Impact of polyols on Oral microbiome of Estonian schoolchildren.

BACKGROUND: Oral microbiome has significant impact on both oral and general health. Polyols have been promoted as sugar substitutes in prevention of oral diseases. We aimed to reveal the effect of candies containing erythritol, xylitol or control (sorbitol) on salivary microbiome. METHODS: Ninety children (11.3 ± 0.6 years) consumed candies during 3 years. Microbial communities were profiled using Illumina HiSeq 2000 sequencing and real-time PCR. RESULTS: The dominant phyla in saliva were Firmicutes (39.1%), Proteobacteria (26.1%), Bacteroidetes (14.7%), Actinobacteria (12%) and Fusobacteria (6%). The microbiome of erythritol group significantly differed from that of the other groups. Both erythritol and xylitol reduced the number of observed bacterial phylotypes in comparison to the control group. The relative abundance of the genera Veillonella, Streptococcus and Fusobacterium were higher while that of Bergeyella lower after erythritol intervention when comparing with control. The lowest prevalence of caries-related mutans streptococci corresponded with the lowest clinical caries markers in the erythritol group. CONCLUSIONS: Daily consumption of erythritol, xylitol or control candies has a specific influence on the salivary microbiome composition in schoolchildren. Erythritol is associated with the lowest prevalence of caries-related mutans streptococci and the lowest levels of clinical caries experience. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT01062633.

Trends in Children's Toothbrushing in the Czech Republic from 1994 to 2014: Results of the HBSC Study.

OBJECTIVE: Brushing one's teeth twice a day is the main self-care method to prevent the most prevalent non-communicable diseases. The aim of the study is to describe the trends in brushing teeth in 11-, 13-, and 15-year-old Czech children between 1994 and 2014. METHODS: One question about oral health from the HBSC study protocol was used in the six surveys (1994, 1998, 2002, 2006, 2010, and 2014). Altogether, 21,170 answers from boys and girls were analyzed using statistical description and binominal logistic regression. RESULTS: The findings showed that the prevalence of brushing their teeth more than once a day increased throughout the twenty years, more so in boys, but a preventive programme is still needed to educate the 21-38% of those who brush their teeth less than twice a day. CONCLUSION: Although the recommended frequency of brushing their teeth has increased among Czech school-aged children, it still lags far behind the recommended twice-a-day regularity, especially among boys.

Long-Term Effect of Erythritol on Dental Caries Development during Childhood: A Posttreatment Survival Analysis.

OBJECTIVE: To assess the effect of daily consumption of erythritol, xylitol, and sorbitol candies on caries development in mixed dentition during a 3-year intervention and 3 years after the intervention. METHODS: 485 Estonian first- and second-grade primary school children participated. Children were randomly allocated to an erythritol, xylitol, or sorbitol (control) group. Polyol-containing candies were administered on school days with a daily polyol consumption of 3 × 2.5 g. Yearly, caries development was assessed by calibrated dentists using the ICDAS criteria. Six years after initiation of the study and 3 years after cessation of daily polyol consumption, 420 participants were re-examined to identify potential long-term effects of polyol consumption. Survival curves were generated at the end of the intervention period and 3 years after intervention. The model included age of the subjects, schools, tooth surface ages and years of surface exposure to intervention. ICDAS scoring system-based events included enamel/dentin caries development, dentin caries development, increase in caries score, and dentist intervention. RESULTS: At the end of the intervention, time to enamel/dentin caries development, dentin caries development, increase in caries score, and dentist intervention were significantly longer in the erythritol group as compared to the sorbitol group. Except for increase in caries score, all effects persisted 3 years after cessation of daily polyol consumption. CONCLUSIONS: A caries-preventive effect of 3-year erythritol consumption as compared to sorbitol was established in children with mixed dentition. The effect persisted up to 3 years after the end of the intervention.

Sealant versus Fluoride in Primary Molars of Kindergarten Children Regularly Receiving Fluoride Varnish: One-Year Randomized Clinical Trial Follow-Up.

