Percepción de calidad de vida asociada a salud bucal y determinantes sociales en inmigrantes haitianos

Introducción: El objetivo de este estudio fue identificar la autopercepción de calidad de vida asociada a salud bucal y los determinantes sociales, con la ayuda de un instrumento adaptado culturalmente en inmigrantes haitianos de la ciudad de Talca. Materiales y Métodos: Este estudio tuvo un diseño transversal, incluyendo adaptación cultural (grupos focales) y traducción al créole de encuestas poblacionales chilenas. Se aplicó el instrumento a una muestra por conveniencia de haitianos/as. Se analizaron descriptivamente los datos demográficos, socio-económicos y de calidad de vida asociada con salud bucal (OHIP-7), seguido por un análisis bivariante (chi-cuadrado). Resultados: Participaron un total de 116 personas, mayoría hombres (60.4%) con edades de 19 a 47 años. Un 33% no entiende español. Un 51,7% considera que su salud oral es regular o mala. Factores demográficos no se asociaron a una peor percepción de salud bucal. Calidad de la vivienda, problemas de comunicación y desconocimiento del sistema de salud afectan negativamente la percepción de calidad de vida asociada con salud bucal. Conclusión: Los migrantes haitianos, en su mayoría, perciben su salud oral como regular o mala. Sobre todo, en grupos más desprotegidos la salud oral es percibida como deteriorada y parece tener un efecto negativo en su calidad de vida.

Introduction: The aim of this study was to explore the oral health-related quality of life and social determinants among Haitian immigrants residing in the city of Talca. A culturally adapted survey instrument was designed and used. Methods: The study had a cross-sectional design, including a cultural adaptation (focus groups) and translation to creole of national health surveys. The survey was applied in a convenience sample of Haitian immigrants. Descriptive analyses of demographic, socio-economic and oral health-related quality of life (OHIP-7) were conducted. Bivariate analyses included chi-squared tests. Results: A total of 116 respondents answered the survey. The majority were males (60.4%) with ages ranging from 19 to 47 years. 33% of the sample did not comprehend Spanish. Most than half of participants (51.7%) perceived their oral health as fair or poor. Demographic factors did not affect the oral health perception. Housing, language and health system ignorance negatively affected the perception of the oral health-related quality of life. Conclusion: The majority of Haitian immigrants perceived their oral health as fair or poor. Among more vulnerable groups, oral health is perceived as deteriorated and with an adverse effect on the quality of life.

Understanding dental caries as a non-communicable and behavioral disease: Management implications.

New paradigms in caries conceptualization have emerged during the last decades, leading to intense debate and discussion on how to approach the disease, both from a preventive and a therapeutic perspective. Among many new ideas, research discoveries and technologies, one major concept can be highlighted that created a deep frontier between the old and the new paradigm in caries conceptualization; the non-communicable nature of the disease, firmly associated with behaviors and lifestyles. This article synthetizes the conceptual construction of dental caries as a non-communicable disease (NCD) based on the current evidence and discusses the appropriate management of the disease in this context. Dental caries has shifted from being considered transmissible and infectious to an ecological and non-communicable disease. Environmental factors such as frequent sugars intake, disrupt the symbiosis of the dental biofilm leading to a dysbiosis, which favors caries lesion initiation and progression. As an NCD, dental caries shares characteristics with other NCDs such as cardiovascular and chronic respiratory diseases, cancer and diabetes, including long duration and slow progression, not being transmissible from person-to-person, being strongly related to modifiable behavioral risk factors, and affecting preferentially disadvantaged populations with a strong inequality gradient. Given the high prevalence of dental caries, and its consequences on people's health and quality of life, a recognizable conceptual view of caries as a NCD is required to target an effective management. Current understanding of dental caries supports prevention through acting on the modifiable risk factors (behaviors) and involves management based on an interdisciplinary approach. Communicating these modern concepts among researchers, clinicians and policymakers is needed to decrease the global high burden of the disease.

