Oral conditions are associated with salt taste disability among American adults.

AIM: To explore the association between oral conditions and their interaction with salt taste disability among American adults. METHODS: Data from the 2013-2014 NHANES cycle were used (n = 2373). The exposures were periodontitis, defined by the 2017 EFP-AAP classification, dental caries, missing teeth, and edentulism, as per the DMF-T index, and xerostomia. The outcome was salt taste disability, objectively assessed. Covariates included sex, age, educational level, poverty index, obesity, diabetes, smoking, alcohol consumption, and medications related to mouth dryness. Weighted multivariable logistic regression modeling was used to evaluate the relationship between oral conditions and their interaction and salt taste disability. RESULTS: Participants who reported xerostomia were more likely to have salt taste disability (OR 2.42; 95%CI 1.44-4.07), especially those older than 60 years (OR 3.63; 95%CI 1.72-7.63). Among participants aged 40-59, xerostomia increased the chance of salt taste disability; however, the confidence interval included the null value. The interactions between xerostomia and edentulism increased the chance of salt taste disability. CONCLUSION: Oral conditions seem to influence the ability to taste salt. Dental professionals may help identify individuals with taste alterations and raise their awareness of the risk of systemic diseases that require the reduction of salt intake.

Sugar-sweetened beverage consumption and periodontitis among adults: A population-based cross-sectional study.

AIM: Investigating the association between sugar-sweetened beverages (SSBs) and periodontitis and whether the awareness of diabetes modifies this relationship. MATERIALS AND METHODS: Cross-sectional analysis was conducted using the National Health and Nutrition Examination Survey (NHANES III) data involving US adults aged 30-50. Periodontitis was classified according to the Centers for Disease Control and Prevention and American Academy of Periodontology (CDC-AAP), and SSB consumption as dichotomous (<5 or ≥5, <7 or ≥7 and <14 or ≥14 times/week), ordinal and continuous variables. Confounders included family income poverty ratio, education, race/ethnicity, sex, age, food energy intake, smoking and alcohol. Odds ratios (ORs) were obtained by logistic regressions using inverse probability weighting. Effect modification analysis was performed considering self-reported diabetes. RESULTS: Among 4473 cases analysed, 198 self-reported diabetes. SSBs were associated with periodontitis when individuals consumed ≥5 (OR 1.64; 95% confidence interval [CI] = 1.30-2.06), ≥7 (OR 1.92; 95% CI = 1.50-2.46) and ≥14 (OR 2.19; 95% CI = 1.50-3.18) times/week. The combined effect of consuming SSBs (≥5 and ≥14 times/week) and self-reported diabetes had less impact than the cumulative effect. CONCLUSIONS: SSB consumption was associated with higher odds of periodontitis, and the estimates were reduced among those with awareness of diabetes.

Behavioral and metabolic risk factors associated with periodontitis in Brazil, 1990-2019: a multidimensional analysis for the Global Burden of Disease Study 2019.

OBJECTIVES: Periodontitis is a non-communicable disease (NCD) that may be linked to other NCDs through shared risk factors. Accordingly, we analyzed the relationship between periodontitis and behavioral and metabolic risks common to NCDs in Brazilian adults over three decades. METHODS: Indicators of periodontitis, behavioral risks (smoking, alcohol use, sugar-sweetened beverages (SSB), and physical activity), and metabolic risks (overweight/obesity, dyslipidemia, hyperglycemia, and hypertension) in Brazilian adults (25-49 y-old) between 1990 to 2019 were obtained from the Global Burden of Disease Study 2019. Data were adjusted for Gini index. Fixed-effects and Prais-Winsten regressions were performed (p < 0.05). RESULTS: The prevalence of periodontitis has increased among Brazilians since 2005. High-SSB diet, alcohol use, and metabolic risks increased between 1990-2019, whereas smoking decreased. In crude models, periodontitis prevalence increased with alcohol use (2545.1; 95%CI: 2307.9-2782.3), high-SSB diet (365.5; 95%CI: 322.5-408.4), low physical activity (1784.4; 95%CI: 763.7-2805.0), overweight/obesity (172.3; 95%CI: 156.3-188.4), dyslipidemia (734.5; 95%CI: 624.7-844.2), and hyperglycemia (1774.3; 95%CI: 1555.9-1992.7). After adjustment for the Gini index, periodontitis prevalence raised with a high-SBB diet (1416.0; 95%CI: 1120.2-1711.8), overweight/obesity (629.9; 95%CI: 573.1-686.8), dyslipidemia (2035.8; 95%CI: 1728.1-2343.5), and hyperglycemia (8918.1; 95%CI: 7979.8-9856.3). CONCLUSIONS: Periodontitis has increased in Brazil since 2005, despite the smoking reduction. Sugar-sweetened beverage was the behavioral risk that mostly accompanied the periodontal trend. CLINICAL RELEVANCE: Our results support upstream strategies targeting commercial, social, political, and structural determinants to tackle NCDs and reduce oral health inequities.