OBJECTIVES: The objectives of this study were to measure the caries preventive effect of sealants applied to occlusal surfaces of primary molars compared to fluoride varnish applications, and to assess the retention rate of sealants after 1 year. METHODS: 147 first-grade pupils from two kindergarten schools in Kuwait, whose parents gave their written consent, were included. The children were examined by one dentist using the International Caries Detection and Assessment System. After the examination, sealants and fluoride varnish were applied on the selected occlusal surfaces of primary molars by another dentist. The jaw quadrant for intervention was selected randomly; molars on the contralateral side of the mouth received the contralateral intervention. Examinations and intervention were provided on the school premises in the mobile dental unit with a portable spotlight. Moisture was controlled by cotton rolls, suction and air drying. The follow-up examinations were conducted after 1 year. All children received fluoride varnish before and 6 months after the intervention. RESULTS: From 267 matched pairs of occlusal surfaces of primary molars, varnished surfaces were significantly more likely to develop new caries lesions than the sealed ones (odds ratio = 2.92; 95% confidence interval = 1.82-4.71) during the 1-year follow-up. The majority (73.0%) of the sealants were completely retained and 15.1% partially. CONCLUSIONS: Sealing fissures seems to be better in preventing occlusal caries lesions in primary molars than applying only fluoride varnish. After 1 year, the majority of sealants were retained sound.

Trends in toothbrushing in 20 countries/regions from 1994 to 2010.

BACKGROUND: For maintaining good oral health, twice-a-day toothbrushing routine is recommended world-wide. As an association between oral diseases and the main non-communicable diseases is confirmed, the importance of brushing is rising. The aim of this article is to describe trends in more-than-once-a-day toothbrushing frequency in 20 countries/regions participating in five consecutive HBSC Surveys between 1994 and 2010. METHODS: Eleven-, 13-, and 15-year-old children, who replied to the questionnaire in any of the five surveys, were included (N = 474 760). Trends were analysed by logistic regression and multilevel logistic regression modelling. RESULTS: Prevalence of recommended toothbrushing behaviour increased in all countries except in Scandinavia, which had already attained a very high level in 1994. The highest increase (more than + 16%) was observed in Estonia, Russia, Latvia, Finland and in Flemish Belgium. Girls had higher prevalence of toothbrushing than boys (OR = 2.06, 99% CI 2.03-2.10). However, the increasing trend was stronger among boys (OR(2010 vs. 1994) for boys 1.60; for girls 1.48), and among the younger adolescents (OR(2010 vs. 1994) for 11-year-olds 1.64; for 15-year-olds 1.45). CONCLUSION: Recommended toothbrushing frequency increased in most of the studied countries/regions and differences between the countries diminished during 2004-2010.

Effects of short-term xylitol gum chewing on the oral microbiome.

OBJECTIVES: The aim of this study was to determine the effects of short-term xylitol gum chewing on the salivary microbiota of children. MATERIALS AND METHODS: The study was a randomised, controlled, double-blind trial. Healthy children used xylitol chewing gum (xylitol group, n = 35) or sorbitol chewing gum (control group, n = 38) for 5 weeks. The daily dose of xylitol/sorbitol was approximately 6 g/day. At baseline and at the end of the test period, unstimulated and paraffin-stimulated saliva were collected. The microbial composition of the saliva was assessed using human oral microbe identification microarray (HOMIM). Mutans streptococci (MS) were plate cultured. RESULTS: As judged by HOMIM results, no xylitol-induced changes in the salivary microbiota took place in the xylitol group. In the control group, Veillonella atypica showed a significant decrease (p = 0.0001). The xylitol gum chewing decreased viable counts of MS in both stimulated (p = 0.006) and unstimulated (p = 0.002) saliva, but similar effects were also seen in the control group. CONCLUSIONS: The use of xylitol gum decreased MS, in general, but did not change the salivary microbial composition. CLINICAL RELEVANCE: Short-term consumption of xylitol had no impact on the composition of the salivary microbiota, but resulted in a decrease in the levels of MS.

Effect of erythritol and xylitol on dental caries prevention in children.

