups ZP, GI and C2 showed demineralization in relation to C1, which was more superficial in enamel than in root dentin. In root dentin, mineral loss in ZP and GI was smaller than in C2. Distance from the cavity margins was not significant. There was no difference between resin-modified glass-ionomer cement and zinc phosphate cement regarding artificial secondary caries development in both dental substrates.

Entendendo a cárie radicular / Understanding root carie

O presente trabalho tem como objetivo descrever a dinâmica de desenvolvimento da lesäo de cárie radicular, permitindo um melhor entendimento dos fatores etiológicos da doença. A partir desse conhecimento, o Cirurgiäo-Dentista estará melhor capacitado para diagnosticar näo só o risco como também o grau de atividade da cárie, possibilitando o estabelecimento de um adequado plano de tratamento centrado na promoçäo de saúde e consequentemente em um efetivo controle da doença

Avaliaçäo clínica de pacientes portadores de lesöes dentárias cervicais näo cariosas, relacionadas com alguns aspectos físicos, químicos e mecânicos da cavidade bucal / Clinical evaluation of patients with non carious cervical dental lesions and the oral cavity conditions

Avaliaram-se clinicamente pacientes portadores de lesöes dentárias cervicais näo cariosas, relacionando-se com alguns aspectos físicos, químicos e mecânicos da cavidade bucal. Foram relacionados 100 pacientes de ambos os sexos e da faixa etária entre 18 a 75 anos, portadores de lesöes dentárias näo cariosas, localizadas na regiäo cervical dos dentes. Os pacientes relacionados responderam a um questionário envolvendo identificaçäo, registro dos hábitos de higiene bucal, alimentos e condiçäo de saúde. Era feito exame clínico, com classificaçäo da lesäo e sensibilidade dentinária, seguido de identificaçäo dos contatos oclusais do paciente em MIH, em lateralidade e protrusäo. Fazia-se o mapeamento oclusal com registro das características oclusais do paciente, documentaçäo radiográfica, fotográfica e confecçäo dos modelos de estudo. Os dados obtidos foram avaliados e concluiu-se que: 1) Pacientes do sexo masculino apresentaram maior prevalência de lesäo cervical näo cariosa; 2) Observou-se maior ocorrência de lesöes cervicais com hipersensibilidade em pacientes do sexo masculino; 3) Os pré-molares mostraram maior prevalência de lesöes cervicais seguidos dos molares, caninos e incisivos respectivamente; o mesmo foi encontrado com relaçäo a hipersensibilidade; 4) As lesöes cervicais e hipersensibilidade dentinária ocorreram mais frequentemente nos dentes superiores...