Oral and systemic health in Singapore: Revisiting the past to define the future.

OBJECTIVES: This study aimed to identify studies exploring oral and systemic conditions using Singapore data. METHODS: Studies were searched using the databases PubMed, Embase and Web of Science, with no publication date or language restrictions. Studies analysing Singaporean data were included in this review. RESULTS: Six domains were identified: pregnancy and gingivitis; tooth eruption, dental caries and early-life factors; Crohn's disease and oral microbiome; diabetes and periodontal diseases; number of teeth, chewing ability and cognitive status; and oral health and pneumonia. Using data from Singapore, oral-systemic studies have prompted reflections on the aetiopathogenesis of oral disorders, such as common causes connecting oral and systemic chronic conditions. Moreover, it is speculated whether oral conditions could be used as a marker to predict future systemic diseases or whether early-life factors could affect the development of oral and systemic immune responses. CONCLUSIONS: While Singapore provides opportunities to explore challenges connected to healthy ageing, it also explores health development in many stages of life. Singapore has been prioritizing investigations on a healthier life, and new initiatives are paving the way for oral health research across the lifespan.

Obesity, Insulin Resistance, Caries, and Periodontitis: Syndemic Framework.

(1) Background: To investigate the grouping of obesity and insulin resistance with caries and periodontitis from a syndemic perspective through pathways of socioeconomic inequalities, smoking, alcohol, and high sugar consumption in adolescence. (2) Methods: The population-based RPS Cohort study, São Luís, Brazil, in ages 18-19 years (n = 2515) was used. The outcomes were the grouping of pbesity and Insulin Resistance Phenotype (latent variable formed by Triglycerides/HDL ratio, TyG index, and VLDL) and the Chronic Oral Disease Burden (latent variable comprising caries, bleeding on probing, probing depth ≥ 4 mm, clinical attachment level ≥ 3 mm, and visible plaque index ≥ 15%). Socioeconomic Inequalities influencing the Behavioral Risk Factors (latent variable formed by added sugar, smoking, and alcohol) were analyzed using structural equation modeling. (3) Results: Socioeconomic Inequalities were associated with the Chronic Oral Disease Burden [Standardized Coefficient (SC) = 0.222, p < 0.001]. Behavioral Risk Factors were associated with increased Chronic Oral Disease Burden (SC = 0.103; p = 0.013). Obesity was associated with the Insulin Resistance Phenotype (SC = 0.072; p < 0.001) and the Chronic Oral Disease Burden (SC = 0.066; p = 0.005). The Insulin Resistance Phenotype and the Chronic Oral Disease Burden were associated (SC = 0.053; p = 0.032). (4) Conclusion: The grouping of obesity and early events of diabetes with caries and periodontitis call for a syndemic approach in adolescence.

Oropharyngeal complex differences related to sex and occlusal factors in adolescents aged 12-17 years.

OBJECTIVE: To investigate oropharyngeal complex differences related to sex and occlusal factors in adolescents. METHODS: A cross-sectional study was conducted with 108 patients aged 12-17 years. The oropharyngeal complex was evaluated by imaging exams. Occlusal variables included molar relationship, facial growth pattern, maxilla shape, tooth loss, anterior crossbite, and anterior open bite. Statistical analysis included independent t-test, Mann-Whitney, ANOVA, and Kruskal-Wallis tests. The significance level was 5%. RESULTS: There were increases of the tongue measurement (p = 0.026) and the hyoid approach at the base of the mandible among boys (p = 0.016) and the distance from the hyoid at the base of the mandible among girls (p = 0.039). There was shortening of the soft palate measurements (p = 0.003 and p = 0.007) and tongue (p = 0.018) among adolescents with an anterior crossbite. CONCLUSION: Findings suggest sex, age, and anterior crossbite can be related to oropharyngeal morphology.

Sugar intake above international recommendations and oral disease burden: A population-based study.