Effect of liners on composite resin microleakage after selective carious lesion removal: an experimental study / Efecto de los recubrimiento en la microfiltración de resina compuesta después de la eliminación selectiva de lesiones cariosas: un estudio experimental

Objetive: To evaluate microleakage of composite resins (CR) placed over different cavitary liners after managing deep caries lesions through selective removal of soft carious tissue to soft dentin (SRCT-S). Material and Methods: Fifty four human teeth were collected for microleakage testing. Each assay comprised ICDAS 5 or ICDAS 6 carious lesions and sound teeth for controls. Sound teeth were prepared with cavities that mirrored the carious teeth cavities, which were prepared with SRCT-S. Sound and carious teeth were further randomly assigned to one of the three experimental groups: Group A: universal adhesive (UA) + CR, Group B: glass ionomer cement liner + UA + CR, and Group C: calcium hydroxide + UA+ CR. Occlusal microleakage (OM) and cervical microleakage (CM) was classified within one of 5 depth categories. ANOVA and Chi-square tests were computed (p<0.05). Results: OM and CM were similarly distributed across subgroups (p>0.05). All Group C samples with carious lesions presented some degree of microleakage. However, no statistically significant differences were observed between groups and within each group (p>0.05). Conclusion: Teeth restored with CR after SRCT-S using calcium hydroxide as a liner material seem to exhibit higher microleakage than those restored using glass ionomer or UA alone. Further clinical research is needed to deepen these findings. Clinical significance: The application of calcium hydroxide as a liner under a composite resin may reduce the longevity of a restoration after performing selective or partial removal of carious tissues. Clinicians should rethink the need of using calcium hydroxide for this application, albeit the lack of clinical evidence.

Objetivo: Evaluar la microfiltración de resinas compuestas (RC) colocadas sobre diferentes liners cavitarios después del manejo de lesiones de caries profundas mediante la remoción selectiva de tejido cariado blando hasta dentina blanda (SRCT-S). Material y Métodos: Se recolectaron 54 dientes humanos para pruebas de microfiltración. Cada ensayo comprendía lesiones cariosas ICDAS 5 o ICDAS 6 y dientes sanos para los controles. Se prepararon dientes sanos con cavidades que reflejaban las cavidades de los dientes cariados, que se prepararon con SRCT-S. Los dientes sanos y cariados se asignaron al azar a uno de los tres grupos experimentales: Grupo A: adhesivo universal (AU) + RC, Grupo B: revestimiento de cemento de ionómero de vidrio + AU + RC, y Grupo C: hidróxido de calcio + AU+ RC. La microfiltración oclusal (MO) y la microfiltración cervical (MC) se clasificaron dentro de una de las 5 categorías de profundidad. Se calcularon las pruebas ANOVA y Chi-cuadrado (p<0,05). Resultados: La MO y MC se distribuyeron de manera similar en los subgrupos (p> 0,05). Todas las muestras del Grupo C con lesiones cariosas presentaron algún grado de microfiltración. Sin embargo, no se observaron diferencias estadísticamente significativas entre grupos y dentro de cada grupo (p>0,05). Conclusión: Los dientes restaurados con RC después de SRCT-S usando hidróxido de calcio como material de revestimiento parecen exhibir una mayor microfiltración que aquellos restaurados usando ionómero de vidrio o AU solo. Se necesita más investigación clínica para profundizar estos hallazgos. Relevancia clínica: la aplicación de hidróxido de calcio como revestimiento debajo de una resina compuesta puede reducir la longevidad de una restauración después de realizar la eliminación selectiva o parcial de los tejidos cariados. Los médicos deberían reconsiderar la necesidad de usar hidróxido de calcio para esta aplicación, aunque no haya evidencia clínica.

Detection of Cavitated Proximal Carious Lesions in Permanent Teeth: A Visual and Radiographic Assessment.

