Studies on strains of Streptococcus mutans isolated from caries-active and caries-free individuals in Iceland.

BACKGROUND: Dental caries has been strongly associated with mutans streptococci, particularly Streptococcus mutans and S. sobrinus. Many studies have linked these organisms to the carious process and counts of mutans streptococci have been used to monitor caries risk. The high levels of caries generally found in Iceland have enabled several studies to be performed on the variation within strains of S. mutans. METHODS: This paper reports some studies showing phenotypic differences between strains of S. mutans that were related to whether the strain was isolated from an individual with active caries or from a caries-free subject. RESULTS: Strains from individuals with active caries generally adhered better to apatite, were more vigorous in decalcifying apatite and had bacteriocin-like activity that was likely to help the strain compete successfully with other strains, for example in the dental plaque biofilm. CONCLUSIONS: Phenotypic differences exist between strains of S. mutans depending on the caries activity of the individual from whom the strain was isolated.

A study of the clinical activity of a gel combining monocaprin and doxycycline: a novel treatment for herpes labialis.

BACKGROUND: Current treatment of herpes labialis is usually with topical antiviral drugs and early drug administration is required for effectiveness. Monocaprin, a 1-monoglyceride of capric acid, has high microbicidal activity in vitro and efficiently inactivates herpes simplex virus. Tetracyclines are inhibitors of matrix metalloproteinases that are part of the inflammatory response and contribute to the breakdown of tissue in ulcers. The study objective was to investigate the antiviral and wound-healing effect of a hydrogel containing either monocaprin or a combination of monocaprin and a low dose of doxycycline in vivo against herpes labialis. METHODS: Subjects were divided into two groups: (i) with prodromal symptoms of herpes labialis; (ii) with a vesicle. Both groups applied the hydrogel five times a day for five days. Test formulations were: (i) hydrogel containing monocaprin and doxycycline (MCD), (ii) hydrogel containing only monocaprin and (iii) placebo hydrogel. Formulations were distributed randomly to subjects within each group. Subjects recorded treatment results in a 6-day diary and a 7-day follow-up diary. RESULTS: For the MCD group the mean time to healing was 5.5 days (prodromal) and 5.3 days (vesicles/ulceration) or significantly shorter than for the placebo groups (7.25 and 7.5 days respectively; P < 0.05). Pain relief was significantly more with MCD (combining both the prodromal and vesicle groups) than with the monocaprin and placebo groups (P = 0.0114). CONCLUSION: Combining monocaprin with low-dose doxycycline offers an effective treatment for herpes labialiss, significantly reducing time to healing and pain compared with the placebo and monocaprin alone.

Prevalence of dental erosion in children: a national survey.

OBJECTIVES: To measure the prevalence of dental erosion in permanent teeth in Iceland as part of the National Oral Health Survey. METHODS: A representative, nationwide sample of 2251 Icelandic children, 20% of those aged 6, 12 and 15 year, was examined. Dental erosion was recorded for all erupted permanent teeth and graded using the modified scale of Lussi. RESULTS: Erosion was not seen in the permanent teeth of six-year-olds, but was present in 15.7% of 12-year-olds, more frequently in boys than girls (19.9% boys, 11.0% girls; P < 0.001). Among 15-year-olds, dental erosion was seen among 30.7% of subjects (38.3% boys, 22.7% girls; P < 0.001). Severity of erosion was mostly scored as grade I, with only 5.5% of 15-year-olds scored as grade II, mostly on tooth 46 (4.3%) and 36 (4.2%). For 12-year-olds, 0.9% had erosion scores of grade II mostly on tooth 46 (0.8%) and 36 (0.7%). No subjects had erosion of grade III. The most common clinical manifestation of erosion was the appearance of cup-like lesions on the cusps of lower first molars. CONCLUSIONS: Dental erosion was frequently present by the age of 12; the prevalence doubled by age 15 and was seen almost twice as often among boys than girls. Teeth most frequently showing signs of erosion were the lower first molars. The rapidly growing prevalence of erosion demonstrated by this nationwide survey emphasizes the need for further research into the aetiology of erosion and possible methods of preventing and treating this emerging dental problem.

Caries prevalence of permanent teeth: a national survey of children in Iceland using ICDAS.