OBJECTIVE: To evaluate the association between added sugar intake above the daily limit for the risk of noncommunicable diseases (NCDs) and the Chronic Oral Disease Burden in adolescents. METHODS: This was a population-based study using cross-sectional data nested to RPS Cohorts Consortium, São Luís, Brazil, from the 18-19-year-old follow-up (n = 2515). High consumption of added sugars was estimated according to the limits of the World Health Organization guidelines (WHO) (≥5% of total energy/day) and the American Heart Association statement (AHA) (≥25 g/day). The Chronic Oral Disease Burden was a latent variable (number of decayed teeth, periodontal probing depth ≥4 mm, clinical attachment level ≥3 mm, and bleeding on probing). Models were adjusted for Socioeconomic Status, sex, obesity, and plaque index and analyzed through structural equation modeling. RESULTS: Adolescents had high sugar consumption according to the WHO (78.6%) and AHA (81.4%) recommendations. High sugar intake, according to WHO (SC = 0.096; p = 0.007) and AHA (SC = 0.056; p = 0.027), was associated with a heavier Chronic Oral Disease Burden. Even half of the recommended dose was sufficient to affect some oral disease indicators. CONCLUSION: Sugar intake over international statements to prevent NCDs is associated with higher Chronic Oral Disease Burden among adolescents.

In vivo effect of fluoride combined with amoxicillin on enamel development in rats.

Some evidence in vitro suggested that amoxicillin and fluoride could disturb the enamel mineralization. OBJECTIVE: To assess the effect of amoxicillin and of the combination of amoxicillin and fluoride on enamel mineralization in rats. METHODOLOGY: In total, 40 rats were randomly assigned to four groups: control group (CG); amoxicillin group (AG - amoxicillin (500 mg/kg/day), fluoride group (FG - fluoridated water (100 ppm -221 mg F/L), and amoxicillin + fluoride group (AFG). After 60 days, the samples were collected from plasma and tibiae and analyzed for fluoride (F) concentration. The incisors were also collected to determine the severity of fluorosis using the Dental Fluorosis by Image Analysis (DFIA) software, concentration of F, measurements of enamel thickness, and hardness. The data were analyzed by ANOVA, Tukey's post-hoc test, or Games-Howell post-hoc test (α=0.05). RESULTS: Enamel thickness of the incisors did not differ statistically among the groups (p=0.228). Groups exposed to fluoride (AFG and FG) have higher F concentrations in plasma, bone and teeth than those not exposed to fluoride (CG and AG). The groups showed a similar behavior in the DFIA and hardness test, with the FG and AFG groups showing more severe fluorosis defects and significant lower hardness when compared with the AG and CG groups, with no difference from each other. CONCLUSION: The rats exposed to fluoride or fluoride + amoxicillin developed dental fluorosis, while exposure to amoxicillin alone did not lead to enamel defects.

Impact of the undergraduate clinical teaching-learning process on caries detection and treatment decision-making

Aim: The aim of this study was to evaluate caries diagnosis and treatment decisions made by undergraduate dental students based on ICDAS or Nyvad criteria. Methods: Twelve students analyzed 90 digital photographs of permanent teeth at different clinical stages of carious lesion development and chose among different treatments in three different assessments: when there was no knowledge of the criteria (described as "No knowledge (N)"; when there was theoretical knowledge of the criteria (described as "Theoretical knowledge (T)" and when there was theoretical knowledge, clinical experience about dental caries and the criteria (described as "Theoretical and clinical knowledge (TC)". For "T" and "TC" the students were randomized into two experimental groups ­ ICDAS or Nyvad (experimental units: 6 students/group). The reference standard was established cooperatively by two experienced researchers. Criteria performance was evaluated by sensitivity, specificity, AUC, and Kappa statistics. Treatment decision was described in percentage by contingency tables and Spearman's correlation with the reference standard. Results: The first assessment demonstrated a high percentage of operative treatment even for initial enamel lesions based on ICDAS criteria and treatment was proposed for both active and inactive lesions, according to the Nyvad criteria. In the second assessment, the students continued recommending treatments for initial or inactive lesions, but less frequently. In the third assessment, treatment decisions presented greater cohesion in relation to the assigned classification criterion. The criteria presented no differences between them in terms of diagnostic in the third assessment. Conclusion: Clinical experience may improve caries detection and treatment decisions with the use of ICDAS and Nyvad criteria

In vivo effect of fluoride combined with amoxicillin on enamel development in rats

Abstract Some evidence in vitro suggested that amoxicillin and fluoride could disturb the enamel mineralization. Objective: To assess the effect of amoxicillin and of the combination of amoxicillin and fluoride on enamel mineralization in rats. Methodology: In total, 40 rats were randomly assigned to four groups: control group (CG); amoxicillin group (AG - amoxicillin (500 mg/kg/day), fluoride group (FG - fluoridated water (100 ppm -221 mg F/L), and amoxicillin + fluoride group (AFG). After 60 days, the samples were collected from plasma and tibiae and analyzed for fluoride (F) concentration. The incisors were also collected to determine the severity of fluorosis using the Dental Fluorosis by Image Analysis (DFIA) software, concentration of F, measurements of enamel thickness, and hardness. The data were analyzed by ANOVA, Tukey's post-hoc test, or Games-Howell post-hoc test (α=0.05). Results: Enamel thickness of the incisors did not differ statistically among the groups (p=0.228). Groups exposed to fluoride (AFG and FG) have higher F concentrations in plasma, bone and teeth than those not exposed to fluoride (CG and AG). The groups showed a similar behavior in the DFIA and hardness test, with the FG and AFG groups showing more severe fluorosis defects and significant lower hardness when compared with the AG and CG groups, with no difference from each other. Conclusion: The rats exposed to fluoride or fluoride + amoxicillin developed dental fluorosis, while exposure to amoxicillin alone did not lead to enamel defects.