Detection of proximal carious lesions involves the combination of clinical and radiographic methods, both with inherent difficulties. The present cross-sectional study is aimed at estimating the prevalence of cavitation in proximal carious lesions, based on a direct clinical assessment of previously detected radiographic lesions, in permanent molars and premolars. Proximal dental surfaces were radiographically evaluated using the ADA coding system and cavitation was determined through clinical visual examination of the surfaces after separation with elastomeric bands. One-hundred and twenty-six patients attending the dental clinics at the University of Talca were examined, comprising 508 proximal surfaces with radiographic codes ranging from E1 to D3. Two examiners were trained and calibrated for radiographic and clinical detection of proximal lesions. Most participants were females (61.9%). The age mean of participants was 28.7 (0.8) years old. A total of 22.2% of the examined surfaces were cavitated. Only few lesions coded as E1 (n = 4; 2.1%) and E2 (n = 9; 9.8%) were cavitated. Fifty D1 (35.5%) and 22 D2 (41.5%) lesions were cavitated after separation. Most lesions coded as D3 (n = 28; 84.8%) were cavitated. The multilevel binary regression model (p = 0.003) demonstrated that sex, age, jaw, tooth type, surface, and side were not associated with the likelihood of having proximal cavitation. Challenging conventional wisdom, most D1 and D2 lesions were not cavitated. Combining detection methods seems desirable to increase the accuracy in assessing approximal posterior lesions. The low proportion of cavitated lesions reinforces the idea of cautiously indicating invasive approaches for managing proximal carious lesions.

¿Cómo Intervenir el Proceso de Caries en Niños? Adaptación del Consenso de ORCA/EFCD/DGZ

RESUMEN: La caries dental afecta alrededor del 70% de los niños y en Latinoamérica este problema es aún más complejo, dadas las barreras socioeconómicas y culturales que dificultan el acceso a la salud bucal, con grandes inequidades. Durante el año 2019, un panel de expertos de la Organización Europea para la Investigación en Caries (ORCA), la Federación Europea de Odontología Conservadora (EFCD) y la Federación Alemana de Odontología Conservadora (DGZ) elaboraron revisiones sistemáticas de la literatura y consensuaron recomendaciones basadas en evidencia destinadas a dentistas, mediante un taller en Berlín, Alemania, seguido de un trabajo de consenso mediante metodología e-Delphi. El propósito de este artículo es presentar las principales conclusiones del consenso adaptadas idiomáticamente al español y al contexto de Latinoamérica para permitir una mejor difusión del conocimiento generado y su aplicación en la práctica clínica. El artículo proporciona evidencia y recomendaciones clínicas para las intervenciones preventivas, no invasivas, microinvasivas, mínimamente invasivas e invasivas mejor sustentadas por la ciencia para el manejo de la enfermedad de caries y de las lesiones de caries en niños, con énfasis en la caries de la infancia temprana (CIT), dientes primarios y superficies oclusales de dientes permanentes.

ABSTRACT: Dental caries remains the most prevalent chronic disease in the world, affecting around 70% of children and posing a challenge for public health. Given the socioeconomic, cultural barriers and great inequalities that hinder access to oral health, in Latin America this problem is even more complex. During 2019, a panel of experts from the European Organization for Caries Research (ORCA), the European Federation for Conservative Dentistry (EFCD) and the German Federation for Conservative Dentistry (DGZ) prepared systematic reviews of the literature to reach consensus and generate evidence-based recommendations for dentists on how to manage caries in children. In a workshop in Berlin, Germany, followed by an e-Delphi methodology the experts published the consensus. The purpose of this article is to present the main conclusions of the consensus adapted idiomatically to Spanish and to the Latin American context to allow a better dissemination of the knowledge generated and facilitate its application in clinical practice. The article provides evidence and clinical recommendations for the best science-supported preventive, non-invasive, micro-invasive, minimally invasive, and invasive interventions for the management of caries disease and caries lesions in children, with an emphasis on early childhood caries (ECC), primary teeth and occlusal surfaces of permanent teeth.

Microcavitated (ICDAS 3) carious lesion arrest with resin or glass ionomer sealants in first permanent molars: A randomized controlled trial.

