Effect of arginine-fluoride varnish on preventing enamel erosion by paediatric liquid medicaments.

BACKGROUND: The study objective was to examine the effect of arginine-sodium fluoride (Arg-NaF) varnish on preventing enamel erosion by acidic paediatric liquid medicaments (PLM). METHODS: The treatment groups were: 1) 2% Arg-NaF; 2) 4% Arg-NaF; 3) 8% Arg-NaF; 4) NaF; 5) MI (CPP-ACFP) varnishes; and 6) no varnish. The pH of PLM (paracetamol and chlorpheniramine) was measured at baseline and after immersing the Perspex® blocks coated with varnishes at 0 min, 30 min, 1 h, and 4 h. Seventy-two enamel specimens (n = 72) were randomly divided into 2 groups by PLM and further by treatment groups. Then, the specimens were pre-treated with varnishes and subjected to erosive cycles (5 min, 2×/day for 4 days) by PLM. After each erosive challenge, the specimens were stored in artificial saliva. At baseline and after 4 days, the specimens were assessed for surface roughness (Ra) using 2D-surface profilometric analysis (SPA) and atomic force microscopy (AFM). Additionally, the Ca/P ratio was determined using scanning electron microscopy with energy-dispersive X-ray spectroscopy. Paired samples dependent t-test, 1-way ANOVA and 2-way ANOVA with Bonferroni post-hoc tests were used to analyse data with the level of significance set at p < 0.05. RESULTS: The pH of PLM with 8% Arg-NaF was significantly higher than the other groups at 30 min and 4 h (p < 0.05). With paracetamol, no significant difference was observed between the baseline and post-erosive cycle measured enamel Ra (by SPA/AFM) and Ca/P ratio for all treatment groups (p > 0.05). The Ra determined by AFM, at the post-erosive cycle with chlorpheniramine, when treated with 4 and 8% Arg-NaF was significantly lower than the other groups (p < 0.05); except CPP-ACFP (p > 0.05). With the chlorpheniramine post-erosive cycle, the Ca/P ratio for 4, 8% Arg-NaF and CPP-ACFP treated specimens was significantly higher than the baseline Ca/P (p < 0.05). CONCLUSION: The 4%/8% Arg-NaF and MI varnish® application exhibit an enhanced preventive effect against low pH (pH < 3.0) PLM-mediated enamel erosive challenges compared to 5% NaF varnish.

Concentration-Dependent Multi-Potentiality of L-Arginine: Antimicrobial Effect, Hydroxyapatite Stability, and MMPs Inhibition.

This study's objective was to examine L-arginine (L-arg) supplementation's effect on mono-species biofilm (Streptococcus mutans/Streptococcus sanguinis) growth and underlying enamel substrates. The experimental groups were 1%, 2%, and 4% arg, and 0.9% NaCl was used as the vehicle control. Sterilised enamel blocks were subjected to 7-day treatment with test solutions and S. mutans/S. sanguinis inoculum in BHI. Post-treatment, the treated biofilms stained for live/dead bacterial cells were analysed using confocal microscopy. The enamel specimens were analysed using X-ray diffraction crystallography (XRD), Raman spectroscopy (RS), and transmission electron microscopy (TEM). The molecular interactions between arg and MMP-2/MMP-9 were determined by computational molecular docking and MMP assays. With increasing arg concentrations, bacterial survival significantly decreased (p < 0.05). The XRD peak intensity with 1%/2% arg was significantly higher than with 4% arg and the control (p < 0.05). The bands associated with the mineral phase by RS were significantly accentuated in the 1%/2% arg specimens compared to in other groups (p < 0.05). The TEM analysis revealed that 4% arg exhibited an ill-defined shape of enamel crystals. Docking of arg molecules to MMPs appears feasible, with arg inhibiting MMP-2/MMP-9 (p < 0.05). L-arginine supplementation has an antimicrobial effect on mono-species biofilm. L-arginine treatment at lower (1%/2%) concentrations exhibits enamel hydroxyapatite stability, while the molecule has the potential to inhibit MMP-2/MMP-9.

Enhanced Fluoride Bioavailability with Incorporation of Arginine in Child Dentifrices.

