Advanced dental maturity of Finnish 6- to 12-yr-old children is associated with high energy intake.

We studied the association of dental maturity with body mass index (BMI), energy intake, and macronutrient intake. A randomly selected subset (n = 148) of the Special Turku Coronary Risk Factor Intervention Project (STRIP) was invited to an oral follow-up study, and the 6- and 12-yr-examination data (n = 111, 60 boys) were used. Food records for four consecutive days and BMI values were extracted from the databank of the main STRIP project. The developmental stage of seven permanent mandibular teeth was assessed using panoramic radiographs. The resulting maturity scores were converted to dental age estimates. Three dental-maturity groups (delayed, average, and advanced) and two BMI groups [normal BMI (≤mean+1SD) and high BMI (>mean+1SD)] were formed. The dental age was higher than the chronological age by 0.6-0.8 yr. Maturity scores for girls were statistically significantly higher than for boys. The distribution of girls into dental-maturity groups at age 12 yr was different from that of the boys and there were more boys than girls among the high-BMI group. Children of the advanced dental-maturity group had a statistically significantly higher energy intake than children in the other groups. We conclude that advanced dental maturity is associated with higher energy intake.

High sucrose intake at 3 years of age is associated with increased salivary counts of mutans streptococci and lactobacilli, and with increased caries rate from 3 to 16 years of age.

OBJECTIVE: We aimed to study the long-term associations between sucrose intake (SI), selected representatives of the cariogenic oral flora, and the dental health of children from 3 to 16 years of age. METHODS: At 7 months of age 1,062 infants (540 intervention; 522 controls) were included in the prospective, randomised STRIP-project aimed at restricting the child's saturated fat and cholesterol intake to prevent atherosclerosis when they become adults. At 3 years of age, every fifth child was invited (n = 178) to an oral sub-study, and 148 (78 boys) children attended. A restudy was conducted on 135 children aged 6, 127 aged 9, 114 aged 12 and 88 aged 16. SI using 4-day food records, plate-cultured mutans streptococci (MS), salivary lactobacilli (LB) and yeasts using commercial kits (Orion Diagnostica, Espoo Finland), toothbrushing frequency using fluoridated toothpaste and dental health expressed as d 3 mft/D 3 MFT were regularly recorded. RESULTS: The SI of children whose intake was ≥ 10 E% (high SI) at 3 years remained high throughout the entire follow-up (p < 0.001, GLM for repeated measures) period, and they had higher salivary MS and LB counts (p = 0.024 and p = 0.068, respectively, GLM) than their counterparts whose SI was below 10 E% (low SI). No differences in toothbrushing habits were found between the high and low SI-groups. Caries-survival was strongly associated with low 6-year-counts of MS (p = 0.008, Cox regression analysis), and the d 3 mft/D 3 MFTscores of the high SI-group were higher than those of the low SI-group (p = 0.046, GLM). CONCLUSIONS: High SI at 3 years was associated with high MS-counts ( ≥ 10 5 cfu/ml) and with a high risk for caries.

Short-term consumption of probiotic lactobacilli has no effect on acid production of supragingival plaque.

Acidogenicity and the levels of mutans streptococci (MS) in dental plaque after the use of Lactobacillus rhamnosus GG (LGG) and Lactobacillus reuteri were determined. The study had a randomised, double-blind, crossover design. Thirteen volunteers used tablets containing LGG or a combination of L. reuteri SD2112 and PTA 5289 for 2 weeks. At baseline and at the end of each tablet period, all available supragingival plaque was collected. Lactic acid production was determined from a fixed volume (8 µl) of fresh plaque and the rest of the plaque was used for culturing MS and lactobacilli. The retention of probiotics to the plaque was assessed using PCR techniques. No probiotic-induced changes were found in the acidogenicity of plaque. Also, MS counts remained at the original level. The number of subjects with lactobacilli in plaque increased in the L. reuteri group (p = 0.011) but not in the LGG group. PCR analysis of plaque revealed the presence of LGG in four and L. reuteri in six subjects after the use of the probiotic. The use of the lactobacilli did not affect the acidogenicity or MS levels of plaque. Short-term consumption of LGG and L. reuteri appeared not to influence the acidogenicity of plaque.