OBJECTIVES: Although there is some consensus that carious lesions in early stages (non-cavitated) could be treated using sealants, neither the type of materials nor their use in lesions with localized enamel breakdown (microcavitated) has been reported To compare the efficacy of resin or glass ionomer (GI) sealants in arresting microcavitated carious lesions (ICDAS 3) in first permanent molars. MATERIALS AND METHODS: A double-blinded randomized controlled clinical trial was conducted in 41 healthy 6 to 11-year-old children. At the baseline examination, each subject had at least one carious lesion classified as ICDAS 3 on the first permanent molar. One hundred fifty-one lesions were randomized into: Group 1: resin sealants (76 lesions) and Group 2: GI sealant (75 lesions). Carious lesion progression was assessed clinically and radiographically. Progression and retention failure were the outcomes used for group comparisons at p-value<0.05. RESULTS: After a two-year follow-up, only one lesion progressed to ICDAS 5, without statistically significant differences between the groups (χ2(1) = 0.90, p = 0.53). Radiographically, 100 lesions (98%) were arrested and 2 (2%) showed radiographic progression, without differences between groups (χ2(1) = 0.93, p = 0.93). At 2 years, complete retention was observed in 77% of the resin-based and in 83% of the GI sealants, without statistical differences between type of sealant (χ2(1) = 0.71, p = 0.48). The multilevel mixed model demonstrated that location and type of sealant did not affect retention rates (χ2(1) = 24,98, p < 0.001). CONCLUSION: Sealing ICDAS 3 carious lesions in permanent molars appears to be effective in arresting lesions after a two-year follow-up. Clinicaltrials.gov: RCTICDAS3/2015. CLINICAL SIGNIFICANCE: Minimally invasive approaches for carious lesion management have been promoted. Using sealants for the treatment of microcavitated lesions (ICDAS 3) appears predictable in the routine practice, without predilection for resin or glass ionomer materials. In addition to preserving tooth structure, this strategy reduces chair-time, dental fear and costs, and increases coverage to dental care.

Anticaries activity of egg ovalbumin in an experimental caries biofilm model on enamel and dentin.

OBJECTIVES: Limited evidence suggests a putative inhibitory effect of dietary proteins on demineralization during the carious process. The aim was to explore a potential anticaries activity of the egg protein ovalbumin on a relevant in vitro approach. MATERIALS AND METHODS: Biofilms of Streptococcus mutans UA159 were formed on saliva-coated enamel and dentin bovine slabs. Biofilms were challenged with 10% sucrose followed by either a 200 µg/mL solution of ovalbumin or 1:10, 1:100, and 1:1000 (v/v) serial dilutions of that ovalbumin solution, for the entire length of the experiment. Biofilms exposed to 10% sucrose followed only by 0.9% NaCl served as caries-positive control. Once completed the experimental phase, biofilms were analyzed for biomass, viable bacteria, and polysaccharide formation. Final surface hardness (SH) was obtained to calculate %SH loss (demineralization). Two independent experiments were conducted, in triplicate. Data were analyzed by ANOVA and a post hoc test at the 95% confidence level. RESULTS: A reduction (p < 0.05) in biomass and extracellular polysaccharide formation, but not in the number of viable cells, was observed for both dental substrates. All ovalbumin concentrations tested showed lower demineralization than the positive control (p < 0.05), in a dose-dependent manner. The highest concentration showed a reduction in the %SH loss of about 30% for both enamel and dentin. CONCLUSION: Egg ovalbumin presented to sucrose-challenged biofilms of Streptococcus mutans seems to reduce cariogenicity of a biofilm-caries model. CLINICAL RELEVANCE: Ovalbumin may counteract the cariogenic effect of sugars. If these findings are clinically confirmed, novel preventive approaches for caries are warranted.

Evidence-based strategies for the minimally invasive treatment of carious lesions: Review of the literature.