OBJECTIVES: The Icelandic Oral Health Survey aimed to obtain new national data on the oral health of Icelandic children and teenagers. METHODS: A representative stratified random cluster sample of 2251 Icelandic children in first, seventh and 10th grade, aged approximately 6-, 12- and 15-years old was examined for caries prevalence using the ICDAS criteria. Bite-wing digital radiographs were obtained for the children in 7th and 10th grade. RESULTS: D(3)MFT scores by visual examination of 6-, 12- and 15-year olds were 0.12, 1.43 and 2.78 respectively but when including radiographs, the D(3)MFT rose to 2.11 at 12 years and 4.25 at 15 years. The Significant Caries Index, SiC, by visual examination for 12 and 15 y was 3.7 and 6.7 respectively but was 4.7 for 12 y and 8.9 for 15 y with radiographs. In all age groups and at most disease levels, caries was active in the majority of the lesions (58-100%). The percentage of children with no visually detectable caries at D(3)/D(1) level was 93%/74% for 6 years, 48%/22% for 12 years and 35%/16% for 15 years. When radiographs were included the percentage reduced to 34%/15% for 12 years and 20%/6% for 15 years. Approximately 80% of 12- and 15-year-olds had at least one of their first molars sealed, with the mean number of sealed first molars being 2.2 among 12 y and 2.0 among 15 y. CONCLUSIONS: Caries levels were higher than expected in this national survey and further away from the goals of the National Health Plan for 2010 than anticipated. Caries distribution was skewed with more than half of the children having low caries scores but a wide distribution of caries experience was seen among the remaining population.

Is diagnosing exposed dentine a suitable tool for grading erosive loss?

Quantifying tooth wear in general and erosion in particular mostly is made by distinguishing between lesions restricted to enamel and lesions reaching the underlying dentine. Various scores for grading have been used, but in all systems, higher scores are given in cases of exposed dentine, thus, indicating a more severe stage of the condition. Clinical diagnosis of exposed dentine is made by assessing changes in colour or optical properties of the hard tissues. This paper aims to review the literature and discuss critically problems arising form this approach. It appears that classifying the severity of erosion by the area or depth of exposed dentine is difficult and poorly reproducible, and taking into account the variation of enamel thickness, the amount of tissue lost often is not related simply to the area of exposed dentine. There has still been very little longitudinal investigation of the significance of exposed dentine as a prognostic indicator. Further work and discussion is needed to reevaluate the explanative power of current grading procedures.

Antimicrobial activity of monocaprin: a monoglyceride with potential use as a denture disinfectant.

Monocaprin is a 1-monoglyceride of capric acid that has antimicrobial activity against enveloped viruses, certain bacteria, and the yeast Candida albicans. Solutions containing monocaprin were formulated and tested in vitro against a number of micro-organisms, including species found in the oral cavity and common pathogenic species. The antimicrobial activity of monocaprin was tested with strains growing on a surface as well as in the planktonic phase. Micro-organisms tested were: Streptococcus mutans, Candida albicans, Lactobacillus sp., Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. Two sets of dilutions were prepared for each test strain; one to be inoculated with the micro-organism growing in the planktonic phase and the other with the same strain growing on a filter paper disk. Control solutions were also prepared to find out if any of the excipients were affecting the microbicidal effect of monocaprin. Test strains growing on the filter paper surface were less sensitive to monocaprin than the same strain growing in its planktonic phase. C. albicans was the micro-organism that was most sensitive to monocaprin, but S. mutans also showed appreciable sensitivity. The indication that monocaprin may have potential as a topical agent against Candida was tested in an open study of denture disinfection in 32 patients attending a geriatric daycare centre. A significant, but short-term, reduction in counts of Candida on the fitting surface of full dentures was observed.

Properties of hemagglutination by Prevotella melaninogenica.

Although Prevotella melaninogenica belongs to the commensal oral microbiota, some strains possess putative virulence factors. For example, we have previously described fimbriated, hemagglutinating strains of P. melaninogenica, isolated from patients with periodontal disease. The aim of this investigation was to compare some chemical and physical properties of hemagglutination (HA) of P. melaninogenica with those of other pigmented gram-negative anaerobes. HA of 13 P. melaninogenica strains proved to be considerably weaker than that of the major periodontal pathogen, Porphyromonas gingivalis. Vigorous shaking reduced HA of shaken cells but the shaken supernatant had the same hemagglutinating activity as non-shaken cells. The hemagglutinating agent on P. melaninogenica seemed to be a protein, which can be separated from the cell and binds to lactose-, galactose-, and raffinose-containing carbohydrates on the erythrocytes. Adherence to epithelial cells did not differ significantly between the hemagglutinating and non-hemagglutinating strains of P. melaninogenica. Although P. melaninogenica is able to agglutinate erythrocytes, this potential virulence factor is of a considerably lower magnitude than that of major periodontal pathogens.

Consistency of DIAGNOdent instruments for clinical assessment of fissure caries.