Manifestações articulares atípicas em pacientes com febre reumática / Articular manifestations in patients with atypical rheumatic fever

Objetivos: Descrever as características clínicas e a ocorrência de artrite atípica em crianças com diagnóstico de febre reumática (FR) acompanhadas em ambulatórios terciários em Salvador, Bahia. Metodologia: Estudo descritivo, de uma série de casos, do quadro clínico inicial ou recorrência de 41 crianças com diagnóstico de FR. Resultados: Dos pacientes estudados (n=41), 61% eram do sexo masculino; com média de idade de 9,2 anos e idade no momento do diagnóstico entre 5 e 16 anos. Artrite esteve presente em 75,6% dos pacientes; cardite em 75,6%; coreia em 31,7%; eritema marginado em 14,6% e nódulos subcutâneos em 4,9%. Um padrão atípico foi observado em 22 dos 31 casos com artrite (70,9%): envolvimento de pequenas articulações e/ou esqueleto axial em 12 casos (38,7%); duração maior que três semanas em nove (29%); resposta inadequada ao AINH em dois (6,5%); oligoartrite (≤ quatro articulações) em 22/31 (71%), sendo monoartrite em 6/31 (uma em pés, uma em tornozelo e quatro em joelho). A febre esteve presente em 78% dos casos e 82,9% dos pacientes utilizavam a profilaxia secundária de forma regular. Conclusão: Artrite atípica esteve presente na maioria dos pacientes que cursaram com acometimento articular, constituindo um fator de confundimento diagnóstico e atraso terapêutico adequado. .

Objectives: To describe the clinical characteristics and the occurrence of atypical arthritis in children diagnosed with rheumatic fever (RF) and followed in tertiary care clinics in Salvador, Bahia, Brazil. Methodology: A descriptive study of a case series, of the initial clinical presentation, and of recurrence in 41 children diagnosed with RF. Results: Of the patients studied (n=41), 61% were male, mean age of 9.2 years, and mean age at diagnosis between 5 and 16 years. Arthritis was present in 75.6% of patients; carditis in 75.6%; chorea in 31.7%; erythema marginatum in 14.6%; and subcutaneous nodules in 4.9%. An atypical pattern was observed in 22 of 31 cases of arthritis (70.9%): involvement of small joints and/or axial skeleton in 12 cases (38.7%); >3 weeks of duration in 9 (29%); inadequate response to NSAIDs in 2 (6.5%); oligoarthritis (≤4 joints) in 22/31 (71%), with monoarthritis in 6/31 (1 in the foot, 1 in the ankle, and 4 in the knee). Fever was present in 78% of the cases, and 82.9% of patients were regularly on secondary prophylaxis. Conclusion: Atypical arthritis was present in most patients presenting with joint involvement, being a confounding factor against a proper diagnosis and of therapeutic delay. .

[Articular manifestations in patients with atypical rheumatic fever]. / Manifestações articulares atípicas em pacientes com febre reumática.

OBJECTIVES: To describe the clinical characteristics and the occurrence of atypical arthritis in children diagnosed with rheumatic fever (RF) and followed in tertiary care clinics in Salvador, Bahia, Brazil. METHODOLOGY: A descriptive study of a case series, of the initial clinical presentation, and of recurrence in 41 children diagnosed with RF. RESULTS: Of the patients studied (n=41), 61% were male, mean age of 9.2 years, and mean age at diagnosis between 5 and 16 years. Arthritis was present in 75.6% of patients; carditis in 75.6%; chorea in 31.7%; erythema marginatum in 14.6%; and subcutaneous nodules in 4.9%. An atypical pattern was observed in 22 of 31 cases of arthritis (70.9%): involvement of small joints and/or axial skeleton in 12 cases (38.7%); >3 weeks of duration in 9 (29%); inadequate response to NSAIDs in 2 (6.5%); oligoarthritis (≤4 joints) in 22/31 (71%), with monoarthritis in 6/31 (1 in the foot, 1 in the ankle, and 4 in the knee). Fever was present in 78% of the cases, and 82.9% of patients were regularly on secondary prophylaxis. CONCLUSION: Atypical arthritis was present in most patients presenting with joint involvement, being a confounding factor against a proper diagnosis and of therapeutic delay.