Resulting in a high economic and biological cost, the traditional therapeutic approach to carious lesion management is still largely restorative. Minimally invasive (MI) treatment offers an attractive alternative to managing carious lesions in a more conservative and effective manner, resulting in enhanced preservation of tooth structure. The aim of this review was to summarize the evidence behind several MI alternatives for carious lesion management, including the use of sealants, infiltration, atraumatic restorative treatment (ART), and selective carious tissue removal (e.g., indirect pulp capping, stepwise removal, or selective removal to soft dentine). Relevant literature was screened, and articles reporting randomized controlled trials or systematic reviews of strategies to manage non-cavitated or cavitated carious lesions in adults and children were included. Fifty six articles met the inclusion criteria. For non-cavitated lesions, the use of sealants is supported by strong evidence, while the evidence for infiltration of proximal lesions is moderate. For deep cavitated lesions, selective removal to soft dentin and/or stepwise excavation is supported by strong evidence. The use of the ART technique to restore cavitated lesions is also supported by strong evidence as a suitable strategy that has been used extensively in the literature concerning non-dental settings. Preservation of tooth structure through the use of MI treatment for both non-cavitated and cavitated lesions is supported by moderatestrong evidence, which supports the paradigm shift towards routine use of more conservative strategies in the treatment of carious lesions.

Longer Retention Time of Fluoridated Varnishes Enhances Enamel Remineralisation In Vitro.

PURPOSE: Widely used in caries prevention, fluoridated varnish (FV) is also capable of remineralising carious lesions. However, the retention time of FV needed on enamel to ensure the maximum benefit is unclear. This study aimed to determine whether an increase in the retention time of 5% sodium fluoride (NaF) varnishes on enamel carious lesions enhances remineralisation. MATERIALS AND METHODS: Carious lesions were generated on bovine enamel slabs and treated with one of three 5% NaF commercial varnishes: Duraphat, Durashield or FlorOpal. After application, the varnishes were maintained on the slabs for 8, 12, 18, 24, 36 or 48 h while immersed in artificial saliva. Remineralisation efficacy was calculated and expressed as the percentage of surface microhardness recovery (%SHR). Untreated carious lesions served as negative controls. Data from each timepoint for each product were compared by ANOVA, followed by a post-hoc test (p < 0.05). RESULTS: There was a trend for increased remineralisation over time, reaching maximum %SHR values of about 30% after 18 to 24 h. No significant differences were detected after 18 h (p > 0.05). This remineralisation dynamic was similar among the three tested products. CONCLUSION: Remineralisation of enamel lesions using 5% NaF varnish appears to be initially dependent on the retention time of the product. Higher remineralisation was observed upon 18 h of varnish retention on the lesions.

Stability of chemically available fluoride in Chilean toothpastes.

BACKGROUND: Storage time may reduce the amount of soluble fluoride (F) in toothpastes. Although we previously studied the type and concentration of F in fresh samples of commercial Chilean toothpastes, their stability was not determined. AIM: To evaluate the stability of soluble F in Chilean toothpastes after 1 year of storage. DESIGN: All the toothpastes (n = 30) previously used were re-analyzed after 1 year of storage time at room temperature (±22°C). Total F (TF = soluble F + insoluble F) and total soluble F (TSF = F ion + MFP ion) were assessed using an ion-specific electrode, through a validated methodology. Data were expressed in ppm of F (mg F/kg). RESULTS: Mean (±SD; n = 30) TF and TSF concentrations after storage were 1049 ± 427 and 987 ± 411 ppm F, respectively. Five toothpastes showed between 30% and 50% of insoluble F, four of them formulated with MFP/calcium-based abrasive. In two products, there was a reduction in TSF below the evidence-based anticaries effectiveness threshold of 1000 ppm F. CONCLUSIONS: Although most of the toothpastes tested kept their original TSF content after 1 year of storage, some products evidenced an important reduction, which may compromise their anticaries efficacy. Reductions in TSF may be explained by an incorrect F salt-abrasive formulation.

In situ anticariogenic activity of free fatty acids after sucrose exposure to oral biofilms formed on enamel.