DIAGNOdent (KaVo, Biberach, Germany) has shown high diagnostic accuracy and intra-operator agreement for caries detection, both in vitro and in vivo. The aims of this study were to compare DIAGNOdent with visual examination (VI) and bitewing radiographs (BW) for clinical assessment of occlusal fissures, and to evaluate inter-device consistency of clinical recording using four different DIAGNOdent instruments; secondly, to correlate DIAGNOdent readings with microbial culture of the measured site. The subjects were young adults, the material comprising 34 occlusal fissures, scheduled for restorative treatment at the Dental School Clinic of the University of Iceland. Two examiners conducted visual and radiographic assessments. One examiner measured each site with four DIAGNOdent instruments in random order. The fissure was then opened and lesion depth was classified on a 4-point scale. Bacterial samples were taken from the fissure before and after opening. Intra-operator agreement was high (r = 0.85-0.98). Inter-device correlation for the four DIAGNOdent instruments was significant in all cases (r = 0.81-0.92). However, a common cut-off point could not be determined. There was weak but significant correlation between DIAGNOdent readings and all three classes of lesion depth. Level of infection showed very weak correlation with the DIAGNOdent readings. It was concluded that DIAGNOdent is more reliable in detecting dentinal caries if a proper cut-off point is used than in indicating actual lesion depth. Readings from the different instruments were not directly comparable, however, owing to the lack of a common cut-off point.

Parental perception of fluorosis among 8-year-old children living in three communities in Iceland, Ireland and England.

OBJECTIVES: To assess the impact of enamel fluorosis in three of the communities examined in 'Project FLINT', it was decided to conduct a structured telephone interview with the parents of some of the children who took part in the study. METHODS: Three communities involved in this project were able to conduct this investigation: Reykjavik (Iceland), Cork (Ireland) and Knowsley (England). The aim was to interview the parents of children with a range of Thylstrup and Fejerskov (TF) index grades selected from each participating centre with respect to the appearance of their child's permanent maxillary central incisors. Interviewers were blinded as to the TF grade of the subject. RESULTS: Interviews were conducted with parents of 215 children: 69 with TF grade 0; 70 with TF grade 1; 60 with TF grade 2 and 16 with TF grade 3 or greater. There was a trend towards more parents being unhappy with the appearance of their child's teeth with increasing TF grade. However, the main reasons given by parents for being unhappy with the appearance of their child's teeth was tooth alignment followed by the more yellow colour of permanent compared with primary teeth. Only with a TF grade of 3 was any appreciable concern expressed about fluorosis. CONCLUSION: It would appear that there is a public awareness of both developmental defects and enamel fluorosis although this is not always expressed as dissatisfaction. Further research is required into the clinical impact of both fluorosis and other developmental defects of enamel.

Development of a standardized method for comparing fluoride ingested from toothpaste by 1.5-3.5-year-old children in seven European countries. Part 1: Field work.

OBJECTIVES: To develop a standardized method for measuring the variables affecting fluoride ingestion from toothpaste in young children between the ages of 1.5 and 3.5 years, and to use the method at seven European sites. METHODS: Random samples of children were invited to take part in the study. Parents who gave consent were visited at home. The children brushed their teeth using the toothpaste brand and toothbrush type currently in use. Variables measured were: type of toothpaste used, fluoride concentration of toothpaste used, weight of toothpaste used, frequency of brushing and body weight of the child. RESULTS: It was not possible to follow the agreed protocol in all seven countries and in three countries appropriate alternative methods were employed. There was considerable variation between countries in the variables investigated. Use of children's toothpaste ranged from 69% in Ireland to 98% in Portugal. In the Netherlands up to 60% of the children were using toothpaste containing <400 ppm F and in Finland up to 27% of children were using toothpaste containing >1200 ppm F. Over half of the children used <0.25 g of toothpaste per brushing and the majority of children brushed once or twice per day. CONCLUSION: Although adherence to the agreed protocol was not possible at all study sites there was a clear picture of considerable variation in the oral hygiene practices of young children throughout Europe.

Development of a standardized method for comparing fluoride ingested from toothpaste by 1.5-3.5-year-old children in seven European countries. Part 2: Ingestion results.

OBJECTIVES: To develop a standardized method for measuring the variables affecting fluoride ingestion from toothpaste in young children between the ages of 1.5 and 3.5 years, and to use the method at seven European sites. METHODS: Random samples of children were invited to take part in the study. Parents who gave consent were visited at home. The children brushed their teeth using the toothpaste brand and toothbrush type currently in use. The difference between the fluoride dispensed onto the toothbrush and the fluoride recovered after accounting for losses was deemed to be the fluoride ingested. Details of other oral health-care habits were collected by questionnaire. For each child, the fluoride concentration of the toothpaste used was measured in the laboratory, from which an estimate of total daily fluoride ingestion was made. RESULTS: There was considerable variation between countries in the types of toothpaste used and in the amounts of toothpaste applied and ingested. The amount of fluoride ingested ranged from 0.01 to 0.04 mg fluoride per kg of body weight per day. CONCLUSION: The amount of fluoride ingested that is likely to be a risk factor for the development of dental fluorosis during tooth formation is equivocal and was found to vary widely between European countries. There appears to be a need for clearer health messages regarding the use of fluoridated toothpaste by young children.