[Treatment of dental accidents and associated alveolar fractures]. / Hammasvammojen ja niihin liittyvien alveolimurtumien hoito.

Diagnosis of dental accidents is based on patient history, clinical examination and imaging. A completely avulsed tooth should immediately be reimplanted, and a dislodged tooth urgently repositioned to the original position. Avulsed primary teeth will never be reimplanted, and primary teeth of children under three years are not repositioned. Furthermore, fractures of the alveolar process and various soft tissue injuries but not dental fractures require urgent treatment. All dental accident patients should be referred to dental consultation for further examinations and treatment.

Eating patterns, diet and dental caries.

UNLABELLED: There is new evidence showing that excessive sugar consumption increases the risk of caries, even if the correlation between sugar intake and dental health has weakened due to exposure to fluoride. Moreover, there are still patient groups whose fluoride exposure seems to be insufficient to tolerate the generally increased level of sugar intake. CLINICAL RELEVANCE: Patients with high caries risk and/or insufficient fluoride exposure need personal advice and recommendations related to the use of sugars, sweets, sweet juices and soft drinks, even today. Patients with increased risk of obesity may also benefit from dietary recommendations conducted by dental professionals.

Salivary calcium reflects skeletal bone density of heavy smokers.

OBJECTIVE: Our recent studies suggest, that elevated calcium concentration of saliva is characteristic of periodontitis. In this study we analyzed the effect of smoking on salivary calcium and bone density by comparing the level of salivary calcium and the ultrasound scale of bone density of heavy smokers to those of non-smokers. DESIGN: Salivary samples were collected from 603 women (50-62 years) participating in a pre-screen referral program for osteoporosis. Out of this group a total of 577 were accepted for the present study. General health, medications and tobacco smoking were recorded. The group included 487 non-smokers, 37 moderate smokers (1-10 cigarettes per day) and 53 heavy smokers (>10 cigarettes per day). Bone density was measured at the right heel by the quantitative ultrasound technique. Calcium and phosphate concentrations of saliva were measured and expressed as microg/ml of saliva. RESULTS: The ultrasonographic variables of the heel, broadband ultrasound attenuation (BUA), speed of sound (SOS) and T-score (a standard deviation unit from mean values of healthy young adults) of heavy smokers were significantly lower than those of women who did not smoke (P = 0.007, 0.014 and 0.011, respectively). Salivary calcium concentration of heavy smokers 70.5 (14.6) microg/ml was higher than that of non-smokers 64.0 (14.1) microg/ml (P = 0.001). There were no significant differences in salivary phosphate level or in the salivary flow rate between heavy smokers and non-smokers. CONCLUSIONS: Heavy smokers seem to have lower bone mineral density and higher salivary calcium than their non-smoking counterparts. We suggest that the high salivary calcium concentration of smokers is in connection with skeletal calcium disturbances.

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

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

The effect of xylitol on the composition of the oral flora: a pilot study.

OBJECTIVES: Our aim was to investigate the effect of short-term xylitol consumption on the microbial composition of plaque and saliva. METHODS: Twelve volunteers (22-38 yrs) harboring mutans streptococci (MS) participated in the randomized, double-blind, cross-over study. The experimental chewing gum contained 65% xylitol while the control gum contained 63% sorbitol and 2% maltitol w/w. The polyol dose was approximately 6 g/day. Stimulated saliva and plaque samples were collected before and after the two four-week test periods. The samples were cultured for MS, total streptococci, lactobacilli, and total facultatives. A part of the samples were subjected to DNA-DNA hybridizations of 14 microbial plaque species: Actinomyces naeslundii, A. viscosus, Fusobacterium nucleatum, Lactobacillus acidophilus, L. fermentum, L. paracasei, L. rhamnose, L. plantarum, Streptococcus gordonii, S. oralis, S. parasanguis, S. salivarius, S. sanguinis, Veillonella parvula. RESULTS: The MS counts of the plaque samples collected from "caries-prone" tooth sites decreased significantly (P<.01) in the xylitol gum group but not in the sorbitol gum group. Also the plaque MS percentage decreased significantly in the xylitol gum group (P<.01). The salivary MS counts did not decrease either in the xylitol or in the sorbitol gum groups. Nor were changes detected in the salivary levels of total streptococci or lactobacilli. The DNA-DNA hybridization assay revealed no study-induced changes in the microbial composition of the dental plaque. CONCLUSIONS: Within the limitations of this pilot study, xylitol consumption reduced MS counts in plaque but appeared not to affect the microbial composition of plaque or saliva in general.