PURPOSE: To test whether the effect of sucrose on enamel is hampered by immediate free fatty acids exposure to the oral biofilm formed under a highly cariogenic environment, in situ. METHODS: A split-mouth, cross-over and double-blind in situ experiment was carried out with 11 volunteers who wore palatal appliances containing bovine enamel slabs. In two 15-day phases, volunteers dripped 20% sucrose onto the slabs eight times per/day for 5 minutes followed by 5 additional minutes with suspensions of 10 mM oleic, linoleic or stearic acid or sucrose (caries-positive control), four times/day. Biofilms were analyzed for biomass, bacteria and polysaccharide formation and enamel demineralization was estimated by surface microhardness. RESULTS: Biofilms exposed to oleic and linoleic acids showed significantly lower biomass than the control. S. mutans counts were reduced upon linoleic acid exposure (P< 0.05). All free fatty acids reduced polysaccharide formation (P < 0.05). Slabs exposed to 20% sucrose followed by free fatty acids had significantly lower demineralization than those exposed to sucrose alone, with reductions of 33%, 27% and 20% for linoleic, oleic and stearic acid, respectively. Data suggest that unsaturated free fatty acids exposed after sucrose might potentially reduce cariogenicity of the oral biofilm formed on enamel in situ, but further clinical confirmation is required.

Sealing Dentin Caries with Resin-Modified Glass Ionomer Decreases Lesion Progression and Bacterial Survival in an Experimental Model.

PURPOSE: To determine if sealing dentin caries with a resin-modified glass ionomer (RMGI) decreases the number of viable microorganisms and demineralization depth, using an experimental dentin caries model of biofilms of Streptococcus mutans (S. mutans). MATERIALS AND METHODS: Dentin caries lesions were created over a 15-day period on bovine dentin slabs with biofilms of S. mutans UA159. Once lesions were formed, biofilms were removed and the slabs were randomly allocated to one of the treatment groups: group A, surface sealed with a RMGI; or group B, unsealed slabs (control). At 5, 10, and 15 days, slabs were longitudinally sectioned to analyze the number of infiltrating viable bacteria by culturing on agar plates and demineralization depth by cross-sectional Knoop microhardness. RESULTS: Dentin lesions sealed with RMGI decreased bacterial counts from the infected dentin, both with respect to baseline counts and also relative to the unsealed control (p < 0.05). Consistently, demineralization depth was lower for sealed lesions when compared with unsealed slabs (p < 0.05) at all analyzed time points. CONCLUSIONS: Sealing dentin lesions with RMGI appears to halt lesion progression in this experimental model by reducing bacterial viability.

Fatty acid effect on sucrose-induced enamel demineralization and cariogenicity of an experimental biofilm-caries model.

Based on scarce evidence, fatty acids have been described as anticariogenic. The aim was to evaluate the effect of different types of fatty acids on enamel demineralization and on the cariogenic properties of Streptococcus mutans biofilms on a biofilm/caries model. Mature biofilms of S. mutans UA159 growing on bovine enamel slabs were exposed to 10% sucrose for 5 min, 3 times per day followed by exposure to a panel of free fatty acids, including monounsaturated (oleic), polyunsaturated (linoleic) and saturated (stearic) fatty acids, in concentrations of 0.1, 1 and 10 mM for five additional minutes. Enamel demineralization was determined before and after the experiments by microhardness. Slabs were retrieved to analyze biofilm biomass, viable bacterial counts and polysaccharide production. Biofilms exposed to sucrose, followed by oleic and linoleic acids, showed less demineralization than sucrose alone (p < 0.05). Biomass, S. mutans colonies and insoluble extracellular polysaccharide production were reduced from the biofilms treated with oleic and linoleic fatty acids (p < 0.05). No differences with the positive control were observed with the saturated stearic acid. Poly and monounsaturated fatty acids presented to S. mutans biofilms after a cariogenic challenge appear to reduce demineralization on enamel and to interfere with cariogenicity of S. mutans biofilms.

Correlation of Streptococcus mutans and Streptococcus sanguinis colonization and ex vivo hydrogen peroxide production in carious lesion-free and high caries adults.