OBJECTIVE(S): To: 1) examine the fluoride concentrations in commercial child formula dentifrices (CFD)s; and 2) investigate the effect of arginine incorporation in CFDs on fluoride bioavailability. STUDY DESIGN: Five commercial CFDs were examined for fluoride concentrations. Total, total soluble, and insoluble fluorides in CFDs were determined by the modified Taves acid-diffusion method (TAD). Ionic F and MFP were estimated by modified direct method with standard addition technique. L-arginine (L-Arg)/L-arginine monohydrochloride (L-Arg.HCl) were incorporated at 2% w/w in the commercial CFDs. The pH of the toothpaste slurries, buffer capacity of the added Arg, potentially available fluorides (PAF) and 1-min PAF by TAD were determined. RESULTS: The CFDs had 4 to 32% of insoluble fluorides. Addition of L-Arg/L-Arg.HCl significantly improved the fluoride bioavailability in CFDs (p<0.05). Incorporation of L-Arg significantly increased the pH of toothpaste slurries (p<0.05); while L-Arg.HCl decreased the pH. Principal component analysis showed that L-Arg.HCl decreased the pH of toothpaste slurries due to the presence of Cl in the form of HCl; whereas the inherent elements/molecules (Na/P/Pi/F) remain distinct with unidentified influence on the variables. CONCLUSION(S): The CFDs containing NaF only have higher concentrations of bioavailable fluoride. Incorporating arginine (L-arginine or L-arginine monohydrochloride) at 2% w/w improves fluoride bioavailability of the child formula dentifrices.

A Scoping Review on Arginine in Caries Prevention.

OBJECTIVES: Emerging science on arginine or arginine formulations has driven the need to examine the research in the field. The scoping study objectives were (1) to identify the extent, range, and type of evidence on the role of arginine or arginine formulations in caries prevention and (2) to explore the future scope of research on arginine-containing caries-preventive agents. METHODS: A systematic search was performed in PubMed, Scopus, and Web of Science. In vitro studies, clinical trials, narrative reviews, systematic reviews and or meta-analysis, and umbrella reviews or meta-evaluation examining arginine or arginine formulations for caries prevention were included. The data-charting process involved extracting variables followed by evidence synthesis. Arginine variants investigated up to date were discussed to explore future scope of research. RESULTS: Thirty-nine articles were included for review from 105 identified citations comprising of in vitro studies, clinical trials, and reviews. Most articles studied 1.5% arginine-fluoride toothpaste. Most studies were from Asia, followed by North America, with fewest studies from Europe and South America. Arginine or arginine formulations demonstrated a superior caries-preventive effect compared with their matched controls (including fluorides); however, the evidence is with high risk of bias. Until now, three arginine variants have been investigated with l-arginine monohydrochloride as the least explored variant. CONCLUSIONS: The evidence on the caries-preventive effect of arginine or arginine formulations has a high risk of bias. High-quality clinical trials are needed to assess the caries-preventive potential of arginine in commercial formulations. The role of l-arginine monohydrochloride in caries prevention can further be explored by incorporating in self-applied and professionally applied caries-preventive agents.

Effect of Three Behavior Guidance Techniques on Anxiety Indicators of Children Undergoing Diagnosis and Preventive Dental Care.

Objective(s): To assess the effect of three behavior guidance techniques on anxiety indicators of children undergoing diagnosis and preventive dental care. Study Design: Sixty-three subjects (7-9 years) were divided into three groups as per the behavior guidance technique namely tell-show-do, live and filmed modeling (using Tablet Computer) to receive diagnostic (Oral examination & radiographic assessment using intraoral periapical radiographs) and preventive dental care (Oral prophylaxis and topical fluoride application). Anxiety indicators-Facial Image Scale (FIS) scores and heart rate were recorded before, during and after diagnosis/preventive treatment. Three-way repeated measures ANOVA with post-hoc analysis was performed at significance of p-value < 0.05. Results: There was a statistically significant difference in the anxiety indicators of children under the influence of different behavior guidance approaches undergoing diagnosis/preventive treatments except for mean heart rate of children while oral examination. Multiple comparison results reveal that the mean FIS scores and heart rate of children with modeling techniques were significantly better as compared to tell-show-do technique with no significant difference between the two modeling techniques. Conclusion: This study suggests that the modeling techniques (filmed and live) seem to be an efficient behavioral guidance approach for children aged 7-9 years undergoing routine diagnosis and preventive dental care as compared to tell-show-do technique.