OBJECTIVE: The aim of this study was to test the efficacy of long-term, daily intake of erythritol and xylitol candy, compared with sorbitol candy, on the development of enamel and dentin caries lesions. METHODS: The study was a double-blind randomized controlled prospective clinical trial. Altogether 485 primary school children, first- and second-graders at baseline, from southeastern Estonia participated in this 3-year intervention. Each child consumed four erythritol, xylitol or sorbitol (control) candies three times per school day. The daily intake of polyol was about 7.5 g. The International Caries Detection and Assessment System (ICDAS) was used in the clinical examinations by four calibrated examiners at baseline and at 12, 24 and 36 months. RESULTS: The annual examination analyses and the follow-up analyses confirmed that the number of dentin caries teeth and surfaces at 24 months follow-up and surfaces at 36 months follow-up was significantly lower in the mixed dentition in the erythritol group than in the xylitol or control group. Time of enamel/dentin caries lesions to develop and of dentin caries lesions to progress was significantly longer in the erythritol group compared to the sorbitol and xylitol groups. Also the increase in caries score was lower in the erythritol group than in the other groups. CONCLUSIONS: In the follow-up examinations, a lower number of dentin caries teeth and surfaces was found in the erythritol group than in the xylitol or control groups. Time to the development of caries lesions was longest in the erythritol group. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT01062633.

World Health Organization approaches for surveys of health behaviour among schoolchildren and for health-promoting schools.

Adolescents make up about one-sixth of the world's population. Most of the healthy and detrimental habits are adopted during childhood and adolescence. In the mid 1980s, a cross-national Health Behaviour in School-Aged Children (HBSC) survey was created to increase information about the well-being, health behaviours and social context of young people by using standard school-based questionnaires adopted by the World Health Organization (WHO) European office. The European Network of Health-Promoting Schools (HPS) was commenced in 1992, followed by the establishment of the WHO Global School Health Initiative in 1995. The initiative aims to improve the health of students, school personnel, families and other members of the community through schools by mobilizing and strengthening health promotion and educational activities at local, national, regional and global levels. The HBSC and HPS programmes have been accepted as activity areas for the WHO Collaborating Centre for Primary Oral Health Care in Kuwait. This article describes the HBSC and the HPS programmes and discusses the importance of establishing these programmes in Kuwait.

Effect of three-year consumption of erythritol, xylitol and sorbitol candies on various plaque and salivary caries-related variables.

OBJECTIVE: The objective of the present paper is to report results from oral biologic studies carried out in connection with a caries study. METHODS: Samples of whole-mouth saliva and dental plaque were collected from initially 7- to 8-year-old subjects who participated in a 3-year school-based programme investigating the effect of the consumption of polyol-containing candies on caries rates. The subjects were randomized in three cohorts, consumed erythritol, xylitol, or sorbitol candies. The daily polyol consumption from the candies was approximately 7.5 g. RESULTS: A significant reduction in dental plaque weight from baseline (p<0.05) occurred in the erythritol group during almost all intervention years while no changes were found in xylitol and sorbitol groups. Usage of polyol candies had no significant or consistent effect on the levels of plaque protein, glucose, glycerol, or calcium, determined yearly in connection with caries examinations. After three years, the plaque of erythritol-receiving subjects contained significantly (p<0.05) lower levels of acetic acid and propionic acid than that of subjects receiving xylitol or sorbitol. Lactic acid levels partly followed the same pattern. The consumption of erythritol was generally associated with significantly (p<0.05) lower counts of salivary and plaque mutans streptococci compared with the other groups. There was no change in salivary Lactobacillus levels. CONCLUSION: Three-year consumption of erythritol-containing candies by initially 7- to 8-year old children was associated with reduced plaque growth, lower levels of plaque acetic acid and propionic acid, and reduced oral counts of mutans streptococci compared with the consumption of xylitol or sorbitol candies.

Relationship between daily habits, Streptococcus mutans, and caries among schoolboys.