Frameshift mutations in dentin phosphoprotein and dependence of dentin disease phenotype on mutation location.

We describe results from a mutational analysis of the region of the dentin sialophosphoprotein (DSPP) gene encoding dentin phosphoprotein (DPP) in 12 families with dominantly inherited dentin diseases. In eight families (five mutations in the N-terminal third of DPP), the clinical and radiologic features were uniform and compatible with dentin dysplasia type II (DD-II) with major clinical signs in the deciduous dentition. In the other families (four mutations in the more C-terminal part), the permanent teeth also were affected, and the diseases could be classified as variants of dentinogenesis imperfecta. Attrition was not prominent, but periapical infections were common. Discoloring with varying intensity was evident, and pulps and root canals were obliterated in the permanent dentition. All mutations caused a frameshift that replaced the Ser-Ser-Asx repeat by a code for a hydrophobic downstream sequence of approximately original length. We conclude that frameshift mutations in DSPP explain a significant part of dentin diseases. Furthermore, we propose that the location of the mutation is reflected in the phenotypic features as a gradient from DD-II to more severe disease that does not conform to the classic definitions of DI-II.

Effect of age on flow-rate, protein and electrolyte composition of stimulated whole saliva in healthy, non-smoking women.

As relatively little is known about the effect of age on salivary electrolytes we studied the composition of saliva as function of age to provide reference values for healthy non-smoking women. All non-medicated and non-smoking 30-59-year-old subjects (n=255) selected from among 1030 women participating in a screening program formed the material of the present study. Salivary calcium, inorganic phosphate, magnesium, sodium, potassium, protein and flow-rate of stimulated whole saliva were measured. We found age-related changes in salivary calcium and phosphate concentrations (p=0.001 and p=0.004, respectively, one-way ANOVA). Peak values occurred at around 50-54 years of age. Age had no effect on flow-rate, magnesium, sodium, potassium or proteins. The concentration of sodium correlated positively, while phosphate, potassium, magnesium and protein correlated negatively with the salivary flow-rate. Calcium was the only electrolyte which had no association with flow-rate. Our study provides reference values for salivary electrolytes of 30-59-year-old women.

Dental health and oral mutans streptococci in 2-4-year-old Estonian children.

OBJECTIVE: The aim of this study was to assess the dental health and presence of mutans streptococci (MS) in 2-4-year-old Estonian children. METHODS: The dental health of 472 2-4-year-old children was examined using a mirror and a penlight in 14 daycare centres representing seven communities around Estonia. The mean (+/-SD) age of the children was 41.4+/-4.1 months (n=222). Plaque samples of 222 children were employed to determine the presence of MS using the Dentocult SM Strip mutans test. RESULTS: Caries was diagnosed in 42% of the children, and the average (+/-SD) dmft index was 1.6+/-2.5, ranging from 1.1+/-1.2 in Tartu to 2.4+/-3.1 in Võru. The proportion of caries-free children decreased from 82% in the younger to 63% in the older group (P=0.001). Among the tested subjects, 58% were colonized with MS, and those with caries were colonized more often than children with no visible caries (80% and 51%, respectively; P=0.001). CONCLUSIONS: The prevalence of dental caries in Estonian 2-4-year-olds is higher than in the Nordic countries, but similar to other Baltic nations. Colonization by MS was associated with dental caries.

Validation and inter-examiner agreement of mutans streptococci levels in plaque and saliva of 10-year-old children using simple chair-side tests.