Enhancing the Remineralization Potential of Child Formula Dentifrices: An In Vitro Study.

Objective(s): The incorporation of Arginine (Arg) in NaF-containing child dentifrice might enhance its remineralizing potential, reducing fluorosis risk with significant anti-caries benefit. The study objective was to examine the remineralizing potential of arginine in child formula dentifrice (600-ppm NaF).Study Design: Primary teeth enamel specimens (n = 10) with artificial caries-like lesion were randomly divided to 4 treatment groups: A: 2% Arg-(600-ppm) NaF; B: 600-ppm NaF; C: 1100-ppm NaF; and D: deionized water subjected to 7-day pH-cycling. The mineral density (MD) of the treated specimens was assessed using micro-CT. The pre-/post-treated artificial caries-like lesion were acid-etched for enamel fluoride uptake (EFU) evaluation, Ca and P element analysis using ICP-OES, and the inorganic phosphate (PO43-) determination using colorimetric assay. Results: The percentage remineralization of the 2% Arg-NaF and 1100-ppm NaF groups was significantly higher than the 600-ppm NaF group (p<0.001). However, no significant difference in remineralization was observed between the two groups (p>0.05). The EFU, Ca/P ratio, PO43- content of the 2% Arg-NaF group were significantly higher than the 600-ppm NaF group (p<0.01); while no significant difference was found between the 2% Arg-NaF and 1100-ppm NaF groups. Conclusion: Within the limitations of the present study, incorporation of 2% arginine in 600-ppm NaF child formula dentifrice enhanced the remineralization potential of artificial enamel caries, to a level comparable to 1100-ppm NaF adult formula dentifrice.

A META-EPIDEMIOLOGICAL REVIEW OF META-ANALYSIS ON ANTI-CARIES EFFECT OF ARGININE-CONTAINING FORMULATIONS.

BACKGROUND: Several significant issues on clinical trials reporting the effect of arginine-containing dental products have been addressed in systematic reviews and meta-analyses identifying the need for high-quality randomized clinical trials. A further methodological analysis of the given systematic reviews with meta-analysis on arginine products might provide information for future high-quality randomized clinical trials and current clinical practice. OBJECTIVE(S): The objective was to perform a meta-epidemiological assessment of meta-analyses reporting the anticaries effect of arginine-containing formulations. METHODS: The data on risk-of-bias assessment, effect size measure, dispersion of estimated precision, and follow-up period were summarized for the meta-epidemiological review analysis. RESULTS: Studies with larger magnitude of effect sizes might present with unclear random sequence generation and unclear allocation concealment representing the selection bias. There was a significant strong negative correlation between the follow-up time and dispersion of precision estimates (rs = -0.79, P = .034). CONCLUSION: Results show that clinical trials on arginine dental products have methodological shortcomings. Both the selection bias and follow-up period influence the effect size magnitude and subsequent precision dispersion during evidence synthesis in clinical trials on arginine-containing dental products.

Can oral ADS activity or arginine levels be a caries risk indicator? A systematic review and meta-analysis.

OBJECTIVES: The objective of this study was to evaluate the association between salivary and plaque arginine levels/ADS activities with dental caries. MATERIALS AND METHODS: A systematic search was performed as per PRISMA statement using PubMed, Scopus, Cochrane Library, and Web of Science. Published studies that investigated adults and children (P) with caries-active status (E) and caries-free status (C), whereby arginine levels/ADS activity (O) was measured in saliva/plaque to analyze exposure-outcome association compared to the control group were deemed eligible for inclusion. Quality assessment was performed using combined Newcastle-Ottawa Scale and Modified RTI Item Bank scale. Meta-analysis was performed for effect size, precision estimation, and subgroup effects analysis. RESULTS: Of 233 records identified, seven (κ = 1.00) were included for qualitative synthesis (systematic review) and four for quantitative synthesis (meta-analysis). No specific bias could be identified in five studies assessed as per the Modified RTI Item Bank scale. Two studies received lower scores on the Newcastle Ottawa scale. Plaque ADS activity in adults (effect size = 0.93, p = 0.008), salivary ADS activity in adults and children (effect size = 0.85, p < 0.001), and salivary ADS activity in adults (effect size = 0.87, p < 0.001) identified a statistically significant effect size. Subgroup analysis demonstrated non-significant variance (Q value = 0.042, p = 0.838) between saliva and plaque ADS activities of adults. CONCLUSIONS: The results of this review suggest the salivary and plaque ADS activities appear to be promising caries risk indicators for adults, while results remain inconclusive in children. CLINICAL RELEVANCE: Measuring ADS activities (saliva or plaque) can be a potential caries risk indicator in adults. The protocol was registered on PROSPERO database: CRD42017060701.