OBJECTIVES: The purpose of this study was to examine the associations between daily habits, Streptococcus mutans, and caries using International Caries Detection and Assessment System Caries Index (ICDAS CI); and compare it to the DMF index. SUBJECTS AND METHODS: Altogether 122 children were examined and interviewed. Saliva and plaque samples were collected and analyzed by Dentocult SM(®) Strip Mutans test. ICDAS CI was calculated by counting all ICDAS caries scores of all surfaces divided by total number of carious teeth. RESULTS: ICDAS CI was significantly (p<0.01) and strongly associated with DMFT/dmft (ρ=0.72), DMFS/dmfs (ρ=0.72), total number of carious teeth (DT/dt) (ρ=0.77), enamel caries surfaces (ρ=0.61) and dentine caries surfaces (ρ=0.75). Plaque S. mutans was significantly (p<0.05) correlated with ICDAS CI and DT/dt. Children who brushed once a day or more had significantly lower ICDAS CI (p<0.01). Children who consumed sweets or drank soft drinks more than once a day had significantly higher ICDAS CI (p<0.05). No significant association was found between ICDAS CI and frequency of flossing, use of mouthrinse, or gum chewing. CONCLUSION: ICDAS CI seems to have similar trends as DMF indices, but includes more information about the stage, severity, and progress of the caries lesions of the patient.

Children's dental fear in relation to dental health and parental dental fear.

OBJECTIVE: The aim was to (1) assess the proportion of children with dental fear, to (2) compare results obtained by a single fear question to those obtained by using a set of 11 fear questions, to (3) study associations between children's dental fear and their dental health, and to (4) compare children's dental fears to those of their parents. MATERIALS AND METHODS: A cross-sectional sample of 344 8-10-year-old schoolchildren from South Estonian primary schools participated. Children's fears were measured with the modified Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS). The scale includes 11 fear items amongst which five represent less invasive (noninvasive items), another five invasive aspects of dental treatment (invasive items), and one question represents general dental fear of the child. In addition, two questions were included to assess parental dental fear. The dental health of children was examined using the International Caries Detection and Assessment System (ICDAS) criteria. RESULTS: The proportion of children with general dental fear was 6.1%. The mean score of noninvasive fears was higher among the youngest than among the oldest age group (p<0.02). Children whose dmft/DMFT-scores were >0 had higher fear scores than those whose dmft/DMFT-scores were =0 (p<0.01). A total of 16.8% and 15.7% of mothers and fathers afraid of dentistry in general. There were strong correlations between children's dental fears and maternal (p<0.01), and paternal (p<0.01) dental fear. CONCLUSIONS: Children's fears were strongly associated with untreated caries and experience of dental treatment, and with parental fears.

Caries experience in the permanent dentition among first- and second-grade schoolchildren in southeastern Estonia.

OBJECTIVE: This study aims to assess the caries experience among first- and second-grade children in the elementary schools of southeastern Estonia. MATERIALS AND METHODS: A representative sample of 485 children was studied. The mean age of children in the first grade was 7.8 years (SD = 0.35) and in the second grade 8.8 years (0.38). The clinical examinations using ICDAS criteria were completed by four calibrated examiners. The inter- and intra-examiner consistency of the examiners was high (surface and tooth-based kappa >0.9). RESULTS: The mean caries experience of dentinal caries lesions was 0.8 (D 4-6 MFT) and 1.6 (D 4-6 MFS) among the first graders and 1.1 (D 4-6 MFT) and 1.6 (D 4-6 MFS) among the second graders. The mean caries enamel lesions among the first graders was 1.6 (D1-3T) and 2.2 (D1-3S) and among the second graders 2.1 and 3.0, respectively. The most affected surfaces were the occlusal surfaces of the lower first molars. The prevalence of sealants was very low-only 2.4% of the first molars were sealed among the first graders and 3.9% among the second graders. There were no statistically significant differences in caries experience or in the provision of restorative treatment between the schools. CONCLUSIONS: Caries experience is high in southeastern Estonia. Preventive programs are urgently needed.

Oral health-related quality of life among parents and teachers of disabled schoolchildren in Kuwait.