OBJECTIVE: This study was conducted to estimate oral colonization by Streptococcus mutans and Streptococcus sanguinis in adults with high and without any caries experience. Furthermore, differences in the amount of hydrogen peroxide (H2O2) produced by S. sanguinis isolated from both groups were assessed. DESIGN: Forty adults were divided into: (i) carious lesion-free, without any carious lesion, assessed by the International Caries Detection and Assessment System (ICDAS), or restoration, (CF) and (ii) high caries experience (HC). Saliva samples were collected and seeded on respective agar-plates for enumeration of total streptococci, S. mutans and S. sanguinis (CFU/mL) and compared between groups. Additionally, S. sanguinis colonies obtained from both groups were inoculated on Prussian blue agar for H2O2 detection. Production of H2O2 was quantified and compared between the two groups. S. sanguinis counts were significantly higher in CF than HC individuals (p<0.05). Conversely, S. mutans showed significantly higher levels in HC than CF subjects (p<0.001). S. sanguinis colonies from CF individuals produced significantly larger H2O2 halos compared with HC subjects. CONCLUSIONS: S. sanguinis predominates over S. mutans in saliva of adults without caries experience. In those people, S. sanguinis produces more H2O2ex vivo.

Cariogenicity of different commercially available bovine milk types in a biofilm caries model.

PURPOSE: This study's purpose was to assess the cariogenicity of commercial bovine milk types in an experimental biofilm/caries model. METHODS: Enamel and dentin slabs were used to grow biofilms of Streptococcus mutans UA159. Slabs/biofilms were exposed three times per day to commercial skim, semi-skim, whole, whole lactose-free, and whole with 10 percent sucrose-added bovine milk and to 10 percent sucrose and 0.9 percent sodium chloride as positive and negative caries-control, respectively. Biofilms were analyzed for bacterial counts, biomass, proteins, and polysaccharide production. Slab's demineralization was assessed by loss of surface microhardness and the biofilm acidogenicity by medium pH. RESULTS: Only whole and whole lactose-free milk kept pH above the demineralization threshold, inducing the lowest demineralization in both enamel and dentin (P<.05). Skim and semi-skim milk induced similar demineralization to the sucrose control, albeit slightly lower for semi-skim milk (P<.05). Whole and whole lactose-free milk produced lower biomass and less insoluble polysaccharides than the other treatments in enamel and dentin (P<.05). Adding 10 percent sucrose to whole milk turned it as cariogenic as 10 percent sucrose solution. CONCLUSION: Bovine whole milk seemed less cariogenic than sucrose and the other commercial milk types, but not anticariogenic. Fat content in milk seemed to reduce cariogenicity of the fluid.

Cariogenic potential of commercial sweeteners in an experimental biofilm caries model on enamel.

OBJECTIVE: Scarce evidence is available on the cariogenic potential of the widely used commercial sweeteners. The aim of this study was to evaluate the effect of several sweeteners on enamel demineralisation and on the cariogenic properties of Streptococcus mutans biofilms in an artificial caries model. METHODS: S. mutans-UA159 biofilms were cultured on bovine enamel slabs and exposed to one of the following commercial sweeteners in tablet or powder form: stevia, sucralose, saccharin, aspartame or fructose. Ten percent sucrose and 0.9% NaCl were used as caries-positive and caries-negative controls, respectively. Slabs/biofilms were exposed to the sweeteners three times per day for 5min each time. After 5 days, biofilms were recovered to determine: biomass, bacterial counts and intra- and extracellular polysaccharides. Surface microhardness was measured before and after the experiment to assess enamel demineralisation, expressed as percentage of surface hardness loss (%SHL). Data were analysed using analysis of variance (ANOVA) and Bonferroni (p<0.05). RESULTS: All tested commercial sweeteners, except fructose, showed less enamel demineralisation than sucrose (p<0.05). Only saccharine showed less biomass and intracellular polysaccharides than the rest of the groups (p<0.05). Stevia, sucralose and saccharine reduced the number of viable cells when compared with sucrose (p<0.05). All sugar alternatives reduced extracellular polysaccharide formation when compared with sucrose (p<0.05). CONCLUSIONS: Most commercial sweeteners appear to be less cariogenic than sucrose, but still retaining some enamel demineralisation potential. Products containing stevia, sucralose and saccharine showed antibacterial properties and seem to interfere with bacterial metabolism. Further studies are necessary to deepen these findings.