Calcium-Based Caries Preventive Agents: A Meta-evaluation of Systematic Reviews and Meta-analysis.

OBJECTIVE: This article aims to assess systematic reviews and/or meta-analyses on calcium-based caries preventive agents, evaluating reported evidence, thereby summarizing a critical appraisal on the subject. MATERIALS AND METHODS: A systematic search was done using PubMed, Cochrane Library, and Web of Science. Systematic reviews and/or meta-analyses addressing PICO: P: any age or gender; I: calcium-based caries preventive agents; C: with/without control; and O: any early caries lesion measures were included. Inter-reviewer reliability was assessed using Cohen's kappa coefficient. RESULTS: One hundred sixty-four records were identified, of which 10 (κ = 1.00) were included for quality evaluation. Seven reviews were systematic reviews (only), whereas 3 were meta-analyses. None of the articles provided with an "a priori" review design. Majority of the reviews (7 of 10) were of high quality as assessed by Assessing the Methodological Quality of Systematic Reviews, whereas 3 articles were scored as moderate quality of evidence. All the included meta-analyses were of high-quality evidence as assessed by meta-evaluation of meta-analysis: 10 appraisal questions for biologists. Eight reviews addressed the intervention: casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)/casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP). Two reviews were performed on arginine-containing formulations. Majority of the high-quality systematic reviews were inconclusive over the effects of CPP-ACP/CPP-ACFP. CONCLUSION: This meta-evaluation suggests that CPP-ACP/CPP-ACFP can be considered as an adjunct to fluorides but not as an alternative until long-term well-designed clinical trials assessed by systematic reviews and meta-analysis are available. Arginine-containing dentifrice with an insoluble calcium base and fluoride seem to be a promising agent, but more well-designed non-industry-supported clinical trials can provide better insights in future.

Comparative evaluation and correlation of salivary total antioxidant capacity and salivary pH in caries-free and severe early childhood caries children.

BACKGROUND: Dental caries is a major problem in preschool children. The contribution of saliva in providing defense during caries process is of primary importance. pH buffer capacity through bicarbonate, phosphate and protein buffer systems have universal acceptance as a caries defense mechanism. Antioxidant capacity of saliva can constitute a first line of defense against chronic degenerative diseases including dental caries. Till date, no study is presented with salivary antioxidant capacity of younger children affected with severe early childhood caries with its salivary pH correlation. Hence, this study was carried out to compare, evaluate and correlate the salivary total antioxidant capacity (TAC) and salivary pH of children with caries-free and severe early childhood caries. MATERIALS AND METHODS: Fifty children from ages 3 to 5 years divided into two study groups had undergone screening. Group I (n = 25) with severe early childhood caries (S-ECC) and group II (n = 25) who were caries free. Unstimulated whole saliva of subjects were in the collection during the study by draining method. Salivary pH determination of saliva samples was done using pH indicator paper strips. The TAC was done using an antioxidant assay with the help of a spectrophotometer at wavelength 532 nm. The means of salivary pH and TAC were subjected to analysis using unpaired student 't' test and correlation was determined using Pearsons correlation coefficient analysis. RESULTS: Mean salivary pH was higher in group II (7.46 ± 0.37). Mean TAC was greater in group I (1.82 ± 0.19). A statistically significant negative correlation as seen between TAC and salivary pH in S-ECC patients. CONCLUSION: The study concludes that salivary TAC increases in patients with S-ECC are by that showing a high indirect relationship with salivary pH.

Comparative evaluation of cariogenic and erosive potential of commonly prescribed pediatric liquid medicaments: an in vitro study.