OBJECTIVE: The objective of this study was to assess the oral health-related quality of life between the parents and the teachers of disabled schoolchildren in Kuwait. SUBJECTS AND METHODS: The three category response version of the General Oral Health Assessment Index (GOHAI) (12 questions, always, sometimes, never) was used in the questionnaires in Kuwait. Three hundred and eight (308) parents and 112 teachers were enrolled in this study. RESULTS: The mean age of the parents was 45 ± 9.9 years and of the teachers 38 ± 8.4 years. The mean GOHAI was 27.2 ± 3.5 among the parents and 27.8 ± 3.3 among the teachers (p = 0.091). GOHAI was higher in the older age groups (p = 0.002) and among the parents with a university education (p < 0.001). GOHAI was also higher with increasing toothbrushing frequency among the parents (p = 0.047) and the teachers (p = 0.003). Altogether, 203 (66%) of the parents and 85 (76%) of the teachers were always able to swallow comfortably; 123 (40%) of the parents and 41 (37%) of the teachers were able to eat without discomfort. Overall, 132 (43%) of the parents and 41 (37%) of the teachers were always pleased and happy with the looks of their teeth and gums, or dentures. The Cronbach's alpha (0.83) indicated a high degree of internal consistency between different GOHAI items. CONCLUSION: There seemed to be no difference in the impact of oral health on the quality of life between the parents and the teachers of disabled schoolchildren. Oral health had a relatively weak impact on the quality of life of these adults.

Daily consumption of sugary drinks and foods as a behavioural risk for health of adolescents in Kuwait.

PURPOSE: To determine the levels of daily consumption of soft drinks, sweets and cakes/pastries by schoolchildren in Kuwait and the possible background factors associated with these habits. In addition, the association between daily consumption of these sugar-rich products and other health-related habits was studied. MATERIALS AND METHODS: A nationally representative sample of children from public schools was drawn for this study. Altogether, 1292 schoolchildren of an average age of 13 years (SD ± 1.04) participated by anonymously filling out a structured questionnaire in school classrooms. The questionnaire of the WHO Collaborative study (Health Behaviour in School-aged Children) was used after modifications for the Kuwaiti situation. RESULTS: Daily consumption of soft drinks, sweets and cakes was very high, especially among the Kuwaiti schoolchildren. Very strong correlations were found between daily consumption of sweets and cakes/pastries (r = 0.60; P < 0.01), soft drinks and sweets (r = 0.50; P < 0.01) and between soft drinks and cakes/pastries (r = 0.42; P < 0.01). Among other unfavourable habits, late bedtime, watching TV often and smoking were strongly correlated with the daily use of sugary drinks and foods. Sociodemographic or socioeconomic factors were only weakly associated with the consumption of sugar-rich products. CONCLUSIONS: Daily consumption of sugar-rich products seems to be alarmingly high in Kuwait, higher than in any other of the 34 countries in the HBSC study. Other unhealthy habits were associated with the daily consumption of these sugar-rich products.

Measuring Dental Caries in the Mixed Dentition by ICDAS.

Caries has traditionally been assessed with WHO criteria including only obvious caries lesions. ICDAS has been developed to detect also the enamel caries lesions. This study aims to study caries and the associations of the number of caries lesions between the permanent and primary molars with ICDAS in the mixed dentition of the first and second grade primary school children. The clinical examinations of 485 children were conducted by four examiners with high reproducibility (inter- and intraexaminer kappas >0.9). The mean number of caries lesions-especially dentine caries-seemed to be higher in the second primary molars than in the first permanent molars. There were significant correlations between the number of lesions on occlusal and lingual surfaces between the primary and permanent molars. Enamel caries lesions, restorations, and caries experience did not increase according to age. Therefore, caries might be increasing in this population. As a conclusion, ICDAS recording seems to give appropriate information from the occurrence of caries lesions and its correlations between the primary and permanent teeth and surfaces.

Toothbrushing and smoking among adolescents--aggregation of health damaging behaviours.

AIM: The aim of this study was to determine whether an association exists between daily smoking and infrequent toothbrushing habits among adolescents. MATERIALS AND METHODS: Nationally representative samples of 14-, 16- and 18-year-old Finns (N=5643) took part in the survey. A 12-page structured questionnaire was posted to the adolescents, asking them to complete it and return it in an enclosed pre-paid envelope. The χ(2)-test and a logistic regression model were used for analyses. RESULTS: At the age of 14 years, 8.5% reported smoking daily, at 16 years 25.0% and at 18 years 33.2%. Only 28.3-54.7% of the adolescents reported brushing their teeth more than once a day. Among 14-year-olds, 6.5% of the adolescents reported both smoking daily and brushing less than twice a day. The respective figures were 17.7% for the 16-year-olds and 21.6% for the 18-year-olds. Among the 14-year-olds, the strongest association with smoking daily and brushing less than twice a day was found with low school performance (OR=8.2), and among 16- and 18-year-olds school career (studying at a vocational school, OR=3.4). CONCLUSION: Daily smoking and infrequent toothbrushing are strongly associated in adolescence.