Since there are few validation studies of chair-side tests of oral mutans streptococci, we compared a commercially available strip test with the conventional laboratory assay. Two plaque samples obtained from the mesial surfaces of the upper right and lower left permanent molars of sixty-five 10-year-old children (boys = 38, girls = 27) were cultured and incubated using chair-side site strip tests (Dentocult SM, Orion Diagnostica). Two plaque sampling tools, namely dental floss and micro-brush, were compared, and inter-examiner agreement between recordings of three examiners was assessed. Paraffin-stimulated saliva was then collected for laboratory and chair-side assays. The plaque and saliva chair-side tests correlated well with each other (Spearman rho, r = 0.72) and with the laboratory method, showing coefficients of 0.76 and 0.80 for saliva and plaque, respectively. Compared to the laboratory method, the sensitivity (Sn), specificity (Sp), accuracy (A), and kappa (K) values of the salivary and plaque chair-side tests were 0.63, 0.75 (Sn), 0.93, 0.90 (Sp), 0.82, 0.85 (A), and 0.58, 0.66 (K), respectively. Agreement between the two plaque sampling techniques was good (0.91). Inter-examiner agreement of plaque scores ranged between 0.65 and 0.86 when all density categories were analysed separately; when dichotomized into low and high categories, complete agreement was found. Agreement between the plaque and saliva chair-side tests and the laboratory salivary assay was good, and in terms of sensitivity, accuracy, and kappa values, the site strip plaque test surpassed the salivary chair-side test.

Long-term physical inactivity and oral health in Finnish adults with intellectual disability.

Physical inactivity is prevalent among patients with intellectual disability. Because little is known about the oral effects of poor mobility, we reviewed the medical and dental charts of institutionalized dentate patients (n = 214; 40.2 years +/- 12.1) of the Special Welfare District of Southwestern Finland. The number of decayed, missing, and filled teeth (DMFT), the number of retained teeth, dental treatment visits, and the type of the first treatment visit were recorded. Physical activity was good in 55% and severely reduced or completely absent in 45% of the patients. The degree of intellectual disability was mild or moderate in 40% and severe or profound in 60% of the patients. The walking patients weighed more (64.3 (19.6) versus 44.4 (14.4) kg; P< 0.001), had fewer secondary diagnoses (1.4 (1.3) versus 2.2 (1.4); P< 0.001), fewer daily medications (4.0 (2.1) versus 4.8 (2.4); P< 0.02), higher DMFT scores (18.5 (8.2) versus 14.8 (9.2); P < 0.05), and more dental treatment visits (2.7 (2.4) versus 2.0 (1.3); P< 0.03) than patients with poor physical activity. Periodontal treatment given as the primary type of dental care was more common among subjects with poor mobility than among those with good motor activity (P < 0.002). Poor physical activity was related to better dental health, higher need for periodontal therapy, and fewer dental visits than in patients with good motor activity.

Salivary variables in relation to tobacco smoking and female sex steroid hormone-use in 30 to 59-year-old women.

Several systemic conditions may have an influence on oral health. Hormone replacement therapy (HRT) has a positive effect on alveolar bone of menopausal women and smoking a negative effect. However, little is known about their effect on saliva. The purpose of this study was to examine the effect of hormone-use and tobacco smoking on the composition of saliva, in particular on the inorganic constituents. Salivary samples were collected from a representative study group comprising 1,013 women (30-59 years) participating in a pre-screen referral program for osteoporosis. The participants were divided into 2 subgroups according to age. The younger group (< or = 45 years) comprised 413 women and the older group (> or = 50 years) 600 women. Salivary calcium, magnesium, sodium, potassium, inorganic phosphate, total protein, and flow rate of paraffin-stimulated saliva were measured. In the older age group, female sex steroid users (hormone users) had lower salivary protein concentrations than non-users. Smoking was associated with high salivary calcium, magnesium, and potassium levels in the group of older participants. Neither tobacco smoking nor female sex steroid hormones had any significant effect on the salivary composition in the younger age group. In conclusion, smoking was reflected more clearly than female sex steroid hormone-use in the inorganic composition of saliva in the older age group. The salivary composition was not affected by hormone-use or by smoking among the younger age group.