INTRODUCTION: Liquid oral medicines being the most accepted form of medication in children are frequently prescribed. The harmful effects of these liquid medicaments on a child's dental health are not known to many. The present study aimed to evaluate and compare the cariogenic and erosive potential of 5 most commonly prescribed pediatric liquid medicaments (PLM) in Pimpri Chinchwad and Pune city, Pune district. MATERIALS AND METHODS: Most commonly prescribed PLM in Pune district were selected as opined by 50 pediatricians. The selected medicaments were Syr. Augmentin® Duo, Syr. Valparin®, Syr. Combiflam®, Syr. Visyneral and Syr. Orofer®. An estimation of pH, percentage of sucrose concentration and calcium dissolving capacity of these preparations was carried out. The results as obtained were subjected to statistical analysis using SPSS v 17.0 for windows. The statistical test as undertaken was Pearson's correlation coeffcient(r). RESULTS: Sucrose was seen to be present in Syr. Combiflam® (35.75% ± 0.25%) and Syr. Visyneral (18.48% ± 0.43%). Acidic pH was observed for Syr. Visyneral (mean pH 3.63 ± 0.04), Syr. Combiflam®(mean pH 5.03 ± 0.02) and Syr. Augmentin® (mean pH 6.22 ± 0.02). Highest calcium dissolution was seen with Syr. Combiflam®(295.86 mg/ml) and the least with Syr. Orofer® (25.51 mg/ml). No statistical significant correlation was observed with calcium dissolution potential of PLM in comparison with their respective pH. CONCLUSION: Syr. Combiflam® can be regarded as the highest cariogenic and erosive potential medicament among the compared and tested PLM. CLINICAL SIGNIFICANCE: Considering syrups with high cariogenic and erosive potential should always follow with proper oral hygiene practices or search for an alternative drugs void of such detrimental effects.

The effect of arginine on the growth of probiotics.

OBJECTIVE(S): The study objective was to examine the effect of arginine (Arg) supplementation on the growth of probiotics. METHODS: Lacticaseibacillus rhamnosus GG, Lactiplantibacillus plantarum, and Lactobacillus acidophilus were identified as potential probiotics. L. rhamnosus GG and L. plantarum were selected for further experimentation. The probiotics were co-treated with 0.9 % NaCl (negative control), 0.5 % Arg, and 1.0 % Arg in a 1:1 ratio for 24 h at 5 % CO2, 37 °C. The probiotics were tested for growth profiles, spectroscopic turbidity assay, metabolic assays (XTT and WST-8), live/dead cell assessment using confocal laser scanning microscopy (CLSM), and colony forming units (CFU). RESULTS: The growth profiles of L. rhamnosus GG and L. plantarum were found to be similar, whereas L. acidophilus showed minimal or no transition from the initial lag phase. In the turbidity assay, the end-point absorbance for L. rhamnosus GG with 1.0 % Arg was significantly lower than 0.9 % NaCl and 0.5 % Arg (p < 0.05). For metabolic assays and CFU, increasing concentrations of Arg increased the viable cells for L. rhamnosus GG (p < 0.05), but decreased viability for L. plantarum (p < 0.05). Metabolic assays with dual-species bacterial suspensions indicated that Arg co-treatment inhibited viable proportions compared to control (p < 0.05). The dead cell proportion was significantly lower than live cell proportion for all tested interventions and probiotics (p < 0.05). CONCLUSION: Increasing concentrations of Arg promote the growth of L. rhamnosus GG, while conversely inhibiting the growth of L. plantarum. Therefore, the effect of prebiotic Arg on probiotics is concentration-dependent, leading to a selective promotion or inhibition of growth. CLINICAL SIGNIFICANCE: The present study results show that Arg supplementation can selectively enhance the growth of L. rhamnosus GG while inhibit the growth of L. plantarum. This underscores the need to consider strain-specific responses in probiotic formulations when developing Arg-based synbiotics for modulating biofilms and creating ecologically homeostatic biofilm microenvironments.

Caries preventive potential of professionally deliverable fluoride-containing agents with incorporated arginine: A scoping review.