Barriers to seeking preventive dental care by Kuwaiti adults.

OBJECTIVE: The aim of this study was to assess the prevalence of preventive dental visits and to identify self-reported barriers for this practice among Kuwaiti adults. MATERIALS AND METHODS: A self-administered, anonymous, structured questionnaire was distributed to a random sample of Kuwaiti nationals 18 years of age or older recruited from all six health districts of Kuwait. A total of 2,400 questionnaires were distributed. Multiple logistic regression analysis was performed to identify factors independently associated with not having a preventive dental visit for more than 1 year. RESULTS: Of the 2,400 questionnaires, 1,925 (80.2%) were completed. Of these, 620 (32.2%) had a dental visit within the previous 6 months, 504 (26.2%) between 6 and 12 months and 801 (41.6%) more than 12 months ago. The most common reasons for the last dental visits were pain or a dental emergency, need for restorative treatment, and an examination/prophylaxis. The strongest factors for not having preventive visits were not using a mouthrinse daily, flossing less than once a day, dental fear, belief that there is no need for visits unless pain was present, brushing the teeth less than twice a day, and believing that appointments are too far ahead. Also older respondents (>30 years), female gender, and those having only high school education or less were less likely to visit a dentist for preventive reasons. CONCLUSION: More than half of the studied population reported not having had a preventive visit for more than 1 year. Unfavorable self-care habits, dental fear and belief that visiting a dentist is necessary only for pain relief were the strongest factors for the nonattendance behavior.

Gender differences in oral health knowledge and behavior of the health science college students in Kuwait.

Dental caries and periodontal diseases have been declining in most industrialized countries, but this positive trend has not been seen in the Middle East. This study aimed to determine oral health knowledge and behavior of the students at the Health Sciences College in Kuwait as well as possible associated factors. This study was first conducted at the college of the male students (n = 153) during the autumn semester in 2001. A similar questionnaire study was then conducted at the college of the female students (n = 547) during the spring semester in 2002. The samples were merged for this study, for a total sample of 700 students. The response rate was 84% (n = 128) among the male students and 73% (n = 400) among the female students. Most of the students had visited a dentist during the past year, and quite a high proportion was seen for an examination or prevention. Female students reported twice-a-day tooth-brushing frequency much more often than did male students. They also used fluoride toothpaste more often than male students. Oral health knowledge (as a summary variable) was statistically significantly higher among the female students than among the male students. It was also strongly associated with the older age among the female students. The knowledge and oral health behavior of the Health Sciences College students in Kuwait, especially among the male students, seems to be poor and calls for an urgent improvement of health education programs.

Effect of xylitol candies on plaque and gingival indices in physically disabled school pupils.

OBJECTIVE: To evaluate the effectiveness of xylitol candies on plaque and gingival index scores on physically disabled school pupils in Kuwait. METHODOLOGY: Altogether 145 school pupils (105 in the xylitol group and 40 in the control group), with ages ranging from 10 to 27 years (mean age = 14.7 +/- 3.1 years), participated in this 18-month intervention program. The school health nurses distributed xylitol candies to the pupils three times during the school day. Plaque was scored according to the Silness and Löe Plaque Index, and gingivitis according to the Löe and Silness Gingival Index. RESULTS: The mean Plaque Index score decreased from 1.73 to 1.14 (p < 0.001), and the mean Gingival Index score from 1.74 to 1.16 (p < 0.001) in the study group. Significant differences were found between the xylitol and the control groups in the reduction of Plaque (p = 0.037) and Gingival Index scores (p = 0.008). There was high correlation between the individual Plaque and Gingival Index scores at baseline (r = 0.93) and at the final examinations (r = 0.95). CONCLUSION: Consuming xylitol candies three times during school days seemed to reduce both the Plaque and Gingival Index scores. This school-based delivery system offered a practical way to distribute and use xylitol candies among these disabled pupils. The regular use of xylitol candies may, therefore, support oral hygiene routines in disabled pupils.