Urinary fluoride excretion by preschool children in six European countries.

OBJECTIVE: To measure and compare 24-h urinary fluoride excretion in children aged 1.5-3.5 years from European study sites and to use these data to estimate the 24-h fluoride intake. METHOD: Twenty-four-hour urine samples were collected from 3-year-old children (n = 86) who were already participating in a European multicentre study. Samples were collected from Cork, Ireland (n = 19) where the water is fluoridated to a concentration between 0.8 and 1.0 ppm and from five sites with a water fluoride concentration <0.15 ppm: Knowsley, England (n = 18); Oulu, Finland (n = 18); Reykjavik, Iceland (n = 4); Haarlem, the Netherlands (n = 6); Almada/Setubal, Portugal (n = 21). The volume of the samples was measured; they were analysed for fluoride concentration and the 24-h urinary fluoride excretion was calculated. From this an estimate of the daily fluoride intake was made. RESULTS: It was found that the mean fluoride excretion in response to the usual conditions of fluoride intake in the children in the nonfluoridated areas ranged from 0.16 mg (+/-0.08) in Oulu to 0.33 mg (+/-0.27) in Almada/Setubal with an overall mean of 0.23 mg (+/-0.19). The mean 24-h fluoride excretion in fluoridated Cork was 0.37 mg (+/-0.11). There was a significant difference between the fluoride excretion in the nonfluoridated areas and that in the fluoridated areas, and the data were broadly in agreement with WHO standards. CONCLUSIONS: The daily urinary fluoride excretion and estimated fluoride intake in these children appeared to be within acceptable limits.

A European perspective on fluoride use in seven countries.

OBJECTIVES: The aim of this study was to collate data on national policies for the use of fluoride in the seven European countries participating in the FLINT project. METHODS: Policies on the use of fluoride were obtained for each of the study areas. Data collected included the presence of water fluoridation and regulations governing fluoride toothpaste and fluoride supplements. RESULTS: In Ireland 74% of the population had a fluoridated water supply but in all the other countries fluoride toothpaste was the principal form of delivering fluoride, usually recommended as a dose of a pea-sized amount. Fluoride supplement use varied considerably between countries. The Netherlands had the clearest regulations covering the use of fluoride supplements and definition of at-risk individuals. Most countries, even if they recognized particular caries-risk did not define the term clearly. In Iceland all children were regarded as being at high risk of developing caries. CONCLUSION: Considerable variation exists between European countries in their policies for fluoride use and no clear definitions of high-caries-risk individuals were found. The results show that there is even a lack of coherent thought and planning within the different countries, let alone between them.

Fluoride ingestion from toothpaste: conclusions of European Union-funded multicentre project.

An important challenge encountered in this multicentred project was the need to take account of the different cultural and legal differences between the seven sites when agreeing the protocol. Examples such as access to registers of births and subject consent dictated that there were some differences in the methods used in the different sites. The data presented showed that it was possible to train and calibrate a number of examiners in a standardized photographic method for recording enamel fluorosis. This method has a number of important advantages for the objective monitoring of enamel fluorosis over time. There were considerable differences between the seven sites in the formulations of the toothpaste used and in the pattern of their use. The results indicate that it is possible to agree and adopt a standardized method for measuring fluoride ingestion from toothpaste. The aesthetic impact of enamel fluorosis seemed low in the populations included in this project, but further work is required on this issue.

Clonal similarity of salivary and nasopharyngeal Fusobacterium nucleatum in infants with acute otitis media experience.

The environment of an infant's nasopharynx during acute otitis media (AOM) favours the growth of anaerobic bacteria, which can be recovered frequently during infection, but hardly at all if the infant is healthy. The aim of this investigation was to identify the potential source and inoculation route of anaerobes that were present in the nasopharynx. Eleven Fusobacterium nucleatum isolates that were collected through the nasal cavity from the nasopharynx of eight infants with a history of AOM, and 161 F. nucleatum isolates from the saliva of the same infants, were typed to the clonal level by using arbitrarily primed PCR (AP-PCR). In five of the eight infants examined, identical AP-PCR types were found among nasopharyngeal and salivary isolates. As anaerobes seem to be present only transiently in the nasopharynx and salivary contamination of the nasopharyngeal samples can be excluded, this observation indicates that the source of nasopharyngeal anaerobes is the oral cavity and that saliva is their transmission vehicle.