The scoping review objectives were to: 1) investigate the caries preventive potential of professionally deliverable fluoride (F)-containing agents with incorporated arginine (Arg); and 2) identify the future scope of research on Arg-F interventions for caries prevention. Of 150 identified records, 7 articles (6 in vitro investigations and 1 scoping review) were included for a complete review; with no clinical studies with/without appraisal. Arginine variants (L-Arg/Arg.HCl at 1% to 10% w/v.) were examined for a potential professional application aimed at caries prevention, as reported with in vitro studies. Of the included articles, four in vitro studies explored L-Arg enriched 5% NaF varnish (Duraphat®) as a promising caries preventive agent, while only one considered incorporating L-Arg in MI varnish®/nanohydroxyapatite and one investigated glass ionomer cement for primary/secondary and tertiary caries prevention. The scoping review highlighted the scope for incorporating Arg to professionally deliverable F-containing agents. No clinical data are available to make conclusive recommendations about the caries preventive potential of professionally deliverable F-containing agents with incorporated Arg. With Arg-F varnish being investigated predominantly through in vitro studies, the data so far suggest that Arg was incorporated exclusively in Duraphat®, while the potential of Arg to prevent caries in other F-containing varnishes remains unexplored.

Physical properties and enamel remineralization potential of arginine-fluoride varnishes.

OBJECTIVE: The study objectives were to examine the physical properties and enamel remineralization potential of fluoride (F) varnishes incorporated with arginine (Arg). METHODS: Four commercial F varnishes: 1) Duraphat®; 2) Flúor Protector®, 3) Fluor Protector S®, and 4) Fluorimax™ were supplemented with 2% w/v. Arg. The control/experimental varnishes underwent rheometric analysis to assess varnish density (δ), velocity (ν), and associated viscosity, both quantitatively (ν/δ) and qualitatively based on determined mass, volume, distance flow, and time under experimentation. The varnish wet/dry weights (at 2 h) were also analysed. Further, sound enamel specimens (T0) with artificial incipient caries-like lesions (T1) were treated with control/experimental varnishes and subjected to remineralization assay with artificial saliva for 6 h. Thereafter (T2), the specimens were characterized to estimate precipitated Ca and net enamel F uptake. Additionally, mineral density (MD) was assessed using micro-CT at T0, T1, and T2 to derive mineral gain (MG) and % remineralization for the treatment groups. RESULTS: When Arg is incorporated, the physical properties of the F-containing varnishes undergo a significant transformation, resulting in higher density, varnish weight, dry varnish weight, and viscosity compared to their respective control varnishes (p < 0.05). Incorporating Arg-in Duraphat®, Fluor Protector S®, and Fluorimax™ significantly improved both enamel Ca precipitation and F uptake compared to the respective controls (p < 0.05). Additionally, the enamel F uptake was significantly higher with all the tested varnishes when enriched with Arg (p < 0.05). The combined data for MD, MG, and % remineralization suggests that the remineralization potential of F-varnishes significantly increased when enriched with Arg (p < 0.05). CONCLUSION: Incorporating Arg in inorganic F varnishes improves their physical properties and enhances the enamel remineralization potential of the varnishes. CLINICAL SIGNIFICANCE: This study highlights the possibility of incorporating Arg in distinct F-source varnishes. The synergism between active components (Arg-F) aids in enhanced remineralization and superior varnish physical properties, demonstrating a promising approach for high caries-risk patients.

Fluoride release potential of arginine-incorporated fluoride varnishes.

The study aimed to examine the fluoride (F) release potential of arginine (Arg)-incorporated F varnishes. Four commercially available F varnishes were included in the study: Duraphat® (5% NaF), Flúor Protector® (0.9% SiH2F2), Fluor Protector S® (NH4F), and Fluorimax™ (2.5% NaF). L-arginine (2% w/v.) was incorporated in these varnishes to estimate F release at 1 h, 4 h, 6 h, 24 h, 3 days, and 7 days using an F-ion selective electrode. The media pH of eluded varnishes was estimated and primary inorganic F extraction was performed. The main effects pH, F release, and computed integrated mean/cumulative F release for experimental groups were significantly higher than the controls (p<0.01). The primary extracted F concentrations for the Arg-containing groups were significantly lower than the control groups (p<0.001) demonstrating a chemical interplay with Arg incorporation. To conclude, irrespective of the inorganic F content, incorporating Arg in F-containing varnishes increases their F release potential.