Fluoride content in toothpastes commercialized for children in Chile and discussion on professional recommendations of use.

BACKGROUND: In Chile, no information is available regarding the soluble fluoride (F) content in the toothpastes commercialized for children and the country's guidelines recommend the use of F in toothpastes in an age-dependent concentration. No global consensus has been reached on this subject. AIM: To determine the soluble F concentration in dentifrices for children sold in Chile and to discuss Chilean guidelines and professional recommendations of use. DESIGN: Three samples of twelve different dentifrices were purchased from drugstores. Toothpastes were analysed in duplicate using an ion-specific electrode. The concentrations of total F (TF) and total soluble F (TSF) were determined (µg F/g). RESULTS: Measured TF was consistent with that declared by the manufacturer in eight products. Two dentifrices showed lower TF and two higher F concentrations than declared. A toothpaste, marketed as low-F (450 ppm), showed F concentration threefold higher. Most dentifrices exhibited TSF concentrations similar to the TF content, except one sample that displayed considerably lower TSF than TF. Recommendations on F toothpastes use in children widely vary from country to country. CONCLUSIONS: Most dentifrices for children match F content in the labelling, but recommendations are not supported by the best evidence available on the benefit/risk of F toothpastes use.

Effect of bovine milk on Streptococcus mutans biofilm cariogenic properties and enamel and dentin demineralization.

PURPOSE: The purpose of this study was to evaluate the effect of whole bovine milk on Streptococcus mutans biofilms and on demineralization of enamel and root dentin. METHODS: S mutans UA159 biofilms were cultured on enamel and dentin bovine slabs of known surface hardness (SH) and exposed (8x/day) to 10% sucrose (positive control), whole bovine milk, and 4.5% lactose. Biofilm acidogenicity was estimated by medium pH (2x/day). After 4 days for dentin and 5 days for enamel, biofilms were collected to obtain biomass, viable bacteria, total protein, and intra- and extracellular polysaccharides. Final SH was measured on the slabs. Demineralization was calculated as percentage of SH loss (%SHL). Differences were determined by analysis of variance and Tukey's test (P<.05). RESULTS: Biofilms formed on both substrates under 10% sucrose showed higher acidogenicity, biomass, protein concentration, insoluble polysaccharides, and %SHL than those treated with milk or lactose (P<.05), which did not differ in any parameter (P>.05). Higher bacterial counts were obtained from biofilms treated with milk on enamel, but not on dentin. Dentin was significantly more demineralized by milk than enamel (P<.05). CONCLUSIONS: Although bovine milk appears to be less cariogenic than sucrose, this dairy product should not be considered caries-safe.

Total and soluble fluoride content in commercial dentifrices in Chile.

OBJECTIVE: Regardless of the total amount of fluoride (F) in a dentifrice, only the soluble fraction presents anti-caries activity and its concentration must be above 1000 ppm. No information regarding the quality of F in Chilean toothpastes is available. The aim of this study, therefore, was to determine the F concentration present in commercially-available toothpastes in Chile. MATERIALS AND METHODS: Eighteen toothpastes of five different brands were tested, each purchased from three different chain drugstores in Chile. For each toothpaste, total, total soluble and ionic F concentrations were assessed and expressed as ppm of F (µg F/g). RESULTS: Among the dentifrices evaluated, 77.8% contained NaF (sodium fluoride), 16.7% MFP (monofluorphosphate) and 5.6% both types of F salts; 77.2% of the dentifrices showed similar total F content to that declared by the manufacturer in the labeling with only five with lower concentration than expected, beyond a 5% disagreement tolerance range. Total soluble F ranged from 958.8-1496.3 ppm (mean ± SD: 1270.5 ± 183.7). Five toothpastes showed lower total soluble F than total F. Only one toothpaste showed soluble salt levels below the recommended dose for this type of dentifrice. CONCLUSION: Most Chilean dentifrices evaluated contained soluble F within the range of 1000-1500 ppm and, therefore, may have anti-caries activity.