The relationship between prosthetic status and the Geriatric Oral Health Assessment Index in a group of institutionalized elderly of an Indian city: a cross-sectional study.

AIM: To assess and compare the quality of life and oral health status among institutionalized elderly in Pune. MATERIALS AND METHODS: A cross-sectional, quantitative exploratory study was conducted in persons 60 years of age in an institutionalized elderly home. The GOHAI questionnaire was completed by a single examiner, who interviewed the patients in their local language. The oral examination was carried out according to WHO oral health survey using the DMFT-index, community periodontal index (CPI), periodontal loss of attachment (PLA), prosthetic use, and needs according to criteria established by the WHO by a calibrated examiner. Descriptive analysis was carried out using absolute and relative frequencies of the qualitative variables and means with respective standard deviations for the quantitative variables. The Student's t-test was applied to compare groups. RESULTS: Out of the total 110 individuals interviewed for the study, 64% were males and 36% were females. Individuals with up to 20 missing teeth and individuals with more than 20 missing teeth were 20 and 80% respectively. Based on the prosthetic need, 66% individuals needed replacement of teeth by dentures in one or both arches while 34% did not need any replacement by complete denture. The mean value for physical dimension was 5.40 whereas for psychosocial dimension, pain/discomfort and behavioral dimension were 8.02, 4.58 and 7.32. CONCLUSION: The quality of life was found to be more favorable in individuals with less than 20 teeth missing. The quality of life among complete denture wearers in both the arches was better as compared to the quality of life among nondenture wearers. Prosthetic replacement by complete denture helps the individuals to maintain better oral health. CLINICAL SIGNIFICANCE: The data obtained from the present study may serve as a reference point for comparisons of the magnitude of quality-of-life indicators relating to oral health.

Awareness of dental surgeons in Pune and Mumbai, India, regarding chemomechanical caries removal system.

AIM: To evaluate awareness of dental surgeons in Pune and Mumbai, India regarding chemomechanical caries removal system (CMCR). STUDY DESIGN: Sixty practicing dental surgeons from Mumbai (30) and Pune (30) were surveyed using questionnaire. MATERIALS AND METHODS: Qualitative data was collected on the basis of structured schedule questionnaire method. STATISTICS: Statistical analysis was done using SPSS v. 12.0. To test statistical significance, Chi-square test, Fishers exact test and Mann-Whitney U test were used. RESULTS: Of total respondents, 46.7% dental surgeons in Pune and 13.3% in Mumbai were aware about CMCR products. Carisolv® was known to 57.1% of dental surgeons in Pune and 75% in Mumbai, whereas, Papacarie® was known to 28.6% of dentists in Pune and none in Mumbai among the respondents aware about CMCR products. CONCLUSION: A significantly higher proportion of dental surgeons from Pune were aware about CMCR products compared to Mumbai. Dental surgeons from Mumbai were unaware about Papacarie®. Almost equal proportion of Dentists from Mumbai and Pune would like to undergo CDE programs to seek knowledge on CMCR, particularly Papacarie®.

Assessment of some biochemical oxidative stress markers in male smokers with chronic periodontitis.

The present study aims to assess and compare the biochemical oxidative stress markers in male smokers and non-smokers with chronic periodontitis. One hundred thirty-four male chronic periodontitis patients and 64 apparently healthy male volunteers were recruited for the study. The periodontal status was evaluated by measuring gingival index, plaque index, papillary bleeding index and clinical attachment loss using UNC-15 probe. The biochemical markers estimated were total antioxidant capacity, RBC-superoxide dismutase, glutathione peroxidase, vitamin C, malondialdehyde and C-reactive protein. The obtained results indicate higher oxidative stress in chronic periodontitis. Smokers with chronic periodontitis show significantly higher periodontal clinical parameters and relatively higher systemic oxidative stress. Vitamin C estimation may be an important biochemical parameter in conjunction with clinical parameters for diagnosis of chronic periodontitis in smokers.

The effect of synbiotic-fluoride therapy on multi-species biofilm.

OBJECTIVES: The study objective was to examine the effect of synbiotic-fluoride (SF) therapy within a multi-species cariogenic biofilm model system comprising of S. mutans, S. sanguinis, and S. gordonii. METHODS: The SF therapy was prepared using 2% L-arginine (Arg), 0.2% NaF and probiotic L. rhamnosus GG (LRG). The 8 treatment groups were: Group 1: No treatment, Group 2: 2% Arg, Group 3: 0.2% NaF, Group 4: LRG, Group 5: 2% Arg+0.2% NaF, Group 6: 2% Arg+LRG, Group 7: 0.2% NaF+LRG, and Group 8: SF therapy (2% Arg+0.2% NaF +LRG). Multi-species biofilm model over 96 h comprising Streptococcus mutans, Streptococcus sanguinis, and Streptococcus gordonii was utilized. The biofilms received cariogenic challenge and SF therapy 2 × /day. The extracellular matrix components were analyzed for carbohydrates, proteins, and extra-cellular DNA (eDNA). The live/dead cells were imaged and quantified using confocal microscopy. The viable/dead bacterial concentrations were estimated using propidium monoazide-quantitative polymerase chain reaction (PMA-qPCR). The gene expressions for gtfB, sagP, arcA, argG, and argH were measured using real-time reverse transcriptase qPCR. RESULTS: Carbohydrates and protein content with SF therapy were higher than non-LRG containing groups, while eDNA content was lower than other groups (p<0.05). Live bacterial proportions determined using confocal imaging with SF therapy were the lowest (p<0.05). The 2% Arg+LRG and SF therapy showed higher viable L. rhamnosus GG than 0.2% NaF+LRG (p<0.05). The dead S. mutans with SF therapy were higher than the other groups (p<0.05) with no difference from 2% Arg+0.2% NaF and 2% Arg+LRG (p>0.05). The SF therapy significantly downregulates gtfB and upregulates sagP, arcA, argG, argH gene expression (p<0.05). CONCLUSION: Synbiotic-fluoride therapy effectuates multi-fold changes in the multi-species biofilm matrix and cellular components leading to superior ecological homeostasis than its individual contents, prebiotics (arginine), probiotic (L. rhamnosus GG), and fluorides (NaF). CLINICAL SIGNIFICANCE: The ecological-based synbiotic-fluoride caries-preventive therapy aids in maintaining biofilm homeostasis to preempt/restore dysbiosis thereby sustaining dynamic-diverse health-associated microbial stability significant as a preventive regimen for high caries-risk patients.

Enamel remineralization potential and antimicrobial effect of a fluoride varnish containing calcium strontium silicate.

OBJECTIVES: To investigate enamel remineralization and antimicrobial effect of sodium fluoride (NaF) varnish containing calcium strontium silicate (CSR). METHODS: CSR was synthesized by sol-gel process and incorporated in 5 % NaF varnish at three different concentrations (1 %, 2 %, and 4 % w/v). The treatment/control groups were: 1 % CSR+NaF, 2 % CSR+NaF, 4 % CSR+NaF, NaF, and no treatment. Strontium and fluoride release from the varnishes was evaluated. Sound enamel specimens (n = 6) were demineralized, varnish-treated, and subjected to remineralization cycle. Mineral density of enamel specimens was evaluated using micro-CT. Antimicrobial effect of the varnishes on Streptococcus mutans and Lactobacillus acidophilus biofilms was assessed using confocal laser scanning microscopy. The HGF-1 cytotoxicity of the varnishes was examined using CCK-8 assay. RESULTS: Both 2 % and 4 % CSR+NaF varnishes showed significantly higher F release and remineralization potential than NaF varnish (p < 0.05). Dead bacterial proportion of 4 % CSR+NaF varnish was significantly higher than NaF varnish (p < 0.05). The CFUs values of both S. mutans and L. acidophilus were significantly lower in 4 % CSR+NaF group than NaF group (p < 0.05). No significant difference in cell viability was observed among the groups (p > 0.05). CONCLUSIONS: Incorporation of 4 % CSR in a NaF varnish significantly enhanced its enamel remineralization and antimicrobial potential with no cytotoxic effect. CLINICAL SIGNIFICANCE: Dental caries is a major public health problem globally. The study highlights the great potential of CSR-doped NaF varnish as a novel anti-caries agent with synergistic remineralizing and antimicrobial properties to combat early enamel caries lesions in the general population.